WorldWideScience

Sample records for part emergent qualities

  1. Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department.

    Science.gov (United States)

    Chartier, Lucas B; Cheng, Amy H Y; Stang, Antonia S; Vaillancourt, Samuel

    2018-01-01

    Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses-Ishikawa diagrams, Pareto charts and process mapping-and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.

  2. Part I. Emergency workers

    International Nuclear Information System (INIS)

    2004-01-01

    This monograph deals with assessment of radiological health effects of the Chernobyl accident for emergency workers (part 1) and the population of the contaminated areas in Russia (part 2). The Chernobyl emergency workers and people living in the contaminated areas of Russia received much lower doses than the population of Hiroshima and Nagasaki and it was unclear whether risks of radiation-induced cancers derived with the Japanese data could be extrapolated to the low dose range However, it was predicted as early as in 1990 that the thyroid cancer incidence might be increasing due to incorporated 131 irradiation. What conclusions can be drawn from regarding cancer incidence among emergency workers and residents of the contaminated areas in Russia and the role of the radiation factor on the basis of the registry data? Leukemia incidence. Leukemia incidence is known to be one of principal indications of radiation effects. The radiation risk for leukemias is 3-4 times higher that for solid cancers and its latent period is estimated to be 2-3 years after exposure. Results of the radiation epidemiological studies discussed in this book show that in the worst contaminated Bryansk region the leukemia incidence rate is not higher than in the country in general. Even though some evidence exists for the dose response relationship, the radiation risks appear to be not statistically significant. Since risks of leukemia are known to be higher for those who were children at exposure, long-term epidemiological studies need to be continued. The study of leukemias among emergency workers strongly suggest the existence of dose response relationship. In those who received external doses more than 0.15 Gy the leukemia incidence rate is two time higher and these emergency workers should be referred to as a group of increased radiation risk. Solid cancers. The obtained results provide no evidence to a radiation-induced increase in solid cancers among residents of the contaminated areas

  3. Challenges of measuring quality in emergency management

    DEFF Research Database (Denmark)

    Lynette, Jennifer Elyse

    2016-01-01

    This paper describes the challenges and importance of measuring quality within the field of emergency response. Using quality as a standard of measurement to evaluate response efforts of trained personnel in emergency situations is necessary to increase effectiveness in the response phase...... of an emergency event. The intended outcome of utilizing quality as a tool of measurement is to save additional lives, property, and resources. The adoption of a system to measure quality can be utilized by multiple professions under the broader field of emergency response services. Quality is discussed in terms...

  4. Coastal pollution emergency plan. Part I

    Energy Technology Data Exchange (ETDEWEB)

    Semanov, G.; Volkov, V.; Somkin, V.; Iljushenko-Krylov, D.

    1997-12-31

    A higher degree of ecological safety in ship traffic depends on onboard measures as well as reception facilities on shore, treatment of ship generated wastes and preparedness for combating emergency oil spills. The problem is particularly acute in the North Sea Route (NSR) due to high vulnerability of the Arctic ecosystems, low rates of natural degradation of oil, absence of forward coastal infrastructure, low efficiency of oil combating means in ice conditions and severe climatic conditions. Oil spills in the NSR are likely to occur as the offshore production and transportation of oil increase. Therefore a regional Oil Spill Contingency Plan (OSCP) is being constructed and developed on 3 levels: 1) Development of concept, definition of response organisations and their technical ability (Part I). 2) Collection and analysis of information, development of scenarios of probable oil spills, clearing of the funding mechanism and basis for additional outside co-operation from other Russian regions and circumpolar countries (part II). 3) Development of NSR OSCP (part III). The present report (part I) provides the plan concept, rescue organisations and data on types and amounts of the oil spill combating technical means and of the floating facilities available in the NSR or it`s vicinity. The concept takes into account subdivision of the Route, interaction and links between responsible organisations, realities of the Russian Arctic such as transport, communications, energy, labour resources etc. and requirements of the IMO and of the International Convention OPRC 90. According to Russian legislation implementation of combating operations at sea is the responsibility of the Maritime Pollution Control and Salvage Administration that consists of a Central Administration and basin emergency divisions situated in Murmansk and Nahodka. The body is responsible for carrying out cleaning operations at sea from installations and may be assisted by resources and means of the co

  5. Part 2: Surface water quality

    International Nuclear Information System (INIS)

    1997-01-01

    In 1996 the surface water quality measurements were performed, according to the Agreement, at 8 profiles on the Hungarian territory and at 15 profiles on the Slovak territory. Basic physical and chemical parameters (as water temperature, pH values, conductivity, suspended solids, cations and anions (nitrates, ammonium ion, nitrites, total nitrogen, phosphates, total phosphorus, oxygen and organic carbon regime parameters), metals (iron, manganese and heavy metals), biological and microbiological parameters (coliform bacteria, chlorophyll-a, saprobity index and other biological parameters) and quality of sediment were measured

  6. Quality Indicators and Outcomes of Emergency Caesarean ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    The objective of this research study is to identify quality indicators of cesarean deliveries and determine their relationship to neonatal ..... (N=39). P value. Mean. Age. 24.8 + 5.8. 25.6 + 5.9. 0.74. Duration of labor. (hours) ... chains must be improved on a national and local ... emergency obstetric care: A handbook, Geneva,.

  7. 14 CFR Appendix J to Part 25 - Emergency Evacuation

    Science.gov (United States)

    2010-01-01

    ... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Pt. 25, App. J Appendix J to Part 25—Emergency Evacuation...-candles prior to the activation of the airplane emergency lighting system. The source(s) of the initial... airplane emergency lighting system. (b) The airplane must be in a normal attitude with landing gear...

  8. REQUIREMENTS FOR IMAGE QUALITY OF EMERGENCY SPACECRAFTS

    Directory of Open Access Journals (Sweden)

    A. I. Altukhov

    2015-05-01

    Full Text Available The paper deals with the method for formation of quality requirements to the images of emergency spacecrafts. The images are obtained by means of remote sensing of near-earth space orbital deployment in the visible range. of electromagnetic radiation. The method is based on a joint taking into account conditions of space survey, characteristics of surveillance equipment, main design features of the observed spacecrafts and orbital inspection tasks. Method. Quality score is the predicted linear resolution image that gives the possibility to create a complete view of pictorial properties of the space image obtained by electro-optical system from the observing satellite. Formulation of requirements to the numerical value of this indicator is proposed to perform based on the properties of remote sensing system, forming images in the conditions of outer space, and the properties of the observed emergency spacecraft: dimensions, platform construction of the satellite, on-board equipment placement. For method implementation the authors have developed a predictive model of requirements to a linear resolution for images of emergency spacecrafts, making it possible to select the intervals of space shooting and get the satellite images required for quality interpretation. Main results. To verify the proposed model functionality we have carried out calculations of the numerical values for the linear resolution of the image, ensuring the successful task of determining the gross structural damage of the spacecrafts and identifying changes in their spatial orientation. As input data were used with dimensions and geometric primitives corresponding to the shape of deemed inspected spacecrafts: Resurs-P", "Canopus-B", "Electro-L". Numerical values of the linear resolution images have been obtained, ensuring the successful task solution for determining the gross structural damage of spacecrafts.

  9. Signal Quality Evaluation of Emerging EEG Devices

    Directory of Open Access Journals (Sweden)

    Thea Radüntz

    2018-02-01

    Full Text Available Electroencephalogram (EEG registration as a direct measure of brain activity has unique potentials. It is one of the most reliable and predicative indicators when studying human cognition, evaluating a subject's health condition, or monitoring their mental state. Unfortunately, standard signal acquisition procedures limit the usability of EEG devices and narrow their application outside the lab. Emerging sensor technology allows gel-free EEG registration and wireless signal transmission. Thus, it enables quick and easy application of EEG devices by users themselves. Although a main requirement for the interpretation of an EEG is good signal quality, there is a lack of research on this topic in relation to new devices. In our work, we compared the signal quality of six very different EEG devices. On six consecutive days, 24 subjects wore each device for 60 min and completed tasks and games on the computer. The registered signals were evaluated in the time and frequency domains. In the time domain, we examined the percentage of artifact-contaminated EEG segments and the signal-to-noise ratios. In the frequency domain, we focused on the band power variation in relation to task demands. The results indicated that the signal quality of a mobile, gel-based EEG system could not be surpassed by that of a gel-free system. However, some of the mobile dry-electrode devices offered signals that were almost comparable and were very promising. This study provided a differentiated view of the signal quality of emerging mobile and gel-free EEG recording technology and allowed an assessment of the functionality of the new devices. Hence, it provided a crucial prerequisite for their general application, while simultaneously supporting their further development.

  10. Media and public relation. Part of emergency planning

    International Nuclear Information System (INIS)

    Jurkovic, I.A.; Debrecin, N.; Feretic, D.; Skanata, D.

    2000-01-01

    In the event of an emergency, media relation should be considered as one of the most important functions in emergency management. Individuals should be trained to be able to provide factual information to the media and the citizens during nuclear emergencies. Media can be also acquainted with the scope, ways and means of providing information related to nuclear emergencies during the predefined and regular media training or workshops, or as a part of regular training routine of involved organizations and institutions. This paper is through various approaches trying to present one of the possible ways that media and public relation can be treated during the emergencies and inside the developed emergency plans and procedures. It also represents an idea, based on the authors' experience, on a way in which things can be organized in the Croatian Technical Support Center when it comes to the media/public relation issue. (author)

  11. Comparisons between Full-time and Part-time Pediatric Emergency Physicians in Pediatric Emergency Department.

    Science.gov (United States)

    Huang, I-Anne; Tuan, Pao-Lan; Jaing, Tang-Her; Wu, Chang-Teng; Chao, Minston; Wang, Hui-Hsuan; Hsia, Shao-Hsuan; Hsiao, Hsiang-Ju; Chang, Yu-Ching

    2016-10-01

    Pediatric emergency medicine is a young field that has established itself in recent decades. Many unanswered questions remain regarding how to deliver better pediatric emergency care. The implementation of full-time pediatric emergency physicians is a quality improvement strategy for child care in Taiwan. The aim of this study is to evaluate the quality of care under different physician coverage models in the pediatric emergency department (ED). The medical records of 132,398 patients visiting the pediatric ED of a tertiary care university hospital during January 2004 to December 2006 were retrospectively reviewed. Full-time pediatric emergency physicians are the group specializing in the pediatric emergency medicine, and they only work in the pediatric ED. Part-time pediatricians specializing in other subspecialties also can work an extra shift in the pediatric ED, with the majority working in their inpatient and outpatient services. We compared quality performance indicators, including: mortality rate, the 72-hour return visit rate, length of stay, admission rate, and the rate of being kept for observation between full-time and part-time pediatric emergency physicians. An average of 3678 ± 125 [mean ± standard error (SE)] visits per month (with a range of 2487-6646) were observed. The trends in quality of care, observed monthly, indicated that the 72-hour return rate was 2-6% and length of stay in the ED decreased from 11.5 hours to 3.2 hours over the study period. The annual mortality rate within 48 hours of admission to the ED increased from 0.04% to 0.05% and then decreased to 0.02%, and the overall mortality rate dropped from 0.13% to 0.07%. Multivariate analyses indicated that there was no change in the 72-hour return visit rate for full-time pediatric emergency physicians; they were more likely to admit and keep patients for observation [odds ratio = 1.43 and odds ratio = 1.71, respectively], and these results were similar to those of senior

  12. Integrated concurrent utilization quality review, Part one.

    Science.gov (United States)

    Caterinicchio, R P

    1987-01-01

    This article is the first of a two-part series which argues for the concurrent management of the appropriateness, necessity, and quality of patient care. Intensifying scrutiny by the credentialing groups, the PROs and all third-party payors underscores the vital need to implement cost-effective information systems which integrate the departmentalized functions of patient-physician profiling, DRG case-mix analyses, length of stay monitoring, pre-admission/admission and continued stay review, discharge planning, risk management, incident reporting and quality review. In the domain of physician performance regarding admitting and practice patterns, the ability to exercise concurrent utilization-quality review means early detection and prevention of events which would otherwise result in denials of payment and/or compromised patient care. Concurrent utilization-quality review must, by definition, be managerially invasive and focused; hence, it is integral to maintaining the integrity of the services and product lines offered by the provider. In fact, if PPO status is a marketing agenda, then the institutional objectives of cost-effectiveness, productivity, value, and competitiveness can only be achieved through concurrent utilization-quality review.

  13. Province of Ontario nuclear emergency plan part V - Chalk River

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1991-10-01

    The aim of Part 5 of the Provincial Nuclear Emergency Plan is to describe the measures that shall be undertaken to deal with a nuclear emergency caused by the Chalk River Laboratories. This plan deals mainly with actions at the Provincial level and shall by supplemented by the appropriate Municipal Plan. The Townships of Rolph, Buchanan, Wylie, and McKay, the Town of Deep River and the Village of Chalk River are the designated municipalities with respect to CRL. 2 tabs., 5 figs.

  14. Province of Ontario nuclear emergency plan part V - Chalk River

    International Nuclear Information System (INIS)

    1991-10-01

    The aim of Part 5 of the Provincial Nuclear Emergency Plan is to describe the measures that shall be undertaken to deal with a nuclear emergency caused by the Chalk River Laboratories. This plan deals mainly with actions at the Provincial level and shall by supplemented by the appropriate Municipal Plan. The Townships of Rolph, Buchanan, Wylie, and McKay, the Town of Deep River and the Village of Chalk River are the designated municipalities with respect to CRL. 2 tabs., 5 figs

  15. Quality improvement and emerging global health priorities

    Science.gov (United States)

    Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

    2018-01-01

    Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC. PMID:29873793

  16. Emerging and Temporary Connections in Quality Work

    DEFF Research Database (Denmark)

    Madsen, Marie Henriette

    The issue of quality and how to provide the best possible care for patients has always been a central concern in the health care sector. For the last decades, this concern has resulted in formulations of quality standards and clinical guidelines that define best practices for clinical work, as well...

  17. Quality Indicators and Outcomes of Emergency Caesarean ...

    African Journals Online (AJOL)

    Uterine rupture and cesarean hysterectomy were associated with an outcome of neonatal death (p<0.001). Infrastructure and personnel limitations are major barriers to the improvement of quality of cesarean deliveries. Future endeavors towards quality improvement must address these deficiencies. (Afr J Reprod Health ...

  18. The emerging EU quality of care policy

    DEFF Research Database (Denmark)

    Vollaard, Hans; van de Bovenkamp, Hester M.; Vrangbæk, Karsten

    2013-01-01

    initiatives regarding the quality systems of the Member States and the quality of services, this paper shows how the depth of EU interference has increased from sharing information to standardization and even to the first signs of enforcement. We argue that at this stage, reflection on the feasibility...

  19. Quality Indicators and Outcomes of Emergency Caesarean ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    personnel limitations are major barriers to the improvement of quality of cesarean deliveries. Future endeavors towards ..... order to address this problem, medication supply chains must be improved on a national and local level and improved ...

  20. Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta.

    Science.gov (United States)

    Buttigieg, Sandra Catherine; Dey, Prasanta Kumar; Cassar, Mary Rose

    2016-01-01

    The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital. The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital. The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit. PRACTICAL/IMPLICATIONS: The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been

  1. Service providers' perception of the quality of emergency obsteric ...

    African Journals Online (AJOL)

    Facility/staff themes which emerged as contributing to the poor care were; inadequate resources, inadequate staffing, poor teamwork, and inadequate knowledge/supervision. Conclusion The findings of this study reveal that health care workers rate the quality of emergency obstetric care they provide as poor. They were ...

  2. Quality assurance measurement for emergency management

    International Nuclear Information System (INIS)

    Pawlowski, M.S.

    1993-01-01

    Under the Federal Civil Defense Act of 1950, as amended, the Federal Emergency Management Agency (FEMA) is charged with maintenance of a nationwide inventory of 4.3 million radiological instruments procured and granted by the federal government to state and local governments. These instruments are used by trained state Radiological Response Team Members, first responders, and critical workers to support the population from a national security or large-scale peacetime radiological disaster, e.g., Chernobyl, Three Mile Island, Satellite Reentry, etc. The inventory is maintained through a network of 100% federally funded state maintenance and calibration facilities, with overall technical guidance and standardization provided by the FEMA Radiological Instrumentation Test Facility. The system used to support maintenance and standardized calibration of the inventory consists of CDV-794 Radiation Calibrator (High Range), CDV-765 Model 2 Gamma Transfer Standard, CDV-790 Model 1 Calibrator (Low Range), and Dosimeter Transfer Standards. Past studies have indicated the open-quotes Readinessclose quotes and open-quotes Reliabilityclose quotes of the inventory to meet mission requirements based upon a standardized system of maintenance and calibration. FEMA has just initiated a new instrument Readiness and Reliability study with the State of Ohio Radiological Instrument Maintenance and Calibration Program to provide data to reassess the capability of the current inventory to support all types of peacetime and national security missions

  3. Quality assurance measurement for emergency management

    Energy Technology Data Exchange (ETDEWEB)

    Pawlowski, M.S. [SL-OE-SD-IN Federal Emergency Management Agency, Washington, DC (United States)

    1993-12-31

    Under the Federal Civil Defense Act of 1950, as amended, the Federal Emergency Management Agency (FEMA) is charged with maintenance of a nationwide inventory of 4.3 million radiological instruments procured and granted by the federal government to state and local governments. These instruments are used by trained state Radiological Response Team Members, first responders, and critical workers to support the population from a national security or large-scale peacetime radiological disaster, e.g., Chernobyl, Three Mile Island, Satellite Reentry, etc. The inventory is maintained through a network of 100% federally funded state maintenance and calibration facilities, with overall technical guidance and standardization provided by the FEMA Radiological Instrumentation Test Facility. The system used to support maintenance and standardized calibration of the inventory consists of CDV-794 Radiation Calibrator (High Range), CDV-765 Model 2 Gamma Transfer Standard, CDV-790 Model 1 Calibrator (Low Range), and Dosimeter Transfer Standards. Past studies have indicated the {open_quotes}Readiness{close_quotes} and {open_quotes}Reliability{close_quotes} of the inventory to meet mission requirements based upon a standardized system of maintenance and calibration. FEMA has just initiated a new instrument Readiness and Reliability study with the State of Ohio Radiological Instrument Maintenance and Calibration Program to provide data to reassess the capability of the current inventory to support all types of peacetime and national security missions.

  4. Diagnosing Total Quality Management. Part I

    NARCIS (Netherlands)

    Bossink, B.A.G.; Gieskes, J.F.B.; Pas, T.N.M.

    1992-01-01

    From extensive literature research a total quality management (TQM) model is developed. This model describes the basic elements of the concept of TQM. It also provides the way in which the basic elements can be made operational in practice. Based on this model a quality-diagnostical instrument is

  5. Diagnosing Total Quality Management - part 2

    NARCIS (Netherlands)

    Bossink, B.A.G.; Gieskes, J.F.B.; Pas, T.N.M.

    1993-01-01

    From extensive literature research a total quality management (TQM) model is developed. This model describes the basic elements of the concept of TQM. It also provides the way in which the basic elements can be made operational in practice. Based on this model a quality-diagnostical instrument is

  6. [Comparative quality measurements part 3: funnel plots].

    Science.gov (United States)

    Kottner, Jan; Lahmann, Nils

    2014-02-01

    Comparative quality measurements between organisations or institutions are common. Quality measures need to be standardised and risk adjusted. Random error must also be taken adequately into account. Rankings without consideration of the precision lead to flawed interpretations and enhances "gaming". Application of confidence intervals is one possibility to take chance variation into account. Funnel plots are modified control charts based on Statistical Process Control (SPC) theory. The quality measures are plotted against their sample size. Warning and control limits that are 2 or 3 standard deviations from the center line are added. With increasing group size the precision increases and so the control limits are forming a funnel. Data points within the control limits are considered to show common cause variation; data points outside special cause variation without the focus of spurious rankings. Funnel plots offer data based information about how to evaluate institutional performance within quality management contexts.

  7. Emerging tropical diseases in Australia. Part 3. Australian bat lyssavirus.

    Science.gov (United States)

    Moore, P R; Jansen, C C; Graham, G C; Smith, I L; Craig, S B

    2010-12-01

    Since its discovery in a juvenile black flying fox (Pteropus alecto) in 1996, Australian bat lyssavirus (ABLV) has become the cause of a potentially important emerging disease for health authorities in Australia, with two human deaths (one in 1996 and one in 1998) attributed to the virus in the north-eastern state of Queensland. In Australia, the virus has been isolated from all four species of flying fox found on the mainland (i.e. P. alecto, P. scapulatus, P. poliocephalus and P. conspicillatus) as well as a single species of insectivorous bat (Saccolaimus flaviventris). Australian bat lyssavirus belongs to the Lyssavirus genus and is closely related, genetically, to the type strain of Rabies virus (RABV). Clinically, patients infected with ABLV have displayed the 'classical' symptoms of rabies and a similar disease course. This similarity has led to the belief that the infection and dissemination of ABLV in the body follows the same pathways as those followed by RABV. Following the two ABLV-related deaths in Queensland, protocols based on the World Health Organization's guidelines for RABV prophylaxis were implemented and, presumably in consequence, no human infection with ABLV has been recorded since 1998. ABLV will, however, probably always have an important part to play in the health of Australians as the density of the human population in Australia and, consequently, the level of interaction between humans and flying foxes increase.

  8. Spatial audio quality perception (part 2)

    DEFF Research Database (Denmark)

    Conetta, R.; Brookes, T.; Rumsey, F.

    2015-01-01

    location, envelopment, coverage angle, ensemble width, and spaciousness. They can also impact timbre, and changes to timbre can then influence spatial perception. Previously obtained data was used to build a regression model of perceived spatial audio quality in terms of spatial and timbral metrics...

  9. Fold-Back: Using Emerging Technologies to Move from Quality Assurance to Quality Enhancement

    Science.gov (United States)

    Leonard, Simon N.; Fitzgerald, Robert N.; Bacon, Matt

    2016-01-01

    Emerging technologies offer an opportunity for the development, at the institutional level, of quality processes with greater capacity to enhance learning in higher education than available through current quality processes. These systems offer the potential to extend use of learning analytics in institutional-level quality processes in addition…

  10. Some reflections on the emerging notion of personal quality management

    NARCIS (Netherlands)

    Jonker, J.

    1999-01-01

    States that the concept of the “classical” organisation is undoubtedly in transition. As a result new organisational concepts emerge. Addresses the nature of quality management and assurance in “organisations under construction”. Starting with a brief overview of the characteristics of new

  11. 14 CFR Appendix A to Part 125 - Additional Emergency Equipment

    Science.gov (United States)

    2010-01-01

    ... armed during taxiing, takeoffs, and landings. However, if the Administrator finds that the design of the.... (b) Interior emergency exit marking. The following must be complied with for each passenger-carrying... microlamberts. The colors may be reversed if it increases the emergency illumination of the passenger...

  12. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

    Science.gov (United States)

    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases.

    Science.gov (United States)

    Testa, A; Giannuzzi, R; Sollazzo, F; Petrongolo, L; Bernardini, L; Dain, S

    2013-02-01

    In this Part II psychiatric disorders coexisting with organic diseases are discussed. "Comorbidity phenomenon" defines the not univocal interrelation between medical illnesses and psychiatric disorders, each other negatively influencing morbidity and mortality. Most severe psychiatric disorders, such as schizophrenia, bipolar disorder and depression, show increased prevalence of cardiovascular disease, related to poverty, use of psychotropic medication, and higher rate of preventable risk factors such as smoking, addiction, poor diet and lack of exercise. Moreover, psychiatric and organic disorders can develop together in different conditions of toxic substance and prescription drug use or abuse, especially in the emergency setting population. Different combinations with mutual interaction of psychiatric disorders and substance use disorders are defined by the so called "dual diagnosis". The hypotheses that attempt to explain the psychiatric disorders and substance abuse relationship are examined: (1) common risk factors; (2) psychiatric disorders precipitated by substance use; (3) psychiatric disorders precipitating substance use (self-medication hypothesis); and (4) synergistic interaction. Diagnostic and therapeutic difficulty concerning the problem of dual diagnosis, and legal implications, are also discussed. Substance induced psychiatric and organic symptoms can occur both in the intoxication and withdrawal state. Since ancient history, humans selected indigene psychotropic plants for recreational, medicinal, doping or spiritual purpose. After the isolation of active principles or their chemical synthesis, higher blood concentrations reached predispose to substance use, abuse and dependence. Abuse substances have specific molecular targets and very different acute mechanisms of action, mainly involving dopaminergic and serotoninergic systems, but finally converging on the brain's reward pathways, increasing dopamine in nucleus accumbens. The most common

  14. Characterizing the "Time of Emergence" of Air Quality Climate Penalties

    Science.gov (United States)

    Rothenberg, D. A.; Garcia-Menendez, F.; Monier, E.; Solomon, S.; Selin, N. E.

    2017-12-01

    By driving not only local changes in temperature, but also precipitation and regional-scale changes in seasonal circulation patterns, climate change can directly and indirectly influence changes in air quality and its extremes. These changes - often referred to as "climate penalties" - can have important implications for human health, which is often targeted when assessing the potential co-benefits of climate policy. But because climate penalties are driven by slow, spatially-varying, temporal changes in the climate system, their emergence in the real world should also have a spatio-temporal component following regional variability in background air quality. In this work, we attempt to estimate the spatially-varying "time of emergence" of climate penalty signals by using an ensemble modeling framework based on the MIT Integrated Global System Model (MIT IGSM). With this framework we assess three climate policy scenarios assuming three different underlying climate sensitivities, and conduct a 5-member ensemble for each case to capture internal variability within the model. These simulations are used to drive offline chemical transport modeling (using CAM-Chem and GEOS-Chem). In these simulations, we find that the air quality response to climate change can vary dramatically across different regions of the globe. To analyze these regionally-varying climate signals, we employ a hierarchical clustering technique to identify regions with similar seasonal patterns of air quality change. Our simulations suggest that the earliest emergence of ozone climate penalties would occur in Southern Europe (by 2035), should the world neglect climate change and rely on a "business-as-usual" emissions policy. However, even modest climate policy dramatically pushes back the time of emergence of these penalties - to beyond 2100 - across most of the globe. The emergence of climate-forced changes in PM2.5 are much more difficult to detect, partially owing to the large role that changes in

  15. Quality and safety implications of emergency department information systems.

    Science.gov (United States)

    Farley, Heather L; Baumlin, Kevin M; Hamedani, Azita G; Cheung, Dickson S; Edwards, Michael R; Fuller, Drew C; Genes, Nicholas; Griffey, Richard T; Kelly, John J; McClay, James C; Nielson, Jeff; Phelan, Michael P; Shapiro, Jason S; Stone-Griffith, Suzanne; Pines, Jesse M

    2013-10-01

    The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services "meaningful use" incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals' electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital's or physician group's approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order-wrong patient errors, poor data display, and alert fatigue. Case studies are presented that illustrate the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of such a product in the clinical environment. The authors have developed 7 recommendations to improve patient safety with respect to the deployment of EDISs. These include ensuring that emergency providers actively participate in selection of the EDIS product, in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system's ongoing success or failure. Our recommendations apply to emergency departments using any type of EDIS: custom-developed systems, best-of-breed vendor systems, or enterprise systems

  16. [Substance-abuse related emergencies--illegal drugs, part I].

    Science.gov (United States)

    Kinn, Michael; Holzbach, Rüdiger; Pajonk, Frank-Gerald Bernhard

    2008-11-01

    For the first time since the year 2000 the number of death due to substance abuse of illegal drugs has increased in Germany in 2007 (+8 % compared to 2006). Emergency situations due to drug abuse are frequent, particular in big cities. They may be, however, difficult to diagnose and/or treat for an emergency physician on scene because of a lack of diagnostic tools, the local and personal surroundings, and the unknown number and nature of drugs. Many drug intoxications must be considered suicidal. On the other hand, drug intoxications may mask (other) life-threatening conditions. Emergency situations due to withdrawal offer the possibility to motivate patients to take advantage of specialist-guided abstinence programs.

  17. Quality control of injection moulded micro mechanical parts

    DEFF Research Database (Denmark)

    Gasparin, Stefania; Tosello, Guido; Hansen, Hans Nørgaard

    2009-01-01

    Quality control of micro components is an increasing challenge. Smaller mechanical parts are characterized by smaller tolerance to be verified. This paper focuses on the dimensional verification of micro injection moulded components selected from an industrial application. These parts are measured...... using an Optical Coordinate Measuring Machine (OCMM), which guarantees fast surface scans suitable for in line quality control. The uncertainty assessment of the measurements is calculated following the substitution method. To investigate the influence parameters in optical coordinate metrology two...

  18. Measuring and improving cardiopulmonary resuscitation quality inside the emergency department.

    Science.gov (United States)

    Crowe, Christopher; Bobrow, Bentley J; Vadeboncoeur, Tyler F; Dameff, Christian; Stolz, Uwe; Silver, Annemarie; Roosa, Jason; Page, Rianne; LoVecchio, Frank; Spaite, Daniel W

    2015-08-01

    To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality. CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing. A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p training, real-time audiovisual CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Emerging tropical diseases in Australia. Part 5. Hendra virus

    DEFF Research Database (Denmark)

    Tulsiani, Suhella; Graham, G C; Moore, P R

    2011-01-01

    gene of the virus and the discovery that the virus had an exceptionally large genome subsequently led to HeV being assigned to a new genus, Henipavirus, along with Nipah virus (a newly emergent virus in pigs). The regular outbreaks of HeV-related disease that have occurred in Australia since 1994 have...

  20. Alcoholics and the emergency ward. Part I. Clinical characteristics.

    Science.gov (United States)

    Fialkov, M J

    1977-10-01

    A study of White and Black (Black, Cape Coloured and Asiatic) male alcoholics who attended the psychiatric emergency service unit at Groote Schuur Hospital, Cape Town, is presented. The psychosocial and clinical characteristics are described and compared. In addition, the associated physical and psychiatric morbidity is tabulated.

  1. Quality Teaching in Science: an Emergent Conceptual Framework

    Science.gov (United States)

    Jordens, J. Zoe; Zepke, Nick

    2017-09-01

    Achieving quality in higher education is a complex task involving the interrelationship of many factors. The influence of the teacher is well established and has led to some general principles of good teaching. However, less is known about the extent that specific disciplines influence quality teaching. The purposes of the paper are to investigate how quality teaching is perceived in the sciences and from these perceptions to develop for discussion a framework for teaching practice in the sciences. A New Zealand study explored the views of national teaching excellence award winners in science on quality teaching in undergraduate science. To capture all possible views from this expert panel, a dissensus-recognising Delphi method was used together with sensitising concepts based on complexity and wickedity. The emergent conceptual framework for quality teaching in undergraduate science highlighted areas of consensus and areas where there were a variety of views. About the purposes of science and its knowledge base, there was relative consensus, but there was more variable support for values underpinning science teaching. This highlighted the complex nature of quality teaching in science. The findings suggest that, in addition to general and discipline-specific influences, individual teacher values contribute to an understanding of quality in undergraduate science teaching.

  2. Assessing Data Quality in Emergent Domains of Earth Sciences

    Science.gov (United States)

    Darch, P. T.; Borgman, C.

    2016-12-01

    As earth scientists seek to study known phenomena in new ways, and to study new phenomena, they often develop new technologies and new methods such as embedded network sensing, or reapply extant technologies, such as seafloor drilling. Emergent domains are often highly multidisciplinary as researchers from many backgrounds converge on new research questions. They may adapt existing methods, or develop methods de novo. As a result, emerging domains tend to be methodologically heterogeneous. As these domains mature, pressure to standardize methods increases. Standardization promotes trust, reliability, accuracy, and reproducibility, and simplifies data management. However, for standardization to occur, researchers must be able to assess which of the competing methods produces the highest quality data. The exploratory nature of emerging domains discourages standardization. Because competing methods originate in different disciplinary backgrounds, their scientific credibility is difficult to compare. Instead of direct comparison, researchers attempt to conduct meta-analyses. Scientists compare datasets produced by different methods to assess their consistency and efficiency. This paper presents findings from a long-term qualitative case study of research on the deep subseafloor biosphere, an emergent domain. A diverse community converged on the study of microbes in the seafloor and those microbes' interactions with the physical environments they inhabit. Data on this problem are scarce, leading to calls for standardization as a means to acquire and analyze greater volumes of data. Lacking consistent methods, scientists attempted to conduct meta-analyses to determine the most promising methods on which to standardize. Among the factors that inhibited meta-analyses were disparate approaches to metadata and to curating data. Datasets may be deposited in a variety of databases or kept on individual scientists' servers. Associated metadata may be inconsistent or hard to

  3. Parts Quality Management: Direct Part Marking of Data Matrix Symbol for Mission Assurance

    Science.gov (United States)

    Moss, Chantrice; Chakrabarti, Suman; Scott, David W.

    2013-01-01

    A United States Government Accountability Office (GAO) review of twelve NASA programs found widespread parts quality problems contributing to significant cost overruns, schedule delays, and reduced system reliability. Direct part marking with Data Matrix symbols could significantly improve the quality of inventory control and parts lifecycle management. This paper examines the feasibility of using direct part marking technologies for use in future NASA programs. A structural analysis is based on marked material type, operational environment (e.g., ground, suborbital, Low Earth Orbit), durability of marks, ease of operation, reliability, and affordability. A cost-benefits analysis considers marking technology (label printing, data plates, and direct part marking) and marking types (two-dimensional machine-readable, human-readable). Previous NASA parts marking efforts and historical cost data are accounted for, including inhouse vs. outsourced marking. Some marking methods are still under development. While this paper focuses on NASA programs, results may be applicable to a variety of industrial environments.

  4. Parts Quality Management: Direct Part Marking via Data Matrix Symbols for Mission Assurance

    Science.gov (United States)

    Moss, Chantrice

    2013-01-01

    A United States Government Accountability Office (GAO) review of twelve NASA programs found widespread parts quality problems contributing to significant cost overruns, schedule delays, and reduced system reliability. Direct part-marking with Data Matrix symbols could significantly improve the quality of inventory control and parts lifecycle management. This paper examines the feasibility of using 15 marking technologies for use in future NASA programs. A structural analysis is based on marked material type, operational environment (e.g., ground, suborbital, orbital), durability of marks, ease of operation, reliability, and affordability. A cost-benefits analysis considers marking technology (data plates, label printing, direct part marking) and marking types (two-dimensional machine-readable, human-readable). Previous NASA parts marking efforts and historical cost data are accounted for, including in-house vs. outsourced marking. Some marking methods are still under development. While this paper focuses on NASA programs, results may be applicable to a variety of industrial environments.

  5. Electric utility strategies and the emerging industry structure - Part 1

    International Nuclear Information System (INIS)

    Motupalli, S.

    1991-01-01

    The electric utility industry is our most capital intensive industry by far. Over the past few decades, socioeconomic and technological forces have been quietly revolutionizing the way the industry conducts itself. During the 1980s, these changes have been particularly intense, often catching both regulators and regulated ill-prepared to develop effective and profitable strategies to deal with such change. Much has already been written about these changes: independent power producers, competitive procurement of resources, incentive-based regulation, the benefits of affiliated company structures, mergers and consolidation, customer energy conservation, and marketing strategy development are all currently highly popular article and seminar topics. The author's object in this two-part series is to facilitate development of a decision framework to put these various changes in perspective, to help develop effective strategies through better focused and equipped planning methodologies. Gaining an understanding of the role, strengths and weaknesses of the various players in an industry and the structural constraints in which they operate is a necessary precursor to developing effective operating strategies to deal with change or to manipulate industry forces in your favor. Michael Port's popular five forces model provides a convenient way to develop such an understanding. It provides a way to map the industry forces driving profitability, through a review of the strengths, weaknesses and leverage of: current industry players, suppliers to the industry, customers for the industry's product, new entrants into the market, and substitute products providing equal or better value. Part 1 of this series reviews each of these five forces along some key dimensions to determine their direction of change or influence, and whether this change impacts a utility's competitive position favorably or unfavorably

  6. A tiered analytical approach for investigating poor quality emergency contraceptives.

    Directory of Open Access Journals (Sweden)

    María Eugenia Monge

    Full Text Available Reproductive health has been deleteriously affected by poor quality medicines. Emergency contraceptive pills (ECPs are an important birth control method that women can use after unprotected coitus for reducing the risk of pregnancy. In response to the detection of poor quality ECPs commercially available in the Peruvian market we developed a tiered multi-platform analytical strategy. In a survey to assess ECP medicine quality in Peru, 7 out of 25 different batches showed inadequate release of levonorgestrel by dissolution testing or improper amounts of active ingredient. One batch was found to contain a wrong active ingredient, with no detectable levonorgestrel. By combining ultrahigh performance liquid chromatography-ion mobility spectrometry-mass spectrometry (UHPLC-IMS-MS and direct analysis in real time MS (DART-MS the unknown compound was identified as the antibiotic sulfamethoxazole. Quantitation by UHPLC-triple quadrupole tandem MS (QqQ-MS/MS indicated that the wrong ingredient was present in the ECP sample at levels which could have significant physiological effects. Further chemical characterization of the poor quality ECP samples included the identification of the excipients by 2D Diffusion-Ordered Nuclear Magnetic Resonance Spectroscopy (DOSY 1H NMR indicating the presence of lactose and magnesium stearate.

  7. Quality assurance in a cask fleet parts control system

    International Nuclear Information System (INIS)

    Fernandez, C.; Shappert, L.B.

    1992-01-01

    This paper discusses applicable portions of the eighteen Quality Assurance criteria of Subpart H, 10 CFR 71 which are incorporated into a relational data base system which has been designed to manage the spare parts control system for a fleet of spent nuclear fuel casks. The system includes not only parts in warehouse storage but parts in use in the field plus casks, ancillary equipment, test equipment, support devices, and even personnel. It provides a high degree of assurance that any device for which a condition for certification has expired will be flagged for recertification testing or removal from service well before the critical date

  8. Quality assurance in a cask fleet parts control system

    International Nuclear Information System (INIS)

    Fernandez, C.; McCreery, P.N.; Shappert, L.B.

    1991-01-01

    Applicable portions of the eighteen Quality Assurance criteria of Subpart H, 10 CFR 71 are incorporated into a relational data base system which has been designed to manage the spare parts control system for a fleet of spent nuclear fuel casks. The system includes not only parts in warehouse storage but parts in use in the field plus casks, ancillary equipment, test equipment, support devices, and even personnel. It provides a high degree of assurance that any device for which a condition for certification has expired will be flagged for recertification testing or removal from service well before the critical date

  9. Leadership Qualities Emerging in an Online Social Support Group Intervention.

    Science.gov (United States)

    Kodatt, Stephanie A; Shenk, Jared E; Williams, Mark L; Horvath, Keith J

    2014-11-01

    Technology-delivered interventions addressing a broad range of problems for which clients present for therapy are proliferating. However, little is known of leadership dynamics that emerge in online group interventions. The purpose of this study was to assess the types of leadership qualities that would emerge in an online social support group intervention to improve medication adherence for men with HIV, and to characterize the demographic and psychosocial profiles of leaders. Written posts ( n =616) from 66 men were coded using an adapted version of the Full Range Model of Leadership. Results showed that 10% ( n =64) of posts reflected one of five leadership types, the most common of which was mentoring/providing feedback (40% of leadership posts). The next most common leadership style were instances in which encouragement was offered (30% of leadership posts). Leaders appeared to have lived with HIV longer and have higher Internet knowledge scores than non-leaders. Results indicate that online group interventions potentially may be useful to supplement traditional face-to-face treatment by providing an additional venue for group members to mentor and provide emotional support to each other. However, additional research is needed to more fully understand leadership qualities and group dynamics in other online group intervention settings.

  10. Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review.

    Science.gov (United States)

    Howard, Ian; Cameron, Peter; Wallis, Lee; Castren, Maaret; Lindstrom, Veronica

    2018-02-01

    Introduction Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC. Problem Quality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature. A scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment. The majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of

  11. Quality of life after percutaneous coronary intervention: part 1.

    Science.gov (United States)

    Cassar, Stephen; R Baldacchino, Donia

    Quality of life (QOL) is a complex concept comprised of biopsychosocial, spiritual and environmental dimensions. However, the majority of research addresses only its physical function perspectives. This two-part series examines the holistic perspective of QOL of patients after percutaneous coronary intervention (PCI). Part 1 explains the research process of a cross-sectional descriptive study and its limitations. Data were collected by a mailed WHOQOL-BREF questionnaire in Maltese from a systematic sample of patients who had undergone PCI; the response rate was 64% (n=228; males n=169, females n=59, age 40-89 years). Part 1 also considers limitations, such as its cross-sectional design and retrospective data collection. The hierarchy of human needs theory (Maslow, 1999) guided the study. Part 2 gives the findings on the holistic view of QOL. Having social and family support, as a characteristic of Maltese culture appeared to contribute towards a better QOL.

  12. Quality of emergency rooms and urgent care services: user satisfaction.

    Science.gov (United States)

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

    2015-01-01

    To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

  13. The evolving story of medical emergency teams in quality improvement.

    Science.gov (United States)

    Amaral, André Carlos Kajdacsy-Balla; Shojania, Kaveh G

    2009-01-01

    Adverse events affect approximately 3% to 12% of hospitalized patients. At least a third, but as many as half, of such events are considered preventable. Detection of these events requires investments of time and money. A report in a recent issue of Critical Care used the medical emergency team activation as a trigger to perform a prospective standardized evaluation of charts. The authors observed that roughly one fourth of calls were related to a preventable adverse event, which is comparable to the previous literature. However, while previous studies relied on retrospective chart reviews, this study introduced the novel element of real-time characterization of events by the team at the moment of consultation. This methodology captures important opportunities for improvements in local care at a rate far higher than routine incident-reporting systems, but without requiring substantial investments of additional resources. Academic centers are increasingly recognizing engagement in quality improvement as a distinct career pathway. Involving such physicians in medical emergency teams will likely facilitate the dual roles of these as a clinical outreach arm of the intensive care unit and in identifying problems in care and leading to strategies to reduce them.

  14. Lean thinking in emergency departments: concepts and tools for quality improvement.

    Science.gov (United States)

    Bruno, Frances

    2017-10-12

    The lean approach is a viable framework for reducing costs and enhancing the quality of patient care in emergency departments (EDs). Reports on lean-inspired quality improvement initiatives are rapidly growing but there is little emphasis on the philosophy behind the processes, which is the essential ingredient in sustaining transformation. This article describes lean philosophy, also referred to as lean, lean thinking and lean healthcare, and its main concepts, to enrich the knowledge and vocabulary of nurses involved or interested in quality improvement in EDs. The article includes examples of lean strategies to illustrate their practical application in EDs. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  15. Quality assurance program description: Hanford Waste Vitrification Plant, Part 1

    International Nuclear Information System (INIS)

    1992-01-01

    This document describes the Department of Energy's Richland Field Office (DOE-RL) quality assurance (QA) program for the processing of high-level waste as well as the Vitrification Project Quality Assurance Program for the design and construction of the Hanford Waste Vitrification Plant (HWVP). It also identifies and describes the planned activities that constitute the required quality assurance program for the HWVP. This program applies to the broad scope of quality-affecting activities associated with the overall HWVP Facility. Quality-affecting activities include designing, purchasing, fabricating, handling, shipping, storing, cleaning, erecting, installing, inspecting, testing, maintaining, repairing, and modifying. Also included are the development, qualification, and production of waste forms which may be safely used to dispose of high-level radioactive waste resulting from national defense activities. The HWVP QA program is made up of many constituent programs that are being implemented by the participating organizations. This Quality Assurance program description is intended to outline and define the scope and application of the major programs that make up the HWVP QA program. It provides a means by which the overall program can be managed and directed to achieve its objectives. Subsequent parts of this description will identify the program's objectives, its scope, application, and structure

  16. Natural gas quality for the future. Part 2

    International Nuclear Information System (INIS)

    Klooster, J.; Metselaar, E.; Warringa, G.; Levinsky, H.B.; Van Rij, M.L.D.

    2011-03-01

    By request of various market parties (suppliers and users of natural gas), the Dutch Ministry of Economic Affairs, Agriculture and Innovation (ELI) took a leading role in anticipating the future changes in gas quality. To integrate anticipated gases in the Dutch gas supply, measures will be required that can prevent the undesired effects on safety and effectiveness as mentioned in Part 1 of this study; at the same time the possible impact of these measures on security of supply must be minimized. [nl

  17. Emerging melt quality control solution technologies for aluminium melt

    Directory of Open Access Journals (Sweden)

    Arturo Pascual, Jr

    2009-11-01

    Full Text Available The newly developed “MTS 1500” Melt Treatment System is performing the specifi cally required melt treatment operations like degassing, cleaning, modification and/or grain refinement by an automated process in one step and at the same location. This linked process is saving time, energy and metal losses allowing - by automated dosage of the melt treatment agents - the production of a consistent melt quality batch after batch. By linking the MTS Metal Treatment System with sensors operating on-line in the melt, i.e., with a hydrogen sensor “Alspek H”, a fully automated control of parts of the process chain like degassing is possible. This technology does guarantee a pre-specifi ed and documented melt quality in each melt treatment batch. Furthermore, to ensure that castings are consistent and predictable there is a growing realization that critical parameters such as metal cleanliness must be measured prior to casting. There exists accepted methods for measuring the cleanliness of an aluminum melt but these can be both slow and costly. A simple, rapid and meaningful method of measuring and bench marking the cleanliness of an aluminum melt has been developed to offer the foundry a practical method of measuring melt cleanliness. This paper shows the structure and performance of the integrated MTS melt treatment process and documents achieved melt quality standards after degassing, cleaning, modifi cation and grain refi nement operations under real foundry conditions. It also provides an insight on a melt cleanliness measuring device “Alspek MQ” to provide foundry men better tools in meeting the increasing quality and tighter specifi cation demand from the industry.

  18. [Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-01-22

    In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.

  19. Investigating emergency room service quality using lean manufacturing.

    Science.gov (United States)

    Abdelhadi, Abdelhakim

    2015-01-01

    The purpose of this paper is to investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital's service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances. The patient treatment lead time within the hospital's two EDs (one department serves male and the other female patients) are the study's focus. A lean metric called Takt time is used to find the service's relative efficiency. Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analyzing relative efficiency and identifies bottlenecks in different departments providing the same services. The paper presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.

  20. Air Quality and Heart Health: An Emerging Topic for Heart ...

    Science.gov (United States)

    Air Quality and Heart Health: An Emerging Topic for Heart Month: Ambient air particle pollution increases short- and long-term cardiovascular morbidity and mortality. Older-people, those with pre-existing heart disease and lung disease and diabetes are at higher risk. Mechanisms are under investigation and are likely related to oxidative stress, inflammation and effects on autonomic control. Improvements in air pollution levels reduce health impacts and increase life expectancy. Reductions of short-term exposure in those at highest risk are predicted to mitigate adverse health effects. EPA regularly evaluates the standards, health risks and issues improved standards when needed. Public health action is needed along with EPA standards to reduce the public health burden of short- and long-term adverse health effects of air pollution. Health risks remain and need to be addressed through integrated efforts of public health, health care, environmental health, individuals and communities. Presented at Webinar for the National Association of Clean Air Agencies, February 2, 2017, Chapel Hill, NC- This webinar provided an update of environmental health information related to the effects of air pollution and heart and blood vessel disease. Such information is critically important for the Clean Air Agencies to understand as it provides the justification of their actions.

  1. A platform for quality management in research institutes (part II

    Directory of Open Access Journals (Sweden)

    Klembalska Agnieszka

    2016-09-01

    Full Text Available In the recent years there has been a particularly strong pressure on changing old structures and management models in research institutes. Contemporary research institutes are scientific units which are commercial in character – almost 80% of funds come from companies and contractual research activity and services. They are the basic sector of science aiming at cooperation with the economy, applied and innovative research. In order to maintain the current and start new cooperation it is necessary to pay particular attention to maintaining, improving and exposing high level of quality of conducted activity. Taking into consideration the necessity of carrying out ever more complex research projects, conducting activity requiring fast reaction to change, risk analysis, which is assessed every year by the Ministry of Science and Higher Education – it seems that it is necessary to apply tools supporting the assessment of quality. In the proposed three-aspect perspective the following scopes of activity are emphasized: implemented quality management systems, area of scientific information and the sphere of cooperation with the client. This article constitutes the continuation of the subjects discussed in the first part – an extension of issues associated with the scope of responsibilities of particular Sections of the proposed Quality Management Platform in research institutes.

  2. [Estimating emergency hospital admissions to gauge short-term effects of air pollution: evaluation of health data quality].

    Science.gov (United States)

    Bois de Fer, Béatrice; Host, Sabine; Chardon, Benoît; Chatignoux, Edouard; Beaujouan, Laure; Brun-Ney, Dominique; Grémy, Isabelle

    2009-01-01

    The study of the short-term effects and health impact of air pollution is carrier out by the ERPURS regional surveillance program which utilizes hospitalization data obtained from the French hospital information system (PMSI) to determine these links. This system does not permit the distinction between emergency hospital admissions from scheduled ones, which cannot be related to short term changes in air pollution levels. This study examines how scheduled admissions affect the quality of the health indicators used to estimate air pollution effects. This indicator is compared to three new emergency hospitalisation indicators reconstructed based on data from the public hospitals in Paris, partly from the PMSI data and partly with data from an on-line emergency network that regroups all of the computerized emergency services. According to the pathology, scheduled admissions present a difficulty which affects the capacity to highlight the weakest risks with any precision.

  3. Comprehensive genomic studies: emerging regulatory, strategic, and quality assurance challenges for biorepositories.

    Science.gov (United States)

    McDonald, Sandra A; Mardis, Elaine R; Ota, David; Watson, Mark A; Pfeifer, John D; Green, Jonathan M

    2012-07-01

    As part of the molecular revolution sweeping medicine, comprehensive genomic studies are adding powerful dimensions to medical research. However, their power exposes new regulatory, strategic, and quality assurance challenges for biorepositories. A key issue is that unlike other research techniques commonly applied to banked specimens, nucleic acid sequencing, if sufficiently extensive, yields data that could identify a patient. This evolving paradigm renders the concepts of anonymized and anonymous specimens increasingly outdated. The challenges for biorepositories in this new era include refined consent processes and wording, selection and use of legacy specimens, quality assurance procedures, institutional documentation, data sharing, and interaction with institutional review boards. Given current trends, biorepositories should consider these issues now, even if they are not currently experiencing sample requests for genomic analysis. We summarize our current experiences and best practices at Washington University Medical School, St Louis, MO, our perceptions of emerging trends, and recommendations.

  4. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-02-05

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  5. Emergency department overcrowding: Quality improvement in a Taiwan Medical Center.

    Science.gov (United States)

    Hsu, Chen-Mei; Liang, Li-Lin; Chang, Yun-Te; Juang, Wang-Chuan

    2018-04-14

    Overcrowding of hospital emergency departments (ED) is a worldwide health problem. The Taiwan Joint Commission on Hospital Accreditation has stressed the importance of finding solutions to overcrowding, including, reducing the number of patients with >48 h stay in the ED. Moreover, the Ministry of Health and Welfare aims at transferring non-critical patients to district or regional hospitals. We report the results of our Quality Improvement Project (QIP) on ED overcrowding, especially focusing on reducing length of stay (LOS) in ED. For QIP, the following 3 action plans were initiated: 1) Changing the choice architecture of patients' willingness to transfer from opt-in to opt-out; 2) increasing the turnover rate of beds and daily monitoring of the number of free beds for boarding ED patients; 3) reevaluation of patients with a LOS of >32 h after the morning shift. Transfer rates increased minimally after implementation of this project, but the sample size was too small to achieve statistical significance. No significant increase was observed in the number of free medical beds, but discharge rates after 12 pm decreased significantly (p 32 h were reevaluated first. After QIP, the proportion of LOSs of >48 h dropped significantly. Changing the choice architecture may require further systemic effort and a longer observation duration. Higher-level administrators will need to formulate a more comprehensive bed management plan to speed up the turnover rate of free inpatient beds. Copyright © 2018. Published by Elsevier B.V.

  6. Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene.

    Science.gov (United States)

    Sliker, Clint W; Steenburg, Scott D; Archer-Arroyo, Krystal

    2013-06-01

    An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and nontraumatic pathology. In this second part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.

  7. 10 CFR Appendix E to Part 50 - Emergency Planning and Preparedness for Production and Utilization Facilities

    Science.gov (United States)

    2010-01-01

    ... of the time required to evacuate various sectors and distances within the plume exposure pathway EPZ.... Implementing Procedures VI. Emergency Response Data System I. Introduction Each applicant for a construction... preliminary safety analysis report for a construction permit and submitted as part of the final safety...

  8. A Four-Part Model of Autonomy during Emerging Adulthood: Associations with Adjustment

    Science.gov (United States)

    Lamborn, Susie D.; Groh, Kelly

    2009-01-01

    We found support for a four-part model of autonomy that links connectedness, separation, detachment, and agency to adjustment during emerging adulthood. Based on self-report surveys of 285 American college students, expected associations among the autonomy variables were found. In addition, agency, as measured by self-reliance, predicted lower…

  9. 40 CFR Appendix L to Part 51 - Example Regulations for Prevention of Air Pollution Emergency Episodes

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Example Regulations for Prevention of Air Pollution Emergency Episodes L Appendix L to Part 51 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS REQUIREMENTS FOR PREPARATION, ADOPTION, AND SUBMITTAL OF IMPLEMENTATION PLANS Pt. 51, App. L Appendix L to Par...

  10. Additive Manufacturing: Multi Material Processing and Part Quality Control

    DEFF Research Database (Denmark)

    Pedersen, David Bue

    This Ph.D dissertation,ffAdditive Manufacturing: Multi Material Processing and Part Quality Controlff, deal with Additive Manufacturing technologies which is a common name for a series of processes that are recognized by being computer controlled, highly automated, and manufacture objects...... by a layered deposition of material. Two areas of particular interest is addressed. They are rooted in two very different areas, yet is intended to fuel the same goal. To help Additive Manufacturing technologies one step closer to becoming the autonomous, digital manufacturing method of tomorrow. Vision...... systems A paradox exist in the field of Additive Manufacturing. The technologies allow for close-to unrestrained and integral geometrical freedom. Almost any geometry can be manufactured fast, e"ciently and cheap. Something that has been missing fundamental capability since the entering of the industrial...

  11. Modernisation of Radiation Monitoring Room as a Part of Slovenian Emergency Response Centre

    International Nuclear Information System (INIS)

    Sarvari, A.; Mitic, D.

    2003-01-01

    In the year 2002 the Slovenian Nuclear Safety Administration (SNSA) moved to the new premises therefore it had to rearrange some of its rooms for the emergency situation. SNSA does not operate with a dedicated Emergency Response Centre (ERC), instead of it the SNSA has to rearrange the existing rooms in case of an emergency. Modernisation of the equipment, with the help of government of the United Kingdom of Great Britain and Northern Ireland, for the emergency situation was carried out, especially in the monitoring room. The radiation monitoring system, which is placed in the monitoring room, continuously collects, processes and archives the incoming data of exposure to radiation and meteorological parameters on the Slovenian territory (A model national emergency response plan for radiological accidents, IAEA, Vienna, 1993. IAEA-TECDOC-718). In the emergency situation the monitoring room transforms into the room for the Dose Assessment Group (DAG), which is part of ERC (IAEA emergency response network, IAEA, Vienna, 2000, EPR-ERNET (2000)). The modernisation of monitoring room and within the DAG room with new equipment and its purpose is described in this article. Modernisation of the monitoring room and the room for DAG showed to be inevitably needed. Modernisation of the monitoring room has brought the SNSA a sophisticated and reliable system of controlling the external exposure to radiation on the Slovenian territory. The equipment, especially the equipment for the use in the emergency situation, brought novelties for the Dose Assessment Group. The group has now better and easier control of radiation situation in case of an accident. In overall this modernisation has put the Slovenian Nuclear Safety Administration a step forward in having a dedicated Emergency Response Centre, since it does not need to rearrange the room for the Dose Assessment Group. (author)

  12. Interview-based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting.

    Science.gov (United States)

    Ranney, Megan L; Meisel, Zachary F; Choo, Esther K; Garro, Aris C; Sasson, Comilla; Morrow Guthrie, Kate

    2015-09-01

    Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. © 2015 by the Society for Academic Emergency Medicine.

  13. Qualitative Research in Emergency Care Part I: Research Principles and Common Applications.

    Science.gov (United States)

    Choo, Esther K; Garro, Aris C; Ranney, Megan L; Meisel, Zachary F; Morrow Guthrie, Kate

    2015-09-01

    Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. This article, Part I of a two-article series, provides an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field, including observation, individual interviews, and focus groups. In Part II of this series, we will outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. © 2015 by the Society for Academic Emergency Medicine.

  14. The Emergence of Quality Assessment in Brazilian Basic Education

    Science.gov (United States)

    Kauko, Jaakko; Centeno, Vera Gorodski; Candido, Helena; Shiroma, Eneida; Klutas, Anni

    2016-01-01

    The focus in this article is on Brazilian education policy, specifically quality assurance and evaluation. The starting point is that quality, measured by means of large-scale assessments, is one of the key discursive justifications for educational change. The article addresses the questions of how quality evaluation became a significant feature…

  15. Recursive estimation of the parts production process quality indicator

    Directory of Open Access Journals (Sweden)

    Filipovich Oleg

    2017-01-01

    Full Text Available Consideration is given to a mathematical representation for manufacturing of batch parts on a metal-cutting machine tool. Linear dimensions of machined parts are assumed to be the major quality indicator, deviation from these dimensions is determined by size setting of machine tool and ensemble of random factors. It is allowed to have absolutely precise pre-setting of machine tool, effects from setup level offsetting due to deformation in process equipment on the specified indicator are disregarded. Consideration is given to factors which affect the tool wear, with two definitions of tool wear being provided. Reasons for development of random error in processing, dependence of measurement results on error as well as distribution laws and some parameters of random values are provided. To evaluate deviation of size setting value in each cycle, it is proposed to apply a recursive algorithm in description of investigated dynamic discrete process in the space state. Kalman filter equations are used in description of process model by means of first-order difference equations. The algorithm of recursive estimation is implemented in the mathematical software Maple. Simulation results which prove effectiveness of algorithm application to investigate the given dynamic system are provided. Variants of algorithm application and opportunities of further research are proposed.

  16. The art of communication: strategies to improve efficiency, quality of care and patient safety in the emergency department

    International Nuclear Information System (INIS)

    Krug, Steven E.

    2008-01-01

    The practice of pediatric emergency medicine (PEM) has been supported by wonderful advancements in diagnostic testing, particularly in medical imaging. One of the most remarkable has been CT, which has arguably become our most valuable diagnostic tool in the emergency department (ED). PEM specialists have grown increasingly aware of quality and safety concerns in the care of children in emergency medical settings, spurred in part by a rapid growth in ED utilization and significant overcrowding. In the midst of this comes the revelation that one of our most valued diagnostic tools might place our youngest patients at a significant risk for the development of fatal cancer. This article reinforces the fundamental importance of communication and teamwork as a means to promote patient care quality and safety in the ED, and it offers partnership strategies for PEM and pediatric radiology specialists to consider as they address these important concerns. (orig.)

  17. The art of communication: strategies to improve efficiency, quality of care and patient safety in the emergency department

    Energy Technology Data Exchange (ETDEWEB)

    Krug, Steven E. [Northwestern University, Children' s Memorial Hospital, Feinberg School of Medicine, Chicago, IL (United States)

    2008-11-15

    The practice of pediatric emergency medicine (PEM) has been supported by wonderful advancements in diagnostic testing, particularly in medical imaging. One of the most remarkable has been CT, which has arguably become our most valuable diagnostic tool in the emergency department (ED). PEM specialists have grown increasingly aware of quality and safety concerns in the care of children in emergency medical settings, spurred in part by a rapid growth in ED utilization and significant overcrowding. In the midst of this comes the revelation that one of our most valued diagnostic tools might place our youngest patients at a significant risk for the development of fatal cancer. This article reinforces the fundamental importance of communication and teamwork as a means to promote patient care quality and safety in the ED, and it offers partnership strategies for PEM and pediatric radiology specialists to consider as they address these important concerns. (orig.)

  18. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Jauch, Edward C; Cucchiara, Brett; Adeoye, Opeolu; Meurer, William; Brice, Jane; Chan, Yvonne Yu-Feng; Gentile, Nina; Hazinski, Mary Fran

    2010-11-02

    Advances in stroke care will have the greatest effect on stroke outcome if care is delivered within a regional stroke system designed to improve both efficiency and effectiveness. The ultimate goal of stroke care is to minimize ongoing injury, emergently recanalize acute vascular occlusions, and begin secondary measures to maximize functional recovery. These efforts will provide stroke patients with the greatest opportunity for a return to previous quality of life and decrease the overall societal burden of stroke.

  19. Generational influences in academic emergency medicine: teaching and learning, mentoring, and technology (part I).

    Science.gov (United States)

    Mohr, Nicholas M; Moreno-Walton, Lisa; Mills, Angela M; Brunett, Patrick H; Promes, Susan B

    2011-02-01

    For the first time in history, four generations are working together-traditionalists, baby boomers, generation Xers (Gen Xers), and millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. © 2011 by the Society for Academic Emergency Medicine.

  20. Interview-Based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting

    Science.gov (United States)

    Ranney, Megan L.; Meisel, Zachary; Choo, Esther K.; Garro, Aris; Sasson, Comilla; Morrow, Kathleen

    2015-01-01

    Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. PMID:26284572

  1. National Assessment of Quality Programs in Emergency Medical Services.

    Science.gov (United States)

    Redlener, Michael; Olivieri, Patrick; Loo, George T; Munjal, Kevin; Hilton, Michael T; Potkin, Katya Trudeau; Levy, Michael; Rabrich, Jeffrey; Gunderson, Michael R; Braithwaite, Sabina A

    2018-01-01

    This study aims to understand the adoption of clinical quality measurement throughout the United States on an EMS agency level, the features of agencies that do participate in quality measurement, and the level of physician involvement. It also aims to barriers to implementing quality improvement initiatives in EMS. A 46-question survey was developed to gather agency level data on current quality improvement practices and measurement. The survey was distributed nationally via State EMS Offices to EMS agencies nation-wide using Surveymonkey©. A convenience sample of respondents was enrolled between August and November, 2015. Univariate, bivariate and multiple logistic regression analyses were conducted to describe demographics and relationships between outcomes of interest and their covariates using SAS 9.3©. A total of 1,733 surveys were initiated and 1,060 surveys had complete or near-complete responses. This includes agencies from 45 states representing over 6.23 million 9-1-1 responses annually. Totals of 70.5% (747) agencies reported dedicated QI personnel, 62.5% (663) follow clinical metrics and 33.3% (353) participate in outside quality or research program. Medical director hours varied, notably, 61.5% (649) of EMS agencies had quality measures compared to fire-based agencies. Agencies in rural only environments were less likely to follow clinical quality metrics. (OR 0.47 CI 0.31 -0.72 p quality improvement resources, medical direction and specific clinical quality measures. More research is needed to understand the impact of this variation on patient care outcomes.

  2. Guide for Developing High-Quality School Emergency Operations Plans

    Science.gov (United States)

    Office of Safe and Healthy Students, US Department of Education, 2013

    2013-01-01

    Each school day, our nation's schools are entrusted to provide a safe and healthy learning environment for approximately 55 million elementary and secondary school students in public and nonpublic schools. In collaboration with their local government and community partners, schools can take steps to plan for these potential emergencies through the…

  3. Toxicological relevance of emerging contaminants for drinking water quality

    OpenAIRE

    Schriks, M.; Heringa, M.B.; van der Kooij, M.M.E.; de Voogt, P.; van Wezel, A.P.

    2010-01-01

    The detection of many new compounds in surface water, groundwater and drinking water raises considerable public concern, especially when human health based guideline values are not available it is questioned if detected concentrations affect human health. In an attempt to address this question, we derived provisional drinking water guideline values for a selection of 50 emerging contaminants relevant for drinking water and the water cycle. For only 10 contaminants, statutory guideline values ...

  4. Influence of Coal Ash Leachates and Emergent Macrophytes on Water Quality in Wetland Microcosms

    Data.gov (United States)

    U.S. Environmental Protection Agency — Influence of Coal Ash Leachates and Emergent Macrophytes on Water Quality in Wetland Microcosms. This dataset is associated with the following publication: Olson,...

  5. 75 FR 51825 - Quality and Compliance in Merging and Emerging Cultures; Public Conference

    Science.gov (United States)

    2010-08-23

    ... announcing a public conference entitled ``The New Paradigm: Quality and Compliance in Merging and Emerging... accommodations because of a disability, please contact Wanda Neal, at least 7 days in advance of the conference...

  6. Quality Air Force in an Emergency. Leadership Principles and Concepts for Emergency Response Forces

    National Research Council Canada - National Science Library

    Byrd, David

    1996-01-01

    ... during a crisis. He proposes that senior leaders view quality concepts and principles as a way of creating an environment to spark the highest performance by their subordinates and not as giving up authority or control...

  7. Quality of care using a multidisciplinary team in the emergency room

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Maaløe, Rikke; Jensen, Nanna Martin

    2011-01-01

    Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients re...... received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients....

  8. Air Quality and Heart Health: Managing an Emerging ...

    Science.gov (United States)

    Dr. Cascio will share with a broad range of federal agencies current understanding of the links between air quality and cardiovascular health. The key facts include that air pollution contributes a high attributable health burden. That certain well-defined vulnerable subpopulations are at higher risk. At-risk populations include those with heart disease, lung disease and diabetes, older adults, children and individuals living in low socioeconomic neighborhoods. There is no established threshold level for safe long-term exposure to air particle pollution, and some of the basic biological mechanisms that account for adverse health effects are now known. This knowledge is giving us insight into how we might mitigate the effects apart from the regulatory efforts to improve overall air quality. Moreover, the work that each State has done to improve air quality has resulted in improved health outcomes including cardiovascular outcomes, and longer lives. The presentation will address: 1) What do we know? 2) Who are the at-risk populations? 3) What can communities do to reduce risk? 4) What can healthcare professionals do to reduce risk of the at-risk population? And 5) What tools are available to help healthcare professionals and their patients reduce exposure and risk from air pollutants? The talk will feature a description of the Air Quality Index and associated EPA tools and health information that can be used by health care providers to educate their at-ris

  9. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I)

    Science.gov (United States)

    Mohr, Nicholas M.; Moreno-Walton, Lisa; Mills, Angela M.; Brunett, Patrick H.; Promes, Susan B.

    2010-01-01

    For the first time in history, four generations are working together – Traditionalists, Baby Boomers, Generation Xers, and Millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine (SAEM) Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. PMID:21314779

  10. Sustainable Inclusion of Smallholders in the Emerging High Quality ...

    African Journals Online (AJOL)

    BRIAN

    Journal of Agricultural Extension. Vol. 14 (1), June ... The two-sided economic down-turn and food crisis being experienced in many parts of the world ... The developing countries are still dominating the population stage with 5.1 ..... use, underdevelopment and stagnation of economy, debt management – all will be a step in ...

  11. Sustainable Inclusion of Smallholders in the Emerging High Quality ...

    African Journals Online (AJOL)

    BRIAN

    devolution, and transfer to private firms and NGO), and cost-sharing. ... and independent economic, political and technical determinations, not the use of ... other development beneficiaries have real decision-making power and are part of the ... agricultural extension is discussed, privatization is used in the broadest sense ...

  12. The writer's guide to education scholarship in emergency medicine: Education innovations (part 3).

    Science.gov (United States)

    Hall, Andrew K; Hagel, Carly; Chan, Teresa M; Thoma, Brent; Murnaghan, Aleisha; Bhanji, Farhan

    2018-05-01

    The scholarly dissemination of innovative medical education practices helps broaden the reach of this type of work, allowing scholarship to have an impact beyond a single institution. There is little guidance in the literature for those seeking to publish program evaluation studies and innovation papers. This study aims to derive a set of evidence-based features of high-quality reports on innovations in emergency medicine (EM) education. We conducted a scoping review and thematic analysis to determine quality markers for medical education innovation reports, with a focus on EM. A search of MEDLINE, EMBASE, ERIC, and Google Scholar was augmented by a hand search of relevant publication guidelines, guidelines for authors, and website submission portals from medical education and EM journals. Study investigators reviewed the selected articles, and a thematic analysis was conducted. Our search strategy identified 14 relevant articles from which 34 quality markers were extracted. These markers were grouped into seven important themes: goals and need for innovation, preparation, innovation development, innovation implementation, evaluation of innovation, evidence of reflective practice, and reporting and dissemination. In addition, multiple outlets for the publication of EM education innovations were identified and compiled. The publication and dissemination of innovations are critical for the EM education community and the training of health professionals. We anticipate that our list of innovation report quality markers will be used by EM education innovators to support the dissemination of novel educational practices.

  13. Quality assessment of drinking water in Temeke District (part II ...

    African Journals Online (AJOL)

    Water quality studied includes pH, chloride, nitrate and total hardness levels. The concentrations of total hardness in mg CaCO3/L and chloride were obtained by titration method while the nitrate concentration levels were determined by spectrophotometer. Tap water was found to be of high quality than other sources in ...

  14. 40 CFR Appendix C to Part 61 - Quality Assurance Procedures

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 8 2010-07-01 2010-07-01 false Quality Assurance Procedures C Appendix...—Quality Assurance Procedures Procedure 1—Determination of Adequate Chromatographic Peak Resolution In this....” Procedure 2—Procedure for Field Auditing GC Analysis Responsibilities of audit supervisor and analyst at the...

  15. Quality of Service in Bluetooth networking - part I

    NARCIS (Netherlands)

    van der Zee, Martin; Heijenk, Geert

    The Quality of Service functions and procedures included in the Bluetooth 1.0 specification have been reviewed. Next issues associated with providing Quality of Service over a wireless link in general and Bluetooth in particular have been investigated. Allthough the Bluetooth 1.0 specification

  16. Adapting protocols of CT imaging in a pediatric emergency department. Evaluation of image quality and dose

    International Nuclear Information System (INIS)

    Batista Arce, A.; Gonzalez Lopez, S.; Catalan Acosta, A.; Casares Magaz, O.; Hernandez Armas, O.; Hernandez Armas, J.

    2011-01-01

    The purpose of this study was to assess qualitatively the picture quality in relation to the radiation dose delivered in CT studies of computer tomograph Pediatric Emergency Department of Hospital Universitario de Canarias (HUC) in order to optimize the technical parameters used these radiological examinations so as to obtain optimal image quality at the lowest possible dose.

  17. [Gender influence on health related quality of life among resident physicians working in an emergency department].

    Science.gov (United States)

    Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José

    2014-02-01

    The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.

  18. Managing emergencies and abnormal situations in air traffic control (part II): teamwork strategies.

    Science.gov (United States)

    Malakis, Stathis; Kontogiannis, Tom; Kirwan, Barry

    2010-07-01

    Team performance has been studied in many safety-critical organizations including aviation, nuclear power plant, offshore oil platforms and health organizations. This study looks into teamwork strategies that air traffic controllers employ to manage emergencies and abnormal situations. Two field studies were carried out in the form of observations of simulator training in emergency and unusual scenarios of novices and experienced controllers. Teamwork strategies covered aspects of team orientation and coordination, information exchange, change management and error handling. Several performance metrics were used to rate the efficiency of teamwork and test the construct validity of a prototype model of teamwork. This is a companion study to an earlier investigation of taskwork strategies in the same field (part I) and contributes to the development of a generic model for Taskwork and Teamwork strategies in Emergencies in Air traffic Management (T(2)EAM). Suggestions are made on how to use T(2)EAM to develop training programs, assess team performance and improve mishap investigations. Copyright 2010 Elsevier Ltd. All rights reserved.

  19. Emerging technology: A key enabler for modernizing pharmaceutical manufacturing and advancing product quality.

    Science.gov (United States)

    O'Connor, Thomas F; Yu, Lawrence X; Lee, Sau L

    2016-07-25

    Issues in product quality have produced recalls and caused drug shortages in United States (U.S.) in the past few years. These quality issues were often due to outdated manufacturing technologies and equipment as well as lack of an effective quality management system. To ensure consistent supply of safe, effective and high-quality drug products available to the patients, the U.S. Food and Drug Administration (FDA) supports modernizing pharmaceutical manufacturing for improvements in product quality. Specifically, five new initiatives are proposed here to achieve this goal. They include: (i) advancing regulatory science for pharmaceutical manufacturing; (ii) establishing a public-private institute for pharmaceutical manufacturing innovation; (iii) creating incentives for investment in the technological upgrade of manufacturing processes and facilities; (iv) leveraging external expertise for regulatory quality assessment of emerging technologies; and (v) promoting the international harmonization of approaches for expediting the global adoption of emerging technologies. Published by Elsevier B.V.

  20. Quality Assurance in the European Higher Education Area: The Emergence of a German Market for Quality Assurance Agencies

    Science.gov (United States)

    Serrano-Velarde, Kathia E.

    2008-01-01

    Most European countries have introduced systematic quality assurance as part of an overall governance reform aimed at enhancing universities' autonomy. Researchers and economic entrepreneurs tend, however, to underestimate the political dimension of accreditation and evaluation when they consider the contribution of quality assurance to the…

  1. Assessment of emergency general surgery care based on formally developed quality indicators.

    Science.gov (United States)

    Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

    2017-08-01

    Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Capsicum--production, technology, chemistry, and quality. Part IV. Evaluation of quality.

    Science.gov (United States)

    Govindarajan, V S; Rajalakshmi, D; Chand, N

    1987-01-01

    Capsicum fruits are popular worldwide and are used in the cuisines of both the developing and the developed countries. With its different varieties, forms, and uses, the spice capsicum contributes to the entire gamut of sensory experience--color as finely ground paprika powder or extract in sausages, goulash, cheese, and snacks; both pungency and color as the many varieties of chillies used in Mexican, African, Indian, and southeast Asian cuisines; color, aroma, and mild pungency as the fresh green chillies used in many of the growing countries; and appearance, color, aroma, and texture as fresh fruit in salads and as a pickled and canned product. In three earlier parts in this series, the varieties, cultivation, and primary processing; the processed products, world production, and trade; and the chemistry of the color, aroma, and pungency stimuli have been reviewed. In this part, the evaluation of quality through instrumental determination of the causal components and the sensory evaluation of color, aroma, and pungency are discussed. Several methods for quantitative determination of the stimuli and the sensory evaluation of the responses to the stimuli are reviewed. The problems of sensory evaluation of color, aroma, and pungency, the dominant attributes for validation of the instrumentally determined values for carotenoids, volatiles, or particular fractions, and total and individual capsaicinoids are specifically discussed. Summarized details of selected instrumental methods for evaluating the stimuli, which are either validated by correlation to sensorily perceived responses or to adopted standards, are given along with representative data obtained for discussing the adequacy and reliability of the methods. Pungency as a specific gustatory perception and the many methods proposed to evaluate this quality are discussed. A recommended objective procedure for obtaining reproducible values is discussed, and a method for relating different panel results is shown

  3. Australasian emergency physicians: a learning and educational needs analysis. Part Four: CPD topics desired by emergency physicians.

    Science.gov (United States)

    Dent, Andrew W; Weiland, Tracey J; Paltridge, Debbie

    2008-06-01

    To report the preferences of Fellows of the Australasian College for Emergency Medicine for topics they would desire for their continuing professional development (CPD). A mailed survey of Fellows of the Australasian College for Emergency Medicine asked for Likert type responses on the desirability of CPD on 15 procedural skills, 13 management skills, 11 clinical emergency topics, 9 topics related to teaching, 7 related to diagnostics and 5 evidence based practice topics. CPD in procedural skills of advanced and surgical airways, ED ultrasound, ventilation, skills, plastic procedures and regional anaesthesia were nominated as desirable by 85% of emergency physicians (EP). More than 90% desired CPD in ophthalmological, otorhinolaryngeal, neonatal and paediatric emergencies. Of diagnostic skills, more than 80% considered CPD on computerized tomography, electrocardiography and plain X-ray interpretation as desirable, well as CPD about teaching in general, simulation and preparing candidates for fellowship exams. Of the 12 management skills, 11 were seen as desirable topics by more than 70%, with counter disaster planning, giving feedback and dealing with complaints the most popular. All evidence based practice related skills, including interpreting statistics and undertaking literature searches were seen as desirable topics by more than 80% of EP. This information may assist in the planning of future educational interventions for emergency physicians. EP seek CPD on management, educational and other non clinical skills, as well as topics relating directly to patient care.

  4. River Quality Investigations, Part 1: Some Diversity and Biotic Indices.

    Science.gov (United States)

    Hewitt, G.

    1991-01-01

    The following indices for assessing river water quality are described: Shannon-Weiner Diversity Index, Sorenson Quotient of Similarity, Czekanowski's Index of Similarity, Trent Biotic Index, Chandler Score, and Biological Monitoring Working Party Score. Their advantages and disadvantages are outlined. (Author)

  5. Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique. Part 2.

    Science.gov (United States)

    Redfern, S; Norman, I

    1999-07-01

    The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 included the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and draws conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. The themes were grouped into eight clusters: therapeutic context for care, attitudes and sensitivity, teaching and leadership, motivation to nurse, monitoring and informing, high-dependency care, efficiency and thoroughness, reflection and anticipation. As shown in Part 1 of the paper, congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis. The findings support an emerging theory of interpersonal competence and quality in nursing care.

  6. Quality and safety is the integral part of our business

    International Nuclear Information System (INIS)

    Fadeev, Y.

    2011-01-01

    During 65 years from Joint-stock Company Afrikantov OKBM foundation over 400 reactor projects were developed - primarily, various modifications of marine propulsion reactors for nuclear submarines and icebreakers of several generations. Today, OKBM designs reactors of various types and purposes as well as equipment, control and protection mechanisms, and is the world leader in fast-neutron sodium-cooled reactor technology. Much attention in OKBM is given to the safety and quality of production, specialists education [ru

  7. Integrated surgical emergency training plan in the internship: A step toward improving the quality of training and emergency center management.

    Science.gov (United States)

    Akhlaghi, Mohammad Reza; Vafamehr, Vajiheh; Dadgostarnia, Mohammad; Dehghani, Alireza

    2013-01-01

    , facing a variety of patients, practicing the role of general practitioners, role-playing on a real patient's bedside, having a multilateral approach to the patient, reducing the wasting time on minor wards, balancing the work and rest schedules of the interns, and better learning and satisfaction of the interns. Over 60% of the participants believed the program has the following benefits: More attention on the training plan, improving the learning of patient management, being more responsive for the training of interns, increasing operational approach to emergency patients, being more aware of the performed actions, and increasing the quality and speed of services provided to patients. The mean score assigned to the whole questionnaire of investigating the viewpoints was 37.5 out of 50. The mean score of the interns' questionnaire was significantly more than the mean score of the assistants. The results obtained indicated that the greatest existing consensus about this plan was the positive impact on the learning of interns in the emergency setting. Thus, it will not only increase the number of patients who the interns are managing during the internship course, but also increases the balance of their workload and they can learn and manage the emergency patients with more leisure.

  8. Initiatives to Improve Quality of Additively Manufactured Parts

    Science.gov (United States)

    Waller, Jess; Nichols, Charles

    2017-01-01

    NASA is providing leadership in an international effort linking government and industry resources to speed adoption of additive manufactured (AM) parts. Participants include government agencies (NASA, USAF, NIST, FAA), industry (commercial aerospace, NDE manufacturers, AM equipment manufacturers), standards organizations and academia. NASA is also partnering with its international space exploration organizations such as ESA and JAXA. NDT is identified as a universal need for all aspects of additive manufacturing.

  9. Quality of work life of rural emergency department nurses and physicians: a pilot study

    OpenAIRE

    Bragard, Isabelle; Fleet, Richard; Etienne, Anne-Marie; Archambault, Patrick; L?gar?, France; Chauny, Jean-Marc; L?vesque, Jean-Fr?d?ric; Ouimet, Mathieu; Poitras, Julien; Dupuis, Gilles

    2015-01-01

    Background Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Methods Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Fa...

  10. Embedding Quality Culture in Higher Education in Ghana: Quality Control and Assessment in Emerging Private Universities

    Science.gov (United States)

    Ntim, Stephen

    2014-01-01

    High quality provision has been one of the key aims of the current reforms in higher educational institutions across the globe since the beginning of the century and the millennium. Consequently this has led to the increasing demand for quality assurance (QA). This report identifies those institutional processes and structures that support the…

  11. The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services.

    Science.gov (United States)

    Hosseinabadi, Reza; Karampourian, Arezou; Beiranvand, Shoorangiz; Pournia, Yadollah

    2013-10-01

    Quality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today's workers. This study was conducted to investigate the effect of implementation of quality circles on nurses' quality of work-life and job satisfaction. In this study, two emergency medical services (EMS) of Hamedan province were selected and randomly assigned as the experimental and control groups. After the experimental group was trained and quality circles were established in this group, the levels of quality of work-life and job satisfaction were measured in the two groups. Then, the statistical analyses were performed using t-test. After the intervention, the results showed significant differences between the scores of motivational factors (p=0.001), the total scores of job satisfaction (p=0.003), and the scores of some quality of work life (QWL) conceptual categories including the use and development of capacities (p=0.008), the total space of life (p=0.003), and the total scores of QWL (p=0.031) in the experimental group compared to those in the control group. This study confirms the effectiveness of quality circles in improving quality of work-life and job satisfaction of nurses working in EMS, and offers their application as a management method that can be used by EMS managers. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Effect of power quality on windings temperature of marine induction motors. Part I: Machine model

    Energy Technology Data Exchange (ETDEWEB)

    Gnacinski, P. [Gdynia Maritime Univ., Dept. of Ship Electrical Power Engineering, Morska Str. 83, 81-225 Gdynia (Poland)

    2009-10-15

    Marine induction machines are exposed to various power quality disturbances appearing simultaneously in ship power systems: frequency and voltage rms value deviation, voltage unbalance and voltage waveform distortions. As a result, marine induction motors can be seriously overheated due to lowered supply voltage quality. Improvement of the protection of marine induction machines requires an appropriate method of power quality assessment and modification of the power quality regulations of ship classification societies. This paper presents an analytical model of an induction cage machine supplied with voltage of lowered quality, used in part II of the work (effect of power quality on windings temperature of marine induction motors. Part II. Results of investigations and recommendations for related regulations) for power quality assessment in ship power systems, and for justification of the new power quality regulations proposal. The presented model is suitable for implementation in an on-line measurement system. (author)

  13. Depressive Symptoms and Romantic Relationship Qualities from Adolescence through Emerging Adulthood: A Longitudinal Examination of Influences

    Science.gov (United States)

    Vujeva, Hana M.; Furman, Wyndol

    2011-01-01

    Research has consistently demonstrated the negative consequences of depression on adolescents' functioning in peer and family relationships, but little work has examined how depressive symptoms affect the quality of adolescents' and emerging adults' romantic relationships. Five waves of data on depressive symptoms, romantic relationship conflict,…

  14. Air Quality and Heart Health: An Emerging Topic for Heart Month

    Science.gov (United States)

    Air Quality and Heart Health: An Emerging Topic for Heart Month: Ambient air particle pollution increases short- and long-term cardiovascular morbidity and mortality. Older-people, those with pre-existing heart disease and lung disease and diabetes are at higher risk. Mechanism...

  15. The value of the pre-hospital learning environment as part of the emergency nursing programme

    Directory of Open Access Journals (Sweden)

    Sonett van Wyk

    2015-06-01

    Conclusion: The research findings support the value and continuation of utilising the pre-hospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  16. A survey of quality gap of Khoramabad medical emergency services using SERVQUAL model

    Directory of Open Access Journals (Sweden)

    gholamreza Toushmal

    2015-05-01

    Full Text Available Background : Awareness of perceptions and expectations of receivers of health centers services, as well as determination of gap between these two subjects can play an important role in better services rendering of these centers. Thise survey was conducted to evaluate quality of emergency centers of Khorramabad city by use of SERVQUAL model in 2012. Materials and Methods: This analytic-descriptive research was carried out on 400 people receiving services of Khorramabad emergency centers, selected using continuous sampling method. Data was gathered using standard SERVQUAL questionnaire and then analyzed by SPSS software, descriptive and inferential statistics such as Kruskal-wallis, paired T test And ANOVA. Results: The results showed that there was negative gap of quality in all five dimensions of services (sensible thing, guarantee and trust, responsibility, and empathy. The most quality gap was in empathy aspect and the least belonged to politeness and trust, and this gap among all dimensions, exception for trust, was statistically significant. But no significant statistical relation was found between age, sex and educational level and quality gap score. Conclusion: Expectation of customers in all dimensions was higher than their perceptions, and it should promote the quality of all dimensions, specially empathy. It is suggested to evaluate services quality in these centers and other centers periodically to promote their quality of services.

  17. Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

    Science.gov (United States)

    Malamed, Stanley F

    2015-12-01

    Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

  18. Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies

    Directory of Open Access Journals (Sweden)

    Sundby Johanne

    2009-04-01

    Full Text Available Abstract Background Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. Methods From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge. Results Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs. Conclusion The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia.

  19. Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

    Directory of Open Access Journals (Sweden)

    Jeffrey J. Guterman

    2016-09-01

    Full Text Available Introduction: Attending physician judgment is the traditional standard of care for emergency department (ED admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality. Methods: We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days, and quality indicators (15- and 30-day ED returns; delayed hospital admissions. We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates. Results: Admission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0% and correlated with Medicaid denied-payment day rates (p=0.038. There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission. There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%. Conclusion: Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality.

  20. Validating emergency department vital signs using a data quality engine for data warehouse.

    Science.gov (United States)

    Genes, N; Chandra, D; Ellis, S; Baumlin, K

    2013-01-01

    Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes.

  1. Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Michael W. Manning

    2017-12-01

    Full Text Available Introduction The Association of American Medical Colleges’ (AAMC initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to “identify system failures and contribute to a culture of safety and improvement.” We set out to determine the feasibility of using medical students’ action learning projects (ALPs to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism. Methods These prospective quality improvement (QI initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home for patients. Results Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders’ positions that were involved in the respective patient’s care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students’ projects. After implementation, 86% (38/44 of queried ED providers felt comfortable

  2. Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department.

    Science.gov (United States)

    Manning, Michael W; Bean, Eric W; Miller, Andrew C; Templer, Suzanne J; Mackenzie, Richard S; Richardson, David M; Bresnan, Kristin A; Greenberg, Marna R

    2018-01-01

    The Association of American Medical Colleges' (AAMC) initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to "identify system failures and contribute to a culture of safety and improvement." We set out to determine the feasibility of using medical students' action learning projects (ALPs) to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED) setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism). These prospective quality improvement (QI) initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management) to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home) for patients. Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders' positions that were involved in the respective patient's care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students' projects. After implementation, 86% (38/44) of queried ED providers felt comfortable with medical students being a part of future ED QI

  3. Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

    Directory of Open Access Journals (Sweden)

    John H. Burton

    2016-05-01

    Full Text Available Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED; unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months. Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months. Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2 they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider. Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01, and Stage 3 mean 8% (60% reduction, p<0.01. The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01, and 13 pills in Stage 3 (18% reduction, p<0.01. The group mean

  4. The value of the pre-hospital learning environment as part of the emergency nursing programme

    Directory of Open Access Journals (Sweden)

    Sonett van Wyk

    2015-10-01

    Objective: The study explored the views of the emergency nurse students regarding the value of rotating through the pre-hospital learning environment during an emergency nursing programme. Methods: A qualitative, explorative, descriptive and contextual research design using an Appreciative Inquiry approach was used to collect the data. Through purposive sampling a total of 45 emergency nursing students participated. Data was collected by means of selfreported Appreciative Inquiry interview guides and individual Appreciative Inquiry interviews.The data was analysed using content analysis. Results: Four major themes were identified: an unpredictable environment, role players in emergency medical services, team work, and competencies. Conclusion: The research findings support the value and continuation of utilising the prehospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  5. 40 CFR Appendix B to Part 132 - Great Lakes Water Quality Initiative

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Great Lakes Water Quality Initiative B Appendix B to Part 132 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS... Water Quality Initiative Methodology for Deriving Bioaccumulation Factors Great Lakes States and Tribes...

  6. MATLAB-based Applications for Image Processing and Image Quality Assessment – Part II: Experimental Results

    Directory of Open Access Journals (Sweden)

    L. Krasula

    2012-04-01

    Full Text Available The paper provides an overview of some possible usage of the software described in the Part I. It contains the real examples of image quality improvement, distortion simulations, objective and subjective quality assessment and other ways of image processing that can be obtained by the individual applications.

  7. Manual for best practice for emergency response procedures, part 2: the management of inrushes, fires, explosions and other emergencies.

    CSIR Research Space (South Africa)

    Spencer, KC

    2000-02-01

    Full Text Available to the strong likelihood of low visibility, disorientation and psychological trauma that can exist following a fire or explosion in a colliery, it is imperative that adequate provision be made to ensure that affected persons reach a place of safety... on the job safety training. 3.3 Locating the refuge bay or place of safety Having to escape in adverse conditions (i.e. zero visibility) can cause considerable psychological trauma and panic. It is therefore suggested that as part of the initial...

  8. Reverse quality management: developing evidence-based best practices in health emergency management.

    Science.gov (United States)

    Lynch, Tim; Cox, Paul

    2006-01-01

    The British Columbia Ministry of Health's Framework for Core Functions in Public Health was the catalyst that inspired this review of best practices in health emergency management. The fieldwork was conducted in the fall of 2005 between hurricane Katrina and the South Asia earthquake. These tragedies, shown on 24/7 television news channels, provided an eyewitness account of disaster management, or lack of it, in our global village world. It is not enough to just have best practices in place. There has to be a governance structure that can be held accountable. This review of best practices lists actions in support of an emergency preparedness culture at the management, executive, and corporate/governance levels of the organization. The methodology adopted a future quality management approach of the emergency management process to identify the corresponding performance indictors that correlated with practices or sets of practices. Identifying best practice performance indictors needed to conduct a future quality management audit is described as reverse quality management. Best practices cannot be assessed as stand-alone criteria; they are influenced by organizational culture. The defining of best practices was influenced by doubt about defining a practice it is hoped will never be performed, medical staff involvement, leadership, and an appreciation of the resources required and how they need to be managed. Best practice benchmarks are seen as being related more to "measures" of performance defined locally and agreed on by 2 or more parties rather than to achieving industrial standards. Relating practices to performance indicators and then to benchmarks resulted in the development of a Health Emergency Management Best Practices Matrix that lists specific practice in the different phases of emergency management.

  9. New information technologies as a means of quality improvement of part-time students’ training

    Directory of Open Access Journals (Sweden)

    Нестеренко В. В.

    2016-09-01

    Full Text Available Ways and means aimed at facilitating the quality of part-time students’ training at an institution of higher education are considered in the article. The principles the conditions facilitating quality increase of adult part-time students’ training are based on as well as criteria of their effectiveness assessment are described. The definition of the notion «distance learning» has been given. Tuition by correspondence as a special form of continuous education allowing the use of elements of distance educational technologies is examined. The role of informational technologies in correspondence form of education providing essential improvement of students’ training quality is described.

  10. 14 CFR Appendix B to Part 125 - Criteria for Demonstration of Emergency Evacuation Procedures Under § 125.189

    Science.gov (United States)

    2010-01-01

    ...: CERTIFICATION AND OPERATIONS CERTIFICATION AND OPERATIONS: AIRPLANES HAVING A SEATING CAPACITY OF 20 OR MORE... must be kept low and shielded against shining into the airplane's windows or doors. (2) The airplane... the ground to protect participants. No other equipment that is not part of the airplane's emergency...

  11. 14 CFR Appendix D to Part 121 - Criteria for Demonstration of Emergency Evacuation Procedures Under § 121.291

    Science.gov (United States)

    2010-01-01

    ... against shining into the airplane's windows or doors. (2) The airplane must be a normal ground attitude with landing gear extended. (3) Unless the airplane is equipped with an off-wing descent means, stands... is not part of the emergency evacuation equipment of the airplane may be used to aid the participants...

  12. Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea.

    Science.gov (United States)

    Brea Álvarez, B; Tuñón Gómez, M; Esteban García, L; García Hidalgo, C Y; Ruiz Peralbo, R M

    2016-01-01

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Controlling the quality of replacement parts in nuclear station, class 1E equipment

    International Nuclear Information System (INIS)

    Pierson, R.K.; Clemons, R.W.

    1984-01-01

    Nuclear station owners have traditionally purchased replacement parts for Class 1E equipment from the original supplier of the equipment. By this method, part and equipment quality could be maintained. In recent years, however, this traditional source of parts has continuously declined as an increasing number of original equipment suppliers stop producing Class 1E equipment or no longer stock parts for older equipment. When replacement parts for Class 1E equipment are not obtainable from the original suppliers, equipment owners have created a variety of methods for assuring the quality of parts obtained from other sources. A standard that provides direction and guidance for maintaining the quality of Class 1E equipment when repaired with parts from alternate sources is, therefore, needed to assure the methods in use are satisfactory and to alert the equipment owners to additional acceptable methods. The standard has now been proposed. IEEE Standard P934 (June, 1983 Draft): ''Requirements for Replacement Parts for Class 1E Equipment in Nuclear Power Generating Stations'' (Ref-3) consist of an introductory section followed by sections on part selection, procurement, replacement (including inspections and tests), non-conforming conditions and records. The proposed standard also includes a non-mandatory appendix on acceptable procurement methods and a summary intended to assist the user in selecting a proper procurement method

  14. Quality Evaluation Scores are no more Reliable than Gestalt in Evaluating the Quality of Emergency Medicine Blogs: A METRIQ Study.

    Science.gov (United States)

    Thoma, Brent; Sebok-Syer, Stefanie S; Colmers-Gray, Isabelle; Sherbino, Jonathan; Ankel, Felix; Trueger, N Seth; Grock, Andrew; Siemens, Marshall; Paddock, Michael; Purdy, Eve; Kenneth Milne, William; Chan, Teresa M

    2018-01-30

    Construct: We investigated the quality of emergency medicine (EM) blogs as educational resources. Online medical education resources such as blogs are increasingly used by EM trainees and clinicians. However, quality evaluations of these resources using gestalt are unreliable. We investigated the reliability of two previously derived quality evaluation instruments for blogs. Sixty English-language EM websites that published clinically oriented blog posts between January 1 and February 24, 2016, were identified. A random number generator selected 10 websites, and the 2 most recent clinically oriented blog posts from each site were evaluated using gestalt, the Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) score, and the Medical Education Translational Resources: Impact and Quality (METRIQ-8) score, by a sample of medical students, EM residents, and EM attendings. Each rater evaluated all 20 blog posts with gestalt and 15 of the 20 blog posts with the ALiEM AIR and METRIQ-8 scores. Pearson's correlations were calculated between the average scores for each metric. Single-measure intraclass correlation coefficients (ICCs) evaluated the reliability of each instrument. Our study included 121 medical students, 88 EM residents, and 100 EM attendings who completed ratings. The average gestalt rating of each blog post correlated strongly with the average scores for ALiEM AIR (r = .94) and METRIQ-8 (r = .91). Single-measure ICCs were fair for gestalt (0.37, IQR 0.25-0.56), ALiEM AIR (0.41, IQR 0.29-0.60) and METRIQ-8 (0.40, IQR 0.28-0.59). The average scores of each blog post correlated strongly with gestalt ratings. However, neither ALiEM AIR nor METRIQ-8 showed higher reliability than gestalt. Improved reliability may be possible through rater training and instrument refinement.

  15. Analytical assessment of current insurance as part of management of consequences of emergencies

    Directory of Open Access Journals (Sweden)

    K.Yu. Polyak

    2017-03-01

    Full Text Available The article examines the current state of the insurance system as a component of managing the consequences of emergencies. The researches are presented in the following areas: the insurance against accidents and fire risks and risks of natural disasters; property insurance (property, goods and agricultural products; the insurance of transport (by modes; liability insurance (by liability. So, the author made the statistical and analytical assessment of consequences of emergencies that was learned through the study of modern insurance system, which enabled to identify the complex of accounting objects in the management of consequences of emergencies.

  16. Measuring Outcomes of Clinical Care: Victorian Emergency Laparotomy Audit Using Quality Investigator.

    Science.gov (United States)

    Stevens, Claire L; Brown, Christopher; Watters, David A K

    2018-07-01

    The Australian and New Zealand Audit of Surgical Mortality (ANZASM) National Report 2015 found that within the cohort of audited deaths, 85% were emergencies with acute life-threatening conditions, and by far, the most common procedures were laparotomy and colorectal procedures. Emergency laparotomy outcomes have shown improvement through audit and reporting in the UK. The purpose of this study was to determine the outcome of emergency laparotomy in the state of Victoria, Australia. The Dr Foster Quality Investigator (DFQI) database was interrogated for a set of Australian Classification of Health Intervention (ACHI) codes defined by the authors as representing an emergency laparotomy. The dataset included patients who underwent emergency laparotomy from July 2007 to July 2016 in all Victorian hospitals. There were 23,115 emergency laparotomies conducted over 9 years in 66 hospitals. Inpatient mortality was 2036/23,115 (8.8%). Mortality in the adult population increased with age and reached 18.1% in those patients that were 80 years or older. 51.3% were females, and there was no significant difference in survival between genders. Patients with no recorded comorbidities had a mortality of 4.3%, whereas those with > 5 comorbidities had 19.3% mortality. Administrative data accessed via a tool such as DFQI can provide useful population data to guide further evidence-based improvement strategies. The mortality for emergency laparotomy within Victorian hospitals is comparable, if not better than that seen in overseas studies. There is a need to continue routine audit of mortality rates and implement systems improvement where necessary.

  17. [Quality management in emergency departments: Lack of uniform standards for fact-based controlling].

    Science.gov (United States)

    Ries, M; Christ, M

    2015-11-01

    The general high occupancy of emergency departments during the winter months of 2014/2015 outlined deficits in health politics. Whether on the regional, province, or federal level, verifiable and accepted figures to enable in depth analysis and fact-based controlling of emergency care systems are lacking. As the first step, reasons for the current situation are outlined in order to developed concrete recommendations for individual hospitals. This work is based on a selective literature search with focus on quality management, ratio driven management, and process management within emergency departments as well as personal experience with implementation of a key ratio system in a German maximum care hospital. The insufficient integration of emergencies into the DRG systematic, the role as gatekeeper between inpatient and outpatient care sector, the decentralized organization of emergency departments in many hospitals, and the inconsistent representation within the medical societies can be mentioned as reasons for the lack of key ratio systems. In addition to the important role within treatment procedures, emergency departments also have an immense economic importance. Consequently, the management of individual hospitals should promote implementation of key ratio systems to enable controlling of emergency care processes. Thereby the perspectives finance, employees, processes as well as partners and patients should be equally considered. Within the process perspective, milestones could be used to enable detailed controlling of treatment procedures. An implementation of key ratio systems without IT support is not feasible; thus, existing digital data should be used and future data analysis should already be considered during implementation of new IT systems.

  18. 18 CFR 410.1 - Basin regulations-Water Code and Administrative Manual-Part III Water Quality Regulations.

    Science.gov (United States)

    2010-04-01

    ... Code and Administrative Manual-Part III Water Quality Regulations. 410.1 Section 410.1 Conservation of... CODE AND ADMINISTRATIVE MANUAL-PART III WATER QUALITY REGULATIONS § 410.1 Basin regulations—Water Code and Administrative Manual—Part III Water Quality Regulations. (a) The Water Code of the Delaware River...

  19. Self–Evaluation of Distance Learning Study Program as a Part of Internal Quality Assurance

    Directory of Open Access Journals (Sweden)

    Radojka Krneta

    2012-02-01

    Full Text Available This paper features quality assurance of specific distance learning master study program through self-evaluation. This unique program involving e-learning as the program content, as well as delivery method, is presented in the paper from the aspects of its quality assurance. Student evaluation of this study program as a part of the internal quality assurance is performed at the end of every school year in the aim of its quality assurance. Results and conclusions of self-evaluation conducted in this school year by known SEVAQ+ evaluation tool are presented here.

  20. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

    Science.gov (United States)

    Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

    2016-01-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

  1. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

    Directory of Open Access Journals (Sweden)

    Jennifer L. Wiler, MD, MBA

    2016-03-01

    Full Text Available In 2007, the Centers for Medicaid and Medicare Services (CMS created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS. As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM. For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

  2. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

    Science.gov (United States)

    Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D

    2016-03-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

  3. Characteristics of effective interventions supporting quality pain management in Australian emergency departments: an exploratory study.

    Science.gov (United States)

    Shaban, Ramon Z; Holzhauser, Kerri; Gillespie, Kerri; Huckson, Sue; Bennetts, Scott

    2012-02-01

    It is well established that pain is the most common presenting complaint in Emergency Departments. Despite great improvements in available pain management strategies, patients are left waiting for longer than 60min for pain relief on arrival to the emergency department. The aim of this study was to describe interventions that lead to successful implementation of the National Health and Medical Research Council approved guidelines Acute Pain Management: Scientific Evidence (2nd Edition) that include specific recommendations for best practice pain management. A two-phased, mixed-method, exploratory study of all 52 Australian hospital emergency departments participating in the National Emergency Care Pain Management Initiative incorporating interview and document analysis was undertaken. Interventions used by clinicians to improve pain management included nurse initiated analgesia, intranasal fentanyl for paediatric patients and lignocaine, and facio illiaca block. Education formed a major part of the intervention and the development of a working group of key stakeholders was critical in the successful implementation of change. Staff perceptions of patients' pain level and attitudes toward pain assessment and pain management were identified as barriers. This study highlighted how an effective framework to plan and implement practice change and tailored interventions, including education and training systems and products using the best available evidence, best equipped clinicians to manage pain in the ED. Copyright © 2011 College of Emergency Nursing Australasia Ltd. All rights reserved.

  4. Education scholarship in emergency medicine part 1: innovating and improving teaching and learning.

    Science.gov (United States)

    Sherbino, Jonathan; Van Melle, Elaine; Bandiera, Glen; McEwen, Jill; Leblanc, Constance; Bhanji, Farhan; Frank, Jason R; Regehr, Glenn; Snell, Linda

    2014-05-01

    As emergency medicine (EM) education evolves, a more advanced understanding of education scholarship is required. This article is the first in a series of three articles that reports the recommendations of the 2013 education scholarship consensus conference of the Academic Section of the Canadian Association of Emergency Physicians. Adopting the Canadian Association for Medical Education's definition, education scholarship (including both research and innovation) is defined. A rationale for why education scholarship should be a priority for EM is discussed.

  5. Real time quality control of meteorological data used in SRP's emergency response system

    International Nuclear Information System (INIS)

    Pendergast, M.M.

    1980-05-01

    The Savannah River Laboratory's WIND minicomputer system allows quick and accurate assessment of an accidental release at the Savannah River Plant using data from eight meteorological towers. The accuracy of the assessment is largely determined by the accuracy of the meteorological data; therefore quality control is important in an emergency response system. Real-time quality control of this data will be added to the WIND system to automatically identify inaccurate data. Currently, the system averages the measurements from the towers to minimize the influence of inaccurate data being used in calculations. The computer code used in the real-time quality control has been previously used to identify inaccurate measurements from the archived tower data

  6. Impact on Quality of Life in Dermatology Patients Attending an Emergency Department.

    Science.gov (United States)

    Alegre-Sánchez, A; de Perosanz-Lobo, D; Pascual-Sánchez, A; Pindado-Ortega, C; Fonda-Pascual, P; Moreno-Arrones, Ó M; Jaén-Olasolo, P

    2017-12-01

    Dermatological complaints have been estimated to represent up to 5-10% of all the visits to emergency departments. The main objective of our study was to determine how affected is the Health related Quality of Life (HRQL) in a series of patients attending an emergency department due to skin symptoms. A prospective study during one month (July 2016) was conducted in a hospital with full-time on-call dermatologists. The Short-Form SF-12v2 Health Survey and the Dermatology Life Quality Index (DLQI) were offered to all the patients over 18 years old attending the emergency department with cutaneous complaints. Clinical and epidemiological characteristics were also collected. In total 108 patients completed the study. Mean age found was 45.1±16.1 years. Mean DLQI score found was 10.56±6.12. Fifty-three patients (49%) had a score of 11 or higher in the DLQI questionnaire. Most affected subscales were "Symptoms and Feelings" in DLQI scale and "Overall Health" and "Vitality" for the SF-12. A very significant difference (p<0.0001) was found between women's (12.4±5.7) and men's (7.5±5.6) DLQI mean score (mean difference of 4.9; 95% confidence interval of the difference: 2.7-7.1). Patients visiting emergency units with cutaneous complaints seem to feel a moderate-large impact on their quality of life which is mainly related to the symptoms and feelings that they are experiencing. This impact is significantly higher among women. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Quality Improvement Practices in Academic Emergency Medicine: Perspectives from the Chairs

    Directory of Open Access Journals (Sweden)

    DelliFraine, Jami L

    2010-12-01

    Full Text Available Objective: To assess academic emergency medicine (EM chairs’ perceptions of quality improvement (QI training programs.Methods: A voluntary anonymous 20 item survey was distributed to a sample of academic chairs of EM through the Association of Academic Chairs of Emergency Medicine. Data was collected to assess the percentage of academic emergency physicians who had received QI training, the type of training they received, their perception of the impact of this training on behavior, practice and outcomes, and any perceived barriers to implementing QI programs in the emergency department.Results: The response rate to the survey was 69% (N = 59. 59.3% of respondents report that their hospital has a formal QI program for physicians. Chairs received training in a variety of QI programs. The type of QI program used by respondents was perceived as having no impact on goals achieved by QI (χ2 = 12.382; p = 0.260, but there was a statistically significant (χ2 = 14.383; p = 0.006 relationship between whether or not goals were achieved and academic EM chairs’ perceptions about return on investment for QI training. Only 22% of chairs responded that they have already made changes as a result of the QI training. 78.8% of EM chairs responded that quality programs could have a significant positive impact on their practice and the healthcare industry. Chairs perceived that QI programs had the most potential value in the areas of understanding and reducing medical errors and improving patient flow and throughput. Other areas of potential value of QI include improving specific clinical indicators and standardizing physician care.Conclusion: Academic EM chairs perceived that QI programs were an effective way to drive needed improvements. The results suggest that there is a high level of interest in QI but a low level of adoption of training and implementation.[West J Emerg Med. 2010; 11(5:479-485.

  8. The Effect of Quality Circles on Nurses Job Satisfaction Working Emergency Medical Service

    Directory of Open Access Journals (Sweden)

    Reza Hossein abadi

    2012-12-01

    Full Text Available Introduction: Quality circle are considered an important approach to improving behavior, increasing motivation, and reducing stress. The aim of this study was to determining the effect of training and applying quality control circles on the nurses’ level of occupation satisfaction.Material and Methods: This research is a two-group quasi-experimental study that after selection of two EMS stations, by simple randomization method 25 nurses worked in central station of Hamden emergency medical service were chosen as the quality circle group and 16 nurses of central station of Malayer emergency medical service formed the control group. The tools was used in this research was the occupation satisfaction questionnaire that was made on Herzburg Two factor theory. After training and performing of quality circle in trial group the occupation satisfaction test was carried out on both groups to get the change taken place in their level of job satisfactions. Then statistical analysis was performed using SPSS.Results: The analysis of data showed that before and after intervention there was significant differences in scores of health (P<0.001 and motivation factors (P<0.001 and also in global scores of occupation satisfaction in quality circle group (P<0.001, but there was no significant differences before and after intervention in scores of health (P=0.069 and motivation factors (P=0.094 and also in global scores of occupation satisfaction in control group (P=0.495. After intervention, the analysis of data showed significant differences in scores motivation factors (P=0.001 and global scores of occupation satisfaction (P=0.003 whereas there was no significant differences in scores of health factors between two groups (P=0.089.Conclusion: This study confirmed the effectiveness of training and applying quality circle in improving EMS nurses job satisfaction and offered as management method for use by EMS managers.

  9. 40 CFR Appendix B to Part 75 - Quality Assurance and Quality Control Procedures

    Science.gov (United States)

    2010-07-01

    ...-, nozzle-, or venturi-type fuel flowmeter under section 2.1.6 of appendix D to this part. These procedures... procedures for inspection of the primary element (i.e., orifice, venturi, or nozzle) of an orifice-, venturi... bypass stack, each of which has a certified flow monitor (e.g., a unit with a wet SO2 scrubber...

  10. Quality and Safety in Health Care, Part I: Five Pioneers in Quality.

    Science.gov (United States)

    Harolds, Jay

    2015-08-01

    Five pioneers had a huge impact on the quality movement in health care in the United States. Ernest Codman contributed in many ways, including his focus on outcome analysis. Avidis Donabedian is known for his focus on the 3 domains of structure, process, and outcome in health care. Walter Shewhart is known especially for the control chart and early work on what W. Edwards Deming made into the PDSA cycle. Deming is also known for other contributions, including his 14 points of management, correcting system problems rather than blaming the workers, and his System of Profound Knowledge. Juran is known for the Pareto principle and his emphasis on customer satisfaction and addressing the human, not just statistical side, of quality improvement.

  11. [Assessment of quality indicators in pediatric poisoning in an emergency service].

    Science.gov (United States)

    Giménez Roca, C; Martínez Sánchez, L; Calzada Baños, Y; Trenchs Sainz de la Maza, V; Quintilla Martínez, J M; Luaces Cubells, C

    2014-01-01

    Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2hours of poison ingestion (standard=90%, result=83.5%); attention within the first 15minutes of arriving in the emergency service (standard=90%, result=60.4%); start of gastrointestinal decontamination within 20minutes of arrival in emergency services (standard=90%, result=29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard=95%, result=87%); judicial communication of cases of poisoning that could conceal a crime (standard=95%, result=31.3%), and collection of the minimal set of information of poisoned patients (standard=90%, result=1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (de Pediatría. Published by Elsevier Espana. All rights reserved.

  12. Accumulation of contaminants of emerging concern in food crops-part 2: Plant distribution.

    Science.gov (United States)

    Hyland, Katherine C; Blaine, Andrea C; Higgins, Christopher P

    2015-10-01

    Arid agricultural regions often turn to using treated wastewater (reclaimed water) to irrigate food crops. Concerns arise, however, when considering the potential for persistent contaminants of emerging concern to accumulate into plants intended for human consumption. The present study examined the accumulation of a suite of 9 contaminants of emerging concern into 2 representative food crops, lettuce and strawberry, following uptake via the roots and subsequent distribution to other plant tissues. Calculating accumulation metrics (concentration factors) allowed for comparison of the compartmental affinity of each chemical for each plant tissue compartment. The root concentration factor was found to exhibit a positive linear correlation with the pH-adjusted octanol-water partition coefficient (DOW ) for the target contaminants of emerging concern. Coupled with the concentration-dependent accumulation observed in the roots, this result implies that accumulation of these contaminants of emerging concern into plant roots is driven by passive partitioning. Of the contaminants of emerging concern examined, nonionizable contaminants, such as triclocarban, carbamazepine, and organophosphate flame retardants displayed the greatest potential for translocation from the roots to above-ground plant compartments. In particular, the organophosphate flame retardants displayed increasing affinity for shoots and fruits with decreasing size/octanol-water partition coefficient (KOW ). Cationic diphenhydramine and anionic sulfamethoxazole, once transported to the shoots of the strawberry plant, demonstrated the greatest potential of the contaminants examined to be then carried to the edible fruit portion. © 2015 SETAC.

  13. Using magnetic levitation for non-destructive quality control of plastic parts.

    Science.gov (United States)

    Hennek, Jonathan W; Nemiroski, Alex; Subramaniam, Anand Bala; Bwambok, David K; Yang, Dian; Harburg, Daniel V; Tricard, Simon; Ellerbee, Audrey K; Whitesides, George M

    2015-03-04

    Magnetic levitation (MagLev) enables rapid and non-destructive quality control of plastic parts. The feasibility of MagLev as a method to: i) rapidly assess injection-molded plastic parts for defects during process optimization, ii) monitor the degradation of plastics after exposure to harsh environmental conditions, and iii) detect counterfeit polymers by density is demonstrated. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Global health and emergency care: a resuscitation research agenda--part 1

    NARCIS (Netherlands)

    Aufderheide, Tom P.; Nolan, Jerry P.; Jacobs, Ian G.; van Belle, Gerald; Bobrow, Bentley J.; Marshall, John; Finn, Judith; Becker, Lance B.; Bottiger, Bernd; Cameron, Peter; Drajer, Saul; Jung, Julianna J.; Kloeck, Walter; Koster, Rudolph W.; Huei-Ming Ma, Matthew; Shin, Sang Do; Sopko, George; Taira, Breena R.; Timerman, Sergio; Eng Hock Ong, Marcus

    2013-01-01

    At the 2013 Academic Emergency Medicine global health consensus conference, a breakout session on a resuscitation research agenda was held. Two articles focusing on cardiac arrest and trauma resuscitation are the result of that discussion. This article describes the burden of disease and outcomes,

  15. Assessment of color quality and energy effciency : new insights for modern lighting. Part I : color quality in general lighting applications. Part II : mesopic photometry and street lighting

    OpenAIRE

    Quintero, Jesús M.

    2015-01-01

    Cotutela Universitat Politècnica de Catalunya i Institut de Recerca en Energia de Catalunya. La consulta íntegra de la tesi, inclosos els articles no comunicats públicament per drets d'autor, es pot realitzar, prèvia petició, a l'Arxiu de la UPC This dissertation is divided in two parts: The first one deal with two main characteristics of the light sources for general lighting: Color quality and luminous efficacy. The second one deals with technical aspects of the mesopic photometry appli...

  16. Work conditions, mental workload and patient care quality: a multisource study in the emergency department.

    Science.gov (United States)

    Weigl, Matthias; Müller, Andreas; Holland, Stephan; Wedel, Susanne; Woloshynowych, Maria

    2016-07-01

    Workflow interruptions, multitasking and workload demands are inherent to emergency departments (ED) work systems. Potential effects of ED providers' work on care quality and patient safety have, however, been rarely addressed. We aimed to investigate the prevalence and associations of ED staff's workflow interruptions, multitasking and workload with patient care quality outcomes. We applied a mixed-methods design in a two-step procedure. First, we conducted a time-motion study to observe the rate of interruptions and multitasking activities. Second, during 20-day shifts we assessed ED staff's reports on workflow interruptions, multitasking activities and mental workload. Additionally, we assessed two care quality indicators with standardised questionnaires: first, ED patients' evaluations of perceived care quality; second, patient intrahospital transfers evaluated by ward staff. The study was conducted in a medium-sized community ED (16 600 annual visits). ED personnel's workflow was disrupted on average 5.63 times per hour. 30% of time was spent on multitasking activities. During 20 observations days, data were gathered from 76 ED professionals, 239 patients and 205 patient transfers. After aggregating daywise data and controlling for staffing levels, prospective associations revealed significant negative associations between ED personnel's mental workload and patients' perceived quality of care. Conversely, workflow interruptions were positively associated with patient-related information on discharge and overall quality of transfer. Our investigation indicated that ED staff's capability to cope with demanding work conditions was associated with patient care quality. Our findings contribute to an improved understanding of the complex effects of interruptions and multitasking in the ED environment for creating safe and efficient ED work and care systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  17. Construction of the All-region Linkage System for Emergency Management of Agricultural Product Quality and Safety in West China

    Institute of Scientific and Technical Information of China (English)

    Hua; YU; Yanbin; QI; Yubao; YAN

    2013-01-01

    Quality and safety of agricultural products are significant for national socioeconomic development,sustainable development,and vital interests of people.To safeguard quality and safety of agricultural products in west China is to safeguard economic safety and ecological safety of the country,public health and social stability,of which an important task is to properly handle emergencies concerning quality and safety of agricultural products.Considering actual conditions of west China,suggestions are given to construct the all-region linkage system for emergency management of agricultural product quality and safety in the local area,enhance the all-region linkage,and improve the linkage efficiency.

  18. The quality turn in the Danish food scape: new food chains emerging – new territorial impacts?

    DEFF Research Database (Denmark)

    Kjeldsen, Chris; Deleuran, Lise Christina; Noe, Egon

    2013-01-01

    social or physical geographies of such food chains. This study is focused on exploring whether the utilisation of different notions of quality in emerging producer–consumer networks also translates into new patterns of rural development. This paper is based on data on various sub-sectors of Danish food......Accounts of the ‘quality turn’ in agro-food literature suggest that there is a potential for growth in the market for ‘high-quality’ food, which utilises distinct notions like ‘quality’ and ‘place.’ These food chains are typically described as ‘alternative.’ Alterity might stem from alternative...... chains on municipality scale for the period 2000–2005. Specifically, this study seeks to identify whether this is the case in the Danish context. First, the analysis considers the economic geography of Danish food chains on national level. Second, a deviant case on a regional level is considered, which...

  19. Summer school on radio monitoring as a part of radioecological education and emergency preparedness program

    Energy Technology Data Exchange (ETDEWEB)

    Poyarkov, V.; Kadenko, I.; Jordynsky, D.; Nazarov, A.; Dubchak, S. [Ministry of Emergemcies, Kiev (Ukraine). Ukrainian Radiation Trainig Center

    1997-12-31

    The International Summer School is organized by the Ukrainian Radiation Training Centre of the Ministry of Ukraine of Emergencies and Affairs of Population Protection from the Consequences of Chernobyl Catastrophe to provide training and experience in the techniques of environmental radiation monitoring and emergency preparedness training of students and to enhance knowledge`s of specialists in different fields of radioecology as well. It includes classroom instructions and training in areas affected by the Chernobyl accident. Within selected areas dose rates and gamma flux measurements have been conducted at two different heights. Ten measurements for dose rate and for gamma flux were done at each selected point of sites. The main results of summer school activities are briefly presented 4 refs., 1 fig., 8 tab.

  20. Summer school on radio monitoring as a part of radioecological education and emergency preparedness program

    International Nuclear Information System (INIS)

    Poyarkov, V.; Kadenko, I.; Jordynsky, D.; Nazarov, A.; Dubchak, S.

    1997-01-01

    The International Summer School is organized by the Ukrainian Radiation Training Centre of the Ministry of Ukraine of Emergencies and Affairs of Population Protection from the Consequences of Chernobyl Catastrophe to provide training and experience in the techniques of environmental radiation monitoring and emergency preparedness training of students and to enhance knowledge's of specialists in different fields of radioecology as well. It includes classroom instructions and training in areas affected by the Chernobyl accident. Within selected areas dose rates and gamma flux measurements have been conducted at two different heights. Ten measurements for dose rate and for gamma flux were done at each selected point of sites. The main results of summer school activities are briefly presented

  1. Implementing United States Pharmacopeia Chapter quality assurance in pharmaceutical compounding, Part 5: Outsourcing and responsible personnel.

    Science.gov (United States)

    Allen, Loyd V

    2012-01-01

    This final installment of a five-part series relating to United States Pharmacopeia Chapter provides the pros and cons of outsourcing, an extremely important topic because of the many drug shortages and discontinued drugs being experienced, and provides a brief discussion of the importance of having a responsible employee in charge of the quality-assurance program.

  2. Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

    Science.gov (United States)

    Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

    2015-01-01

    Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous

  3. Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies.

    Science.gov (United States)

    Mark, Lynette J; Herzer, Kurt R; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I; Berkow, Lauren C; Haut, Elliott R; Hillel, Alexander T; Miller, Christina R; Feller-Kopman, David J; Schiavi, Adam J; Xie, Yanjun J; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W; Mirski, Marek A

    2015-07-01

    Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty

  4. Quality indicators for the assessment and management of pain in the emergency department: a systematic review.

    Science.gov (United States)

    Stang, Antonia Schirmer; Hartling, Lisa; Fera, Cassandra; Johnson, David; Ali, Samina

    2014-01-01

    Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures. To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED. Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included. The search identified 18,078 citations. Twenty-three articles were included: 15 observational (cohort) studies; three before-after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population. Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.

  5. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

    Directory of Open Access Journals (Sweden)

    Rodrigo Assis Neves Dantas

    2015-06-01

    Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

  6. Organizational factors impacting job strain and mental quality of life in emergency and critical care units.

    Science.gov (United States)

    Bellagamba, Gauthier; Gionta, Guillaume; Senergue, Julie; Bèque, Christine; Lehucher-Michel, Marie-Pascale

    2015-01-01

    This study measures the association between hospital staff's job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units. This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer's efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  7. Organizational factors impacting job strain and mental quality of life in emergency and critical care units

    Directory of Open Access Journals (Sweden)

    Gauthier Bellagamba

    2015-04-01

    Full Text Available Objectives: This study measures the association between hospital staff’s job strain (JS, mental quality of life (MQL and how they are influenced by the organization models within emergency and critical care units. Material and Methods: This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Results: Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer’s efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. Conclusions: If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented.

  8. Examining the relation between adolescent social anxiety, adolescent delinquency (abstention), and emerging adulthood relationship quality.

    Science.gov (United States)

    Mercer, Natalie; Crocetti, Elisabetta; Meeus, Wim; Branje, Susan

    2017-07-01

    Social anxiety symptoms and delinquency are two prevalent manifestations of problem behavior during adolescence and both are related to negative interpersonal relationships in adolescence and emerging adulthood. This study examined the relation between social anxiety and delinquency in adolescence and the interplay between adolescent social anxiety and delinquency on perceived relationship quality in emerging adulthood. In a 10-year long prospective study (T1, n = 923; T2, n = 727; Mage T1 = 12; 49% female), we examined competing hypotheses using regression analyses: the protective perspective, which suggests social anxiety protects against delinquency; and the co-occurring perspective, which suggests social anxiety and delinquency co-occur leading to increased negative interpersonal outcomes. In adolescence, the relation between social anxiety and delinquency was consistent with the protective perspective. In emerging adulthood, consistent with the co-occurring perspective, ever-delinquents (but not delinquency abstainers) with higher social anxiety reported less perceived best friend, mother, and father support compared to delinquents with lower social anxiety. There was no interaction between anxiety and delinquency in predicting perceived conflict. This study highlights the importance of examining the relation between social anxiety and delinquency with regards to different interpersonal outcomes.

  9. Methods for collecting algal samples as part of the National Water-Quality Assessment Program

    Science.gov (United States)

    Porter, Stephen D.; Cuffney, Thomas F.; Gurtz, Martin E.; Meador, Michael R.

    1993-01-01

    Benthic algae (periphyton) and phytoplankton communities are characterized in the U.S. Geological Survey's National Water-Quality Assessment Program as part of an integrated physical, chemical, and biological assessment of the Nation's water quality. This multidisciplinary approach provides multiple lines of evidence for evaluating water-quality status and trends, and for refining an understanding of the factors that affect water-quality conditions locally, regionally, and nationally. Water quality can be characterized by evaluating the results of qualitative and quantitative measurements of the algal community. Qualitative periphyton samples are collected to develop of list of taxa present in the sampling reach. Quantitative periphyton samples are collected to measure algal community structure within selected habitats. These samples of benthic algal communities are collected from natural substrates, using the sampling methods that are most appropriate for the habitat conditions. Phytoplankton samples may be collected in large nonwadeable streams and rivers to meet specific program objectives. Estimates of algal biomass (chlorophyll content and ash-free dry mass) also are optional measures that may be useful for interpreting water-quality conditions. A nationally consistent approach provides guidance on site, reach, and habitat selection, as well as information on methods and equipment for qualitative and quantitative sampling. Appropriate quality-assurance and quality-control guidelines are used to maximize the ability to analyze data locally, regionally, and nationally.

  10. Quality improvement in emergency service delivery: Assessment of knowledge and skills amongst emergency nurses at Connaught Hospital, Sierra Leone

    Directory of Open Access Journals (Sweden)

    Hedda Bøe Nyhus

    2017-09-01

    Conclusion: This study has identified key aspects of emergency nursing speciality training to be developed through theoretical and skill-based education provided by the nursing schools and hospital clinical facilities in Sierra Leone.

  11. Quality of work life and its association with workplace violence of the nurses in emergency departments.

    Science.gov (United States)

    Eslamian, Jalil; Akbarpoor, Ali Akbar; Hoseini, Sayed Abbas

    2015-01-01

    Nurses as the major group of health service providers need to have a satisfactory quality of work life in order to give desirable care to the patients. Workplace violence is one of the most important factors that cause decline in the quality of work life. This study aimed to determine the quality of work life of nurses in selected hospitals of Isfahan University of Medical Sciences and its relationship with workplace violence. This was a descriptive-correlational study. A sample of 186 registered nurses was enrolled in the study using quota sampling method. The research instrument used was a questionnaire consisting of three parts: Demographic information, quality of work life, and workplace violence. Collected data were analyzed using descriptive and inferential statistics by SPSS version 16. The subjects consisted of 26.9% men and 73.1% women, whose mean age was 33.76 (7.13) years. 29.6% were single and 70.4% were married. About 76.9% of the subjects were exposed to verbal violence and 26.9% were exposed to physical violence during past year. Mean score of QNWL was 115.88 (30.98). About 45.7% of the subjects had a low level of quality of work life. There was an inverse correlation between the quality of work and the frequency of exposures to workplace violence. According to the results of this study, it is suggested that the managers and decision makers in health care should plan strategies to reduce violence in the workplace and also develop a program to improve the quality of work life of nurses exposed to workplace violence.

  12. Services quality in emergency department of Nemazee Hospital: Using SERVQUAL model

    Directory of Open Access Journals (Sweden)

    Maryam Gholami

    2016-10-01

    Full Text Available Introduction: Patient satisfaction is crucial to the long-run success in health care center. With regard to the highest patients’ referral to the emergency department and the existing challenges due to the patient’s need to urgent care, we aimed to evaluate health care services quality in this unit to find out whether the patients have different expectations from health care providers and if they perceive some dimensions of care more important than others. Method: The SERVQUAL scale method was used in this cross-sectional study on 100 patients in June 2015. Patient satisfaction questionnaire based on SERVQUAL model was evaluated with high content validity and the reliability was 0.97 and 0.81. The data collected were analyzed using SPSS, version 20.0 (IBM, USA. Statistical analyses included descriptive statistics, paired and independence sample t-test and ANOVA at the significance level 0.05. Results:The results showed that the quality gap in all dimensions was significant (P<0.001. The largest quality gap was related to responsiveness (-1.08 and the lowest belonged to assurance (-0.8. Demographic characteristics were analyzed and the number of referrals was significant in tangibility and assurance dimensions (P = 0.04; also, in all cases the patients’ expectations (total Mean=4.35 were higher than their perception (total Mean = 3.295. Conclusion: In order to improve emergency services, it is recommended that the hospital management should provide appropriate facilities, reduce waiting time, increase in attention to ordering system based on the patients’ condition, and improve the behavior of health care personnel to patient is placed on the agenda of hospital management.

  13. 'Trust my doctor, trust my pancreas': trust as an emergent quality of social practice.

    Science.gov (United States)

    Cohn, Simon

    2015-06-11

    Growing attention is being paid to the importance of trust, and its corollaries such as mistrust and distrust, in health service and the central place they have in assessments of quality of care. Although initially focussing on doctor-patient relationships, more recent literature has broadened its remit to include trust held in more abstract entities, such as organisations and institutions. There has consequently been growing interest to develop rigorous and universal measures of trust. Drawing on illustrative ethnographic material from observational research in a UK diabetes clinic, this paper supports an approach that foregrounds social practice and resists conceiving trust as solely a psychological state that can be divorced from its context. Beyond exploring the less-than-conscious nature of trust, the interpretations attend to the extent to which trust practices are distributed across a range of actors. Data from clinical encounters reveal the extent to which matters of trust can emerge from the relationships between people, and sometimes people and things, as a result of a wide range of pragmatic concerns, and hence can usefully be conceived of as an extended property of a situation rather than a person. Trust is rarely explicitly articulated, but remains a subtle feature of experience that is frequently ineffable. A practice approach highlights some of the problems with adopting a general psychological or intellectualist conception of trust. In particular, assuming it is a sufficiently stable internal state that can be stored or measured not only transforms a diffuse and often ephemeral quality into a durable thing, but ultimately presents it as a generic state that has meaning independent of the specific relationships and context that achieve it. Emphasising the context-specific nature of trust practices does not dismiss the potential of matters of trust, when they emerge, to be transposed to other contexts. But it does highlight how, on each occasion

  14. Quality of coding diagnoses in emergency departments: effects on mapping the public's health.

    Science.gov (United States)

    Aharonson-Daniel, Limor; Schwartz, Dagan; Hornik-Lurie, Tzipi; Halpern, Pinchas

    2014-01-01

    Emergency department (ED) attendees reflect the health of the population served by that hospital and the availability of health care services in the community. To examine the quality and accuracy of diagnoses recorded in the ED to appraise its potential utility as a guage of the population's medical needs. Using the Delphi process, a preliminary list of health indicators generated by an expert focus group was converted to a query to the Ministry of Health's database. In parallel, medical charts were reviewed in four hospitals to compare the handwritten diagnosis in the medical record with that recorded on the standard diagnosis "pick list" coding sheet. Quantity and quality of coding were assessed using explicit criteria. During 2010 a total of 17,761 charts were reviewed; diagnoses were not coded in 42%. The accuracy of existing coding was excellent (mismatch 1%-5%). Database query (2,670,300 visits to 28 hospitals in 2009) demonstrated potential benefits of these data as indicators of regional health needs. The findings suggest that an increase in the provision of community care may reduce ED attendance. Information on ED visits can be used to support health care planning. A "pick list" form with common diagnoses can facilitate quality recording of diagnoses in a busy ED, profiling the population's health needs in order to optimize care. Better compliance with the directive to code diagnosis is desired.

  15. Emergency department visits and 'vog'-related air quality in Hilo, Hawaii

    International Nuclear Information System (INIS)

    Michaud, J.-P.; Grove, J.S.; Krupitsky, Dmitry

    2004-01-01

    Emergency department (ED) visits in Hilo, Hawaii, from January 1997 to May 2001, were examined for associations with volcanic fog, or 'vog', measured as sulfur dioxide (SO 2 ) and submicrometer particulate matter (PM 1 ). Exponential regression models were used with robust standard errors. Four diagnostic groups were examined: asthma/COPD; cardiac; flu, cold, and pneumonia; and gastroenteritis. Before adjustments, highly significant associations with vog-related air quality were seen for all diagnostic groups except gastroenteritis. After adjusting for month, year, and day of the week, only asthma/COPD had consistently positive associations with air quality. The strongest associations were for SO 2 with a 3-day lag (6.8% per 10 ppb; P=0.001) and PM 1 , with a 1-day lag (13.8% per 10 μg/m 3 ; P=0.011). The association of ED visits for asthma/COPD with month of the year was stronger than associations seen with air quality. Although vog appears influential, non-vog factors dominated associations with the frequency of asthma/COPD ED visits

  16. Emergency department visits and "vog"-related air quality in Hilo, Hawai'i.

    Science.gov (United States)

    Michaud, Jon-Pierre; Grove, John Sinclair; Krupitsky, Dmitry

    2004-05-01

    Emergency department (ED) visits in Hilo, Hawai'i, from January 1997 to May 2001, were examined for associations with volcanic fog, or "vog", measured as sulfur dioxide (SO(2)) and submicrometer particulate matter (PM(1)). Exponential regression models were used with robust standard errors. Four diagnostic groups were examined: asthma/COPD; cardiac; flu, cold, and pneumonia; and gastroenteritis. Before adjustments, highly significant associations with vog-related air quality were seen for all diagnostic groups except gastroenteritis. After adjusting for month, year, and day of the week, only asthma/COPD had consistently positive associations with air quality. The strongest associations were for SO(2) with a 3-day lag (6.8% per 10 ppb; P=0.001) and PM(1), with a 1-day lag (13.8% per 10 microg/m(3); P=0.011). The association of ED visits for asthma/COPD with month of the year was stronger than associations seen with air quality. Although vog appears influential, non-vog factors dominated associations with the frequency of asthma/COPD ED visits.

  17. Design of emergency shutdown system for the Tehran Research Reactor; Part I: Neutronics investigation

    International Nuclear Information System (INIS)

    Safarinia, M.; Faghihi, F.; Mirvakili, S.M.; Fakhraei, A.

    2017-01-01

    Highlights: • An emergency shutdown system for the TRR is carried out based on a heavy water tank. • The performance of the heavy water tank are carried out based on “first and equilibrium cores”. • Heavy water discharging flow rate is also studied in the current research. • Thermal flux in the radioisotope channel with and without the heavy water tank are studied. • A core with and without the heavy water tank for the cases of 5 × 6, 5 × 5, 5 × 4, and 4 × 4 fuel assemblies are investigated (for two types of fuel loading—first and equilibrium cores). - Abstract: In this paper, a neutronics design of the secondary (i.e., emergency) shutdown system for the Tehran Research Reactor (TRR) is carried out based on a heavy water tank design. The heavy water tank in a cylindrical shape is around the core, and calculations for the optimized radius and height of the tank are performed. The performance of the heavy water tank calculations are carried out based on two types of fuel loading, which are called the “first and equilibrium cores” of the TRR. For both cases, neutronics and standard safety analysis are taken into account, benchmarked, and described herein. Heavy water discharging flow rate is also studied in the current research, and the results are compared with the IAEA criteria. Moreover, thermal flux in the radioisotope channel with and without the heavy water tank (as the reflector) are studied herein. Specifically, a core with and without the heavy water tank for the cases of 5 × 6, 5 × 5, 5 × 4, and 4 × 4 fuel assemblies are investigated (for two types of fuel loading—first and equilibrium cores). Based on our optimization, the 5 × 5 fuel assembly, which is called “B configuration,” has better performance and efficiency than that of the other described layouts.

  18. Suppression of Emergence of Resistance in Pathogenic Bacteria: Keeping Our Powder Dry, Part 1.

    Science.gov (United States)

    Drusano, G L; Louie, Arnold; MacGowan, Alasdair; Hope, William

    2015-12-28

    We are in a crisis of bacterial resistance. For economic reasons, most pharmaceutical companies are abandoning antimicrobial discovery efforts, while, in health care itself, infection control and antibiotic stewardship programs have generally failed to prevent the spread of drug-resistant bacteria. At this point, what can be done? The first step has been taken. Governments and international bodies have declared there is a worldwide crisis in antibiotic drug resistance. As discovery efforts begin anew, what more can be done to protect newly developing agents and improve the use of new drugs to suppress resistance emergence? A neglected path has been the use of recent knowledge regarding antibiotic dosing as single agents and in combination to minimize resistance emergence, while also providing sufficient early bacterial kill. In this review, we look at the data for resistance suppression. Approaches include increasing the intensity of therapy to suppress resistant subpopulations; developing concepts of clinical breakpoints to include issues surrounding suppression of resistance; and paying attention to the duration of therapy, which is another important issue for resistance suppression. New understanding of optimizing combination therapy is of interest for difficult-to-treat pathogens like Pseudomonas aeruginosa, Acinetobacter spp., and multidrug-resistant (MDR) Enterobacteriaceae. These lessons need to be applied to our old drugs to preserve them as well and need to be put into national and international antibiotic resistance strategies. As importantly, from a regulatory perspective, new chemical entities should have a corresponding resistance suppression plan at the time of regulatory review. In this way, we can make the best of our current situation and improve future prospects. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  19. Suppression of Emergence of Resistance in Pathogenic Bacteria: Keeping Our Powder Dry, Part 2.

    Science.gov (United States)

    Drusano, G L; Hope, William; MacGowan, Alasdair; Louie, Arnold

    2015-12-28

    We are in a crisis of bacterial resistance. For economic reasons, most pharmaceutical companies are abandoning antimicrobial discovery efforts, while, in health care itself, infection control and antibiotic stewardship programs have generally failed to prevent the spread of drug-resistant bacteria. At this point, what can be done? The first step has been taken. Governments and international bodies have declared there is a worldwide crisis in antibiotic drug resistance. As discovery efforts begin anew, what more can be done to protect newly developing agents and improve the use of new drugs to suppress resistance emergence? A neglected path has been the use of recent knowledge regarding antibiotic dosing as single agents and in combination to minimize resistance emergence, while also providing sufficient early bacterial kill. In this review, we look at the data for resistance suppression. Approaches include increasing the intensity of therapy to suppress resistant subpopulations; developing concepts of clinical breakpoints to include issues surrounding suppression of resistance; and paying attention to the duration of therapy, which is another important issue for resistance suppression. New understanding of optimizing combination therapy is of interest for difficult-to-treat pathogens like Pseudomonas aeruginosa, Acinetobacter spp., and multidrug-resistant (MDR) Enterobacteriaceae. These lessons need to be applied to our old drugs as well to preserve them and to be put into national and international antibiotic resistance strategies. As importantly, from a regulatory perspective, new chemical entities should have a resistance suppression plan at the time of regulatory review. In this way, we can make the best of our current situation and improve future prospects. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  20. Production and quality control of concrete for the Rajasthan Atomic Power Station - [Part 2

    International Nuclear Information System (INIS)

    Singh Roy, P.K.; Sukhtankar, K.D.; Prasad, K.

    1975-01-01

    The following aspects of the production and quality control of concrete and concrete materials used in the construction of twin-reactor Rajasthan Atomic Power Station are discussed : (1) relationship between strength of cubes and cylinders made of concrete used for the prestressed dome (2) temperature control during pouring of concrete (3) thermal conductivity of heavy concrete (4) various types of grouting procedures used for different structures forming part of reactors (5) quality control of normal and heavy concrete and (6) leakage through form ties. Typical concrete mixes used for grouts are also given. (M.G.B.)

  1. Occurrence of emerging flame retardants from e-waste recycling activities in the northern part of Vietnam

    OpenAIRE

    Someya, Masayuki; Suzuki, Go; Ionas, Alin C.; Tue, Nguyen Minh; Xu, Fuchao; Matsukami, Hidenori; Covaci, Adrian; Tuyen, Le Huu; Viet, Pham Hung; Takahashi, Shin; Tanabe, Shinsuke; Takigami, Hidetaka

    2016-01-01

    This study investigated the contamination status of 21 emerging flame retardants (FRs) in soils (n = 32) and river sediments (n = 8) from an e-waste recycling (EWR) site in the northern part of Vietnam. Among analyzed FRs, higher levels of decabromodiphenyl ethane (DBDPE) (ND–4200 ng/g dw), 1,2-bis-(2,4,6-tribromophenoxy)ethane (BTBPE) (ND–350 ng/g dw) and Dechlorane Plus isomers (DPs) (ND–65 ng/g dw) were found in soils near EWR workshops and open burning places. The highest concentrations o...

  2. Physics and quality assurance for brachytherapy - Part I: High dose rates

    International Nuclear Information System (INIS)

    Anderson, Lowell L.

    1997-01-01

    Purpose: To review the physical aspects of high dose rate (HDR) brachytherapy, including commissioning and quality assurance, source calibration and dose distribution measurements, and treatment planning methods. Following the introduction of afterloading in brachytherapy, development efforts to make it 'remote' culminated in 1964 with the near-simultaneous appearance of remote afterloaders in five major medical centers. Four of these machines were 'high dose rate', three employing 60Co and one (the GammaMed) using a single, cable-mounted 192Ir source. Stepping-motor source control was added to the GammaMed in 1974, making it the precursor of modern remote afterloaders, which are now suitable for interstitial, well as intracavitary brachytherapy by virtue of small source-diameter and indexer-accessed multiple channels. Because the 192Ir sources currently used in HDR remote afterloaders are supplied at a nominal air-kerma strength of 11.4 cGy cm2 s-1 (10 Ci), are not collimated in clinical use, and emit a significant fraction (15%) of photons at energies greater than 600 keV, shielding and facility design must be undertaken as carefully and thoroughly as for external beam installations. Licensing requirements of regulatory agencies must be met with respect both to maximum permissible dose limits and to the existence and functionality of safety devices (door interlocks, radiation monitors, etc.). Commissioning and quality assurance procedures that must be documented for HDR remote afterloading relate to (1) machine, applicator, guide-tube, and facility functionality checks, (2) source calibration, (3) emergency response readiness, (4) planning software evaluation, and (5) independent checks of clinical dose calculations. Source calibration checks must be performed locally, either by in-air measurement of air kerma strength or with a well ionization chamber calibrated (by an accredited standards laboratory) against an in-air measurement of air kerma strength for the

  3. Dimensional metrology for process and part quality control in micro manufacturing

    DEFF Research Database (Denmark)

    Hansen, Hans Nørgaard; Tosello, Guido; Gasparin, Stefania

    2011-01-01

    dimensions are scaled down and geometrical complexity of objects is increased, the available measurement technologies appear not sufficient. New solutions for measuring principles and instrumentation, tolerancing rules and procedures as well as traceability and calibration are necessary if micro......Micro manufacturing has gained interest over the last decade as the demand for micro mechanical components has increased. The need for dimensional metrology at micro scale is evident both in terms of quality assurance of components and products and in terms of process control. As critical...... manufacturing is to develop into industrial manufacturing solutions. In this paper the application of dimensional precision metrology to both component and process quality control will be demonstrated. The parts investigated are micro injection moulded polymer parts, typical for the field of micro manufacturing....

  4. Quality control and process capability assessment for injection-moulded micro mechanical parts

    DEFF Research Database (Denmark)

    Gasparin, Stefania; Tosello, Guido; Hansen, Hans Nørgaard

    2013-01-01

    Quality control of micro components is an increasing challenge. Smaller mechanical parts are characterized by smaller tolerance to be verified. This paper focuses on the dimensional verification of micro injection-moulded components selected from an industrial application. These parts are measured...... using an optical coordinate measuring machine, which guarantees fast surface scans suitable for inline quality control. The uncertainty assessment of the measurements is calculated and three analyses are carried out and discussed in order to investigate the influence parameters in optical coordinate...... metrology. The estimation of the total variability of the optical measurements and the instrument repeatability are reported; moreover, the measurement system capability is evaluated according to the measurement system capability indices Cg and Cgk....

  5. Resident Workflow and Psychiatric Emergency Consultation: Identifying Factors for Quality Improvement in a Training Environment.

    Science.gov (United States)

    Blair, Thomas; Wiener, Zev; Seroussi, Ariel; Tang, Lingqi; O'Hora, Jennifer; Cheung, Erick

    2017-06-01

    Quality improvement to optimize workflow has the potential to mitigate resident burnout and enhance patient care. This study applied mixed methods to identify factors that enhance or impede workflow for residents performing emergency psychiatric consultations. The study population consisted of all psychiatry program residents (55 eligible, 42 participating) at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles. The authors developed a survey through iterative piloting, surveyed all residents, and then conducted a focus group. The survey included elements hypothesized to enhance or impede workflow, and measures pertaining to self-rated efficiency and stress. Distributional and bivariate analyses were performed. Survey findings were clarified in focus group discussion. This study identified several factors subjectively associated with enhanced or impeded workflow, including difficulty with documentation, the value of personal organization systems, and struggles to communicate with patients' families. Implications for resident education are discussed.

  6. SOFTWARE QUALITY ASSURANCE FOR EMERGENCY RESPONSE CONSEQUENCE ASSESSMENT MODELS AT DOE'S SAVANNAH RIVER SITE

    International Nuclear Information System (INIS)

    Hunter, C

    2007-01-01

    The Savannah River National Laboratory's (SRNL) Atmospheric Technologies Group develops, maintains, and operates computer-based software applications for use in emergency response consequence assessment at DOE's Savannah River Site. These applications range from straightforward, stand-alone Gaussian dispersion models run with simple meteorological input to complex computational software systems with supporting scripts that simulate highly dynamic atmospheric processes. A software quality assurance program has been developed to ensure appropriate lifecycle management of these software applications. This program was designed to meet fully the overall structure and intent of SRNL's institutional software QA programs, yet remain sufficiently practical to achieve the necessary level of control in a cost-effective manner. A general overview of this program is described

  7. Applicability of chemical vapour polishing of additive manufactured parts to meet production-quality

    DEFF Research Database (Denmark)

    Pedersen, D. B.; Hansen, H. N.; Nielsen, J. S.

    2014-01-01

    The Fused Deposition Modelling (FDM) method is the most rapidly growing Additive Manufacturing (AM) method[1]. FDM employs a 2.5D deposition scheme which induce a step-ladder shaped surface definition [2], with seams of the individual layers clearly visible[3]. This paper investigate to which...... of FDM manufactured parts can be taken from their current quality into the precision engineering domain....

  8. Burnout in boiling heat transfer. Part III. High-quality forced-convection systems

    International Nuclear Information System (INIS)

    Bergles, A.E.

    1979-01-01

    This is the final part of a review of burnout during boiling heat transfer. The status of burnout in high-quality forced-convection systems is reviewed, and recent developments are summarized in detail. A general guide to the considerable literature is given. Parametric effects and correlations for water in circular and noncircular ducts are presented. Other topics discussed include transients, steam-generator applications, correlations for other fluids, fouling, and augmentation

  9. Emerging Forms of the Part II of Jonathan Swift's Novel “Gulliver’s Travels”

    Directory of Open Access Journals (Sweden)

    Svitlana Tikhonenko

    2017-11-01

    Full Text Available The article is devoted to the study of grotesque forms in Jonathan Swift's novel "Gulliver’s Travels" based on the text of part II of the novel "A Voyage to Brobdingnag". On the basis of the selected actual material, displays of the grotesque elements in the semantic field of the work’s text are traced. The grotesque world of the novel is the author's model of mankind, in which J. Swift presents his view not only on the state of the modern system of England, but also on the nature of man in general, reveals the peculiarities of the psychology of human nature, especially human socialization. In part II, the author continues to develop a complex and contradictory picture of human existence in front of the reader, the world of giants appears as an ambivalent system in which the features of an ideal society and ideal ruler, in author’s opinion, with the ugly face of man and society, are marvelously combined.

  10. Sociophysiology 25 years ago: early perspectives of an emerging discipline now part of social neuroscience.

    Science.gov (United States)

    Barchas, Patricia R; Barchas, Jack D

    2011-08-01

    Sociophysiology was a term used early in the history of sociology and then again 25 years ago to describe interactions between the "social" and the "biological" worlds. Social scientists had largely viewed biology and the brain as a "black box" that was not an active aspect of their work or theories. A landmark, unpublished conference in 1986 brought together social scientists and biologists dedicated to the idea that bringing sociological conceptualizations and approaches together with those of physiology might create new ways to understand human behavior. The umbrella question for sociophysiology was dual: how do social processes impact the physiology of the organism, and how does that altered physiology affect future social behavior? This paper summarizes that conference with the goal of providing a glimpse into the early history of social neuroscience and to demonstrate the variety of individuals and interests that were present at the emergence of this new field. The late Patricia R. Barchas organized and chaired the conference. © 2011 New York Academy of Sciences.

  11. Emerging hemodynamic signatures of the right heart (Third International Right Heart Failure Summit, part 2).

    Science.gov (United States)

    Maron, Bradley A

    2014-12-01

    Despite the importance of preserved right ventricular structure and function with respect to outcome across the spectrum of lung, cardiac, and pulmonary vascular diseases, only recently have organized efforts developed to consider the pulmonary vascular-right ventricular apparatus as a specific unit within the larger context of cardiopulmonary pathophysiology. The Third International Right Heart Failure Summit (Boston, MA) was a multidisciplinary event dedicated to promoting a dialogue about the scientific and clinical basis of right heart disease. The current review provides a synopsis of key discussions presented during the section of the summit titled "Emerging Hemodynamic Signatures of the Right Heart." Specifically, topics emphasized in this element of the symposium included (1) the effects of pulmonary vascular dysfunction at rest or provoked by exercise on the right ventricular pressure-volume relationship, (2) the role of pressure-volume loop analysis as a method to characterize right ventricular inefficiency and predict right heart failure, and (3) the importance of a systems biology approach to identifying novel factors that contribute to pathophenotypes associated with pulmonary arterial hypertension and/or right ventricular dysfunction. Collectively, these concepts frame a forward-thinking paradigm shift in the approach to right heart disease by emphasizing factors that regulate the transition from adaptive to maladaptive right ventricular-pulmonary vascular (patho)physiology.

  12. Emergency Overcrowding Impact on the Quality of Care of Patients Presenting with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Mehdi Momeni

    2017-12-01

    Full Text Available Introduction: Emergency overcrowding is defined as when the amount of care required for patients overcomes the available amount. This can cause delays in delivering critical care in situations like stroke. Objective: The aim of this study was to assess the possible impact of emergency department (ED crowding on the quality of care for acute stroke patients. Methods: In this cross-sectional prospective study, all patients with symptoms of acute stroke presenting to the ED of educational hospitals were enrolled. All patients were assessed and examined by the emergency medicine (EM residents on shift and a questionnaire was filled out for them. The amount of time that passed from the first triage to performing the required interventions and delivering health services were recorded by the triage nurse. ED crowding was measured by the occupancy rate. Then, the correlation between all of the variables and ED crowding level were calculated. Results: The average daily bed occupancy rate was 184.9 ± 54.3%. The median time passed from the first triage to performing the interventions were as follows: the first EM resident visit after 34 min, the first neurologic visit after 138 min, head CT after 134 min, ECG after 104 min and ASA administration after 210 min. There was no statistically significant relationship between the ED occupancy rate and the time elapsed before different required health services in the management of stroke patients either throughout an entire day or during each 8-hour interval (p > 0.05. Conclusion: In the current study, the ED occupancy rate was not significantly correlated with the time frame associated with management of admitted acute stroke patients.

  13. Application of quality improvement analytic methodology in emergency medicine research: A comparative evaluation.

    Science.gov (United States)

    Harries, Bruce; Filiatrault, Lyne; Abu-Laban, Riyad B

    2018-05-30

    Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care. We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR). QI analytic tools were applied to the data set from this study and evaluated comparatively against the original standard research methodology. The original study concluded that triage nurse-initiated radiographs led to a statistically significant decrease in mean emergency department length of stay. Using QI analytic methodology, we applied control charts and interpreted the results using established methods that preserved the time sequence of the data. This analysis found a compelling signal of a positive treatment effect that would have been identified after the enrolment of 58% of the original study sample, and in the 6th month of this 11-month study. Our comparative analysis demonstrates some of the potential benefits of QI analytic methodology. We found that had this approach been used in the original study, insights regarding the benefits of nurse-initiated radiography using the OAR would have been achieved earlier, and thus potentially at a lower cost. In situations where the overarching aim is to accelerate implementation of practice improvement to benefit future patients, we believe that increased consideration should be given to the use of QI analytic methodology.

  14. Hydrochemical characteristics and spatial analysis of groundwater quality in parts of Bundelkhand Massif, India

    Science.gov (United States)

    Ali, Syed Ahmad; Ali, Umair

    2018-03-01

    The tribulations of water quality have become more serious than the quantity, as the environmental evils are getting more severe day by day in different parts of the world. Large number of components like soil, geology, sewage disposal, effluents and other environmental conditions in which the water tends to reside or move and interact with ground and biological characteristics, greatly persuade the groundwater quality. Therefore, hydrochemical study has been carried out graphically and spatially in GIS environment in part of Bundelkhand Massif. The hydrochemical study exposes the water quality by measuring the concentration of parameters and comparing them with the drinking water and irrigation standards. Groundwater samples have been collected and analysed for physiochemical characteristics in order to understand the hydrochemistry of the water. The results revealed that ground water is alkaline in nature and total hardness observed in all samples falls under moderately hard to very hard category. At some places higher concentration of Cl- could be dangerous from health point of view. Major hydrochemical facies were identified using Piper Trilinear diagram and Durov diagrams, etc. Analysis of different determinations such as sodium adsorption ratio, residual sodium carbonate and per cent sodium revealed that most of the samples are unsuitable for irrigation. It was also observed that the quality of groundwater was not suitable for drinking purpose in industrial and irrigation area. In the area, few sampling sites showed unsuitability because of influences of urban and industrial waste discharge, aquifer material mineralogy, other anthropogenic activities and increased human interventions.

  15. Effect of Tumbling Marination on Marinade Uptake of Chicken Carcass and Parts Quality

    Directory of Open Access Journals (Sweden)

    J U-chupaj

    Full Text Available ABSTRACT The objectives of this study were to evaluate the effect of marination on marinade uptake of chicken carcasses and to determine the meat quality of carcass parts. In total, 45 eviscerated chicken carcasses were divided into three marinating treatments: no marination, marination in water, marination in non-phosphate and low-salt solution (NPLS. The study showed that the marinade uptake of chicken carcasses was higher than 4.0% for NPLS marination and than 3.5% for water marination when compared with the non-marinated treatment. However, raw chicken meat yield after cut-up was not significantly different (p≥0.05 among treatments. Carcasses marinated in NPLS solution presented higher water-holding capacity (WHC. The results showed that NPLS marination may reduce cooking loss and expressible water of chicken meat after cooking. Based on the Warner-Bratzler Shear (WBSF results, NPLS marination had a stronger effect on textural quality of cooked breast meat than thighs and drumsticks. However, no significant differences of texture profile analysis (TPA parameters were observed (p≥0.05. In the sensory evaluation, NPLS marination influenced the sensory quality of cooked meat, particularly texture and appearance attributes, but not the taste and aftertaste attributes of cooked meat. It is concluded that NPLS marination effectively increased carcass weight, despite its effects on meat quality varied according to the anatomical location of the parts.

  16. Improving the Quality of Hot Stamping Parts with Innovative Press Technology and Inline Process Control

    Science.gov (United States)

    Vollmer, R.; Palm, C.

    2017-09-01

    The increasing number of hot stamped parts in the automotive industry is challenging different process areas. This paper presents a method how to improve the production rates over the whole life cycle of a hot forming part. In the core element of a hot forming line, the hydraulic press, mainly two processing steps are performed. Forming and quenching of the sheet metal part. In addition to the forming operation, it is inevitable to optimize the quenching condition in the bottom dead centre in order to reach a fully martensitic structure and tight geometrical tolerances of the part. Deviations in the blank thickness, tool wear, polishing of classical tools impair the quenching condition and therefore the part quality over the time. A new press and tool design has been developed to counter this effect by providing homogenous contact pressure over the whole die. Especially with a multi cavity tool, the new method is advantageous. Test series have shown that the new tool and press concept can produce parts with a blank thickness of 1.0 mm within 8.0 s cycle time. The so called PCH flex principle makes it possible to produce such high output rates under reliable conditions.

  17. Influence of reinforcement and cemented parts on quality of radiological shields

    International Nuclear Information System (INIS)

    Ablewicz, Z.

    1974-01-01

    Results of studies of the influence of reinforcement density and shape of cemented parts on quality of radiological shields are presented. The studies were carried out on built shields and on experimental blocks. The experimental studies were aimed at determination of filling degree under cemented parts of different shapes using two kinds of cement normal and heavy one and at determination of filling degree of space with dense reinforcement as well as space near boarding. The influence of reinforcement density was studied using different spacing between bars and rows of bars. In the case of difficulties with good filling under the cemented parts so called ''beard'' and more liquid mixtures were used with success. (Z.M.)

  18. Quality of work life of rural emergency department nurses and physicians: a pilot study.

    Science.gov (United States)

    Bragard, Isabelle; Fleet, Richard; Etienne, Anne-Marie; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Poitras, Julien; Dupuis, Gilles

    2015-04-01

    Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Factors Questionnaire (39 items) was sent to ED nurses and physicians of these two EDs. Descriptive statistics of percentage, mean and standard deviation and correlations were used to analyse the data. Forty out of 64 eligible workers (62%) gave their consent to participate, but only 20 had completed both questionnaires. Participants' mean age was 42 years (SD = 11.6). The average participants satisfaction with their access to continuing education was low (Mean = 1.6, SD = 0.8). However, their satisfaction with technical resources (Mean = 2.4, SD = 0.7), pre-hospital and inter-hospital transfer services (Mean = 2.5, SD = 0.6), relationships with colleagues (Mean = 2.7, SD = 0.6) and managers (Mean = 2.2, SD = 0.7), work-life balance (Mean = 2.4, SD = 0.6) and emergency patient access to other departments (Mean = 3.7, SD = 0.6) was in the average. The impact of several aspects of the rural environment (e.g. tranquility) on quality of life was also in the average (Mean = 2.5, SD = 0.7). QWL was in the average, excepted subscale 'support offered to employee' for which the QWL was lower. Data collection was difficult and the larger study will require strategies to improve recruitment such as a paper alternative. The study showed globally good recruitment and retention factors and QWL for these ED nurses and physicians. These results will help hospital administrations better plan initiatives aimed at improving retention and QWL.

  19. Chinese Undergraduate Students' Work Values: The Role of Parental Work Experience and Part-Time Work Quality

    Science.gov (United States)

    Cheung, Francis Yue-lok; Tang, Catherine So-kum

    2012-01-01

    In this study, the authors investigated the association of perceived parental job insecurity and students' part-time work quality on work values among 341 Hong Kong Chinese undergraduate students. Correlation and regression results showed that work values were strongly related to students' part-time work satisfaction and work quality. In…

  20. 40 CFR Appendix R to Part 50 - Interpretation of the National Ambient Air Quality Standards for Lead

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Interpretation of the National Ambient Air Quality Standards for Lead R Appendix R to Part 50 Protection of Environment ENVIRONMENTAL.... 50, App. R Appendix R to Part 50—Interpretation of the National Ambient Air Quality Standards for...

  1. Quality improvement activity for improving pain management in acute extremity injuries in the emergency department.

    Science.gov (United States)

    Chang, Hyung Lan; Jung, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Lee, Jin Hee; Jung, Jae Yun; Kwon, Hyuksool; Paek, So Hyun; Park, Joong Wan; Shin, Jonghwan

    2018-03-01

    The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40-S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse's pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription. A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P< 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%. ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.

  2. Groundwater quality from a part of Prakasam District, Andhra Pradesh, India

    Science.gov (United States)

    Subba Rao, N.

    2018-03-01

    Quality of groundwater is assessed from a part of Prakasam district, Andhra Pradesh, India. Groundwater samples collected from thirty locations from the study area were analysed for pH, electrical conductivity (EC), total dissolved solids (TDS), calcium (Ca2+), magnesium (Mg2+), sodium (Na+), potassium (K+), bicarbonate ( {HCO}3^{ - } ), chloride (Cl-), sulphate ( {SO}4^{2 - } ), nitrate ( {NO}3^{ - } ) and fluoride (F-). The results of the chemical analysis indicate that the groundwater is alkaline in nature and are mainly characterized by Na+- {HCO}3^{ - } and Na+-Cl- facies. Groundwater chemistry reflects the dominance of rock weathering and is subsequently modified by human activities, which are supported by genetic geochemical evolution and hydrogeochemical relations. Further, the chemical parameters (pH, TDS, Ca2+, Mg2+, Na+, {HCO}3^{ - } , Cl-, {SO}4^{2 - } , {NO}3^{ - } and F-) were compared with the drinking water quality standards. The sodium adsorption ratio, percent sodium, permeability index, residual sodium carbonate, magnesium ratio and Kelly's ratio were computed and USSL, Wilcox and Doneen's diagrams were also used for evaluation of groundwater quality for irrigation. For industrial purpose, the pH, TDS, {HCO}3^{ - } , Cl- and {SO}4^{2 - } were used to assess the impact of incrustation and corrosion activities on metal surfaces. As a whole, it is observed that the groundwater quality is not suitable for drinking, irrigation and industrial purposes due to one or more chemical parameters exceeding their standard limits. Therefore, groundwater management measures were suggested to improve the water quality.

  3. A study on replication and quality correlation of on-part and on-runner polymer injection molded micro features

    DEFF Research Database (Denmark)

    Giannekas, Nikolaos; Tosello, Guido; Zhang, Yang

    Injection molding is increasingly gaining place in manufacturing of polymer components as is can ensure a cost efficient production with short cycle times. To ensure the quality of the produced parts and the stability of the process it is essential to perform frequent metrological inspections....... In contrast to injection molding’s short cycle time, a metrological quality control can require a significant amount of time. The late detection of the problem can result to high losses and scrap rate. This paper presents an alternative approach to process monitoring and part quality control with fast off....../in-line metrology of physical part quality indicators (“Product Fingerprint”). The proposed approach is based on the concept of metrology applied to dedicated micro features, positioned on the runners, similar or equal to those in the part in order to access the quality of the produced plastic parts. A designed...

  4. 40 CFR Appendix S to Part 50 - Interpretation of the Primary National Ambient Air Quality Standards for Oxides of Nitrogen...

    Science.gov (United States)

    2010-07-01

    ... Ambient Air Quality Standards for Oxides of Nitrogen (Nitrogen Dioxide) S Appendix S to Part 50 Protection... National Ambient Air Quality Standards for Oxides of Nitrogen (Nitrogen Dioxide) 1. General (a) This... national ambient air quality standards for oxides of nitrogen as measured by nitrogen dioxide (“NO2 NAAQS...

  5. Quality control for digital mammography: Part II recommendations from the ACRIN DMIST trial

    International Nuclear Information System (INIS)

    Yaffe, Martin J.; Bloomquist, Aili K.; Mawdsley, Gordon E.

    2006-01-01

    The Digital Mammography Imaging Screening Trial (DMIST), conducted under the auspices of the American College of Radiology Imaging Network (ACRIN), is a clinical trial designed to compare the accuracy of digital versus screen-film mammography in a screening population [E. Pisano et al., ACRIN 6652--Digital vs. Screen-Film Mammography, ACRIN (2001)]. Part I of this work described the Quality Control program developed to ensure consistency and optimal operation of the digital equipment. For many of the tests, there were no failures during the 24 months imaging was performed in DMIST. When systems failed, they generally did so suddenly rather than through gradual deterioration of performance. In this part, the utility and effectiveness of those tests are considered. This suggests that after verification of proper operation, routine extensive testing would be of minimal value. A recommended set of tests is presented including additional and improved tests, which we believe meet the intent and spirit of the Mammography Quality Standards Act regulations to ensure that full-field digital mammography systems are functioning correctly, and consistently producing mammograms of excellent image quality

  6. What makes British general practitioners take part in a quality improvement scheme?

    Science.gov (United States)

    Spooner, A; Chapple, A; Roland, M

    2001-07-01

    To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.

  7. [Impact of quality-indicator-based measures to improve the treatment of acute poisoning in pediatric emergency patients].

    Science.gov (United States)

    Martínez Sánchez, Lidia; Trenchs Sainz de la Maza, Victoria; Azkunaga Santibáñez, Beatriz; Nogué-Xarau, Santiago; Ferrer Bosch, Nuria; García González, Elsa; Luaces I Cubells, Carles

    2016-02-01

    To analyze the impact of quality-indicator-based measures for improving quality of care for acute poisoning in pediatric emergency departments. Recent assessments of quality indicators were compared with benchmark targets and with results from previous studies. The first study evaluated 6 basic indicators in the pediatric emergency departments of members of to the working group on poisoning of the Spanish Society of Pediatric Emergency Medicine (GTI-SEUP). The second study evaluated 20 indicators in a single emergency department of GTI-SEUP members. Based on the results of those studies, the departments implemented the following corrective measures: creation of a team for gastric lavage follow-up, preparation of a new GTI-SEUP manual on poisoning, implementation of a protocol for poisoning incidents, and creation of specific poisoning-related fields for computerized patient records. The benchmark targets were reached on 4 quality indicators in the first study. Improvements were seen in the availability of protocols, as indicators exceeded the target in all the pediatric emergency departments (vs 29.2% of the departments in an earlier study, P < .001). No other significant improvements were observed. In the second study the benchmarks were reached on 13 indicators. Improvements were seen in compliance with incident reporting to the police (recently, 44.4% vs 19.2% previously, P = .036), case registration in the minimum basic data set (51.0% vs 1.9%, P < .001), and a trend toward increased administration of activated carbon within 2 hours (93.1% vs 83.5%, P = .099). No other significant improvements were seen. The corrective measures led to improvements in some quality indicators. There is still room for improvement in these emergency departamens' care of pediatric poisoning.

  8. Estimation of the groundwater quality in the western part of Lipjan (Kosovo

    Directory of Open Access Journals (Sweden)

    Fatbardh Gashi

    2015-12-01

    Full Text Available The study of the effect of anthropogenic activity on the water quality was carried out in the western part of Lipjan (Kosovo. The software “Statistica 6.0” was used for calculations of basic statistical parameters and anomalies (extremes and outliers. The levels of some physicochemical parameters of groundwater are compared with the World Health Organization standards for drinking water. Our results show significant pollution (high values of electrical conductivity, total dissolved solids and consumption of KMnO4 of groundwaters as a result of anthropogenic activity coming from settlements, pollution of small rivers (Vodavoda and Grika and wastewaters in the surrounding area.

  9. Quality and Safety in Health Care, Part XXXII: Additional Outcome Predictors for Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Harolds, Jay A

    2018-02-01

    Mortality 12 months after a transcatheter aortic valve replacement (TAVR) is partly due to a number of reasons in addition to the usual preprocedural medical patient risk factors. In patients who need a permanent pacemaker placed after the procedure, the mortality risk goes up. The death rate following a TAVR varies considerably at different institutions, and the past death rate of TAVR patients at an institution is predictive of the mortality rate of new patients having this procedure. In addition, the quality of life of the individual before the procedure is predictive of the 12-month mortality outcome after the TAVR is done.

  10. Guidelines for quality assurance and quality control of fish taxonomic data collected as part of the National Water-Quality Assessment Program

    Science.gov (United States)

    Walsh, Stephen Joseph; Meador, Michael R.

    1998-01-01

    Fish community structure is characterized by the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program as part of a perennial, multidisciplinary approach to evaluating the physical, chemical, and biological conditions of the Nation's water resources. The objective of quality assurance and quality control of fish taxonomic data that are collected as part of the NAWQA Program is to establish uniform guidelines and protocols for the identification, processing, and archiving of fish specimens to ensure that accurate and reliable data are collected. Study unit biologists, collaborating with regional biologists and fish taxonomic specialists, prepare a pre-sampling study plan that includes a preliminary faunal list and identification of an ichthyological curation center for receiving preserved fish specimens. Problematic taxonomic issues and protected taxa also are identified in the study plan, and collecting permits are obtained in advance of sampling activities. Taxonomic specialists are selected to identify fish specimens in the field and to assist in determining what fish specimens should be sacrificed, fixed, and preserved for laboratory identification, independent taxonomic verification, and long-term storage in reference or voucher collections. Quantitative and qualitative sampling of fishes follows standard methods previously established for the NAWQA Program. Common ichthyological techniques are used to process samples in the field and prepare fish specimens to be returned to the laboratory or sent to an institutional repository. Taxonomic identifications are reported by using a standardized list of scientific names that provides nomenclatural consistency and uniformity across study units.

  11. Occurrence of emerging flame retardants from e-waste recycling activities in the northern part of Vietnam

    Directory of Open Access Journals (Sweden)

    Masayuki Someya

    2016-06-01

    Full Text Available This study investigated the contamination status of 21 emerging flame retardants (FRs in soils (n = 32 and river sediments (n = 8 from an e-waste recycling (EWR site in the northern part of Vietnam. Among analyzed FRs, higher levels of decabromodiphenyl ethane (DBDPE (ND–4200 ng/g dw, 1,2-bis-(2,4,6-tribromophenoxyethane (BTBPE (ND–350 ng/g dw and Dechlorane Plus isomers (DPs (ND–65 ng/g dw were found in soils near EWR workshops and open burning places. The highest concentrations of DBDPE (20 ng/g dw, BTBPE (5.7 ng/g dw and DPs (6.7 ng/g dw were also detected in sediments collected from the middle of the EWR site. The levels decreased concomitantly with increasing distance from the EWR site. These results indicate that these FRs were released to the surrounding environment from improper recycling activities, such as manual dismantling of devices and open burning of e-wastes. Moreover, the estimated daily intakes of those FRs via soil ingestion were approximately ten times higher for children than adults. To our knowledge, this is a first comprehensive study on characterization of soil and sediment contamination by a series of emerging FRs at an EWR site in Vietnam.

  12. [Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission].

    Science.gov (United States)

    Bartiaux, M; Mols, P

    2017-01-01

    patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

  13. Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project.

    Science.gov (United States)

    Bunch, Azalea Marie; Leasure, A Renee; Carithers, Cathrin; Burnette, Robert E; Berryman, Michael Scott

    2016-02-01

    The purpose of this quality improvement (QI) project is to compare the effectiveness of a rapid 90-min chest pain screening and evaluation protocol to a 120-min screening and evaluation protocol in determining patient readiness for hospital admission or discharge home. The existing chest pain protocol utilized in the emergency department (ED) was revised based on a review of current research changing initial screening and reevaluation times from 120 to 90 min. A prospective comparative study of patients presenting to the ED with chest pain was performed comparing the existing chest pain protocol of 120 min (standard care) with a rapid screening evaluation protocol of 90 min. A total of 128 patients presenting to an ED in Texas with chest pain comprised the sample for this study. There was a significant difference in the number of minutes between the groups for readiness for disposition. The average time from chest pain evaluation to readiness for disposition home, observation, or admission decreased from an average of 191 min in the standard care group to an average of 118 min in the rapid screening group. Use of the rapid screening and evaluation protocol decreased the time to disposition by an average of 73 min, which enhanced ED flow without influencing disposition and patient safety. ©2015 American Association of Nurse Practitioners.

  14. Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

    Science.gov (United States)

    Househ, Mowafa; Yunus, Faisel

    2014-01-01

    Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

  15. A model for emergency department end-of-life communications after acute devastating events--part II: moving from resuscitative to end-of-life or palliative treatment.

    Science.gov (United States)

    Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

    2012-11-01

    The model for emergency department (ED) end-of-life communications after acute devastating events addresses decision-making capacity, surrogates, and advance directives, including legal definitions and application of these steps. Part II concerns communications moving from resuscitative to palliative and end-of-life treatments. After completing the steps involved in determining decision-making, emergency physicians (EPs) should consider starting palliative measures versus continuing resuscitative treatment. As communications related to these end-of-life decisions increasingly fall within the scope of emergency medicine (EM) practice, we need to become educated about and comfortable with them. © 2012 by the Society for Academic Emergency Medicine.

  16. Examination of the Perception and Experiences of the Patients in the Emergency Departments of Imam Khomeini and Shariati Hospitals Regarding the Quality of Care Provided by the Health Care System

    Directory of Open Access Journals (Sweden)

    Somaye Fakharian

    2017-01-01

    Full Text Available Background: The emergency department (ED is considered to act as a gate keeper of treatment for patients. Thereby, EDs must achieve customer satisfaction by providing quality services. Patient satisfaction and experiences are important parts of health care quality, but patient expectations are seldom included in quality assessments. Materials and Methods: The objective of this study was to identify patient’s perception of quality of care are given by care system at ED in Imam Khomeini and Shariaty Hospital. A qualitative approach using content analysis was adopted. Data was collected via semi-structured interviews from 45 patients hospitalized at different ward from emergency department. The method proposed by Colizzi was used for data analysis. Results: The finding of this study revealed that patient experience were five main category: patient satisfaction, dissatisfaction, interpretation, attendant role and advices. Each of these group included five subcategories included: environment, medical staff, hospital management, information and education factor, patient rights. Therefore, all factors in subgroups are effective in satisfaction or dissatisfaction and others. Response to these patient need and expectation are almost easy and practicable and our finding of this study can help health and emergency care provider for doing that and improvement of quality of care. Conclusion: Identifying areas for quality improvement are important, to know where to take action. These finding may facilitate this work and improve patients perception of quality of care at emergency department. The use of a these data can also provide a research-based instrument for future studies.

  17. The Effects of the Sleep Quality of 112 Emergency Health Workers in Kayseri, Turkey on Their Professional Life.

    Science.gov (United States)

    Senol, Vesile; Soyuer, Ferhan; Guleser, Gulsum Nihal; Argun, Mahmut; Avsarogullari, Levent

    2014-12-01

    Sleep adequacy is one of the major determinants of a successful professional life. The aim of this study is to determine the sleep quality of emergency health workers and analyze its effects on their professional and social lives. The study was carried out on 121 voluntary emergency health workers in 112 Emergency Aid Stations in Kayseri, Turkey, in 2011. The data was collected through the Socio-Demographics Form and the Pittsburgh Sleep Quality Index (PSQI) and analyzed via SPSS 18.00. The statistical analysis involved percentage and frequency distributions, mean±standard deviations, a chi-square test, correlations, and logistic regression analysis. The mean score of the participants according to the Pittsburgh Sleep Quality Index was 4.14±3.09, and 28.9% of participants had poor sleep quality. Being single and being a woman accounted for 11% (p=0.009, 95% CI: 0.111-0.726) and 7% (p=0.003, 95% CI: 0.065-0.564) of poor sleep quality respectively. There was a positive correlation between sleep quality scores and negative effects on professional and social life activities. Negative effects on professional activities included increased loss of attention and concentration (40.0%, p=0,016), increased failure to take emergency actions (57.9%, p=0.001), reduced motivation (46.2%, p=0.004), reduced performance (41.4%, p=0.024), and low work efficiency (48.1%, p=0.008). Poor sleep quality generally negatively affected the daily life of the workers (51.6%, p=0.004), restricted their social life activities (45.7%, p=0.034), and caused them to experience communication difficulties (34.7%, p=0.229). One third of the emergency health workers had poor sleep quality and experienced high levels of sleep deficiency. Being a woman and being single were the most important factors in low sleep quality. Poor sleep quality continuously affected daily life and professional life negatively by leading to a serious level of fatigue, loss of attention-concentration, and low levels of

  18. An Emerging Theory for Evidence Based Information Literacy Instruction in School Libraries, Part 1: Building a Foundation

    Directory of Open Access Journals (Sweden)

    Carol A. Gordon

    2009-06-01

    Full Text Available Objective – Part I of this paper aims to create a framework for an emerging theory of evidence based information literacy instruction. In order to ground this framework in existing theory, a holistic perspective views inquiry as a learning process that synthesizes information searching and knowledge building. An interdisciplinary approach is taken to relate user-centric information behavior theory and constructivist learning theory that supports this synthesis. The substantive theories that emerge serve as a springboard for emerging theory. A second objective of this paper is to define evidence based information literacy instruction by assessing the suitability of performance based assessment and action research as tools of evidence based practice.Methods – An historical review of research grounded in user-centered information behavior theory and constructivist learning theory establishes a body of existing substantive theory that supports emerging theory for evidence based information literacy instruction within an information-to-knowledge approach. A focused review of the literature presents supporting research for an evidence based pedagogy that is performance assessment based, i.e., information users are immersed in real-world tasks that include formative assessments. An analysis of the meaning of action research in terms of its purpose and methodology establishes its suitability for structuring an evidence based pedagogy. Supporting research tests a training model for school librarians and educators which integrates performance based assessment, as well as action research. Results – Findings of an historical analysis of information behavior theory and constructivist teaching practices, and a literature review that explores teaching models for evidence based information literacy instruction, point to two elements of evidence based information literacy instruction: the micro level of information searching behavior and the macro level of

  19. Quality and Capacity Document 2011. Part 1; Kwaliteits- en Capaciteitsdocument 2011. Deel 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-01-15

    In accordance with Article 21 of the Dutch Electricity Law 1998 this quality and capacity document was drafted. The document describes (a) the level of quality which is aimed at and the scores over the last years; (b) the quality management system; (c) the estimated results of the total need for transport for the period 2012-2021; (d) bottlenecks and solutions required to meet the demand for future transport capacity; and (e) measures to be taken for maintenance and replacements. This document comprises chapters 1-5. In parts 2, 3 and 4 you can find the rest of the chapters [Dutch] Conform artikel 21 van de Elektriciteitswet 1998 is het titel document opgesteld. In dit document wordt en worden door TenneT (a) aangegeven welk kwaliteitsniveau wordt nagestreefd en wat de scores in de laatste drie jaar zijn geweest; (b) het kwaliteitbeheerssysteem beschreven; (c) de resultaten van de raming van de totale transportbehoefte beschreven voor de periode 2012-2021; (d) de knelpunten en oplossingen beschreven die nodig zijn om in de behoefte aan de toekomstige transportcapaciteit te kunnen voldoen; en (e) de maatregelen beschreven inzake vervanging en onderhoud. Dit document bevat de hoofdstukken 1-5. In de delen 2, 3 en 4 kunt u de overige hoofdstukken vinden.

  20. Quality and Capacity Document 2011. Part 2; Kwaliteits- en Capaciteitsdocument 2011. Deel 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-01-15

    In accordance with Article 21 of the Dutch Electricity Law 1998 this quality and capacity document was drafted. The document describes (a) the level of quality which is aimed at and the scores over the last years; (b) the quality management system; (c) the estimated results of the total need for transport for the period 2012-2021; (d) bottlenecks and solutions required to meet the demand for future transport capacity; and (e) measures to be taken for maintenance and replacements. This document comprises chapters 6-8. In parts 1, 3 and 4 you can find the rest of the chapters [Dutch] Conform artikel 21 van de Elektriciteitswet 1998 is het titel document opgesteld. In dit document wordt en worden door TenneT (a) aangegeven welk kwaliteitsniveau wordt nagestreefd en wat de scores in de laatste drie jaar zijn geweest; (b) het kwaliteitbeheerssysteem beschreven; (c) de resultaten van de raming van de totale transportbehoefte beschreven voor de periode 2012-2021; (d) de knelpunten en oplossingen beschreven die nodig zijn om in de behoefte aan de toekomstige transportcapaciteit te kunnen voldoen; en (e) de maatregelen beschreven inzake vervanging en onderhoud. Dit document bevat de hoofdstukken 6-8. In de delen 1, 3 en 4 kunt u de overige hoofdstukken vinden.

  1. Use of statistic control of the process as part of a quality assurance plan

    International Nuclear Information System (INIS)

    Acosta, S.; Lewis, C.

    2013-01-01

    One of the technical requirements of the standard IRAM ISO 17025 for the accreditation of testing laboratories, is the assurance of the quality of the results through the control and monitoring of the factors influencing the reliability of them. The grade the factors contribute to the total measurement uncertainty, determines which of them should be considered when developing a quality assurance plan. The laboratory of environmental measurements of strontium-90 in the accreditation process, performs most of its determinations in samples with values close to the detection limit. For this reason the correct characterization of the white, is a critical parameter and is verified through a letter for statistical process control. The scope of the present work is concerned the control of whites and so it was collected a statistically significant amount of data, for a period of time that is covered of different conditions. This allowed consider significant variables in the process, such as temperature and humidity, and build a graph of white control, which forms the basis of a statistical process control. The data obtained were lower and upper limits for the preparation of the charter white control. In this way the process of characterization of white was considered to operate under statistical control and concludes that it can be used as part of a plan of insurance of the quality

  2. Quality and Capacity Document 2011. Part 4; Kwaliteits- en Capaciteitsdocument 2011. Deel 4

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-01-15

    In accordance with Article 21 of the Dutch Electricity Law 1998 this quality and capacity document was drafted. The document describes (a) the level of quality which is aimed at and the scores over the last years; (b) the quality management system; (c) the estimated results of the total need for transport for the period 2012-2021; (d) bottlenecks and solutions required to meet the demand for future transport capacity; and (e) measures to be taken for maintenance and replacements. This document comprises chapters 10-12. In parts 1, 2 and 3 you can find the rest of the chapters [Dutch] Conform artikel 21 van de Elektriciteitswet 1998 is het titel document opgesteld. In dit document wordt en worden door TenneT (a) aangegeven welk kwaliteitsniveau wordt nagestreefd en wat de scores in de laatste drie jaar zijn geweest; (b) het kwaliteitbeheerssysteem beschreven; (c) de resultaten van de raming van de totale transportbehoefte beschreven voor de periode 2012-2021; (d) de knelpunten en oplossingen beschreven die nodig zijn om in de behoefte aan de toekomstige transportcapaciteit te kunnen voldoen; en (e) de maatregelen beschreven inzake vervanging en onderhoud. Dit document bevat de hoofdstukken 10-12. In de delen 1, 2 en 3 kunt u de overige hoofdstukken vinden.

  3. Evaluation of performance quality of an advanced scope physiotherapy role in a hospital emergency department

    Directory of Open Access Journals (Sweden)

    Morris J

    2015-07-01

    independent prescription of medicines, the ASoP-PT could have worked in an extended scope role, and his performance in meeting targets may have been better.Keywords: advanced scope physiotherapy practice, emergency department, quality indicators, satisfaction

  4. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

    Science.gov (United States)

    Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

    2014-02-01

    Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

  5. A Conceptual Model for Assessing Quality of Care for Patients Boarding in the Emergency Department: Structure-Process-Outcome

    Science.gov (United States)

    Liu, Shan W.; Singer, Sara J.; Sun, Benjamin C.; Camargo, Carlos A.

    2013-01-01

    Many believe that the “boarding” of emergency department (ED) patients awaiting inpatient beds compromises quality of care. To better study the quality of care of boarded patients, one should identify and understand the mechanisms accounting for any potential differences in care. This paper present a conceptual boarding “structure-process-outcome” model to help assess quality of care provided to boarded patients, and to aid in recognizing potential solutions to improve that quality, if it is deficient. The goal of the conceptual model is to create a practical framework on which a research and policy agenda can be based to measure and improve quality of care for boarded patients. PMID:21496148

  6. An Emerging Theory for Evidence Based Information Literacy Instruction in School Libraries, Part 2: Building a Culture of Inquiry

    Directory of Open Access Journals (Sweden)

    Carol A. Gordon

    2009-09-01

    Full Text Available Objective – The purpose of this paper is to articulate a theory for the use of action research as a tool of evidence based practice for information literacy instruction in school libraries. The emerging theory is intended to capture the complex phenomenon of information skills teaching as it is embedded in school curricula. Such a theory is needed to support research on the integrated approach to teaching information skills and knowledge construction within the framework of inquiry learning. Part 1 of this paper, in the previous issue, built a foundation for emerging theory, which established user‐centric information behavior and constructivist learning theory as the substantive theory behind evidence based library instruction in schools. Part 2 continues to build on the Information Search Process and Guided Inquiry as foundational to studying the information‐to‐knowledge connection and the concepts of help and intervention characteristic of 21st century school library instruction.Methods – This paper examines the purpose and methodology of action research as a tool of evidence based instruction. This is accomplished through the explication of three components of theory‐building: paradigm, substantive research, and metatheory. Evidence based practice is identified as the paradigm that contributes values and assumptions about school library instruction. It establishes the role of evidence in teaching and learning, linking theory and practice. Action research, as a tool of evidence based practice is defined as the synthesis of authentic learning, or performance‐based assessment practices that continuously generate evidence throughout the inquiry unit of instruction and traditional data collection methods typically used in formal research. This paper adds social psychology theory from Lewin’s work, which contributes methodology from Gestalt psychology, field theory, group dynamics, and change theory. For Lewin the purpose of action

  7. Quality Management in Higher Education: Towards a Better Understanding of an Emerging Field

    Science.gov (United States)

    Pratasavitskaya, Halina; Stensaker, Bjorn

    2010-01-01

    The article analyses how quality management is understood in higher education research. By reviewing a number of academic contributions addressing quality management issues in "Quality in Higher Education" from 1995-2008, the article identifies central concepts associated with quality management, discusses whether there are commonalities to be…

  8. Assessment of air quality benefits from national air pollution control policies in China. Part II: Evaluation of air quality predictions and air quality benefits assessment

    Science.gov (United States)

    Wang, Litao; Jang, Carey; Zhang, Yang; Wang, Kai; Zhang, Qiang; Streets, David; Fu, Joshua; Lei, Yu; Schreifels, Jeremy; He, Kebin; Hao, Jiming; Lam, Yun-Fat; Lin, Jerry; Meskhidze, Nicholas; Voorhees, Scott; Evarts, Dale; Phillips, Sharon

    2010-09-01

    Following the meteorological evaluation in Part I, this Part II paper presents the statistical evaluation of air quality predictions by the U.S. Environmental Protection Agency (U.S. EPA)'s Community Multi-Scale Air Quality (Models-3/CMAQ) model for the four simulated months in the base year 2005. The surface predictions were evaluated using the Air Pollution Index (API) data published by the China Ministry of Environmental Protection (MEP) for 31 capital cities and daily fine particulate matter (PM 2.5, particles with aerodiameter less than or equal to 2.5 μm) observations of an individual site in Tsinghua University (THU). To overcome the shortage in surface observations, satellite data are used to assess the column predictions including tropospheric nitrogen dioxide (NO 2) column abundance and aerosol optical depth (AOD). The result shows that CMAQ gives reasonably good predictions for the air quality. The air quality improvement that would result from the targeted sulfur dioxide (SO 2) and nitrogen oxides (NO x) emission controls in China were assessed for the objective year 2010. The results show that the emission controls can lead to significant air quality benefits. SO 2 concentrations in highly polluted areas of East China in 2010 are estimated to be decreased by 30-60% compared to the levels in the 2010 Business-As-Usual (BAU) case. The annual PM 2.5 can also decline by 3-15 μg m -3 (4-25%) due to the lower SO 2 and sulfate concentrations. If similar controls are implemented for NO x emissions, NO x concentrations are estimated to decrease by 30-60% as compared with the 2010 BAU scenario. The annual mean PM 2.5 concentrations will also decline by 2-14 μg m -3 (3-12%). In addition, the number of ozone (O 3) non-attainment areas in the northern China is projected to be much lower, with the maximum 1-h average O 3 concentrations in the summer reduced by 8-30 ppb.

  9. An alternative method for noise analysis using pixel variance as part of quality control procedures on digital mammography systems.

    NARCIS (Netherlands)

    Bouwman, R.; Young, K.; Lazzari, B.; Ravaglia, V.; Broeders, M.J.M.; Engen, R. van

    2009-01-01

    According to the European Guidelines for quality assured breast cancer screening and diagnosis, noise analysis is one of the measurements that needs to be performed as part of quality control procedures on digital mammography systems. However, the method recommended in the European Guidelines does

  10. 40 CFR Appendix P to Part 50 - Interpretation of the Primary and Secondary National Ambient Air Quality Standards for Ozone

    Science.gov (United States)

    2010-07-01

    ... the data handling procedures for the reported data). 2.3Comparisons with the Primary and Secondary... Secondary National Ambient Air Quality Standards for Ozone P Appendix P to Part 50 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY...

  11. [Potential for the survey of quality indicators based on a national emergency department registry : A systematic literature search].

    Science.gov (United States)

    Hörster, A C; Kulla, M; Brammen, D; Lefering, R

    2018-06-01

    Emergency department processes are often key for successful treatment. Therefore, collection of quality indicators is demanded. A basis for the collection is systematic, electronic documentation. The development of paper-based documentation into an electronic and interoperable national emergency registry is-besides the establishment of quality management for emergency departments-a target of the AKTIN project. The objective of this research is identification of internationally applied quality indicators. For the investigation of the current status of quality management in emergency departments based on quality indicators, a systematic literature search of the database PubMed, the Cochrane Library and the internet was performed. Of the 170 internationally applied quality indicators, 25 with at least two references are identified. A total of 10 quality indicators are ascertainable by the data set. An enlargement of the data set will enable the collection of seven further quality indicators. The implementation of data of care behind the emergency processes will provide eight additional quality indicators. This work was able to show that the potential of a national emergency registry for the establishment of quality indicators corresponds with the international systems taken into consideration and could provide a comparable collection of quality indicators.

  12. Quality control of outpatient imaging examinations in North Rhine-Westphalia. Part 1

    International Nuclear Information System (INIS)

    Krug, B.; Boettge, M.; Reinecke, T.; Zaehringer, M.; Smekal, U. v.; Winnekendonk, G.; Lackner, K.; Coburger, S.; Lehmacher, W.; Harnischmacher, U.; Luengen, M.; Lauterbach, K.W.

    2003-01-01

    Purpose: In the state of North-Rhine Westphalia (NRW), Germany, a survey was conducted on radiologic examinations ordered by general practitioners (GPs). Part I of this study aims to collect characteristic epidemiological data and to assess structural quality. Materials and methods: All GPs in NRW were asked to cooperate. Participating GPs filled out a questionnaire for each patient. The patients recorded the symptoms prompting the imaging examinations. The radiologists or other physicians performing the examinations were asked to provide the images and written reports and to complete a questionnaire. Two university radiologists documented the pertinent test data from the submitted images and written records. Independently of each other, five university radiologists anonymously reviewed the image quality of each examination using structured questionnaires. Results: A total of 920 patients gave their informed consent and participated. Questionnaires from 787 patients, 852 GPs and 611 radiologists or other interpreting physicians as well as the complete survey data from 530 examinations were available. Of 1503 examinations, conventional radiography made up 52%, sonography 17%, computed tomography (CT) 13% and magnetic resonance imaging (MRI) 5%. Most indications involved the musculoskeletal (37%) and respiratory systems (24%). Physicians without board certification in radiology interpreted 1% of the CT examinations, 26% of the radiographic examinations and 71% of the sonographic examinations. Of the 174 self-referrals, 1% involved CT, 33% conventional radiography and 66% sonography. Written reports were available for 95% of all 469 examinations performed by radiologists and 74% of all 127 examinations conducted by non-radiologists. Only 44% of the 23 sonographic studies were self-referrals by the patient's GP. On average, the radiographic techniques were acceptable in terms of diagnostic information and radiation hygiene. Conventional radiographs were better exposed

  13. American Board of Radiology Maintenance of Certification-Part IV: Practice Quality Improvement for Radiation Oncology

    International Nuclear Information System (INIS)

    Kun, Larry E.; Haffty, Bruce G.; Bosma, Jennifer; Strife, Janet L.; Hattery, Robert R.

    2007-01-01

    Maintenance of Certification is a physician-based response to public concerns about the quality of medical care and physician competency in a rapidly evolving, technically demanding specialty. American Board of Radiology (ABR) has previously described the first three components of the Maintenance of Certification. The ABR is currently developing a program in practice performance, completing Part IV of the competencies. The Practice Quality Improvement (PQI) program is meant to critically evaluate meaningful aspects of a physician's practice in a simple manner, using identifiable metrics and self-assessment to include an action plan for quality improvement. Each diplomate will be expected to complete three PQI projects during a full 10-year Maintenance of Certification cycle. Current diplomates with time-limited certificates will find prorated requirements determined by their year of certification on the ABR Website. Diplomates will have the option of completing zero to two Type I PQI projects (assessing factors relevant to clinical practice by peer review and self-reporting) and one to three Type II projects (i.e., at least one Type II projects of the three required, assessing parameters of practice by comparison with evidence-based guidelines, consensus statements, or peer comparisons; Type II projects are initiated and managed by professional societies). Several examples of Type I projects that might be offered by societies or directly through the ABR are provided, as well as highlights of the two Type II projects that have sought ABR qualification: American Society for Therapeutic Radiology and Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment program and American College of Radiology's RO-PEER program. An additional objective of the PQI is to develop national databases for future reference using aggregate data from the PQI projects

  14. Surface quality and topographic inspection of variable compliance part after precise turning

    Science.gov (United States)

    Nieslony, P.; Krolczyk, G. M.; Wojciechowski, S.; Chudy, R.; Zak, K.; Maruda, R. W.

    2018-03-01

    The paper presents the problem of precise turning of the mould parts with variable compliance and demonstrates a topographic inspection of the machined surface quality. The study was conducted for the cutting tools made of cemented carbide with coatings, in a range of variable cutting parameters. The long shaft with special axial hole, made of hardened 55NiCrMoV6 steel was selected as a workpiece. The carried out study included the stiffness measurement of the machining system, as well as the investigation of cutting force components. In this context, the surface topography parameters were evaluated using the stylus profile meter and analysed. The research revealed that the surface topography, alongside the 3D functional parameters, and PSD influences the performance of the machined surface. The lowest surface roughness parameters values, equalled to Sa = 1 μm and Sz = 4.3 μm have been obtained during turning with cutting speed vc = 90 m/min. The stable turning of variable compliance part affects the surface texture formation with a unidirectional perpendicular, anisotropic structure. Nevertheless, in case of unstable turning, the characteristic chatter marks are observed, and process dynamics has greater contribution in formation of surface finish than turning kinematics and elastic plastic deformation of workpiece.

  15. Total quality management for addressing suspect parts at the Oak Ridge High Flux Isotope Reactor

    International Nuclear Information System (INIS)

    Hendrix, K.A.; Tulay, M.P.

    1993-01-01

    Martin Marietta Energy System (MMES) Research Reactors Division (RRD), operator of the High Flux Isotope Reactor (HFIR) recently embarked on an aggressive Program to address the issue of suspect Parts and to enhance their procurement process. Through the application of TQM process improvement, RRD has already achieved improved efficiency in specifying, procuring, and accepting replacement items for its largest research reactor. These process improvements have significantly decreased the risk of installing suspect parts in the HFIR safety systems. To date, a systematic plan has been implemented, which includes the following elements: Process assessment and procedure review; Procedural enhancements; On-site training and technology transfer; Enhanced receiving inspections; Performance supplier evaluations and source verifications integrated processes for utilizing commercial grade products in nuclear safety-related applications. This paper will describe the above elements, how a partnership between MMES and Gilbert/Commonwealth facilitated the execution of the plan, and how process enhancements were applied. We will also present measures for improved efficiency and productivity, that MMES intends to continually address with Quality Action Teams

  16. Design and transient analyses of passive emergency feedwater system of CPR1000. Part 1. Air cooling condition

    International Nuclear Information System (INIS)

    Zhang Yapei; Qiu Suizheng; Su Guanghui; Tian Wenxi; Cao Jianhua; Lu Donghua; Fu Xiangang

    2011-01-01

    The steam generator secondary passive emergency feedwater system is a new design for traditional generation Ⅱ + reactor CPR1000. The passive emergency feedwater system is designed to supply water to the SG shell side and improve the safety and reliability of CPR1000 by completely or partially replacing traditional emergency water cooling system in the event of the feed line break (FLB) or loss of heat sink accident. The passive emergency feedwater system consists of steam generator (SG), heat exchanger (HX), air cooling tower, emergency makeup tank (EMT), and corresponding pipes and valves for air cooling condition. In order to improve the safety and reliability of CPR1000, the model of the primary loop system and the passive emergency feedwater system was developed to investigate residual heat removal capability of the passive emergency feedwater system and the transient characteristics of the primary loop system affected by the passive emergency feedwater system using RELAP5/MOD3.4. The transient characteristics of the primary loop system and the passive emergency feedwater system were calculated in the event of feed line break accident. Sensitivity studies of the passive emergency feedwater system were also conducted to investigate the response of the primary loop and the passive emergency feedwater system on the main parameters of the passive emergency feedwater system. The passive emergency feedwater system could supply water to the SG shell side from the EMT successfully. The calculation results showed that the passive emergency feedwater system could take away the decay heat from the primary loop effectively for air cooling condition, and that the single-phase and two-phase natural circulations were established in the primary loop and passive emergency feedwater system loop, respectively. (author)

  17. Ground-water conditions and quality in the western part of Kenai Peninsula, southcentral Alaska

    Science.gov (United States)

    Glass, R.L.

    1996-01-01

    The western part of Kenai Peninsula in southcentral Alaska is bounded by Cook Inlet and the Kenai Mountains. Ground water is the predominant source of water for commercial, industrial, and domestic uses on the peninsula. Mean daily water use in an oil, gas, and chemical processing area north of Kenai is more than 3.5 million gallons. Unconsolidated sediments of glacial and fluvial origin are the most productive aquifers. In the upper (northwestern) peninsula, almost all water used is withdrawn from unconsolidated sediments, which may be as thick as 750 feet. In the lower peninsula, unconsolidated sediments are thinner and are absent on many hills. Water supplies in the lower peninsula are obtained from unconsolidated sediments and bedrock, and a public-water supply in parts of Homer is obtained from Bridge Creek. Throughout the peninsula, ground-water flow occurs primarily as localized flow controlled by permeability of aquifer materials and surface topography. The concentration of constituents analyzed in water from 312 wells indicated that the chemical quality of ground water for human consumption varies from marginal to excellent. Even though the median concentration of dissolved solids is low (152 milligrams per liter), much of the ground water on the peninsula does not meet water-quality regulations for public drinking water established by the U.S. Environmental Protection Agency (USEPA). About 8 percent of wells sampled yielded water having concentrations of dissolved arsenic that exceeded the USEPA primary maximum contaminant level of 50 micrograms per liter. Concentrations of dissolved arsenic were as great as 94 micrograms per liter. Forty-six percent of wells sampled yielded water having concentrations of dissolved iron greater than the USEPA secondary maximum contaminant level of 300 micrograms per liter. Unconsolidated sediments generally yield water having calcium, magnesium, and bicarbonate as its predominant ions. In some areas, ground water at

  18. Pollution sources and groundwater quality in the Coastal region of the Yugoslav part of the Danube

    International Nuclear Information System (INIS)

    Komatina, S.

    1997-01-01

    In order to access the vulnerability and risk of the aquifer system in the Yugoslav part of the Danube, as the primary source of drinking water for a numerically substantial community, industrial purposes and irrigation, as well as a high concentration of civil, industrial and agricultural activities (hence, a potential source of pollution of the groundwater resources through land occupation and use as well as the disposal of solid and liquid wastes), a great hydro-geophysical exploration was performed. Within the lower part of the plain, exploratory test of Salinac field, near Smederevo town, was particularly investigated. The reason why is because that part is also an area of the mouth of the Velika Morava into the Danube, where Derdap reservoir is located. Task of complex exploration was to delineate the aquifer, obtain appropriate parameters (groundwater level, groundwater chemistry, clay content, filtration characteristics and physical parameters of geological functions), as well as to map the aquifer vulnerability, in order to prevent and moderate a harmful influence of the performed reservoir on the environment (increased groundwater infiltration from the reservoir into surrounding rocks, permanent groundwater level raising, etc.). Based on the results, zoning of the study area according to the aquifer vulnerability has been done. Then, land-use planning and development of strategy for groundwater protection and management was possible. In the paper, not only sources of contamination, characteristics of pollutants and their influence on the groundwater quality was presented, but also content of organic matters, phosphates and nitrogen compounds, etc. Further, means of protection and management are discussed, as well as the appropriate legal regulations. (author)

  19. In Case of Emergency Card - support of the emergency services and victims on accident site as a part of the campaigns to improve road safety

    Directory of Open Access Journals (Sweden)

    Witold Pawłowski

    2017-07-01

    Full Text Available Emergency medical services, police, firefighters and all others who provide first aid on-site emergency many times have hardness when they have to inform family or people related with victims. Some years ago italian medical rescuers suggest to mark some number in mobile phone in a special way to make contact with family easier. In the opinions of the Italian rescuers the best way to mark this number is to name it I.C.E. (In Case of Emergency. This kind of mark would make job of medical rescuers easier. More than one number in mobile phone should be called ICE1, ICE2, ICE3, etc. ICE begin in 2005 along the world. Its common in England, Italy, German. In Poland is popular from this year. I.C.E. is promoted by Polish Red Cross.

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

    Science.gov (United States)

    Zalai, Dénes; Dietzsch, Christian; Herwig, Christoph

    2013-01-01

    In the last few years, several quality by design (QbD) studies demonstrated the benefit of systematic approaches for biopharmaceutical development. However, only very few studies identified biosimilars as a special case of product development. The targeted quality profile of biosimilars is strictly defined by the originator's product characteristic. Moreover, the major source of prior knowledge is the experience with the originator product itself. Processing this information in biosimilar development has a major effect on risk management and process development strategies. The main objective of this contribution is to demonstrate how risk management can facilitate the implementation of QbD in early-stage product development with special emphasis on fitting the reported approaches to biosimilars. Risk assessments were highlighted as important tools to integrate prior knowledge in biosimilar development. The risk assessment process as suggested by the International Conference on Harmonization (ICH Q9) was reviewed and three elements were identified to play a key role in targeted risk assessment approaches: proper understanding of target linkage, risk assessment tool compliance, and criticality threshold value. Adjusting these steps to biosimilar applications helped to address some unique challenges of these products such as a strictly defined quality profile or a lack of process knowledge. This contribution demonstrates the need for tailored risk management approaches for the risk-based development of biosimilars and provides novel tools for the integration of additional knowledge available for these products. The pharmaceutical industry is facing challenges such as profit loss and price competition. Companies are forced to rationalize business models and to cut costs in development as well as manufacturing. These trends recently hinder the implementation of any concepts that do not offer certain financial benefit or promise a long return of investment. Quality by

  1. Measures of symptoms and life quality to predict emergent use of institutional health care resources in chronic obstructive airways disease.

    Science.gov (United States)

    Traver, G A

    1988-11-01

    Thirty subjects with severe chronic obstructive airways disease participated in a study to identify differences in symptoms and life quality between those with high and low emergent use of institutional health care resources. Emergent use was defined as care obtained through unscheduled, nonroutine methods of access to health care providers. There were 15 subjects in each group; the groups had similar sex distribution and were not significantly different for percent predicted forced expiratory volume in 1 second (mean 29.8%), use of home oxygen (15 of 30 subjects), or prevalence of CO2 retention (nine of 30). Symptoms and life quality were measured by using three paper and pencil tests, the Bronchitis-Emphysema Symptom Checklist, the Sickness-Impact Profile, and the Katz Adjustment Scale for relatives. Findings demonstrated consistently more symptoms and impairment of life quality in the "high emergent" group. The differences reached statistical significance for irritability, anxiety, helplessness, nervousness, peripheral sensory complaints, alienation, social interaction, and emotional behavior. Discriminant analysis provided a prediction formula that yielded 80% correct prediction for the two groups.

  2. Examining the relation between adolescent social anxiety, adolescent delinquency (abstention), and emerging adulthood relationship quality

    NARCIS (Netherlands)

    Mercer, N.; Crocetti, E; Meeus, W.H.J.; Branje, S

    2017-01-01

    Background and Objectives: Social anxiety symptoms and delinquency are two prevalent manifestations of problem behavior during adolescence and both are related to negative interpersonal relationships in adolescence and emerging adulthood. This study examined the relation between social anxiety and

  3. Examining the Relation Between Adolescent Social Anxiety, Adolescent Delinquency (Abstention), and Emerging Adulthood Relationship Quality

    NARCIS (Netherlands)

    Mercer, Natalie; Crocetti, Elisabetta; Meeus, Wim; Branje, Susan

    2017-01-01

    BACKGROUND AND OBJECTIVES: Social anxiety symptoms and delinquency are two prevalent manifestations of problem behavior during adolescence and both are related to negative interpersonal relationships in adolescence and emerging adulthood. This study examined the relation between social anxiety and

  4. Improving Emergency Attendance and Mortality – The Case for Unit ...

    African Journals Online (AJOL)

    BACKGROUND: Emergency attendance and mortality which are reliable indicators of quality of care, have been of concern to many health institutions. Different models are being proposed to improve emergency outcomes in different parts of the world. A model to separate a single emergency Unit into multiple emergency ...

  5. Emergent emotion

    OpenAIRE

    O'Connell, Elaine Finbarr

    2016-01-01

    I argue that emotion is an ontologically emergent and sui generis. I argue that emotion meets both of two individually necessary and jointly sufficient conditions for ontological emergence. These are, (i) that emotion necessarily has constituent parts to which it cannot be reduced, and (ii) that emotion has a causal effect on its constituent parts (i.e. emotion demonstrates downward causation).\\ud \\ud I argue that emotion is partly cognitive, partly constituted by feelings and partly perceptu...

  6. Health-related Quality of Life and Related Factors in Full-time and Part-time Workers.

    Science.gov (United States)

    Kim, Byungsung; Kim, Wonjoon; Choi, Hyunrim; Won, Changwon; Kim, Youngshin

    2012-07-01

    There has been a rapid increase in the number of part-time workers in Korea with little information available on associated changes in quality of life. This study was designed to compare part-time and full-time workers in terms of the quality of life and related factors. Data were extracted from the 4th Korea National Health and Nutrition Examination Survey, conducted in 2008. Of the 1,284 participants selected, 942 were females (range, 20 to 64 years). Based on the information provided by self-administered questionnaire, subjects were categorized according to the working pattern (full-time and part-time) and working hours (part-time group was associated with poorer quality of life (odds ratio [OR], 0.49; P = 0.028). For both sexes, the non-stress group was linked with superior quality of life in comparison to the stress group (OR, 2.64; P = 0.002; OR, 2.17; P < 0.001). Female employees engaged in non-manual labor had superior quality of life than those engaged in manual labor (OR, 1.40; P = 0.027). This study concludes that working less than 30 hours per week is related to lower quality of life in comparison to working 30 hours or more in male employees in Korea.

  7. Ensuring good governance to address emerging and re-emerging animal disease threats: supporting the veterinary services of developing countries to meet OIE international standards on quality.

    Science.gov (United States)

    Vallat, B; Mallet, E

    2006-04-01

    As an effect of increased globalisation, animal diseases, in particular those transmissible to man, have an immediate global economic and social impact. This fact, dramatically illustrated by the current avian influenza epizootic in South-East Asia and Eastern Europe, clearly demonstrates the crucial importance of the national Veterinary Services (VS) for the prevention, early detection and response for the efficient control of animal diseases. Complying with this mission for the VS presupposes the existence of appropriate governance and legislation and of an official system to control their quality and reliability- an obvious weakness in many developing and in transition countries. The World Organisation for Animal Health (OIE) has therefore developed a project aiming at strengthening the VS in those countries facing the greatest animal health threats and to bring them into line with OIE international standards already adopted by the same countries. Based on the evaluation of the VS and subsequent actions at the global, regional and national levels, the project will have a significant beneficial impact on the targeted countries as well as the international community as a whole, not only in the fields of agriculture, food security and production, and food safety, but also for the local and global prevention of emerging and re-emerging diseases of veterinary and public health importance. The project will be implemented in strong collaboration with the Food and Agriculture Organization. The actions proposed must be considered eligible for the concept of International Public Good.

  8. Part 1: Logging residues in piles - Needle loss and fuel quality. Part 2: Nitrogen leaching under piles of logging residues

    International Nuclear Information System (INIS)

    Lehtikangas, P.; Lundkvist, H.

    1991-01-01

    Part 1: Experimental piles were built in three geographical locations during May-Sept. 1989. Logging residues consisted of 95% spruce and 5% pine. Height of the piles varied between 80 and 230 cm. Needles were collected by placing drawers under 40 randomely chosen piles. The drawers were emptied every two weeks during the storage period. Natural needle loss was between 18 and 32% of the total amount of needles after the first two months of storage. At the end of the storage period, 24-42% of the needles had fallen down to the drawers. At the end of the experiment the total needle fall was 95-100% in the shaken piles. According to the results of this study piles smaller than 150 cm had the most effective needle fall. Piles should be placed on open places where the air and sun heat penetrate and dry them. Needles were the most sensitive fraction to variations in precipitation compared to the other components, such as branches. Piles usually dried quickly, but they also rewet easily. This was especially true in the smaller piles. The lowest moisture content was measured at the end of June. The ash content in needles varied between 4 and 8%. 16 refs., 15 figs. Part 2: Three field experiments were equipped with no-tension humus lysimeters. Pairs of lysimeters with the same humus/field layer vegetation material were placed in pairs, one under a pile of felling residues and another in the open clear felling. Leaching of nitrogen as well as pH and electric conductivity in the leachate was followed through sampling of the leachate at regular intervals. The results from the investigation show that: * the amount of leachate was higher in lysimeters in the open clear felling, * pH in the leachate was initially lower under piles of felling residues, * the amount of nitrogen leached was higher in the open clear felling. Thus, storing of felling residues in piles during the summer season did not cause any increase in nitrogen leaching, which had been considered to be a risk

  9. Water quality of the Mississippian carbonate aquifer in parts of middle Tennessee and northern Alabama, 1999

    Science.gov (United States)

    Kingsbury, James A.; Shelton, John M.

    2002-01-01

    Water-quality data for nitrate, fecal-indicator bacteria, pesticides, and volatile organic compounds collected in parts of Middle Tennessee and northern Alabama indicate that the Mississippian carbonate aquifer in these areas is susceptible to contamination from point and nonpoint sources. Thirty randomly located wells (predominantly domestic), two springs, and two additional public-supply wells were sampled in the summer of 1999 as part of the U.S. Geological Survey?s National Water-Quality Assessment (NAWQA) Program. These wells and springs were sampled to characterize the occurrence and distribution of the above constituents in this karst aquifer of Mississippian age and to determine the principal environmental factors related to their occurrence.Nitrate and fecal indicator bacteria were frequently detected at the sampled sites. Nitrate exceeded the drinking-water maximum contaminant level of 10 milligrams per liter in two samples; the median concentration for all samples was about 1.5 milligrams per liter. Correlation of nitrate concentrations to the amount of cropland near a site and to pesticide detections indicates that fertilizer application is the predominant source of nitrogen to the aquifer. Fecal-indicator bacteria were present in samples from about 40 percent of the sites. The presence of fecal-indicator bacteria is weakly correlated to the depth to ground water but is not correlated to a specific land use near the sites.Pesticides and pesticide breakdown products (metabolites) were detected at 74 percent of the sites sampled. Concentrations generally were less than 1 microgram per liter and no pesticide detections exceeded drinking-water maximum contaminant levels. The maximum total pesticide concentration measured was about 4 micrograms per liter. Intensity of pesticide use, proximity of sites to areas of pesticide application, and soil hydrologic group were the primary factors affecting the occurrence of pesticides.Volatile organic compounds were

  10. Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique. Part 1.

    Science.gov (United States)

    Redfern, S; Norman, I

    1999-07-01

    The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 includes the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and the conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. Congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis.

  11. Quality of registration for clinical trials published in emergency medicine journals.

    Science.gov (United States)

    Jones, Christopher W; Platts-Mills, Timothy F

    2012-10-01

    In 2005, the International Committee of Medical Journal Editors established clinical trial registration as a requirement for articles submitted to member journals, with the goal of improving the transparency of clinical research. The objective of this study is to characterize the registration of clinical trials published in emergency medicine journals. Randomized trials involving human subjects and published between June 1, 2008, and May 31, 2011 in the 5 emergency medicine journals with the highest impact factors were included. We assessed the clarity of registered primary outcomes, timing of registration relative to patient enrollment, and consistency between registered and published outcomes. Of the 123 trials included, registry entries were identified for 57 (46%). Of the 57 registered studies, 45 (79%) were registered after the initiation of subject enrollment, 9 (16%) had registered outcomes that were unclear, and 26 (46%) had discrepancies between registered and published outcomes. Only 5 studies were registered before patient enrollment with a clear primary outcome that was consistent with the published primary outcome. Annals of Emergency Medicine was the only journal in which the majority of trials were registered. Current compliance with clinical trial registration guidelines is poor among trials published in emergency medicine journals. Copyright © 2012. Published by Mosby, Inc.

  12. Guide for Developing High-Quality Emergency Operations Plans for Institutions of Higher Education

    Science.gov (United States)

    Office of Safe and Healthy Students, US Department of Education, 2013

    2013-01-01

    Our nation's postsecondary institutions are entrusted to provide a safe and healthy learning environment for students, faculty, and staff who live, work, and study on campus. Many of these emergencies occur with little to no warning; therefore, it is critical for institutions of higher education (IHEs) to plan ahead to help ensure the safety and…

  13. Gender differences in neurological emergencies part II: a consensus summary and research agenda on traumatic brain injury.

    Science.gov (United States)

    Wright, David W; Espinoza, Tamara R; Merck, Lisa H; Ratcliff, Jonathan J; Backster, Anika; Stein, Donald G

    2014-12-01

    Traumatic brain injury (TBI) is a major cause of death and disability worldwide. There is strong evidence that gender and sex play an important role across the spectrum of TBI, from pathophysiology to clinical care. In May 2014, Academic Emergency Medicine held a consensus conference "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." A TBI working group was formed to explore what was known about the influence of sex and gender on TBI and to identify gaps for future research. The findings resulted in four major recommendations to guide the TBI research agenda. © 2014 by the Society for Academic Emergency Medicine.

  14. Manual for best practice for emergency response procedures, part 3: a review of the department of Minerals and Energy guidelines relevant to inrushes, fires, explosions and other emergencies.

    CSIR Research Space (South Africa)

    Spencer, KC

    2000-02-01

    Full Text Available The relevant guidelines issued by the Department of Minerals and Energy were reviewed in light of the findings given in parts one and two of this report. The earlier guidelines were issued unilaterally by the Department of Minerals and Energy...

  15. 44 CFR Appendix A to Part 353 - Memorandum of Understanding Between Federal Emergency Management Agency and Nuclear Regulatory...

    Science.gov (United States)

    2010-10-01

    ... NRC that an emergency, unforeseen contingency, or other reason would prevent FEMA from providing a... they are revised to correct deficiencies noted in the Federal review. If, in FEMA's view, the plans...

  16. Preliminary Water-Table Map and Water-Quality Data for Part of the Matanuska-Susitna Valley, Alaska, 2005

    Science.gov (United States)

    Moran, Edward H.; Solin, Gary L.

    2006-01-01

    The Matanuska-Susitna Valley is in the northeastern part of the Cook Inlet Basin, Alaska, an area experiencing rapid population growth and development proximal to many lakes. Here water commonly flows between lakes and ground water, indicating interrelation between water quantity and quality. Thus concerns exist that poorer quality ground water may degrade local lake ecosystems. This concern has led to water-quality sampling in cooperation with the Alaska Department of Environmental Conservation and the Matanuska-Susitna Borough. A map showing the estimated altitude of the water table illustrates potential ground-water flow directions and areas where ground- and surface-water exchanges and interactions might occur. Water quality measured in selected wells and lakes indicates some differences between ground water and surface water. 'The temporal and spatial scarcity of ground-water-level and water-quality data limits the analysis of flow direction and water quality. Regionally, the water-table map indicates that ground water in the eastern and southern parts of the study area flows southerly. In the northcentral area, ground water flows predominately westerly then southerly. Although ground and surface water in most areas of the Matanuska-Susitna Valley are interconnected, they are chemically different. Analyses of the few water-quality samples collected in the area indicate that dissolved nitrite plus nitrate and orthophosphorus concentrations are higher in ground water than in surface water.'

  17. Quality control of outpatient imaging examinations in North Rhine-Westphalia. Part II

    International Nuclear Information System (INIS)

    Krug, B.; Boettge, M.; Zaehringer, M.; Reinecke, T.; Coburger, S.; Harnischmacher, U.; Luengen, M.; Lauterbach, K.W.; Lehmacher, W.; Lackner, K.

    2003-01-01

    Purpose: In the state of North Rhine-Westphalia (NRW), Germany, a survey was conducted on radiologic examinations ordered by general practitioners (GPs). Part II of this study aims to determine the quality of the process and outcome. The reference standard is the assessment of both radiologists and physicians without board certification in radiology working at a university hospital and in outpatient facilities. Materials and Methods: All GPs in NRW were asked to cooperate. Participating GPs filled out a questionnaire for each patient. The patients recorded the symptoms prompting the imaging examinations. The radiologists or other physicians performing the examinations were asked to provide the images and written reports and to complete a questionnaire. A file was created for each of the 394 patients with image documentation of at least one examination. Each file, which included medical history, physical findings, imaging documentation and written report, was sequentially forwarded to a board-certified radiologist and to a physician without board certification in radiology working in a university hospital and in an outpatient facility. All physicians were requested to complete a structured questionnaire for each file. Results: The referral diagnoses were rated as medically plausible in 81%, the indications for imaging found correct in 76%, the examination techniques considered appropriate in 69%, the clinical question answered in 63%, the interpretation judged medically correct in 50% and all incidental findings documented in 49%. In retrospect, 32% of the examinations were judged superfluous. The sequence of multiple examinations performed on a particular patient was rated as appropriate in 51%. The interpretation revealed specialty-related differences. The plausibility of the referral diagnoses had a significant impact on the appropriateness of subsequent diagnostic investigations. Marked deficits showed sonography, performance by non-radiologists, self

  18. The consumer quality index (CQ-index in an accident and emergency department: development and first evaluation

    Directory of Open Access Journals (Sweden)

    Bos Nanne

    2012-08-01

    Full Text Available Abstract Background Assessment of patients’ views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients’ experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E. Methods Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. Results Survey data of 304 (47% patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: ‘Attitude of the healthcare professionals’, ‘Environment and impression of the A&E’ and ‘Respect for and explanation to the patient’. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: ‘Attitude of the healthcare professionals’, ‘Information and explanation’, ‘Environment of the A&E’,’Leaving the A&E’ and ‘General information and rapidity of care’. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients’ health care expectations. In general, the highest improvement scores concerned patient information. Conclusions The Consumer Quality index for the accident and emergency department measures patients’ experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify

  19. Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project.

    Science.gov (United States)

    Fontaine, Guillaume; Forgione, Massimo; Lusignan, Francis; Lanoue, Marc-André; Drouin, Simon

    2018-05-01

    The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  20. Image and Imaging an Emergency Department: Expense and Benefit of Different Quality Assessment Methods

    Directory of Open Access Journals (Sweden)

    Carmen Andrea Pfortmueller

    2013-01-01

    Full Text Available Introduction. In this era of high-tech medicine, it is becoming increasingly important to assess patient satisfaction. There are several methods to do so, but these differ greatly in terms of cost, time, and labour and external validity. The aim of this study is to describe and compare the structure and implementation of different methods to assess the satisfaction of patients in an emergency department. Methods. The structure and implementation of the different methods to assess patient satisfaction were evaluated on the basis of a 90-minute standardised interview. Results. We identified a total of six different methods in six different hospitals. The average number of patients assessed was 5012, with a range from 230 (M5 to 20 000 patients (M2. In four methods (M1, M3, M5, and M6, the questionnaire was composed by a specialised external institute. In two methods, the questionnaire was created by the hospital itself (M2, M4.The median response rate was 58.4% (range 9–97.8%. With a reminder, the response rate increased by 60% (M3. Conclusion. The ideal method to assess patient satisfaction in the emergency department setting is to use a patient-based, in-emergency department-based assessment of patient satisfaction, planned and guided by expert personnel.

  1. Emerging contaminants of public health significance as water quality indicator compounds in the urban water cycle.

    Science.gov (United States)

    Pal, Amrita; He, Yiliang; Jekel, Martin; Reinhard, Martin; Gin, Karina Yew-Hoong

    2014-10-01

    The contamination of the urban water cycle (UWC) with a wide array of emerging organic compounds (EOCs) increases with urbanization and population density. To produce drinking water from the UWC requires close examination of their sources, occurrence, pathways, and health effects and the efficacy of wastewater treatment and natural attenuation processes that may occur in surface water bodies and groundwater. This paper researches in details the structure of the UWC and investigates the routes by which the water cycle is increasingly contaminated with compounds generated from various anthropogenic activities. Along with a thorough survey of chemicals representing compound classes such as hormones, antibiotics, surfactants, endocrine disruptors, human and veterinary pharmaceuticals, X-ray contrast media, pesticides and metabolites, disinfection-by-products, algal toxins and taste-and-odor compounds, this paper provides a comprehensive and holistic review of the occurrence, fate, transport and potential health impact of the emerging organic contaminants of the UWC. This study also illustrates the widespread distribution of the emerging organic contaminants in the different aortas of the ecosystem and focuses on future research needs. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Views of senior health personnel about quality of emergency obstetric care: A qualitative study in Nigeria.

    Science.gov (United States)

    Okonofua, Friday; Randawa, Abdullahi; Ogu, Rosemary; Agholor, Kingsley; Okike, Ola; Abdus-Salam, Rukayat Adeola; Gana, Mohammed; Abe, Eghe; Durodola, Adetoye; Galadanci, Hadiza

    2017-01-01

    Late arrival in hospital by women experiencing pregnancy complications is an important background factor leading to maternal mortality in Nigeria. The use of effective and timely emergency obstetric care determines whether women survive or die, or become near-miss cases. Healthcare managers have the responsibility to deploy resources for implementing emergency obstetric care. To determine the nature of institutional policies and frameworks for managing obstetric complications and reducing maternal deaths in Nigeria. Thirty-six hospital managers, heads of obstetrics department and senior midwives were interviewed about hospital infrastructure, resources, policies and processes relating to emergency obstetric care, whilst allowing informants to discuss their thoughts and feelings. The interviews were audiotaped, transcribed and analyzed using Atlas ti 6.2software. Hospital managers are aware of the seriousness of maternal mortality and the steps to improve maternal healthcare. Many reported the lack of policies and specific action-plans for maternal mortality prevention, and many did not purposely disburse budgets or resources to address the problem. Although some reported that maternal/perinatal audit take place in their hospitals, there was no substantive evidence and no records of maternal/perinatal audits were made available. Respondents decried the lack of appropriate data collection system in the hospitals for accurate monitoring of maternal mortality and identification of appropriate remediating actions. Healthcare managers are handicapped to properly manage the healthcare system for maternal mortality prevention. Relevant training of healthcare managers would be crucial to enable the development of strategic implementation plans for the prevention of maternal mortality.

  3. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  4. Manual for best practice for emergency response procedures, part 4: a checklist of best practice requirements for the prevention and management of inrushes, fires, explosions and other emergencies.

    CSIR Research Space (South Africa)

    Spencer, KC

    2000-02-01

    Full Text Available . Routine cleaning of air-cooled switchgear and transformers to prevent coal dust build up. 7.3.3.1 All protection relay settings verified and recorded. Check settings have not been altered without approval COL605PART4 CHECKLIST FOR BEST PRACTICES... and/or painted with intumescent paint. Routinely test for hot connections and overheating equipment. Routinely check fire warning system. Fire extinguishers - correct and sufficient. Can overload & overcurrent relays on switches feeding...

  5. Factors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service.

    Science.gov (United States)

    Oberholzer, Nicole; Kaserer, Alexander; Albrecht, Roland; Seifert, Burkhardt; Tissi, Mario; Spahn, Donat R; Maurer, Konrad; Stein, Philipp

    2017-07-01

    Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. For that purpose, this retrospective observational study included all patients with significant pain treated by a Swiss physician-staffed helicopter emergency service between April and October 2011 with the following characteristics to limit selection bias: Age > 15 years, numerical rating scale (NRS) for pain documented at the scene and at hospital admission, NRS > 3 at the scene, initial Glasgow coma scale > 12, and National Advisory Committee for Aeronautics score helicopter emergency service associated with insufficient pain management. A total of 778 patients were included in the analysis. Insufficient pain management (NRS > 3 at hospital admission) was identified in 298 patients (38%). Factors associated with insufficient pain management were higher National Advisory Committee for Aeronautics scores, high NRS at the scene, nontrauma patients, no analgesic administration, and treatment by a female physician. In 16% (128 patients), despite ongoing pain, no analgesics were administered. Factors associated with this untreated persisting pain were short time at the scene (below 10 minutes), secondary missions of helicopter emergency service, moderate pain at the scene, and nontrauma patients. Sufficient management of severe pain is significantly better if ketamine is combined with an opioid (65%), compared to a ketamine or opioid monotherapy (46%, P = .007). In the studied specific Swiss cohort, nontrauma patients, patients on secondary missions, patients treated only for a short time at the scene before transport, patients who receive no

  6. Some Equalities Are More Equal Than Others: Quality Equality Emerges Later Than Numerical Equality.

    Science.gov (United States)

    Sheskin, Mark; Nadal, Amber; Croom, Adam; Mayer, Tanya; Nissel, Jenny; Bloom, Paul

    2016-09-01

    By age 6, children typically share an equal number of resources between themselves and others. However, fairness involves not merely that each person receive an equal number of resources ("numerical equality") but also that each person receive equal quality resources ("quality equality"). In Study 1, children (N = 87, 3-10 years) typically split four resources "two each" by age 6, but typically monopolized the better two resources until age 10. In Study 2, a new group of 6- to 8-year-olds (N = 32) allocated resources to third parties according to quality equality, indicating that children in this age group understand that fairness requires both types of equality. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

  7. 40 CFR Appendix D to Part 132 - Great Lakes Water Quality Initiative Methodology for the Development of Wildlife Criteria

    Science.gov (United States)

    2010-07-01

    ... Methodology for the Development of Wildlife Criteria D Appendix D to Part 132 Protection of Environment... Development of Wildlife Criteria Great Lakes States and Tribes shall adopt provisions consistent with (as protective as) this appendix. I. Introduction A. A Great Lakes Water Quality Wildlife Criterion (GLWC) is the...

  8. Comparative quality measures of emergency care: an outcome cockpit proposal to survey clinical processes in real life

    Directory of Open Access Journals (Sweden)

    Burgemeister S

    2017-10-01

    Full Text Available Susanne Burgemeister,1 Alexander Kutz,1 Antoinette Conca,2 Thomas Holler,3 Sebastian Haubitz,1 Andreas Huber,4 Ulrich Buergi,5 Beat Mueller,1 Philipp Schuetz1 1University Department of Internal Medicine, Medical Faculty of the University of Basel, Kantonsspital Aarau, Basel, 2Department of Clinical Nursing Science, 3Department of Controlling and Quality Management, 4Department of Laboratory Medicine, 5Emergency Department, Kantonsspital Aarau, Aarau, Switzerland Background: Benchmarking of real-life quality of care may improve evaluation and comparability of emergency department (ED care. We investigated process management variables for important medical diagnoses in a large, well-defined cohort of ED patients and studied predictors for low quality of care. Methods: We prospectively included consecutive medical patients with main diagnoses of community-acquired pneumonia, urinary tract infection (UTI, myocardial infarction (MI, acute heart failure, deep vein thrombosis, and COPD exacerbation and followed them for 30 days. We studied predictors for alteration in ED care (treatment times, satisfaction with care, readmission rates, and mortality by using multivariate regression analyses.Results: Overall, 2986 patients (median age 72 years, 57% males were included. The median time to start treatment was 72 minutes (95% CI: 23 to 150, with a median length of ED stay (ED LOS of 256 minutes (95% CI: 166 to 351. We found delayed treatment times and longer ED LOS to be independently associated with main medical admission diagnosis and time of day on admission (shortest times for MI and longest times for UTI. Time to first physician contact (–0.01 hours, 95% CI: –0.03 to –0.02 and ED LOS (–0.01 hours, 95% CI: –0.02 to –0.04 were main predictors for patient satisfaction. Conclusion: Within this large cohort of consecutive patients seeking ED care, we found time of day on admission to be an important predictor for ED timeliness, which again

  9. Impact of chemical polishing on surface roughness and dimensional quality of electron beam melting process (EBM) parts

    Science.gov (United States)

    Dolimont, Adrien; Rivière-Lorphèvre, Edouard; Ducobu, François; Backaert, Stéphane

    2018-05-01

    Additive manufacturing is growing faster and faster. This leads us to study the functionalization of the parts that are produced by these processes. Electron Beam melting (EBM) is one of these technologies. It is a powder based additive manufacturing (AM) method. With this process, it is possible to manufacture high-density metal parts with complex topology. One of the big problems with these technologies is the surface finish. To improve the quality of the surface, some finishing operations are needed. In this study, the focus is set on chemical polishing. The goal is to determine how the chemical etching impacts the dimensional accuracy and the surface roughness of EBM parts. To this end, an experimental campaign was carried out on the most widely used material in EBM, Ti6Al4V. Different exposure times were tested. The impact of these times on surface quality was evaluated. To help predicting the excess thickness to be provided, the dimensional impact of chemical polishing on EBM parts was estimated. 15 parts were measured before and after chemical machining. The improvement of surface quality was also evaluated after each treatment.

  10. Penentuan Critical Parts Alat Bantu Pemeras Santan Menggunakan Quality Function Deployment Fase Kedua

    Directory of Open Access Journals (Sweden)

    Yuswono Hadi

    2017-08-01

    Full Text Available Some previous studies used QFD first phase method to obtain customer satisfaction of coconut milk squeezer machines, as follows: accelerates extortion process, reduces fatigue, easy to use, optimizes the output, strong construction, rustproof materials, compact design, easy to move, and hygienic. Study developing of the squeezer machine of coconut milk is required to deploy customer satisfaction into two parts including specifications and critical parts by using QFD second phase. There are 15 part specifications that obtained by discussing and interviewing with the experts. Then, 4 part specifications such as motor, pressing mechanism, production step, pressing strength, and volume of the cylinder were selected as main part to be used for QFD second phase. While there were 10 critical parts was derived from selected part specification such as pressure strength, hydraulic system, ON/OFF push button, cylinder clamps, the power and voltage that used for the machine,  the piston holder material, and its diameter.

  11. Quality is the key for emerging issues of population-based colonoscopy screening

    Directory of Open Access Journals (Sweden)

    Jin Young Yoon

    2018-01-01

    Full Text Available Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC. However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

  12. Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance

    Directory of Open Access Journals (Sweden)

    Jean-Paul Veronese

    2018-03-01

    Conclusion: Overall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.

  13. A World of Brands: Higher Education and the Emergence of Multinational Quality Franchises

    Science.gov (United States)

    Blanco Ramírez, Gerardo

    2014-01-01

    This article explores the concepts of "brand" and "franchise" in the development of international quality assurance. The impact of corporate language and culture on higher education is evident and has been extensively analysed. Recent attention given to branding of universities reflects the ever-growing influence of corporate…

  14. The Quality of Online Health-Related Information – an Emergent Consumer Health Issue

    Directory of Open Access Journals (Sweden)

    Nădăşan Valentin

    2016-12-01

    Full Text Available The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.

  15. Improving Safety, Quality and Efficiency through the Management of Emerging Processes: The TenarisDalmine Experience

    Science.gov (United States)

    Bonometti, Patrizia

    2012-01-01

    Purpose: The aim of this contribution is to describe a new complexity-science-based approach for improving safety, quality and efficiency and the way it was implemented by TenarisDalmine. Design/methodology/approach: This methodology is called "a safety-building community". It consists of a safety-behaviour social self-construction…

  16. Influences of Coal Ash Leachates and Emergent Macrophytes on Water Quality in Wetland Microcosms

    Science.gov (United States)

    The storage of coal combustion residue (CCR) in surface water impoundments may have an impact on nearby water quality and aquatic ecosystems. CCR contains leachable trace elements that can enter nearby waters through spills and monitored discharge. It is important, therefore, to ...

  17. ¿El proceso de enfermería hace parte de la calidad del cuidado? Is the nursing process part of quality care?

    Directory of Open Access Journals (Sweden)

    MYRIAM ABAUNZA DE GONZÁLEZ

    2007-12-01

    Full Text Available El principal propósito de este artículo es dar respuesta al siguiente interrogante: ¿El proceso de enfermería hace parte de la calidad del cuidado? Para sustentar la respuesta a la pregunta, se parte de referenciar varios autores que han hecho estudios sobre la utilización del método científico, del método de solución de problemas y del proceso de atención de enfermería y su relación con la calidad del servicio y del cuidado de enfermería, al mismo tiempo que se introducen experiencias relacionadas con proyectos de investigación tipo NIPE y Grupos relacionados con el Dx, y experiencias de evaluación de servicios de enfermería en algunos hogares y hospitales en Colombia, México, Cuba y Chile, en donde se aprecia que el proceso de enfermería es el que define el concepto enfermero aplicado. Se concluye que el proceso de enfermería como parte fundamental del cuidado de enfermería, al acortar estancias, disminuir el número de complicaciones y evitar los reingresos, contribuye a mejorar la calidad de su servicio y la calidad de vida de los pacientes/usuarios.The main purpose of this article is to answer the question: Is the nursing process part of quality care? In order to back the answer, it starts by mentioning several authors that have performed studies on the use of scientific methods, problem solving methods and the attention to care -innursing method and its relationship to the quality of service and the nursing care, while at the same time it introduces related experiences associated with NIPE research projects and related Groups with Dx, and evaluation experiences for nursing services in various homes and hospitals in Colombia, México, Cuba and Chile. There, one can appreciate that the nursing process is that which is defined by the concept of applied nurse. It concludes that by saying that the nursing process is fundamental to nursing care, because it shortens distances, reduces the number of complications and avoids

  18. Is the nursing process part of quality care? ¿El proceso de enfermería hace parte de la calidad del cuidado?

    Directory of Open Access Journals (Sweden)

    ABAUNZA DE GONZÁLEZ MYRIAM

    2007-12-01

    Full Text Available The main purpose of this article is to answer the question: Is the nursing process part of quality care? In order to back the answer, it starts by mentioning several authors that have performed studies on the use of scientific methods, problem solving methods and the attention to care -innursing method and its relationship to the quality of service and the nursing care, while at the same time it introduces related experiences associated with NIPE research projects and related Groups with Dx, and evaluation experiences for nursing services in various homes and hospitals in Colombia, México, Cuba and Chile. There, one can appreciate that the nursing process is that which is defined by the concept of applied nurse. It concludes that by saying that the nursing process is fundamental to nursing care, because it shortens distances, reduces the number of complications and avoids risks, while contributing to improve the quality of service and the quality of life of patients /users.El principal propósito de este artículo es dar respuesta al siguiente interrogante: ¿El proceso de enfermería hace parte de la calidad del cuidado? Para sustentar la respuesta a la pregunta, se parte de referenciar varios autores que han hecho estudios sobre la utilización del método científico, del método de solución de problemas y del proceso de atención de enfermería y su relación con la calidad del servicio y del cuidado de enfermería, al mismo tiempo que se introducen experiencias relacionadas con proyectos de investigación tipo NIPE y Grupos relacionados con el Dx, y experiencias de evaluación de servicios de enfermería en algunos hogares y hospitales en Colombia, México, Cuba y Chile, en donde se aprecia que el proceso de enfermería es el que define el concepto enfermero aplicado. Se concluye que el proceso de enfermería como parte fundamental del cuidado de enfermería, al acortar estancias, disminuir el número de complicaciones y evitar los

  19. Decision support for water quality management of contaminants of emerging concern.

    Science.gov (United States)

    Fischer, Astrid; Ter Laak, Thomas; Bronders, Jan; Desmet, Nele; Christoffels, Ekkehard; van Wezel, Annemarie; van der Hoek, Jan Peter

    2017-05-15

    Water authorities and drinking water companies are challenged with the question if, where and how to abate contaminants of emerging concern in the urban water cycle. The most effective strategy under given conditions is often unclear to these stakeholders as it requires insight into several aspects of the contaminants such as sources, properties, and mitigation options. Furthermore the various parties in the urban water cycle are not always aware of each other's requirements and priorities. Processes to set priorities and come to agreements are lacking, hampering the articulation and implementation of possible solutions. To support decision makers with this task, a decision support system was developed to serve as a point of departure for getting the relevant stakeholders together and finding common ground. The decision support system was iteratively developed in stages. Stakeholders were interviewed and a decision support system prototype developed. Subsequently, this prototype was evaluated by the stakeholders and adjusted accordingly. The iterative process lead to a final system focused on the management of contaminants of emerging concern within the urban water cycle, from wastewater, surface water and groundwater to drinking water, that suggests mitigation methods beyond technical solutions. Possible wastewater and drinking water treatment techniques in combination with decentralised and non-technical methods were taken into account in an integrated way. The system contains background information on contaminants of emerging concern such as physical/chemical characteristics, toxicity and legislative frameworks, water cycle entrance pathways and a database with associated possible mitigation methods. Monitoring data can be uploaded to assess environmental and human health risks in a specific water system. The developed system was received with great interest by potential users, and implemented in an international water cycle network. Copyright © 2017 Elsevier

  20. Short time synthesis of high quality carbon nanotubes with high rates by CVD of methane on continuously emerged iron nanoparticles

    International Nuclear Information System (INIS)

    Bahrami, Behnam; Khodadadi, Abasali; Mortazavi, Yadollah; Esmaieli, Mohamad

    2011-01-01

    We report the variation of yield and quality of carbon nanotubes (CNTs) grown by chemical vapor deposition (CVD) of methane on iron oxide-MgO at 900-1000 deg. C for 1-60 min. The catalyst was prepared by impregnation of MgO powder with iron nitrate, dried, and calcined at 300 deg. C. As calcined and unreduced catalyst in quartz reactor was brought to the synthesis temperature in helium flow in a few minutes, and then the flow was switched to methane. The iron oxide was reduced to iron nanoparticles in methane, while the CNTs were growing. TEM micrographs, in accordance with Raman RBM peaks, indicate the formation of mostly single wall carbon nanotubes of about 1.0 nm size. High quality CNTs with I G /I D Raman peak ratio of 14.5 are formed in the first minute of CNTs synthesis with the highest rate. Both the rate and quality of CNTs degrades with increasing CNTs synthesis time. Also CNTs quality sharply declines with temperature in the range of 900-1000 deg. C, while the CNTs yield passes through a maximum at 950 deg. C. About the same CNTs lengths are formed for the whole range of the synthesis times. A model of continuous emergence of iron nanoparticle seeds for CNTs synthesis may explain the data. The data can also provide information for continuous production of CNTs in a fluidized bed reactor.

  1. Short time synthesis of high quality carbon nanotubes with high rates by CVD of methane on continuously emerged iron nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Bahrami, Behnam, E-mail: bahrami@email.sc.edu [Catalysis and Nanostructured Materials Research Laboratory, School of Chemical Engineering, University of Tehran, Tehran (Iran, Islamic Republic of); Nanoelectronics Centre of Excellence, University of Tehran, Tehran (Iran, Islamic Republic of); Khodadadi, Abasali [Catalysis and Nanostructured Materials Research Laboratory, School of Chemical Engineering, University of Tehran, Tehran (Iran, Islamic Republic of); Mortazavi, Yadollah, E-mail: mortazav@ut.ac.ir [Nanoelectronics Centre of Excellence, University of Tehran, Tehran (Iran, Islamic Republic of); Esmaieli, Mohamad [Nanoelectronics Centre of Excellence, University of Tehran, Tehran (Iran, Islamic Republic of)

    2011-09-15

    We report the variation of yield and quality of carbon nanotubes (CNTs) grown by chemical vapor deposition (CVD) of methane on iron oxide-MgO at 900-1000 deg. C for 1-60 min. The catalyst was prepared by impregnation of MgO powder with iron nitrate, dried, and calcined at 300 deg. C. As calcined and unreduced catalyst in quartz reactor was brought to the synthesis temperature in helium flow in a few minutes, and then the flow was switched to methane. The iron oxide was reduced to iron nanoparticles in methane, while the CNTs were growing. TEM micrographs, in accordance with Raman RBM peaks, indicate the formation of mostly single wall carbon nanotubes of about 1.0 nm size. High quality CNTs with I{sub G}/I{sub D} Raman peak ratio of 14.5 are formed in the first minute of CNTs synthesis with the highest rate. Both the rate and quality of CNTs degrades with increasing CNTs synthesis time. Also CNTs quality sharply declines with temperature in the range of 900-1000 deg. C, while the CNTs yield passes through a maximum at 950 deg. C. About the same CNTs lengths are formed for the whole range of the synthesis times. A model of continuous emergence of iron nanoparticle seeds for CNTs synthesis may explain the data. The data can also provide information for continuous production of CNTs in a fluidized bed reactor.

  2. Environmental assessment of three egg production systems--Part I: Monitoring system and indoor air quality.

    Science.gov (United States)

    Zhao, Y; Shepherd, T A; Li, H; Xin, H

    2015-03-01

    To comprehensively assess conventional vs. some alternative laying-hen housing systems under U.S. production conditions, a multi-institute and multi-disciplinary project, known as the Coalition for Sustainable Egg Supply (CSES) study, was carried out at a commercial egg production farm in the Midwestern United States over two single-cycle production flocks. The housing systems studied include a conventional cage house (200,000 hen capacity), an aviary house (50,000 hen capacity), and an enriched colony house (50,000 hen capacity). As an integral part of the CSES project, continual environmental monitoring over a 27-month period described in this paper quantifies indoor gaseous and particulate matter concentrations, thermal environment, and building ventilation rate of each house. Results showed that similar indoor thermal environments in all three houses were maintained through ventilation management and environmental control. Gaseous and particulate matter concentrations of the enriched colony house were comparable with those of the conventional cage house. In comparison, the aviary house had poorer indoor air quality, especially in wintertime, resulting from the presence of floor litter (higher ammonia levels) and hens' activities (higher particulate matter levels) in it. Specifically, daily mean indoor ammonia concentrations had the 95% confidence interval values of 3.8 to 4.2 (overall mean of 4.0) ppm for the conventional cage house; 6.2 to 7.2 (overall mean of 6.7) ppm for the aviary house; and 2.7 to 3.0 (overall mean of 2.8) ppm for the enriched colony house. The 95% confidence interval (overall mean) values of daily mean indoor carbon dioxide concentrations were 1997 to 2170 (2083) ppm for the conventional cage house, 2367 to 2582 (2475) ppm for the aviary house, and 2124 to 2309 (2216) ppm for the enriched colony house. Daily mean indoor methane concentrations were similar for all three houses, with 95% confidence interval values of 11.1 to 11.9 (overall

  3. Environmental assessment of three egg production systems–Part I: Monitoring system and indoor air quality

    Science.gov (United States)

    Zhao, Y.; Shepherd, T. A.; Li, H.; Xin, H.

    2015-01-01

    To comprehensively assess conventional vs. some alternative laying-hen housing systems under U.S. production conditions, a multi-institute and multi-disciplinary project, known as the Coalition for Sustainable Egg Supply (CSES) study, was carried out at a commercial egg production farm in the Midwestern United States over two single-cycle production flocks. The housing systems studied include a conventional cage house (200,000 hen capacity), an aviary house (50,000 hen capacity), and an enriched colony house (50,000 hen capacity). As an integral part of the CSES project, continual environmental monitoring over a 27-month period described in this paper quantifies indoor gaseous and particulate matter concentrations, thermal environment, and building ventilation rate of each house. Results showed that similar indoor thermal environments in all three houses were maintained through ventilation management and environmental control. Gaseous and particulate matter concentrations of the enriched colony house were comparable with those of the conventional cage house. In comparison, the aviary house had poorer indoor air quality, especially in wintertime, resulting from the presence of floor litter (higher ammonia levels) and hens’ activities (higher particulate matter levels) in it. Specifically, daily mean indoor ammonia concentrations had the 95% confidence interval values of 3.8 to 4.2 (overall mean of 4.0) ppm for the conventional cage house; 6.2 to 7.2 (overall mean of 6.7) ppm for the aviary house; and 2.7 to 3.0 (overall mean of 2.8) ppm for the enriched colony house. The 95% confidence interval (overall mean) values of daily mean indoor carbon dioxide concentrations were 1997 to 2170 (2083) ppm for the conventional cage house, 2367 to 2582 (2475) ppm for the aviary house, and 2124 to 2309 (2216) ppm for the enriched colony house. Daily mean indoor methane concentrations were similar for all three houses, with 95% confidence interval values of 11.1 to 11.9 (overall

  4. Impacts of Realistic Urban Heating. Part II: Air Quality and City Breathability

    Science.gov (United States)

    Nazarian, Negin; Martilli, Alberto; Norford, Leslie; Kleissl, Jan

    2018-03-01

    Urban morphology and inter-building shadowing result in a non-uniform distribution of surface heating in urban areas, which can significantly modify the urban flow and thermal field. In Part I, we found that in an idealized three-dimensional urban array, the spatial distribution of the thermal field is correlated with the orientation of surface heating with respect to the wind direction (i.e. leeward or windward heating), while the dispersion field changes more strongly with the vertical temperature gradient in the street canyon. Here, we evaluate these results more closely and translate them into metrics of "city breathability," with large-eddy simulations coupled with an urban energy-balance model employed for this purpose. First, we quantify breathability by, (i) calculating the pollutant concentration at the pedestrian level (horizontal plane at z≈ 1.5 -2 m) and averaged over the canopy, and (ii) examining the air exchange rate at the horizontal and vertical ventilating faces of the canyon, such that the in-canopy pollutant advection is distinguished from the vertical removal of pollution. Next, we quantify the change in breathability metrics as a function of previously defined buoyancy parameters, horizontal and vertical Richardson numbers (Ri_h and Ri_v , respectively), which characterize realistic surface heating. We find that, unlike the analysis of airflow and thermal fields, consideration of the realistic heating distribution is not crucial in the analysis of city breathability, as the pollutant concentration is mainly correlated with the vertical temperature gradient (Ri_v ) as opposed to the horizontal (Ri_h ) or bulk (Ri_b ) thermal forcing. Additionally, we observe that, due to the formation of the primary vortex, the air exchange rate at the roof level (the horizontal ventilating faces of the building canyon) is dominated by the mean flow. Lastly, since Ri_h and Ri_v depend on the meteorological factors (ambient air temperature, wind speed, and

  5. Food risk management quality: Consumer evaluations of past and emerging food safety incidents

    NARCIS (Netherlands)

    Kleef, van E.; Ueland, O.; Theodoridis, G.; Rowe, G.; Pfenning, U.; Houghton, J.R.; Dijk, van H.; Chryssochoidis, G.; Frewer, L.J.

    2009-01-01

    In European countries, there has been growing consumer distrust regarding the motives of food safety regulators and other actors in the food chain, partly as a result of recent food safety incidents. If consumer confidence in food safety is to be improved, a systematic understanding of what

  6. Quality of Care as an Emergent Phenomenon out of a Small-World Network of Relational Actors.

    Science.gov (United States)

    Fiorini, Rodolfo; De Giacomo, Piero; Marconi, Pier Luigi; L'Abate, Luciano

    2014-01-01

    In Healthcare Decision Support System, the development and evaluation of effective "Quality of Care" (QOC) indicators, in simulation-based training, are key feature to develop resilient and antifragile organization scenarios. Is it possible to conceive of QOC not only as a result of a voluntary and rational decision, imposed or even not, but also as an overall system "emergent phenomenon" out of a small-world network of relational synthetic actors, endowed with their own personality profiles to simulate human behaviour (for short, called "subjects")? In order to answer this question and to observe the phenomena of real emergence we should use computational models of high complexity, with heavy computational load and extensive computational time. Nevertheless, De Giacomo's Elementary Pragmatic Model (EPM) intrinsic self-reflexive functional logical closure enables to run simulation examples to classify the outcomes grown out of a small-world network of relational subjects fast and effectively. Therefore, it is possible to take note and to learn of how much strategic systemic interventions can induce context conditions of QOC facilitation, which can improve the effectiveness of specific actions, which otherwise might be paradoxically counterproductive also. Early results are so encouraging to use EPM as basic block to start designing more powerful Evolutive Elementary Pragmatic Model (E2PM) for real emergence computational model, to cope with ontological uncertainty at system level.

  7. A model for emergency department end-of-life communications after acute devastating events--part I: decision-making capacity, surrogates, and advance directives.

    Science.gov (United States)

    Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

    2012-09-01

    Making decisions for a patient affected by sudden devastating illness or injury traumatizes a patient's family and loved ones. Even in the absence of an emergency, surrogates making end-of-life treatment decisions may experience negative emotional effects. Helping surrogates with these end-of-life decisions under emergent conditions requires the emergency physician (EP) to be clear, making medical recommendations with sensitivity. This model for emergency department (ED) end-of-life communications after acute devastating events comprises the following steps: 1) determine the patient's decision-making capacity; 2) identify the legal surrogate; 3) elicit patient values as expressed in completed advance directives; 4) determine patient/surrogate understanding of the life-limiting event and expectant treatment goals; 5) convey physician understanding of the event, including prognosis, treatment options, and recommendation; 6) share decisions regarding withdrawing or withholding of resuscitative efforts, using available resources and considering options for organ donation; and 7) revise treatment goals as needed. Emergency physicians should break bad news compassionately, yet sufficiently, so that surrogate and family understand both the gravity of the situation and the lack of long-term benefit of continued life-sustaining interventions. EPs should also help the surrogate and family understand that palliative care addresses comfort needs of the patient including adequate treatment for pain, dyspnea, or anxiety. Part I of this communications model reviews determination of decision-making capacity, surrogacy laws, and advance directives, including legal definitions and application of these steps; Part II (which will appear in a future issue of AEM) covers communication moving from resuscitative to end-of-life and palliative treatment. EPs should recognize acute devastating illness or injuries, when appropriate, as opportunities to initiate end-of-life discussions and to

  8. Independent oversight review of the Department of Energy Quality Assurance Program for suspect/counterfeit parts. Revision 1

    International Nuclear Information System (INIS)

    1996-05-01

    To address the potential threat that suspect/counterfeit parts could pose to DOE workers and the public, the Office of the Deputy Assistant Secretary for Oversight initiated a number of activities beginning in mid-1995. Oversight placed increased emphasis on the field's quality assurance-suspect/counterfeit parts programs during safety management evaluations, in keeping with the Office of Environment, Safety and Health (EH) oversight responsibilities, which include oversight of the Department's quality assurance (QA) programs. In addition, Oversight reviewed relevant policy documents and occurrence reports to determine the nature and magnitude of the problem within the Department. The results of that review, contained in an Office of Oversight report, Independent Oversight Analysis of Suspect/Counterfeit Parts Within the Department of Energy (November 1995), indicate a lack of consistency and comprehensiveness in the Department's QA-suspect/counterfeit parts program. A detailed analysis of the causes and impacts of the problem was recommended. In response, this review was initiated to determine the effectiveness of the Department's QA program for suspect/counterfeit parts. This study goes beyond merely assessing and reporting the status of the program, however. It is the authors intention to highlight the complex issues associated with suspect/counterfeit parts in the Department today and to present approaches that DOE managers might consider to address these issues

  9. Independent oversight review of the Department of Energy Quality Assurance Program for suspect/counterfeit parts. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    To address the potential threat that suspect/counterfeit parts could pose to DOE workers and the public, the Office of the Deputy Assistant Secretary for Oversight initiated a number of activities beginning in mid-1995. Oversight placed increased emphasis on the field`s quality assurance-suspect/counterfeit parts programs during safety management evaluations, in keeping with the Office of Environment, Safety and Health (EH) oversight responsibilities, which include oversight of the Department`s quality assurance (QA) programs. In addition, Oversight reviewed relevant policy documents and occurrence reports to determine the nature and magnitude of the problem within the Department. The results of that review, contained in an Office of Oversight report, Independent Oversight Analysis of Suspect/Counterfeit Parts Within the Department of Energy (November 1995), indicate a lack of consistency and comprehensiveness in the Department`s QA-suspect/counterfeit parts program. A detailed analysis of the causes and impacts of the problem was recommended. In response, this review was initiated to determine the effectiveness of the Department`s QA program for suspect/counterfeit parts. This study goes beyond merely assessing and reporting the status of the program, however. It is the authors intention to highlight the complex issues associated with suspect/counterfeit parts in the Department today and to present approaches that DOE managers might consider to address these issues.

  10. Cyanide intoxication as part of smoke inhalation--a review on diagnosis and treatment from the emergency perspective

    DEFF Research Database (Denmark)

    Lawson-Smith, Pia; Jansen, Erik C; Hyldegaard, Ole

    2011-01-01

    This paper reviews the current literature on smoke inhalation injuries with special attention to the effects of hydrogen cyanide. It is assumed that cyanide poisoning is still an overlooked diagnosis in fire victims. Treatment against cyanide poisoning in the emergency setting should be given based...

  11. Accumulation of contaminants of emerging concern in food crops-part 1: Edible strawberries and lettuce grown in reclaimed water.

    Science.gov (United States)

    Hyland, Katherine C; Blaine, Andrea C; Dickenson, Eric R V; Higgins, Christopher P

    2015-10-01

    Contaminants of emerging concern present in domestic waste streams include a highly diverse group of potentially biologically active compounds that can be detected at trace levels in wastewater. Concerns about potential uptake into crops arise when reclaimed water is used in food crop production. The present study investigated how 9 contaminants of emerging concern in reclaimed water are taken up into edible portions of two food crops. Two flame retardant chemicals, tris(1-chloro-2-propyl) phosphate (TCPP) and tris(2-chloroethyl) phosphate (TCEP) and several polar pharmaceuticals (carbamazepine, diphenhydramine, sulfamethoxazole, and trimethoprim) accumulated in a linear, concentration-dependent manner in lettuce (Lactuca sativa) irrigated with reclaimed water, suggesting passive uptake of both neutral and ionizable chemical contaminants in lettuce. Furthermore, concentration-dependent accumulation of TCEP and TCPP from reclaimed water was also observed in strawberry fruits (Fragaria ananassa). Collectively, these data suggest that highly polar or charged contaminants can be taken up by crops from water bearing contaminants of emerging concern and can be accumulated in the edible portions. Using these data, however, estimates of human exposure to these contaminants from reclaimed water food crop accumulation suggest that exposure to the contaminants of emerging concern examined in the present study is likely substantially lower than current exposure guidelines. © 2015 SETAC.

  12. Australasian emergency physicians: a learning and educational needs analysis. Part two: confidence of FACEM for tasks and skills.

    Science.gov (United States)

    Paltridge, Debbie; Dent, Andrew W; Weiland, Tracey J

    2008-02-01

    To determine the degree of confidence perceived by Fellows of the Australasian College for Emergency Medicine for a variety of procedural, patient management, educational and research skills, and tasks that may be required of them. Mailed survey with Likert scales and grouped qualitative responses. More than 90% of emergency physicians (EP) feel usually or always confident of their skills for peripheral vascular access, procedural sedation, fluid resuscitation, tube thoracostomy, managing patients with altered conscious state, cardiac emergencies, behavioural disturbance, and interpreting acid base and other blood tests. Less than 50% felt confident performing surgical airways, ED ultrasound, managing neonatal emergencies or interpreting MRI. Of non-clinical skills, while most EP were confident of their ability to write references, debrief staff, lead group tutorials and prepare slides, a minority felt usually or always confident about budgeting and finance, preparing submissions, dealing with the media, appearing in court or marking examination papers. Whilst nearly 75% were confident about the information technology skills required of them for clinical practice, less than 25% of EP felt confident about conducting research and less than 15% were confident applying or interpreting statistics. This information may assist in the planning of future educational interventions for EP.

  13. Evaluation of the quality of nursing records in the emergency department of a teaching hospital

    Directory of Open Access Journals (Sweden)

    Beatriz Araújo Seignemartin

    2014-01-01

    Full Text Available Nursing records are all systematized registers made by the nursing team, with legal and ethical implications on research, patient´s safety and communication among health professionals. This quantitative and retrospective cross-sectional study was conducted in a school hospital dedicated to the woman’s care, aiming at evaluating by auditing the quality of the nursing records. The 168 medical records were evaluated according to the standard established by the literature and the legislation of the Professional Council from January to June 2011. The importance of early contact with the patient, incomplete records or lack of information on the assistance rendered, besides nonconformities related to what is expected, were identified. The conclusion is that there is the need of periodic evaluations of the quality of the records and discussions on the results with the nursing team, on its importance regarding legislation, literature and the safety of patients.

  14. A reassessment of the indicators of primary education quality in developing countries: Emerging evidence from Tanzania

    Science.gov (United States)

    Mosha, Herme Joseph

    1988-03-01

    This article seeks to identify factors affecting the quality of primary education in five regions of Tanzania by extensively reviewing relevant literature and empirical data. Some of the shortcomings emphasised by the author are: frequent staff turnover, declining financial support for primary education, ineffective curricula, shortage of teachers' guides and textbooks, and unfavourable working conditions for teachers in rural areas. Beyond this, the need for freely available material, efficient school management and regular inspections is stressed by the author.

  15. Quality and consistency of guidelines for the management of mild traumatic brain injury in the emergency department.

    Science.gov (United States)

    Tavender, Emma J; Bosch, Marije; Green, Sally; O'Connor, Denise; Pitt, Veronica; Phillips, Kate; Bragge, Peter; Gruen, Russell L

    2011-08-01

    The objective was to provide an overview of the recommendations and quality of evidence-based clinical practice guidelines (CPGs) for the emergency management of mild traumatic brain injury (mTBI), with a view to informing best practice and improving the consistency of recommendations. Electronic searches of health databases (MEDLINE, EMBASE, The Cochrane Library, PsycINFO), CPG clearinghouse websites, CPG developer websites, and Internet search engines up to January 2010 were conducted. CPGs were included if 1) they were published in English and freely accessible, 2) their scope included the management of mTBI in the emergency department (ED), 3) the date of last search was within the past 10 years (2000 onward), 4) systematic methods were used to search for evidence, and 5) there was an explicit link between the recommendations and the supporting evidence. Four authors independently assessed the quality of the included CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) Instrument. The authors extracted and categorized recommendations according to initial clinical assessment, imaging, management, observation, discharge planning, and patient information and follow-up. The search identified 18 potential CPGs, of which six met the inclusion criteria. The included CPGs varied in scope, target population, size, and guideline development processes. Four CPGs were assessed as "strongly recommended." The majority of CPGs did not provide information about the level of stakeholder involvement (mean AGREE standardized domain score = 57%, range = 25% to 81%), nor did they address the organizational/cost implications of applying the recommendations or provide criteria for monitoring and review of recommendations in practice (mean AGREE standardized domain score = 46.6%, range = 19% to 94%). Recommendations were mostly consistent in terms of the use of the Glasgow Coma Scale (GCS) score (adult and pediatric) to assess the level of consciousness, initial

  16. A continuous quality improvement project to reduce medication error in the emergency department.

    Science.gov (United States)

    Lee, Sara Bc; Lee, Larry Ly; Yeung, Richard Sd; Chan, Jimmy Ts

    2013-01-01

    Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED. In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems. Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work. This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

  17. Quality of prescription of high-alert medication and patient safety in pediatric emergency

    Directory of Open Access Journals (Sweden)

    V. Vieira de Melo

    2014-01-01

    Full Text Available Objective: Verify the importance of compliance by prescribed doses of high-alert medications in unit of pediatric emergency in patient safety. Method: This was a cross-sectional descriptive study conducted in a unit of pediatric emergency, for March to April of 2012. This study included all prescriptions that contained at least one high-alert medication, excluding all of others. The data were analyzed using Microsoft Office Excel® version 2007, and the study was approved by the Research Ethics Committee of the Hospital. Results: This study included prescriptions for 100 patients with a mean age of 5.2 ± 4.2 years. Were identified 983 (40.1% high-alert medications (21 different, with predominance of injectable solutions (834, 84,8%, and of these 727 (73.95% were electrolytes. The analysis of the dose was possible for 641 electrolytes and 104 non-electrolytes, being the dose inadequacies observed for some medications. Was observed concentration absent to 189 (18.9% prescribed medications, these with liquid pharmaceutical form or aerosol. Was observed also the absence of maximum dose for 8 (36.3% prescribed drugs “if necessary”. Conclusión: The inadequacies of doses of high-alert medications identified in this study may compromise patient safety, demonstrating the importance of knowledge of multidisciplinary health care team by this subject, in this context, it is noteworthy that the acting of a clinical pharmacist together with the health multidisciplined team can contributes with the review of drug prescriptions, reducing potential errors and collaborating with patient safety.

  18. Comparing the Quality and Complications of Tube Thoracostomy by Emergency Medicine and Surgery Residents; a Cohort Study

    Directory of Open Access Journals (Sweden)

    Parvin Kashani

    2017-01-01

    Full Text Available Introduction: Tube thoracostomy complications depend on the operator’s skill, patients’ general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs and surgery residents (SRs.Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20.Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male. 23 (63.8% cases were complicated in SRs and 22 (61.1% cases in EMRs group (total= 62.5%. Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99, drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50, and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25 were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814 for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867 for EMRs.Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60% for both groups.

  19. Strategic Part Prioritization for Quality Improvement Practice Using a Hybrid MCDM Framework: A Case Application in an Auto Factory

    Directory of Open Access Journals (Sweden)

    Fuli Zhou

    2016-06-01

    Full Text Available Quality improvement practice (QIP, as a competitive strategy, is increasingly vital for auto factories to improve the product quality and brand reputation. Quality activity on selected automotive parts among a variety of competing candidates is featured by prioritization calculation. It arouses our interest how to select the appropriate auto part to perform quality improvement action based on the collected data from the after-sale source. Managers usually select the QIP part by the rule of thumb that is based on the quantitative criterion or the subjective preference of individuals. The total quality management (TQM philosophy requires multiple stakeholders’ involvement, regarded as a multi-criteria decision making (MCDM issue. This paper proposes a novel hybrid MCDM framework to select the best quality improvement solution combining the subjective and objective information. The rough set-based attribute reduction (RSAR technique was employed to establish the hierarchy structure of influential criteria, and the decision information was collected with triangular fuzzy numbers (TFNs for its vagueness and ambiguity. In addition, the novel hybrid MCDM framework integrating fuzzy DEMATEL (decision making trial and evaluation laboratory method, the anti-entropy weighting (AEW technique and fuzzy VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR was developed to rank the alternatives with the combined weight of criteria. The results argue that the optimal solution keeps a high conformance with Shemshadi’s and Chaghooshi’s methods, which is better than the existing determination. Besides, the result analysis shows the robustness and flexibility of the proposed hybrid MCDM framework.

  20. Expansion vs. Quality: Emerging Issues of For-Profit Private Higher Education Institutions in Ethiopia

    Science.gov (United States)

    Alemu, Daniel S.

    2010-02-01

    Private for-profit higher education has been rapidly expanding in developing countries worldwide since the early 1990s. This global trend has been particularly evident in Ethiopia, where only three public universities existed until 1996. By 2005, about 60 private for-profit higher education institutions had been founded in Ethiopia. This has led to mixed feelings among the Ethiopian public. While some laud the opportunities and advantages these new institutions bring, others are apprehensive that the quality of education might be compromised by an expansion motivated by monetary gain. This article sheds light on these paradoxes and provides suggestions for policy and practices.

  1. Quality assessment of emergency wards in Khorramabad public hospitals based on EFQM model

    Directory of Open Access Journals (Sweden)

    mohammad hasan Imani-Nasab

    2012-12-01

    Conclusion: Findings show that quality of studied wards is less than the model standards and other similar studies considerably. From view point of the researcher the existing gap with external studies is logical and in comparison with internal studies is irrational. The studied wards acquired the most score in process criterion and the least score in policy and strategy criterion. Also ,findings shows a negative relation between results of assessment based on EFQM model and current evaluation system of the ministry of health, so it is suggested that the current system should be revised fundamenally.

  2. Heating, Ventilation and Air-Conditioning Systems, Part of Indoor Air Quality Design Tools for Schools

    Science.gov (United States)

    The main purposes of a Heating, Ventilation, and Air-Conditioning system are to help maintain good indoor air quality through adequate ventilation with filtration and provide thermal comfort. HVAC systems are among the largest energy consumers in schools.

  3. The quality and safety of nuclear plants: the part played by the administrative authorities

    International Nuclear Information System (INIS)

    Queniart, Daniel

    1976-01-01

    After specifying the notions of 'safety' and 'quality', the terms and conditions governing the intervention of the public authorities in the matter of safety of nuclear plants are described: individual permits, the establishing and application of technical rules of a general character, surveillance of the plants. The criteria and regulations guiding the evaluation of safety and quality and, in conclusion, insisting on the necessity for permanent discussions among the various organizations concerned are presented [fr

  4. Emergencies in Orthodontics. Part 2: Management of Removable Appliances, Functional Appliances and other Adjuncts to Orthodontic Treatment.

    Science.gov (United States)

    Dowsing, Paul; Murray, Alison; Sandler, Jonathan

    2015-04-01

    In the second of two papers, management of orthodontic emergencies involving appliances other than Fixed appliances will be detailed. Problems relating to removable appliances, as well as other orthodontic adjuncts, will be discussed. Unfortunately, orthodontic appliance breakage does occur, despite the clinicians giving clear and concise instructions to the patients and their parents at fitting. If general dental practitioners have a practical knowledge of how to diagnose problems and to provide appropriate advice or timely 'emergency' treatment, this will significantly reduce the inconvenience for all parties concerned. It should also ensure that treatment progresses in the most efficient and comfortable manner for their patients. In specific situations the early, accurate identification of the problem and instigation of its appropriate management can avoid more serious consequences. Clinical Relevance: Appropriate handling of an orthodontic 'emergency' by the dentist can, on many occasions, provide immediate relief to the patient. This will, in turn, allow treatment to continue in the right direction, thus allowing more efficient and effective use of valuable resources.

  5. On the development of high quality NiTi shape memory and pseudoelastic parts by additive manufacturing

    International Nuclear Information System (INIS)

    Haberland, Christoph; Elahinia, Mohammad; Walker, Jason M; Meier, Horst; Frenzel, Jan

    2014-01-01

    Additive manufacturing provides an attractive processing method for nickel–titanium (NiTi) shape memory and pseudoelastic parts. In this paper, we show how the additive manufacturing process affects structural and functional properties of additively manufactured NiTi and how the process parameter set-up can be optimized to produce high quality NiTi parts and components. Comparisons of shape recovery due to shape memory and pseudoelasticity in additively manufactured and commercial NiTi exhibit promising potential for this innovative processing method. (paper)

  6. Between hermeneutics and datascapes: a critical appreciation of emergent landscape design theory and praxis through the writings of James Corner 1990-2000(Part One

    Directory of Open Access Journals (Sweden)

    Richard Weller

    2001-03-01

    Full Text Available This two-part essay examines the theoretical work of James Corner across the 1990s. Part one begins with a polemical analysis of Corner's originating notion of a hermeneutic practice of design as published in Landscape Journal in 1991. The essay necessarily broaches themes of ecology, critical regionalism and the broader panoramas of landscape planning as they are encountered in Corner's writings. Part one identifies an emergent dialectic between landscape architecture as scenography or infrastructure in his writings. In order to appreciate Corner's work, part one establishes and discusses the philosophical grounding of his position. Part one is concerned with theory, part two with praxis. Part two, following Corner's lead, summarises and comments upon some emerging design methods and specific design projects so as to situate the issues raised in part one. Part two begins with the unbuilt Parc de la Villette of 1982 by Rem Koolhaas and discusses its ramifications. Part two revolves around arguments put forward by Corner in the late 1990s for the agency of landscape design as structuring development rather than symbolising culture and nature, arguments tor what landscape design does not only what it means. To facilitate this, the writings of Bart Lootsma and Alex Wall who, along with Corner, presented the most pertinent and provocative themes in Corner's latest book Recovering Landscape: Essays in Contemporary Landscape Architecture, are considered in some detail. Part two concludes with thoughts on datascaping - a new design methodology synonymous with current trends in Dutch urbanism and one that impresses Corner with its capacity to manage and manipulate complex design programmes. Taken as a whole the essay offers neither a set of findings nor feigns conclusion; rather, it goes to the co-ordinates Corner has set out and explores the field they demarcate. The essay does, however, seek to qualify the claim that James Corner is articulating a

  7. Interaction between litter quality and simulated water depth on decomposition of two emergent macrophytes

    Directory of Open Access Journals (Sweden)

    Yajun Xie

    2015-07-01

    Full Text Available Both water depth and litter quality are important factors influencing litter decomposition in wetlands, but the interactive role of these factors in regulating mass loss and nutrient dynamics is far from clear. The responses of mass loss and nutrient dynamics to simulated water depths and litter quality are investigated in leaves of Carex brevicuspis and leaves and stems of Miscanthus sacchariflorus from the Dongting Lake, China. Three litter types differing in litter quality were incubated for 210 days at three water depths (0 cm, 5 cm, and 80 cm, relative to the water surface in a pond near the Dongting Lake. The litter mass remaining, nitrogen (N, phosphorus (P, organic carbon (organic C, cellulose, and lignin contents were analyzed during the controlled decomposition experiment. Moreover, water properties (temperature, dissolved oxygen content, and conductivity and fungal biomass were also characterized. Initial N and P contents were highest in C. brevicuspis leaves, intermediate in M. sacchariflorus leaves and lowest in M. sacchariflorus stems, whereas the organic C, cellulose, and lignin contents exhibited an opposite trend. After a 210 days incubation, decomposition rate was highest in M. sacchariflorus leaves (0.0034–0.0090 g g-1 DW day-1, in exponential decay model, intermediate in C. brevicuspis leaves (0.0019–0.0041 g g-1 DW day-1, and lowest in M. sacchariflorus stems (0.0005–0.0011 g g-1DW day-1. Decomposition rate of C. brevicuspis leaves was highest at 5 cm water depth, intermediate at 80 cm, and lowest at 0 cm. Decomposition rate of M. sacchariflorus leaves was higher at 5 cm, and 80 cm than at 0 cm water depths. Water depth had no effect on decomposition of M. sacchariflorus stems. At the end of incubation, N and P mineralization was completely in leaf litters with increasing rates along with increasing water depth, while nutrients were accumulated in M. sacchariflorus stem. Organic C, cellulose, and lignin decayed quickly

  8. Virgin olive oil color and perceived quality among consumers in emerging olive-growing countries

    Directory of Open Access Journals (Sweden)

    Gámbaro, A.

    2014-06-01

    Full Text Available Five virgin olive oil samples were evaluated by 122 consumers for their color acceptability and expected quality on 9-point structured scales. A description of the attributes expected in the different oils was obtained from the responding consumers by means of a check-all-that-apply questionnaire consisting of a list of 17 possible virgin olive oil attributes. Hierarchical cluster analysis led to the identification of two consumer clusters with distinct behavior. Whereas one consumer cluster attributed higher quality to those oils that were greener in color, which they described as tasty, rich-flavored, strong-tasting, herb-flavored and expensive, consumers in the other cluster assumed that greener olive oils were of a poorer quality, as they described them as strange-tasting, strong-tasting, herb-tasting and defective. Despite the contrasting perception of a virgin olive oil’s green color, the respondents, irrespective of cluster, presumed that the virgin olive oil that was the yellowest in color was of poor quality and cheap, also assuming that it had a milder taste than the other oils.122 consumidores evaluaron el color de 5 muestras de aceite de oliva virgen, midiendo su aceptabilidad y la calidad esperada por medio de una escala estructurada de 9 puntos y describiéndolas por medio de preguntas “marque todo lo que corresponde” que consiste en una lista de 17 términos posibles para atributos de aceites de oliva extra vírgenes. Mediante un análisis de conglomerados jerárquico se identificó a dos grupos de consumidores Los consumidores de ambos grupos consideraron que los aceites más amarillos eran de baja calidad, describiéndolos como baratos y de gusto suave. Un grupo de consumidores asignó puntuaciones de calidad alta a todos los aceites con colores verdes, describiéndolos como sabrosos, aromáticos, con gusto fuerte, con sabor a hierba y caros. El otro grupo de consumidores consideró que los aceites de color verde m

  9. Guidelines for the processing and quality assurance of benthic invertebrate samples collected as part of the National Water-Quality Assessment Program

    Science.gov (United States)

    Cuffney, T.F.; Gurtz, M.E.; Meador, M.R.

    1993-01-01

    Benthic invertebrate samples are collected as part of the U.S. Geological Survey's National Water-Quality Assessment Program. This is a perennial, multidisciplinary program that integrates biological, physical, and chemical indicators of water quality to evaluate status and trends and to develop an understanding of the factors controlling observed water quality. The Program examines water quality in 60 study units (coupled ground- and surface-water systems) that encompass most of the conterminous United States and parts of Alaska and Hawaii. Study-unit teams collect and process qualitative and semi-quantitative invertebrate samples according to standardized procedures. These samples are processed (elutriated and subsampled) in the field to produce as many as four sample components: large-rare, main-body, elutriate, and split. Each sample component is preserved in 10-percent formalin, and two components, large-rare and main-body, are sent to contract laboratories for further processing. The large-rare component is composed of large invertebrates that are removed from the sample matrix during field processing and placed in one or more containers. The main-body sample component consists of the remaining sample materials (sediment, detritus, and invertebrates) and is subsampled in the field to achieve a volume of 750 milliliters or less. The remaining two sample components, elutriate and split, are used for quality-assurance and quality-control purposes. Contract laboratories are used to identify and quantify invertebrates from the large-rare and main-body sample components according to the procedures and guidelines specified within this document. These guidelines allow the use of subsampling techniques to reduce the volume of sample material processed and to facilitate identifications. These processing procedures and techniques may be modified if the modifications provide equal or greater levels of accuracy and precision. The intent of sample processing is to

  10. Just In Time Value Chain Total Quality Management Part Of Technical Strategic Management Accounting

    Directory of Open Access Journals (Sweden)

    Lesi Hertati

    2015-08-01

    Full Text Available This article aims to determine Just In Time Value Chain Total Quality Management tqm as a technique in management accounting stategis.Tujuan Just In Time value chain or value chain Total Quality Management TQM is strategic for customer satisfaction in the long term obtained from the information. Quality information is the way to continuous improvement in order to increase the companys financial performance in the long term to increase competitive advantage. Strategic Management Accounting process gather competitor information explore opportunities to reduce costs integrate accounting with emphasis on the strategic position of the competition is a great plan. An overall strategic plan interrelated and serves as the basis for achieving targets or goals ahead.

  11. Developing and evaluating the success of a family activated medical emergency team: a quality improvement report.

    Science.gov (United States)

    Brady, Patrick W; Zix, Julie; Brilli, Richard; Wheeler, Derek S; Griffith, Kristie; Giaccone, Mary Jo; Dressman, Kathy; Kotagal, Uma; Muething, Stephen; Tegtmeyer, Ken

    2015-03-01

    Family-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. We aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU). The setting was our free-standing children's hospital. We partnered with families to develop and test an educational intervention for clinicians and families, an informational poster in each patient room and a redesigned process with hospital operators who handle MET calls. We tracked our primary outcome of count of family-activated MET calls on a statistical process control chart. Additionally, we determined the association between family-activated versus clinician-activated MET and transfer to the ICU. Finally, we compared the reason for MET activation between family calls and a 2:1 matched sample of clinician calls. Over our 6-year study period, we had a total of 83 family-activated MET calls. Families made an average of 1.2 calls per month, which represented 2.9% of all MET calls. Children with family-activated METs were transferred to the ICU less commonly than those with clinician MET calls (24% vs 60%, pFamilies, like clinicians, most commonly called MET for concerns of clinical deterioration. Families also identified lack of response from clinicians and a dismissive interaction between team and family as reasons. Family MET activations were uncommon and not a burden on responders. These calls recognised clinical deterioration and communication failures. Family activated METs should be tested and implemented in hospitals that care for children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. The emergence of leaders and followers in foraging pairs when the qualities of individuals differ

    Directory of Open Access Journals (Sweden)

    Cowlishaw Guy

    2008-02-01

    Full Text Available Abstract Background Foraging in groups offers animals a number of advantages, such as increasing their likelihood of finding food or detecting and avoiding predators. In order for a group to remain together, there has to be some degree of coordination of behaviour and movement between its members (which may in some cases be initiated by a decision-making leader, and in other cases may emerge as an underlying property of the group. For example, behavioural synchronisation is a phenomenon where animals within a group initiate and then continue to conduct identical behaviours, and has been characterised for a wide range of species. We examine how a pair of animals should behave using a state-dependent approach, and ask what conditions are likely to lead to behavioural synchronisation occurring, and whether one of the individuals is more likely to act as a leader. Results The model we describe considers how the energetic gain, metabolic requirements and predation risks faced by the individuals affect measures of their energetic state and behaviour (such as the degree of behavioural synchronisation seen within the pair, and the value to an individual of knowing the energetic state of its colleague. We explore how predictable changes in these measures are in response to changes in physiological requirements and predation risk. We also consider how these measures should change when the members of the pair are not identical in their metabolic requirements or their susceptibility to predation. We find that many of the changes seen in these measures are complex, especially when asymmetries exist between the members of the pair. Conclusion Analyses are presented that demonstrate that, although these general patterns are robust, care needs to be taken when considering the effects of individual differences, as the relationship between individual differences and the resulting qualitative changes in behaviour may be complex. We discuss how these results are

  13. Microgrids: An emerging paradigm for meeting building electricity and heat requirements efficiently and with appropriate energy quality

    Energy Technology Data Exchange (ETDEWEB)

    Marnay, Chris; Firestone, Ryan [Berkeley Lab MS 90R4000 (United States)

    2007-07-01

    The first major paradigm shift in electricity generation, delivery, and control is emerging in the developed world, notably Europe, North America, and Japan. This shift will move electricity supply away from the highly centralised universal service quality model with which we are familiar today towards a more dispersed system with heterogeneous qualities of service. One element of dispersed control is the clustering of sources and sinks into semi-autonomous {mu}grids (microgrids). Research, development, demonstration, and deployment (RD3) of {mu}grids are advancing rapidly on at least three continents, and significant demonstrations are currently in progress. This paradigm shift will result in more electricity generation close to end-uses, often involving combined heat and power application for building heating and cooling, increased local integration of renewables, and the possible provision of heterogeneous qualities of electrical service to match the requirements of various end-uses. In Europe, microgrid RD3 is entering its third major round under the 7th European Commission Framework Programme; in the U.S., one specific microgrid concept is undergoing rigorous laboratory testing, and in Japan, where the most activity exists, four major publicly sponsored and two privately sponsored demonstrations are in progress. This evolution poses new challenges to the way buildings are designed, built, and operated. Traditional building energy supply systems will become much more complex in at least three ways: 1. one cannot simply assume gas arrives at the gas meter, electricity at its meter, and the two systems are virtually independent of one another; rather, energy conversion, heat recovery and use, and renewable energy harvesting may all be taking place simultaneously within the building energy system; 2. the structure of energy flows in the building must accommodate multiple energy processes in a manner that permits high overall efficiency; and 3. multiple qualities

  14. The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

    Science.gov (United States)

    Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn

    2015-01-01

    To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an

  15. Health-related quality of life for pediatric emergency department febrile illnesses: an Evaluation of the Pediatric Quality of Life Inventory™ 4.0 generic core scales

    Directory of Open Access Journals (Sweden)

    Stevens Molly W

    2009-01-01

    Full Text Available Abstract Objective We sought to assess the validity and short-term responsiveness of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™ for febrile illnesses evaluated in the pediatric emergency department (ED. Design Prospective cohort study of children 2–18 years discharged after ED evaluation for fever (≥ 38°C. Self-administered, parent-report of health-related quality of life (HRQOL was assessed using the PedsQL™ Acute Version, a validated HRQOL instrument. HRQOL was measured on ED presentation and at 7–10 day follow-up. At follow-up, duration of fever, child functional impairment, missed daycare/school, and disrupted family unit functioning, were assessed. Results Of 160 subjects enrolled, 97 (61% completed the study; mean follow-up was 8.7 days. Mean total HRQOL score on ED presentation was 76.4; mean follow-up score was 86.3. Compared to subjects that returned to baseline, statistically significant differences in HRQOL were noted for those with prolonged fever, child functional impairment, and relapse. Significant correlation was observed between HRQOL at follow-up and days of daycare/school missed (r = -0.35, p = .003 and days of family disruption (r = -0.43, p Conclusion The PedsQL™ appears to be a valid and responsive indicator of HRQOL for short-term febrile illnesses evaluated in the ED.

  16. A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway

    Directory of Open Access Journals (Sweden)

    Staff Trine

    2011-03-01

    Full Text Available Abstract Background Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs. Methods Records from police, Emergency Medical Communication Centers (EMCC, ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS, respiratory rate (RR, and systolic blood pressure (SBP was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend. Results 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: p Conclusion EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research.

  17. The Effects of the Sleep Quality of 112 Emergency Health Workers in Kayseri, Turkey on Their Professional Life

    Directory of Open Access Journals (Sweden)

    Vesile SENOL

    2014-12-01

    Full Text Available SUMMARY: Objectives: Sleep adequacy is one of the major determinants of a successful professional life. The aim of this study is to determine the sleep quality of emergency health workers and analyze its effects on their professional and social lives. Methods: The study was carried out on 121 voluntary emergency health workers in 112 Emergency Aid Stations in Kayseri, Turkey, in 2011. The data was collected through the Socio-Demographics Form and the Pittsburgh Sleep Quality Index (PSQI and analyzed via SPSS 18.00. The statistical analysis involved percentage and frequency distributions, mean±standard deviations, a chi-square test, correlations, and logistic regression analysis. Results: The mean score of the participants according to the Pittsburgh Sleep Quality Index was 4.14±3.09, and 28.9% of participants had poor sleep quality. Being single and being a woman accounted for 11% (p=0.009, 95% CI: 0.111–0.726 and 7% (p=0.003, 95% CI: 0.065–0.564 of poor sleep quality respectively. There was a positive correlation between sleep quality scores and negative effects on professional and social life activities. Negative effects on professional activities included increased loss of attention and concentration (40.0%, p=0,016, increased failure to take emergency actions (57.9%, p=0.001, reduced motivation (46.2%, p=0.004, reduced performance (41.4%, p=0.024, and low work efficiency (48.1%, p=0.008. Poor sleep quality generally negatively affected the daily life of the workers (51.6%, p=0.004, restricted their social life activities (45.7%, p=0.034, and caused them to experience communication difficulties (34.7%, p=0.229. Conclusions: One third of the emergency health workers had poor sleep quality and experienced high levels of sleep deficiency. Being a woman and being single were the most important factors in low sleep quality. Poor sleep quality continuously affected daily life and professional life negatively by leading to a serious level of

  18. Dynamic decision making for dam-break emergency management - Part 2: Application to Tangjiashan landslide dam failure

    Science.gov (United States)

    Peng, M.; Zhang, L. M.

    2013-02-01

    Tangjiashan landslide dam, which was triggered by the Ms = 8.0 Wenchuan earthquake in 2008 in China, threatened 1.2 million people downstream of the dam. All people in Beichuan Town 3.5 km downstream of the dam and 197 thousand people in Mianyang City 85 km downstream of the dam were evacuated 10 days before the breaching of the dam. Making such an important decision under uncertainty was difficult. This paper applied a dynamic decision-making framework for dam-break emergency management (DYDEM) to help rational decision in the emergency management of the Tangjiashan landslide dam. Three stages are identified with different levels of hydrological, geological and social-economic information along the timeline of the landslide dam failure event. The probability of dam failure is taken as a time series. The dam breaching parameters are predicted with a set of empirical models in stage 1 when no soil property information is known, and a physical model in stages 2 and 3 when knowledge of soil properties has been obtained. The flood routing downstream of the dam in these three stages is analyzed to evaluate the population at risk (PAR). The flood consequences, including evacuation costs, flood damage and monetized loss of life, are evaluated as functions of warning time using a human risk analysis model based on Bayesian networks. Finally, dynamic decision analysis is conducted to find the optimal time to evacuate the population at risk with minimum total loss in each of these three stages.

  19. Current Brachytherapy Quality Assurance Guidance: Does It Meet the Challenges of Emerging Image-Guided Technologies?

    International Nuclear Information System (INIS)

    Williamson, Jeffrey F.

    2008-01-01

    In the past decade, brachytherapy has shifted from the traditional surgical paradigm to more modern three-dimensional image-based planning and delivery approaches. The role of intraoperative and multimodality image-based planning is growing. Published American Association of Physicists in Medicine, American College of Radiology, European Society for Therapeutic Radiology and Oncology, and International Atomic Energy Agency quality assurance (QA) guidelines largely emphasize the QA of planning and delivery devices rather than processes. These protocols have been designed to verify compliance with major performance specifications and are not risk based. With some exceptions, complete and clinically practical guidance exists for sources, QA instrumentation, non-image-based planning systems, applicators, remote afterloading systems, dosimetry, and calibration. Updated guidance is needed for intraoperative imaging systems and image-based planning systems. For non-image-based brachytherapy, the American Association of Physicists in Medicine Task Group reports 56 and 59 provide reasonable guidance on procedure-specific process flow and QA. However, improved guidance is needed even for established procedures such as ultrasound-guided prostate implants. Adaptive replanning in brachytherapy faces unsolved problems similar to that of image-guided adaptive external beam radiotherapy

  20. Professional quality of life, wellness education, and coping strategies among emergency physicians.

    Science.gov (United States)

    El-Shafei, Dalia A; Abdelsalam, Amira E; Hammam, Rehab A M; Elgohary, Hayam

    2018-03-01

    Professional quality of life (ProQOL) is affected by and affects professional well-being and performance. The objectives of this study are to identify risk factors of ProQOL among EM physicians in Zagazig University hospitals (ZUHs), to detect the relationship between ProQOL and coping strategies, and to measure the implication of the Worksite Wellness Education (WWE) program on improving knowledge skills, ProQOL, and coping. An intervention study was conducted among 108 EM physicians at ZUHs through two stages: assessing ProQOL subscales (CS, BO, and STS) and coping strategies and conducting the WWE program. A pre-post-test design was used in the evaluation. CS was higher among the older age group, smokers, nighttime sleepers, and hobbies' practitioners. Coping strategies carried out by EM physicians to overcome stress and their ProQOL scores were improved significantly post program. ProQOL has multiple factors that affect it. Applying the WWE program will address this concept and may raise awareness about how to cope with work stressors.

  1. QUALITY OF FINANCIAL CONGLOMERATES’ PERFORMANCE IN EMERGING ECONOMY: THE INDUSTRIAL ORGANIZATION THEORY PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Wiwiek Rabiatul Adawiyah

    2017-04-01

    Full Text Available Financial conglomerates are financial institutions that provide all forms of financial services on the top of ordinary banking service. The quality of financial conglomerates’ performance depends on number of factors namely ownership structure, internal capital market and resources sharing. Research on the performance of financial conglomerates are still lacking in Indonesia. This study, therefore, is among the first attempt to assess the influence of ownership structure, internal capital market and resources sharing on the performance financial conglomerate firms in Indonesia, from the industrial organizational theory perspectives. The methodology employed is the ex-post facto research design, using secondary data. The population of the study is all the conglomerates firms listed on the Indonesian Stock Exchange between 2010 until 2015 persistently. The study used regression as a tool of analysis. Findings supported three out of the five hypotheses proposed. Efficient subsidy and managerial ownership had no significant influence on firms’ performance. Efficient transfer segment had positive influence on firms’ performance. Similarly, result supported the proposition that intangible and tangible resources had positive effect on firms’ performance.

  2. Design of Cycle 3 of the National Water-Quality Assessment Program, 2013-2022: Part 1: Framework of Water-Quality Issues and Potential Approaches

    Science.gov (United States)

    Rowe, Gary L.; Belitz, Kenneth; Essaid, Hedeff I.; Gilliom, Robert J.; Hamilton, Pixie A.; Hoos, Anne B.; Lynch, Dennis D.; Munn, Mark D.; Wolock, David W.

    2010-01-01

    online at http://water.usgs.gov/nawqa/bib/), and are documented by more than 14 million data records representing about 7,600 stream sites, 8,100 wells, and 2,000 water-quality and ecological constituents that are available from the NAWQA data warehouse (http://infotrek.er.usgs.gov/traverse/f?p=NAWQA:HOME:0). The Program promotes collaboration and liaison with government officials, resource managers, industry representatives, and other stakeholders to increase the utility and relevance of NAWQA science to decisionmakers. As part of this effort, NAWQA supports integration of data from other organizations into NAWQA assessments, where appropriate and cost-effective, so that more comprehensive findings are available across geographic and temporal scales.

  3. Measuring Program Quality, Part 2: Addressing Potential Cultural Bias in a Rater Reliability Exam

    Science.gov (United States)

    Richer, Amanda; Charmaraman, Linda; Ceder, Ineke

    2018-01-01

    Like instruments used in afterschool programs to assess children's social and emotional growth or to evaluate staff members' performance, instruments used to evaluate program quality should be free from bias. Practitioners and researchers alike want to know that assessment instruments, whatever their type or intent, treat all people fairly and do…

  4. Google vs. the Library (Part III): Assessing the Quality of Sources Found by Undergraduates

    Science.gov (United States)

    Georgas, Helen

    2015-01-01

    This study assesses and compares the quality of sources found by undergraduate students when doing research using both Google and a library (federated) search tool. Thirty undergraduates were asked to find four sources (one book, two articles, and one additional source of their choosing) related to a selected research topic. Students used both…

  5. 40 CFR Appendix F to Part 132 - Great Lakes Water Quality Initiative Implementation Procedures

    Science.gov (United States)

    2010-07-01

    ...-specific modifications that result in less stringent criteria must be based on a sound scientific rationale... Handbook, Second Edition—Revised (1994). b. Less stringent site-specific modifications to chronic or acute...-specific criteria is provided in Chapter 3 of the U.S. EPA Water Quality Standards Handbook, Second Edition...

  6. Air quality in parts of the University of Port Harcourt, Rivers State ...

    African Journals Online (AJOL)

    The quality of air in the University of Port Harcourt was assessed in forty-one (41) ... the main business areas) environments exposed to prolonged emissions from fossil ... the concentrations of Carbon monoxide (CO), Carbon dioxide (CO2), Ammonia ... identified in this study, the shift to cleaner energy sources is imperative.

  7. [Qualitative Research in Health Services Research - Discussion Paper, Part 3: Quality of Qualitative Research].

    Science.gov (United States)

    Stamer, M; Güthlin, C; Holmberg, C; Karbach, U; Patzelt, C; Meyer, T

    2015-12-01

    The third and final discussion paper of the German Network of Health Services Research's (DNVF) "Qualitative Methods Working Group" demonstrates methods for the evaluation and quality of qualitative research in health services research. In this paper we discuss approaches described in evaluating qualitative studies, including: an orientation to the general principles of empirical research, an approach-specific course of action, as well as procedures based on the research-process and criteria-oriented approaches. Divided into general and specific aspects to be considered in a qualitative study quality evaluation, the central focus of the discussion paper undertakes an extensive examination of the process and criteria-oriented approaches. The general aspects include the participation of relevant groups in the research process as well as ethical aspects of the research and data protection issues. The more specific aspects in evaluating the quality of qualitative research include considerations about the research interest, research questions, and the selection of data collection methods and types of analyses. The formulated questions are intended to guide reviewers and researchers to evaluate and to develop qualitative research projects appropriately. The intention of this discussion paper is to ensure a transparent research culture, and to reflect on and discuss the methodological and research approach of qualitative studies in health services research. With this paper we aim to initiate a discussion on high quality evaluation of qualitative health services research. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Slow growth of a translocated beaver population partly due to a climatic shift in food quality

    NARCIS (Netherlands)

    Nolet, B.A.; Broftová, L.; Heitkönig, I.M.A.; Vorel, A.; Kostkan, V.

    2005-01-01

    In temperate regions climate change has led to advances in plant phenology which may disrupt the synchrony between food availability and reproductive requirements of higher trophic levels. Because leaf quality generally drops with leaf maturation, for herbivorous animals a stoichiometric effect of

  9. The energy balance experiment EBEX-2000. Part III: Behaviour and quality of the radiation measurements

    NARCIS (Netherlands)

    Kohsiek, W.; Liebethal, C.; Foken, T.; Vogt, R.; Oncley, S.P.; Bernhofer, C.; Debruin, H.A.R.

    2007-01-01

    An important part of the Energy Balance Experiment (EBEX-2000) was the measurement of the net radiation and its components. Since the terrain, an irrigated cotton field, could not be considered homogeneous, radiation measurements were made at nine sites using a variety of radiation instruments,

  10. 40 CFR Appendix C to Part 58 - Ambient Air Quality Monitoring Methodology

    Science.gov (United States)

    2010-07-01

    ... to detect small changes in concentration. 2.6.3Requests for approval under section 2.6.2 of this..., including any reasons for considering it necessary or advantageous; 2.8.3.3A brief statement of belief... under paragraph 4.5(b) of Appendix D to part 58 if there is no existing monitoring data indicating that...

  11. Maternal role attainment with medically fragile infants: Part 2. relationship to the quality of parenting.

    Science.gov (United States)

    Holditch-Davis, Diane; Miles, Margaret Shandor; Burchinal, Margaret R; Goldman, Barbara Davis

    2011-02-01

    We examined which components of maternal role attainment (identity, presence, competence) influenced quality of parenting for 72 medically fragile infants, controlling for maternal education and infant illness severity. Maternal competence was related to responsiveness. Maternal presence and technology dependence were inversely related to participation. Greater competence and maternal education were associated with better normal caregiving. Presence was negatively related although competence was positively related to illness-related caregiving. Mothers with lower competence and more technology dependent children perceived their children as more vulnerable and child cues as more difficult to read. Maternal role attainment influenced parenting quality for these infants more than did child illness severity; thus interventions are needed to help mothers develop their maternal role during hospitalization and after discharge. © 2010 Wiley Periodicals, Inc. Res Nurs Health 34:35-48, 2011. Copyright © 2010 Wiley Periodicals, Inc.

  12. Air quality monitoring at Seoul, Korea as a part of East-Asian air surveillance network

    International Nuclear Information System (INIS)

    Hashimoto, Y.; Sekine, Y.; Kim, H.K.; Otoshi, T.

    1989-01-01

    Global scale air pollution study is a recent trend due to a perception that air pollution is changing climate and other essential earth's conditions that could seriously affect our lives. One of the important tasks which can contribute to protect our natural environment must be to know about the present and changing air quality. For this purpose, a regional air monitoring plan was designed by a research group and has proceeded to set up stations in the eastern Asia including Japan, Korea and China to get continuous data which can contribute to world wide data base of air quality. This project was initiated at Seoul, Korea in April, 1986 by the method of National Air Surveillance Network, Japan. Airborne particles were collected by so-called Hi-vol and Lo-vol, and their components were analyzed by neutron activation analysis and others. The results of Seoul sampling as a first step of this network plan are presented

  13. Audit of the informed consent process as a part of a clinical research quality assurance program.

    Science.gov (United States)

    Lad, Pramod M; Dahl, Rebecca

    2014-06-01

    Audits of the informed consent process are a key element of a clinical research quality assurance program. A systematic approach to such audits has not been described in the literature. In this paper we describe two components of the audit. The first is the audit of the informed consent document to verify adherence with federal regulations. The second component is comprised of the audit of the informed consent conference, with emphasis on a real time review of the appropriate communication of the key elements of the informed consent. Quality measures may include preparation of an informed consent history log, notes to accompany the informed consent, the use of an informed consent feedback tool, and the use of institutional surveys to assess comprehension of the informed consent process.

  14. The Global Streamflow Indices and Metadata Archive (GSIM – Part 2: Quality control, time-series indices and homogeneity assessment

    Directory of Open Access Journals (Sweden)

    L. Gudmundsson

    2018-04-01

    Full Text Available This is Part 2 of a two-paper series presenting the Global Streamflow Indices and Metadata Archive (GSIM, which is a collection of daily streamflow observations at more than 30 000 stations around the world. While Part 1 (Do et al., 2018a describes the data collection process as well as the generation of auxiliary catchment data (e.g. catchment boundary, land cover, mean climate, Part 2 introduces a set of quality controlled time-series indices representing (i the water balance, (ii the seasonal cycle, (iii low flows and (iv floods. To this end we first consider the quality of individual daily records using a combination of quality flags from data providers and automated screening methods. Subsequently, streamflow time-series indices are computed for yearly, seasonal and monthly resolution. The paper provides a generalized assessment of the homogeneity of all generated streamflow time-series indices, which can be used to select time series that are suitable for a specific task. The newly generated global set of streamflow time-series indices is made freely available with an digital object identifier at https://doi.pangaea.de/10.1594/PANGAEA.887470 and is expected to foster global freshwater research, by acting as a ground truth for model validation or as a basis for assessing the role of human impacts on the terrestrial water cycle. It is hoped that a renewed interest in streamflow data at the global scale will foster efforts in the systematic assessment of data quality and provide momentum to overcome administrative barriers that lead to inconsistencies in global collections of relevant hydrological observations.

  15. The Global Streamflow Indices and Metadata Archive (GSIM) - Part 2: Quality control, time-series indices and homogeneity assessment

    Science.gov (United States)

    Gudmundsson, Lukas; Do, Hong Xuan; Leonard, Michael; Westra, Seth

    2018-04-01

    This is Part 2 of a two-paper series presenting the Global Streamflow Indices and Metadata Archive (GSIM), which is a collection of daily streamflow observations at more than 30 000 stations around the world. While Part 1 (Do et al., 2018a) describes the data collection process as well as the generation of auxiliary catchment data (e.g. catchment boundary, land cover, mean climate), Part 2 introduces a set of quality controlled time-series indices representing (i) the water balance, (ii) the seasonal cycle, (iii) low flows and (iv) floods. To this end we first consider the quality of individual daily records using a combination of quality flags from data providers and automated screening methods. Subsequently, streamflow time-series indices are computed for yearly, seasonal and monthly resolution. The paper provides a generalized assessment of the homogeneity of all generated streamflow time-series indices, which can be used to select time series that are suitable for a specific task. The newly generated global set of streamflow time-series indices is made freely available with an digital object identifier at https://doi.pangaea.de/10.1594/PANGAEA.887470" target="_blank">https://doi.pangaea.de/10.1594/PANGAEA.887470 and is expected to foster global freshwater research, by acting as a ground truth for model validation or as a basis for assessing the role of human impacts on the terrestrial water cycle. It is hoped that a renewed interest in streamflow data at the global scale will foster efforts in the systematic assessment of data quality and provide momentum to overcome administrative barriers that lead to inconsistencies in global collections of relevant hydrological observations.

  16. USAF Test Pilot School. Flying Qualities Textbook, Volume 2, Part 1

    Science.gov (United States)

    1986-04-01

    Qualities Flight Testing, Performance and Flying Qaulities Branch, Flight Test Engneerd ision, 6510th Test Wing, Air Force Flight Mayst Ce1ter, Edwards...For these aircraft, the program manager may re*uire a mil spec written specifically for the aircraft and control system involwd. 5.20.2 _EL k,Tt...OR MANAGED IN CONTEXT OF MISSION, WITH AVAILABLE PILOT ATTENTION. S UNCONTROLLABLE CONTROL WILL BE LOST DURING SOME PORTION OF MISSION. ACCEPTABLE

  17. Proficiency testing of skin prick testers as part of a quality assurance system

    DEFF Research Database (Denmark)

    Malling, Hans-Jørgen; Allesen-Holm, Pernille; Karved, Lisbeth Sys

    2016-01-01

    BACKGROUND: Skin prick test is an important diagnostic procedure in clinical allergy but documentation of the quality is often missing. METHODS: We describe a proficiency system to evaluate staff members in relation to the international recommended reproducibility in terms of coefficient...... of variation (CV 0.85) based on blinded octuplicate histamine testing using histamine 3, 10, 30 and 100 mg/ml. RESULTS: Fourteen trained allergy nurses participated in the proficiency testing. More than 95 % of the nurses, generated coefficient of variation...

  18. Burnout in boiling heat transfer. Part II: subcooled and low quality forced-convection systems

    International Nuclear Information System (INIS)

    Bergles, A.E.

    1977-01-01

    Recent experimental and analytical developments regrading burnout in subcooled and low quality forced-convection systems are reviewed. Much data have been accumulated which clarify the parametric trends and lead to new design correlations for water and a variety of other coolants in both simple and complex geometries. A number of critical experiments and models have been developed to attempt to clarify the burnout mechanism(s) in simpler geometries and power transients

  19. Doctors’ Support – An important part of medical therapy and quality of life

    Directory of Open Access Journals (Sweden)

    Mariusz Jaworski

    2015-07-01

    Full Text Available Introduction: The correct patient – doctor relationship is important in shaping the whole process of treatment. The scientific studies highlight the various irregularities in this relationship and its negative impact on the effectiveness of medical treatment. The purpose of this study was to assess the relationship between levels of doctors’ support and attitude to certain aspects of the treatment process and quality of life among patients with psoriasis. Material and Methods: The study was conducted on 50 patients with psoriasis aged from 21 to 78 who are treated in dermatological clinics. The Psoriasis Area and Severity Index (PASI was used to assess the severity of psoriatic skin changes. The patients completed a questionnaire for the assessment of receive doctors’ support, and its relationship with the attitude towards the disease. The research tool was developed based on literature review. Results: The level of doctors’ support had a direct impact on the patients’ attitude the disease, including attitudes towards the treatment and medical personnel, as well as adherence to medical recommendations; and indirectly on satisfaction with the treatment and the quality of life. Conclusions: Results of this study have shown clear evidence the importance of the level of doctors’ support in psoriasis which could help to improve the overall functioning of these patients. The level of doctors’ support indirectly affects the quality of life in patients with psoriasis.

  20. Efeito do armazenamento da calda na eficácia de herbicidas aplicados em pré-emergência (parte II Effect of storage time of diluted herbicides mix on their effectiveness: pre-emergency herbicides (part II

    Directory of Open Access Journals (Sweden)

    Hamilton H. Ramos

    1999-04-01

    Full Text Available Diferentes tipos de pulverizadores são utilizados para a aplicação de herbicidas sendo que, em pequenas propriedades, é comum, por questões econômicas, a adaptação de barras ou pistolas manuais a tanques de grande capacidade. Por outro lado, em grandes propriedades, é crescente a tendência da substituição do sistema tradicional de reabastecimento dos pulverizadores pelo sistema de calda pronta. Em ambos os casos, pode haver a necessidade de um armazenamento prolongado nos tanques ou no veículo reabastecedor, principalmente na ocorrência de períodos prolongados de chuva. Torna-se, portanto, importante a determinação de períodos de tempo pelos quais as caldas de herbicidas possam ser armazenadas, sem que haja prejuízo à eficácia dos mesmos. O presente trabalho estudou os efeitos do tempo de armazenamento da calda sobre a eficácia de herbicidas aplicados em pré-emergência. O experimento foi instalado no delineamento experimental de blocos ao acaso, com três repetições, no ano agrícola 91/92, em área da Fazenda Experimental da Faculdade de Ciências Agrárias e Veterinárias da UNESP, município de Jaboticabal, Estado de São Paulo, Brasil. Avaliou-se as formulações comerciais de ametryne e diuron com 00, 05, 10, 15, 20, 25 e 30 dias de armazenamento da calda, além de uma testemunha, onde não se efetuou a aplicação de herbicidas. Foram realizadas contagens do número de emergências e altura, por espécie, das plantas daninhas em 1,2 m2 por parcela, aos 30, 45 e 59 dias após a aplicação e uma avaliação visual do controle geral por parcela aos 95 dias após a aplicação. Os resultados obtidos mostram que nenhum dos períodos de armazenamento testados interferiu significativamente na eficiência dos herbicidas, independente do produto utilizado (teste de F a 5%. Portanto, conclui-se que as caldas dos herbicidas testados puderam ser utilizadas normalmente, quando armazenadas por até 30 dias.Different types of

  1. Magnetic powder crack tests as a means of quality assurance in forged parts

    International Nuclear Information System (INIS)

    Deutsch, V.

    1979-01-01

    The magnetic powder process has been used for years for crack detection in forged parts, which are used as safety parts in car construction. The representation of the present state of technology appears useful, as terms and units have been redefined in DIN draft standards and guidelines, and because alternating field magnetisation has increasingly displaced earlier techniques. The correct choice of equipment, test materials and UV lamps, and the configuration of the working positions are discussed. As the complete automation of this test method is not possible at present, the organisation of the viewing process is of great importance. The comparison with other processes of non-destructive material testing proves the irreplaceability of the magnetic power crack testing at present. (orig.) [de

  2. Parts, materials, and processes experience summary, volume 2. [design, engineering, and quality control

    Science.gov (United States)

    1973-01-01

    This summary provides the general engineering community with the accumulated experience from ALERT reports issued by NASA and the Government-Industry. Data Exchange Program, and related experience gained by Government and industry. It provides expanded information on selected topics by relating the problem area (failure) to the cause, the investigation and findings, the suggestions for avoidance (inspections, screening tests, proper part applications, requirements for manufacturer's plant facilities, etc.), and failure analysis procedures. Diodes, integrated circuits, and transistors are covered in this volume.

  3. The American Board of Radiology perspective on maintenance of certification: Part IV: Practice quality improvement in radiologic physics

    International Nuclear Information System (INIS)

    Frey, G. Donald; Ibbott, Geoffrey S.; Morin, Richard L.; Paliwal, Bhudatt R.; Thomas, Stephen R.; Bosma, Jennifer

    2007-01-01

    Recent initiatives of the American Board of Medical Specialties (ABMS) in the area of maintenance of certification (MOC) have been reflective of the response of the medical community to address public concerns regarding quality of care, medical error reduction, and patient safety. In March 2000, the 24 member boards of the ABMS representing all medical subspecialties in the USA agreed to initiate specialty-specific maintenance of certification (MOC) programs. The American Board of Radiology (ABR) MOC program for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated with full implementation for all three disciplines beginning in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. The four component parts to the MOC process are: Part I: Professional standing, Part II: Evidence of life long learning and periodic self-assessment, Part III: Cognitive expertise, and Part IV: Evaluation of performance in practice (with the latter being the focus of this paper). The key components of Part IV require a physicist-based response to demonstrate commitment to practice quality improvement (PQI) and progress in continuing individual competence in practice. Diplomates of radiologic physics must select a project to be completed over the ten-year cycle that potentially can improve the quality of the diplomate's individual or systems practice and enhance the quality of care. Five categories have been created from which an individual radiologic physics diplomate can select one required PQI project: (1) Safety for patients, employees, and the public, (2) accuracy of analyses and calculations, (3) report turnaround time and communication issues, (4) practice guidelines and technical standards, and (5) surveys (including peer review of self-assessment reports). Each diplomate may select a project appropriate for an individual

  4. 40 CFR Appendix I to Part 50 - Interpretation of the 8-Hour Primary and Secondary National Ambient Air Quality Standards for Ozone

    Science.gov (United States)

    2010-07-01

    ... Secondary National Ambient Air Quality Standards for Ozone 1. General. This appendix explains the data.... Primary and Secondary Ambient Air Quality Standards for Ozone. 2.1 Data Reporting and Handling Conventions... and Secondary National Ambient Air Quality Standards for Ozone I Appendix I to Part 50 Protection of...

  5. Production and quality control of concrete for the Rajasthan Atomic Power Station - [Part 1

    International Nuclear Information System (INIS)

    Singha Roy, P.K.; Sukhtankar, K.D.; Prasad, K.

    1975-01-01

    The production and quality control of concrete and concrete materials for the construction of the twin-reactor Rajasthan Atomic Power Station with its 400 MW net capacity posed many challenges since many of the requirements for the properties of concrete were new and were being laid down for the first time in India. Some of the conditions for the concrete included leak-tightness against gas pressure, total absence of shrinkage in the containment even when the ambient temperature during concreting was as high as 45degC, placing concrete at a temperature as low as 8degC, the use of non-shrink and high strength grout, absolute impermeability against water, high density for radiation shielding, controlled modulus of elasticity for large machine foundations, high strength with high slump for the prestressed concrete dome, etc. Though the total quantity of concrete was not very much compared with a large river valley or steel plant project, (e.g., about 1.2 X 10 6 m 3 for a 2-million tonne steel plant) it was quite significant, being about 70,000 m 3 of normal density and 2,100 m 3 of high density concrete. The production of these quantities entailed intensive material study and investigation, development of new mixes with additives not tried out before in the country, and design and quality control techniques which were unique in many respects. The paper deals with the production and quality control of concrete, including grouts used in the projects, but the actual concreting and construction operations are not discussed. (author)

  6. Mathematical modeling of bone marrow--peripheral blood dynamics in the disease state based on current emerging paradigms, part I.

    Science.gov (United States)

    Afenya, Evans K; Ouifki, Rachid; Camara, Baba I; Mundle, Suneel D

    2016-04-01

    Stemming from current emerging paradigms related to the cancer stem cell hypothesis, an existing mathematical model is expanded and used to study cell interaction dynamics in the bone marrow and peripheral blood. The proposed mathematical model is described by a system of nonlinear differential equations with delay, to quantify the dynamics in abnormal hematopoiesis. The steady states of the model are analytically and numerically obtained. Some conditions for the local asymptotic stability of such states are investigated. Model analyses suggest that malignancy may be irreversible once it evolves from a nonmalignant state into a malignant one and no intervention takes place. This leads to the proposition that a great deal of emphasis be placed on cancer prevention. Nevertheless, should malignancy arise, treatment programs for its containment or curtailment may have to include a maximum and extensive level of effort to protect normal cells from eventual destruction. Further model analyses and simulations predict that in the untreated disease state, there is an evolution towards a situation in which malignant cells dominate the entire bone marrow - peripheral blood system. Arguments are then advanced regarding requirements for quantitatively understanding cancer stem cell behavior. Among the suggested requirements are, mathematical frameworks for describing the dynamics of cancer initiation and progression, the response to treatment, the evolution of resistance, and malignancy prevention dynamics within the bone marrow - peripheral blood architecture. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. The View from the Trenches Part 1: Emergency Medical Response Plans and the Need for EPR Screening

    Science.gov (United States)

    Gougelet, Robert M.; Rea, Michael E.; Nicolalde, Roberto J.; Geiling, James A.; Swartz, Harold M.

    2014-01-01

    Few natural disasters or intentional acts of war or terrorism have the potential for such severe impact upon a population and infrastructure as the intentional detonation of a nuclear device within a major U.S. city. In stark contrast to other disasters or even a “dirty bomb,” hundreds of thousands will be affected and potentially exposed to a clinically significant dose of ionizing radiation. This will result in immediate deaths and injuries and subsequently the development of Acute Radiation Syndrome (ARS). Additionally, millions more who are unlikely to develop ARS will seek medical evaluation and treatment, overwhelming the capacity of an already compromised medical system. In this paper, we propose that in vivo electron paramagnetic resonance (EPR) dosimetry be utilized to screen large numbers of potentially exposed victims, and that this screening process be incorporated into the medical-surge framework that is currently being implemented across the nation for other catastrophic public health emergencies. The National Incident Management System (NIMS), the National Response Framework (NRF), the Target Capabilities list (TCL), Homeland Security Presidential Directives (HSPD), as well as additional guidance from multiple federal agencies provides a solid framework for this response. The effective screening of potentially exposed victims directly following a nuclear attack could potentially decrease the number of patients seeking immediate medical care by greater than 90%. PMID:20065673

  8. Environmetrics. Part 1. Modeling of water salinity and air quality data

    International Nuclear Information System (INIS)

    Braibanti, A.; Gollapalli, N. R.; Jonnalagaddaj, S. B.; Duvvuru, S.; Rupenaguntla, S. R.

    2001-01-01

    Environmetrics utilities advanced mathematical, statistical and information tools to extract information. Two typical environmental data sets are analysed using MVATOB (Multi Variate Tool Box). The first data set corresponds to the variable river salinity. Least median squares (LMS) detected the outliers whereas linear least squares (LLS) could not detect and remove the outliers. The second data set consists of daily readings of air quality values. Outliers are detected by LMS and unbiased regression coefficients are estimated by multi-linear regression (MLR). As explanatory variables are not independent, principal component regression (PCR) and partial least squares regression (PLSR) are used. Both examples demonstrate the superiority of LMS over LLS [it

  9. Pacific Northwest Laboratory annual report for 1983 to the DOE Office of the Assistant Secretary for Environmental Protection, Safety and Emergency Preparedness. Part 5. Overview and assessment

    International Nuclear Information System (INIS)

    Bair, W.J.

    1984-02-01

    The 1983 annual report from Pacific Northwest Laboratory (PNL) to the Department of Energy (DOE) describes research in environment, health, and safety conducted during fiscal year 1983. The report again consists of five parts, each in a separate volume. Part 5 of the 1983 Annual Report to the Department of Energy's Assistant Secretary for Environmental Protection, Safety and Emergency Preparedness presents Pacific Northwest Laboratory's progress on work performed for the Office of Nuclear Safety and the Office of Operational Safety. For each project, as identified by the Field Task Proposal/Agreement, articles describe progress made during FY 1983. Authors of these articles represent a broad spectrum of capabilities derived from various segments of the Laboratory, reflecting the interdisciplinary nature of the work

  10. Benchmarking the performance of fixed-image receptor digital radiographic systems part 1: a novel method for image quality analysis.

    Science.gov (United States)

    Lee, Kam L; Ireland, Timothy A; Bernardo, Michael

    2016-06-01

    This is the first part of a two-part study in benchmarking the performance of fixed digital radiographic general X-ray systems. This paper concentrates on reporting findings related to quantitative analysis techniques used to establish comparative image quality metrics. A systematic technical comparison of the evaluated systems is presented in part two of this study. A novel quantitative image quality analysis method is presented with technical considerations addressed for peer review. The novel method was applied to seven general radiographic systems with four different makes of radiographic image receptor (12 image receptors in total). For the System Modulation Transfer Function (sMTF), the use of grid was found to reduce veiling glare and decrease roll-off. The major contributor in sMTF degradation was found to be focal spot blurring. For the System Normalised Noise Power Spectrum (sNNPS), it was found that all systems examined had similar sNNPS responses. A mathematical model is presented to explain how the use of stationary grid may cause a difference between horizontal and vertical sNNPS responses.

  11. A Six-Year Predictive Test of Adolescent Family Relationship Quality and Effortful Control Pathways to Emerging Adult Social and Emotional Health

    Science.gov (United States)

    Fosco, Gregory M.; Caruthers, Allison S.; Dishion, Thomas J.

    2012-01-01

    This longitudinal study examined how a multimethod (youth report, parent report, direct observation) assessment of family relationship quality (cohesion and conflict) in adolescence (age 16 –17) predicted growth and maintenance of effortful control across ages 17, 22, and 23 years old, and, ultimately, subjective well-being, emotional distress, and aggressive behavior in emerging adulthood (23). A diverse sample of 792 youth at age 17 and their families, and youth at ages 22 and 23, were studied to examine family cohesion and conflict and the growth and maintenance of effortful control as predictors of emerging adult social and emotional health. Results indicated that family cohesion and conflict during late adolescence and mean-level effortful control at age 22 each served as unique pathways to emerging adult adjustment. These findings underscore the importance of family functioning during adolescence and the maintenance of effortful control into emerging adulthood for understanding adjustment during the emerging adulthood period. PMID:22709261

  12. Quality of life during orthopaedic training and academic practice. Part 1: orthopaedic surgery residents and faculty.

    Science.gov (United States)

    Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

    2009-10-01

    A pilot study of two academic training programs revealed concerning levels of resident burnout and psychological dysfunction. The purpose of the present study was to determine the quality of life of orthopaedic residents and faculty on a national scale and to identify risk factors for decompensation. Three hundred and eighty-four orthopaedic residents and 264 full-time orthopaedic faculty members completed a voluntary, anonymous survey consisting of three validated instruments (the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale) and question sets assessing demographic information, relationship issues, stress reactions/management, and work/life balance. High levels of burnout were seen in 56% of the residents and 28% of the faculty members. Burnout risk was greatest among second-postgraduate-year residents and residents in training programs with six or more residents per postgraduate year. Sixteen percent of residents and 19% of faculty members reported symptoms of psychological distress. Sleep deprivation was common among the residents and correlated positively with every distress measure. Faculty reported greater levels of stress but greater satisfaction with work and work/life balance. A number of factors, such as making time for hobbies and limiting alcohol use, correlated with decreased dysfunction for both residents and faculty. Despite reporting high levels of job satisfaction, orthopaedic residents and faculty are at risk for burnout and distress. Identification of protective factors and risk factors may provide guidance to improve the quality of life of academic orthopaedic surgeons in training and beyond.

  13. Mixed-methods research in pharmacy practice: recommendations for quality reporting. Part 2.

    Science.gov (United States)

    Hadi, Muhammad Abdul; Alldred, David Phillip; Closs, S José; Briggs, Michelle

    2014-02-01

    This is the second of two papers that explore the use of mixed-methods research in pharmacy practice. This paper discusses the rationale, applications, limitations and challenges of conducting mixed-methods research. As with other research methods, the choice of mixed-methods should always be justified because not all research questions require a mixed-methods approach. Mixed-methods research is particularly suitable when one dataset may be inadequate in answering the research question, an explanation of initial results is required, generalizability of qualitative findings is desired or broader and deeper understanding of a research problem is necessary. Mixed-methods research has its own challenges and limitations, which should be considered carefully while designing the study. There is a need to improve the quality of reporting of mixed-methods research. A framework for reporting mixed-methods research is proposed, for researchers and reviewers, with the intention of improving its quality. Pharmacy practice research can benefit from research that uses both 'numbers' (quantitative) and 'words' (qualitative) to develop a strong evidence base to support pharmacy-led services. © 2013 Royal Pharmaceutical Society.

  14. The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention.

    Science.gov (United States)

    Cáceres, Carlos F; Koechlin, Florence; Goicochea, Pedro; Sow, Papa-Salif; O'Reilly, Kevin R; Mayer, Kenneth H; Godfrey-Faussett, Peter

    2015-01-01

    Towards the end of the twentieth century, significant success was achieved in reducing incidence in several global HIV epidemics through ongoing prevention strategies. However, further progress in risk reduction was uncertain. For one thing, it was clear that social vulnerability had to be addressed, through research on interventions addressing health systems and other structural barriers. As soon as antiretroviral treatment became available, researchers started to conceive that antiretrovirals might play a role in decreasing either susceptibility in uninfected people or infectiousness among people living with HIV. In this paper we focus on the origin, present status, and potential contribution of pre-exposure prophylaxis (PrEP) within the combination HIV prevention framework. After a phase of controversy, PrEP efficacy trials took off. By 2015, daily oral PrEP, using tenofovir alone or in combination with emtricitabine, has been proven efficacious, though efficacy seems heavily contingent upon adherence to pill uptake. Initial demonstration projects after release of efficacy results have shown that PrEP can be implemented in real settings and adherence can be high, leading to high effectiveness. Despite its substantial potential, beliefs persist about unfeasibility in real-life settings due to stigma, cost, adherence, and potential risk compensation barriers. The strategic synergy of behavioural change communication, biomedical strategies (including PrEP), and structural programmes is providing the basis for the combination HIV prevention framework. If PrEP is to ever become a key component of that framework, several negative beliefs must be confronted based on emerging evidence; moreover, research gaps regarding PrEP implementation must be filled, and appropriate prioritization strategies must be set up. Those challenges are significant, proportional to the impact that PrEP implementation may have in the global response to HIV.

  15. Quality improvement education incorporated as an integral part of critical care fellows training at the Mayo Clinic.

    Science.gov (United States)

    Kashani, Kianoush B; Ramar, Kannan; Farmer, J Christopher; Lim, Kaiser G; Moreno-Franco, Pablo; Morgenthaler, Timothy I; Dankbar, Gene C; Hale, Curt W

    2014-10-01

    The Accreditation Council for Graduate Medical Education emphasizes quality improvement (QI) education in residency/fellowship training programs. The Mayo Clinic Combined Critical Care Fellowship (CCF) program conducted a pilot QI education program to incorporate QI training as a required curriculum for the 2010-2011 academic year. CCF collaborated with the Mayo Quality Academy to customize and teach the existing Mayo Quality Fellows curriculum to the CCF fellows with the help of two quality coaches over five months starting July 2010. All fellows were to achieve Bronze and Silver certification prior to graduation. Silver required passing four written exams and submitting a health care QI project. Five projects were selected on the basis of the Impact-Effort Prioritization matrix, and DMAIC (Define, Measure, Analyze, Improve, and Control) methodology was used to complete the projects. The primary outcome was to assess learners' satisfaction, knowledge, and skill transfer. All 20 fellows were Bronze certified, and 14 (70%) were Silver certified by the time of graduation. All five QI projects were completed and showed positive impacts on patient safety and care. Surveys showed improved learner satisfaction. Graduates felt the QI training improved their QI skills and employment and career advancement. The QI curriculum had appropriate content and teaching pace and did not significantly displace other important clinical core curriculum topics. The pilot was successfully implemented in the CCF program and now is in the fourth academic year as an established and integral part of the fellowship core curriculum.

  16. Construction of quality-assured infant feeding process of care data repositories: definition and design (Part 1).

    Science.gov (United States)

    Garcí A-de-León-Chocano, Ricardo; Sáez, Carlos; Muñoz-Soler, Verónica; Garcí A-de-León-González, Ricardo; García-Gómez, Juan M

    2015-12-01

    This is the first paper of a series of two regarding the construction of data quality (DQ) assured repositories for the reuse of information on infant feeding from birth until two years old. This first paper justifies the need for such repositories and describes the design of a process to construct them from Electronic Health Records (EHR). As a result, Part 1 proposes a computational process to obtain quality-assured datasets represented by a canonical structure extracted from raw data from multiple EHR. For this, 13 steps were defined to ensure the harmonization, standardization, completion, de-duplication, and consistency of the dataset content. Moreover, the quality of the input and output data for each of these steps is controlled according to eight DQ dimensions: predictive value, correctness, duplication, consistency, completeness, contextualization, temporal-stability and spatial-stability. The second paper of the series will describe the application of this computational process to construct the first quality-assured repository for the reuse of information on infant feeding in the perinatal period aimed at the monitoring of clinical activities and research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Dose level investigation in tests with gastrointestinal fluoroscopy as a part of a quality control program

    International Nuclear Information System (INIS)

    Canevaro, L.V.; Borges, J.C.; Kocj, H.A.

    1995-01-01

    The Radiation Protection and Dosimetry Institute of the National Nuclear Energy Commission (IRD/CNEN) Brazilian and the Radiodiagnostic Service of the Rio de Janeiro Federal University Hospital, (Brazil), have been engaged in the development of quality control programs applied to radiodiagnostics, one of them concerning gastrointestinal fluoroscopy. Since fluoroscopic examinations normally deals with high doses, they represent an important fraction of public exposure. They deserve special attention and risks to patients should be considered individually, not only as a population statistics. This work describes steps followed and results obtained in the estimation of doses for patients and physicians. Examinations investigated were esofagography, gastroduodenal seriography and colon with double contrast media, using conventional equipment with fluorescent screens, carried on by physicians engaged in the first year of medical residence. (author). 14 refs., 2 tabs

  18. Cairo city air quality research initiative part-i: A meteorological modelling

    International Nuclear Information System (INIS)

    Abdel-AAl, M.M.

    2001-01-01

    The modified meteorological model Hotmac (Higher order turbulence model for atmospheric circulation) is a three-dimensional and finite grid model developed primarily for simospheric motions and based on solving the conservation equations of mass momentum, energy and turbulent kinetic energy. The model is used for studying air quality of cairo cty and its surrounding to treat a domain that includes an urbanized area for understanding problems of air pollution. The acquired terrain (elevation) data for Egypt was obtained. The local and upper level geostrophic data were provided by rawinsonde of wind speed and direction, temperature,relative humidity, water vapour, and pressure The potential temperature was obtained by a computer program. The meteorological data was obtained for helwan site, about 20 kilometer south of cairo city. Three mested grids were used, with grids resolutions of 2 6 and 18 kilometers to cover a domain of approximately 360 km that extended from the red Sea to the mediterranean Sea

  19. Indoor Air Quality Assessment Based on Human Physiology - Part 2. Limits

    Directory of Open Access Journals (Sweden)

    M. V. Jokl

    2003-01-01

    Full Text Available In order to evaluate indoor air quality in practice it is necessary to establish limits, or more exactly, tolerable ranges for unadapted and adapted persons. The optimal value overwhelmingly corresponds to PD 20 %. A better value of PD 10 % could be prescribed for asthmatics and for persons with increased requirements, i.e. those allergic to the environment and operators in airport control towers and atomic power stations. A worse value PD 30 % could be accepted as an admissible value. These values differ for unadapted and adapted persons (as introduced by BSR/ASHRAE 62-1989 R. The long-term tolerable value is the end of SBS range (for CO2 it is based on USSR space research, for TVOC on Molhave. The short-term tolerable value is the beginning of the toxic range (for CO2 it is taken from British Guidance Note EH 40/90; for TVOC from Molhave.

  20. Software Design Improvements. Part 2; Software Quality and the Design and Inspection Process

    Science.gov (United States)

    Lalli, Vincent R.; Packard, Michael H.; Ziemianski, Tom

    1997-01-01

    The application of assurance engineering techniques improves the duration of failure-free performance of software. The totality of features and characteristics of a software product are what determine its ability to satisfy customer needs. Software in safety-critical systems is very important to NASA. We follow the System Safety Working Groups definition for system safety software as: 'The optimization of system safety in the design, development, use and maintenance of software and its integration with safety-critical systems in an operational environment. 'If it is not safe, say so' has become our motto. This paper goes over methods that have been used by NASA to make software design improvements by focusing on software quality and the design and inspection process.

  1. Using Lean-Six Sigma to reduce hemolysis in the emergency care center in a collaborative quality improvement project with the hospital laboratory.

    Science.gov (United States)

    Damato, Charlotte; Rickard, Dana

    2015-03-01

    As part of a strategic quality improvement plan, laboratory management at Sarasota Memorial Health Care System (SMHCS) focused its efforts on improving preanalytical work flow and blood collection processes-both negatively affected by hemolyzed specimens. When hemolysis is detected in a blood specimen, blood may need to be re-collected, resulting in bottlenecks and rework all along the value stream. From July through December 2009, hemolysis averaged 9.8% in the Emergency Care Center (ECC) and 3.4% housewide. The goal was set to reduce hemolysis to 2%. The project team identified hemolysis as one of seven factors contributing to non-value-added activities and bottlenecks in blood collection and preanalytical processes. Observations and interviews helped to identify error-prone practices and process variation. To verify the root causes of hemolysis, the findings were compared against best practices. The team developed a housewide protocol, standardized collection processes, created competency-based training, and enhanced ECC hiring practices. During December 2010-March 2011, following initial housewide interventions and ECC self-sustaining solutions, ECC hemolysis decreased by 91%-from 9.8% (423 hemolyzed/4,295 collected) to 0.88% (58 hemolyzed/6,560 collected). Housewide hemolysis decreased by 59%-from 3.4% (2,046 hemolyzed/60,307 collected) to 1.39% (619 hemolyzed/44,528 collected). Since the project, hemolysis has continued to trend downward; the mean percentage has consistently been Lean-Six Sigma tools helped to pinpoint hemolysis as a key inefficiency in blood collection and preanalytical work flow. Although focused on the ECC, the project team standardized blood collection practices and instituted quality devices to achieve hemolysis reductions housewide.

  2. Laboratory audit as part of the quality assessment of a primary HPV-screening program.

    Science.gov (United States)

    Hortlund, Maria; Sundström, Karin; Lamin, Helena; Hjerpe, Anders; Dillner, Joakim

    2016-02-01

    As primary HPV screening programs are rolled out, methods are needed for routine quality assurance of HPV laboratory analyzes. To explore the use of similar design for audit as currently used in cytology-based screening, to estimate the clinical sensitivity to identify women at risk for CIN 3 or worse (CIN3+). Population-based cohort study conducted within the cervical screening program in Stockholm, Sweden, in 2011-2012. All women with histopathologically confirmed CIN3+ in the following two years were identified by registry analysis. Primary HPV and cytology screening results were collected. For women who had not been HPV tested, biobanked cytology samples were HPV-tested. If the original HPV result had been negative, the sample and subsequent biopsies were analyzed with broad HPV typing (general primer PCR and Luminex). 154 women had a biobanked prediagnostic cytology sample taken up to 2 years before a histopathologically confirmed CIN3+. The high-risk HPV-positivity was 97% (148/154 women), whereas 143/154 (94%) women had had a cytological abnormality. Among the six HPV-negative samples, one sample was HPV 33 positive in repeat testing whereas the other five cases were HPV-negative also on repeat testing, but HPV-positive in the subsequent tumor tissue. A sensitivity of the HPV test that is higher than the sensitivity of cytology suggests adequate quality of the testing. Regular audits of clinical sensitivity, similar to those of cytology-based screening, should be used also in HPV-based screening programs, in order to continuously monitor the performance of the analyzes. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Quality assurance as an integrated part of the electronic medical record - a prototype applied for colonoscopy.

    Science.gov (United States)

    Hoff, Geir; Ottestad, Per Marcus; Skafløtten, Stein Roger; Bretthauer, Michael; Moritz, Volker

    2009-01-01

    Electronic medical records (EMRs) have not developed much beyond the days of typewritten journals when it comes to facilitating extraction of data for quality assurance (QA) and improvement of health-care performance. Based on 5 years' experience from the Norwegian Gastronet QA programme, we have developed a highly QA-profiled EMR for colonoscopy. We used a three-tier solution (client, server and database) written in the Java programming language using a number of open-source libraries. QA principles from the Norwegian paper-based Gastronet QA programme formed the basis for development of the ColoReg software. ColoReg is developed primarily for colonoscopy reporting in a screening trial, but may be used in routine clinical work. The QA module in ColoReg is well suited for intervention towards suboptimal performance in both settings. We have developed user-friendly software dominated by clickable boxes and curtain menus reducing free text to a minimum. The software gives warnings when illogical registrations are entered and reasons have to be given for divergence from software recommendations for work-up and surveillance. At any time, defined performance quality parameters are readily accessible in tabular form with the named, logged-in endoscopist being compared with all other anonymized endoscopists in the database. The ColoReg software is developed for use in an international, multicentre trial on colonoscopy screening. It is user-friendly and secures continuous QA of the endoscopist's performance. The principles used are applicable to development of EMRs in general.

  4. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital.

    Science.gov (United States)

    Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian

    2017-06-01

    Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  5. Analysis of the importance of drug packaging quality for end users and pharmaceutical industry as a part of the quality management system

    Directory of Open Access Journals (Sweden)

    Lončar Irma M.

    2013-01-01

    's overall quality management system. For them, a big financial investment in the complete traceability chain was not feasible because of the inability to achieve competitive prices in the market. Since only three of surveyed companies were part of international chains, these findings open the path for new research that would include more multinational drug manufacturers from the region, in order to fully comprehend the importance of investing in the drug chain traceability and protection against counterfeiting, as a part of total quality management process in the pharmaceutical industry. [Projekat Ministarstva nauke Republike Srbije, br. 179001

  6. Educational course in emergency radiology

    International Nuclear Information System (INIS)

    Velkova, K.; Stoeva, M.; Cvetkova, S.; Hilendarov, A.; Petrova, A.; Stefanov, P.; Simova, E.; Georgieva, V.; Sirakov, N.

    2012-01-01

    Emergency radiology is the part of radiology primarily focused on acute diagnosing conditions in ER patients. This advanced area of radiology improves the quality of care and treatment of patients and of the emergency medicine as a whole. The educational course in Emergency (ER) Radiology is available for medical students in their 8th and 9th semester. The main objective of the ER course is to obtain knowledge about the indications, possibilities and diagnostic value of the contemporary imaging methods in ER cases. Therapeutic methods under imaging control are also covered by the course. The curriculum of the course consists of 6 lectures and 12 practical classes. (authors)

  7. Nuclear operator emergency response: a robust and proven organisation that is an integral part of nuclear safety

    International Nuclear Information System (INIS)

    Digoin, A.; Godino, O.

    2006-01-01

    Nuclear safety, the priority number one of EDF SA, demands improvement of materials performance, maintaining and developing staff skills, improving organizations in normal or incidental situations. So far, the national crisis organization of the Nuclear Power Plant Department is a whole part of EDF SA crisis organization. It coordinates the decision field, the action field, the expertise field in local and national places. For that, it must train staff which participates in periodic drills limited to the plant and also drills which involve Public Authorities. This crisis organization can also be mobilized for foreign nuclear power plants in China or in South Africa. In anticipation of possible consequences, EDF SA does not hesitate in mobilizing the whole organization two or three times a year for technical events without environmental consequences or for climatic, social, in political issues that can involve the company. For example, the hurricane in December 1999 or for the aridity in 2003, EDF crisis organization was mobilized for several weeks without interruption. These examples show the capacity this organization has to deal with many events and allows EDF to be answerable for all of their activities. (author)

  8. The emergence of a global right to health norm--the unresolved case of universal access to quality emergency obstetric care.

    Science.gov (United States)

    Hammonds, Rachel; Ooms, Gorik

    2014-02-27

    The global response to HIV suggests the potential of an emergent global right to health norm, embracing shared global responsibility for health, to assist policy communities in framing the obligations of the domestic state and the international community. Our research explores the extent to which this global right to health norm has influenced the global policy process around maternal health rights, with a focus on universal access to emergency obstetric care. In examining the extent to which arguments stemming from a global right to health norm have been successful in advancing international policy on universal access to emergency obstetric care, we looked at the period from 1985 to 2013 period. We adopted a qualitative case study approach applying a process-tracing methodology using multiple data sources, including an extensive literature review and limited key informant interviews to analyse the international policy agenda setting process surrounding maternal health rights, focusing on emergency obstetric care. We applied John Kingdon's public policy agenda setting streams model to analyse our data. Kingdon's model suggests that to succeed as a mobilising norm, the right to health could work if it can help bring the problem, policy and political streams together, as it did with access to AIDS treatment. Our analysis suggests that despite a normative grounding in the right to health, prioritisation of the specific maternal health entitlements remains fragmented. Despite United Nations recognition of maternal mortality as a human rights issue, the relevant policy communities have not yet managed to shift the policy agenda to prioritise the global right to health norm of shared responsibility for realising access to emergency obstetric care. The experience of HIV advocates in pushing for global solutions based on right to health principles, including participation, solidarity and accountability; suggest potential avenues for utilising right to health based

  9. The impact of a fast track area on quality and effectiveness outcomes: a Middle Eastern emergency department perspective.

    LENUS (Irish Health Repository)

    Devkaran, Subashnie

    2009-01-01

    BACKGROUND: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and morbidity. |The study objective was to determine the impact of a fast track area (FTA) on both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. LWBS rates and mortality rates) in non-urgent patients. The secondary objective was to assess if a FTA negatively impacted on urgent patients entering the ED. METHODS: The study took place in a 500 bed, urban, tertiary care hospital in Abu Dhabi, United Arab Emirates. This was a quasi-experimental, which examined the impact of a FTA on a pre-intervention control group (January 2005) (n = 4,779) versus a post-intervention study group (January 2006) (n = 5,706). RESULTS: Mean WTs of Canadian Triage Acuity Scale (CTAS) 4 patients decreased by 22 min (95% CI 21 min to 24 min, P < 0.001). Similarly, mean WTs of CTAS 5 patients decreased by 28 min (95% CI 19 min to 37 min, P < 0.001) post FTA. The mean WTs of urgent patients (CTAS 2\\/3) were also significantly reduced after the FTA was opened (P < 0.001). The LWBS rate was reduced from 4.7% to 0.7% (95% CI 3.37 to 4.64; P < 0.001). Opening a FTA had no significant impact on mortality rates (P = 0.88). CONCLUSION: The FTA improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates) whereas mortality rate remained unchanged.

  10. Hydrochemical modelling of water quality in terms of emerging micropollutants in Mpumalanga, Gauteng and North West Provinces

    Science.gov (United States)

    Wanda, Elijah M. M.; Mamba, Bhekie B.; Msagati, Titus A. M.

    2017-08-01

    Emerging micropollutants (EMPs) are ubiquitous in aquatic systems and are associated with a wide range of eco-toxicological effects worldwide. There remains a lack of scientific understanding of the major underlying hydrochemical factors behind variations in concentration heterogeneities of EMPs in time and space. This study was therefore conducted to determine major hydrochemical processes controlling water quality and the occurrence of EMPs mainly, carbamazepine (CBZ), tonalide (AHTN), galaxolide (HHCB), caffeine (CAF), technical 4-nonylphenol (NP) and bisphenol A (BPA) in water from Mpumalanga, Gauteng and North West Provinces in South Africa. Grab water samples were collected bi-monthly between June 2014 and April 2016 from 44 water sources using standard sampling procedures. BPA, NP, CAF, HHCB, AHTN, CBZ were extracted, cleaned and enriched using autotrace-SPE at neutral pH and analyzed using GC × GC-TOFMS. Kruskal Wallis-test was used to test for temporal variations in occurrence of the analytes. The Geochemist's Workbench® Release 11 software, Surfer Golden Graphics for surface mapping, PHREEQC software and bivariate ion plots were used determine the major hydrogeochemical processes. The mean concentrations of EMPs varied from 3.48 μg/L for CAF to 421.53 μg/L for HHCB. Although the Kruskal Wallis test revealed no any statistically significant temporal variations in concentrations of the analytes in water samples at 95% confidence level, their occurrence and distribution vary spatially with BPA being the most widely distributed EMP and was present in 62% of the sampled sites. Municipal waste water inputs, agricultural pollution, ion-exchange reactions, carbonate and silicate weathering were the major processes controlling water quality in the study area. This study may assist water resource managers to ably address and manage water pollution resulting from a number of natural and anthropogenic hydrochemical processes in the study area.

  11. Streptococcus suis: a re-emerging pathogen associated with occupational exposure to pigs or pork products. Part II – Pathogenesis

    Directory of Open Access Journals (Sweden)

    Jacek Dutkiewicz

    2018-03-01

    Full Text Available Streptococcus suis is a re-emerging zoonotic pathogen that may cause severe disease, mostly meningitis, in pigs and in humans having occupational contact with pigs and pork, such as farmers, slaughterhose workers and butchers. The first stage of the pathogenic process, similar in pigs and humans, is adherence to and colonisation of mucosal and/or epithelial surface(s of the host. The second stage is invasion into deeper tissue and extracellular translocation of bacterium in the bloodstream, either free in circulation or attached to the surface of monocytes. If S. suis present in blood fails to cause fatal septicaemia, it is able to progress into the third stage comprising penetration into host’s organs, mostly by crossing the blood-brain barrier and/or blood–cerebrospinal fluid barrier to gain access to the central nervous system (CNS and cause meningitis. The fourth stage is inflammation that plays a key role in the pathogen esis of both systemic and CNS infections caused by S. suis . The pathogen may induce the overproduction of pro-inflammatory cytokines that cause septic shock and/or the recruitment and activation of different leukocyte populations, causing acute inflammation of the CNS. Streptococcus suis can also evoke – through activation of microglial cells, astrocytes and possibly other cell types – a fulminant inflammatory reaction of the brain which leads to intracranial complications, including brain oedema, increased intracranial pressure, cerebrovascular insults, and deafness, as a result of cochlear sepsis. In all stages of the pathogenic process, S. suis interacts with many types of immunocompetent host’s cells, such as polymorphonuclear leukocytes, mononuclear macrophages, lymphocytes, dendritic cells and microglia, using a range of versatile virulence factors for evasion of the innate and adaptive immune defence of the host, and for overcoming environmental stress. It is estimated that S. suis produces more than

  12. [Determinants of health and health policy. Part 3. From intervention of quality of life].

    Science.gov (United States)

    Zácek, A

    2000-03-29

    Effectiveness of outputs of a qualified intervention can be valued by several positive criteria corresponding to the "quality of life" conception, which is based on the feeling of the health and contentment. The finding that great differences in the income among different social groups in conditions of the liberal market society correlate with several health and social problems brought about to the hypothesis that the decrease of the differences in the income, accompanied by strengthening of various forms of the social cohesion, civic solidarity, legitimate equality, and ethical justice may substantially improve the health status of the population. The hypothesis has been verified in many epidemiological studies and found to be valid enough for the health policy and far-seeing economy. Analytics of the World Bank recommend to governments primary invest into the health of socially week groups in order to decrease their poverty and to keep social conciliation. World Health Organization (WHO) sets in its new program for Europe called "21 Goals for the 21st Century" that differences in the health status among the European states should diminish till 2020 by one third and within the countries by one quarter at least. Both goals should be achieved by a substantial improvement of the health status of the ill-adapted social groups and by significant improvement of those socioeconomical conditions which may have adverse effects namely on the differences in incomes, education and opportunities for employment.

  13. Scanning ARM Cloud Radars. Part II: Data Quality Control and Processing

    Energy Technology Data Exchange (ETDEWEB)

    Kollias, Pavlos; Jo, Ieng; Borque, Paloma; Tatarevic, Aleksandra; Lamer, Katia; Bharadwaj, Nitin; Widener, Kevin B.; Johnson, Karen L.; Clothiaux, Eugene E.

    2014-03-01

    The Scanning ARM Cloud Radars (SACR’s) are the primary instruments for documenting the four-dimensional structure and evolution of clouds within a 20-30 km radius from the ARM fixed and mobile sites. Here, the post-processing of the calibrated SACR measurements is discussed. First, a feature mask algorithm that objectively determines the presence of significant radar returns is described. The feature mask algorithm is based on the statistical properties of radar receiver noise. It accounts for atmospheric emission and is applicable even for SACR profiles with few or no signal-free range gates. Using the nearest-in-time atmospheric sounding, the SACR radar reflectivities are corrected for gaseous attenuation (water vapor and oxygen) using a line-by-line absorption model. Despite having a high pulse repetition frequency, the SACR has a narrow Nyquist velocity limit and thus Doppler velocity folding is commonly observed. An unfolding algorithm that makes use of a first guess for the true Doppler velocity using horizontal wind measurements from the nearest sounding is described. The retrieval of the horizontal wind profile from the HS-RHI SACR scan observations and/or nearest sounding is described. The retrieved horizontal wind profile can be used to adaptively configure SACR scan strategies that depend on wind direction. Several remaining challenges are discussed, including the removal of insect and second-trip echoes. The described algorithms significantly enhance SACR data quality and constitute an important step towards the utilization of SACR measurements for cloud research.

  14. Improving packaged food quality and safety. Part 1: synchrotron X-ray analysis.

    Science.gov (United States)

    López-Rubio, A; Hernandez-Muñoz, P; Catala, R; Gavara, R; Lagarón, J M

    2005-10-01

    The objective was to demonstrate, as an example of an application, the potential of synchrotron X-ray analysis to detect morphological alterations that can occur in barrier packaging materials and structures. These changes can affect the packaging barrier characteristics when conventional food preservation treatments are applied to packaged food. The paper presents the results of a number of experiments where time-resolved combined wide-angle X-ray scattering and small-angle X-ray scattering analysis as a function of temperature and humidity were applied to ethylene-vinyl alcohol co-polymers (EVOH), polypropylene (PP)/EVOH/PP structures, aliphatic polyketone terpolymer (PK) and amorphous polyamide (aPA) materials. A comparison between conventional retorting and high-pressure processing treatments in terms of morphologic alterations are also presented for EVOH. The impact of retorting on the EVOH structure contrasts with the good behaviour of the PK during this treatment and with that of aPA. However, no significant structural changes were observed by wide-angle X-ray scattering in the EVOH structures after high-pressure processing treatment. These structural observations have also been correlated with oxygen permeability measurements that are of importance when guaranteeing the intended levels of safety and quality of packaged food.

  15. Indoor Air Quality Assessment Based on Human Physiology - Part 1. New Criteria Proposal

    Directory of Open Access Journals (Sweden)

    M. V. Jokl

    2003-01-01

    Full Text Available Human physiology research makes evident that the Weber-Fechner law applies not only to noise perception but also to the perception of other environmental components. Based on this fact, new decibel units for dor component representing indoor air quality in majority locations have been proposed: decicarbdiox dCd (for carbon dioxide CO2 and decitvoc dTv (for total volatile organic compound TVOC. Equations of these new units have been proved by application of a experimental relationships between odor intensity (representing odor perception by the human body and odor concentrations of CO2 and TVOC, b individually  measured CO2 and TVOC levels (concentrations – from these new decibel units can be calculated and their values compared with decibel units of noise measured in the same locations. The undoubted benefit of using the decibel scale is that it gives much better approximation to human perception of odor intensity compared to the CO2 and TVOC concentration scales.

  16. Influence of the Lubricant Type on the Surface Quality of Steel Parts Obtained by Ironing

    Directory of Open Access Journals (Sweden)

    D. Adamović

    2015-06-01

    Full Text Available If it is needed to achieve a higher strain rate during the ironing process, which is possible without inter-stage annealing, the ironing is performed in succession through multiple dies. During that process, changes of friction conditions occur due to the change of contact conditions (dislodging of lubricants, changes of surface roughness, formation of friction junctions, etc.. In the multistage ironing, after each stage, the completely new conditions on the contact surfaces occur, which will significantly affect the quality of the workpiece surface. Lubricant has a very important role during the steel sheet metal ironing process; to separate the sheet metal surface from the tool and to reduce the friction between the contact surfaces. The influence of tribological conditions in ironing process is extremely important and it was a subject of study among researches in recent years, both in the real processes and on the tribo-models. Investigation of tribological conditions in the real processes is much longer and more expensive, so testing on the tribo-models is more frequent. Experimental research on the original tribo-model presented in this paper was aimed to indicate the changes that occur during multistage ironing, as well as to consider the impact of some factors (tool material, lubricant on die and punch on increase or decrease of the sheet metal surface roughness in ironing stages.

  17. Pediatric сlinic of Odessa National Medical University: the quality of emergency medical care for children

    Directory of Open Access Journals (Sweden)

    E.A. Starets

    2017-04-01

    Full Text Available Background. The purpose of the article is to discuss the issue of improving the quality of emergency care for children with the most common diseases. Materials and methods. The quality of medical care includes 6 characteristics: 1 effectiveness — evidencebased health care results in improved health outcomes; 2 relevancy: health care is delivered in a manner that maximizes resource use and avoids wasting and provided in a setting where skills and resources are appropriate to medical need; 3 accessibility: health care is provided timely, reasonable and affordable; 4 acceptability/patient-centered: health care provided takes into account the preferences and aspirations of individual service users; 5 equity: health care provided does not vary in quality because of personal characteristics or socioeconomic status; 6 safety: health care provided minimizes risks and harm to service users and providers. Results. The Intensive Care Unit (ICU started working in the Pediatric Clinic of the Odessa National Medical University on February 1, 2017. The main task of ICU is the treatment of children with emergency conditions (who needs monitoring of breathing and cardiac activity, oxygen therapy, large-volume rehydration therapy, etc. The patients admit to the ICU according the results of triage. Triage is the process of rapidly screening of sick children soon after their addmission to hospital and in ICU, in order to identify those with emergency signs — obstruc-ted breathing or severe respiratory distress; central cyanosis; signs of shock; signs of severe dehydration; those with priority signs — very high temperature, severe pallor, respiratory distress etc. The local guidelines for the most common diseases in children have been developed in the Pediatric Clinic. These local guidelines are based on: 1 modern national guidelines; 2 WHO: Pocket book of hospital care for children: guidelines for the management of common childhood illnesses (2013; clinical

  18. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments.

    Science.gov (United States)

    Lysaker, Paul H; Pattison, Michelle L; Leonhardt, Bethany L; Phelps, Scott; Vohs, Jenifer L

    2018-02-01

    Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture. © 2018 World Psychiatric Association.

  19. Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments.

    Science.gov (United States)

    Ben-Assuli, Ofir

    2015-03-01

    Recently, the healthcare sector has shown a growing interest in information technologies. Two popular health IT (HIT) products are the electronic health record (EHR) and health information exchange (HIE) networks. The introduction of these tools is believed to improve care, but has also raised some important questions and legal and privacy issues. The implementation of these systems has not gone smoothly, and still faces some considerable barriers. This article reviews EHR and HIE to address these obstacles, and analyzes the current state of development and adoption in various countries around the world. Moreover, legal and ethical concerns that may be encountered by EHR users and purchasers are reviewed. Finally, links and interrelations between EHR and HIE and several quality of care issues in today's healthcare domain are examined with a focus on EHR and HIE in the emergency department (ED), whose unique characteristics makes it an environment in which the implementation of such technology may be a major contributor to health, but also faces substantial challenges. The paper ends with a discussion of specific policy implications and recommendations based on an examination of the current limitations of these systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Epipelic Diatoms as Indicators of Water Quality in the Lower Part of River Melet (Ordu, Türkiye

    Directory of Open Access Journals (Sweden)

    Beyhan Taş

    2015-07-01

    Full Text Available Phytobenthos includes bioindicator species and is widely used in water ecology studies. Diatoms constitute one of the most important groups of phytobenthos in streams. In particular, these organisms are good indicators in investigations related with determining of water quality in medium and long time. In this study, the epipelic diatom flora of the lower part of River Melet were investigated, the most important source of drinking water in Ordu city. The examination was performed periodically in March-November 2012 and total of 56 taxa were identified. Cymbellales (14 taxa and Naviculales (16 taxa ordo constituted 54% of diatom diversity. These were followed by Fragilariales (16%, 9 taxa Bacillariales (14%, 8 taxa Surirellales (9%, 5 taxa Achnanthales (3%, 2 taxa Eunotiales (2%, 1 taxa and Melosirales (2%, 1 taxa, respectively. Diatome vulgaris, Melosira varians, Navicula gregaria, N. tripunctata and Nitzschia sigmoidea species were recorded as widespread and intense in the epipelic communities. These species are usually tolerant to organic pollution and are found in β-α- mesosaprobic conditions. According to the obtained results, the lower part of the Melet River has character from pollution towards moderate pollution. In other words, it has II-III. class water quality.

  1. Chemicals of emerging concern in water and bottom sediment in the Great Lakes Basin, 2012: collection methods, analytical methods, quality assurance, and study data

    Science.gov (United States)

    Lee, Kathy E.; Langer, Susan K.; Menheer, Michael A.; Hansen, Donald S.; Foreman, William T.; Furlong, Edward T.; Jorgenson, Zachary G.; Choy, Steven J.; Moore, Jeremy N.; Banda, JoAnn; Gefell, Daniel J.

    2015-01-01

    In synoptic surveys of surface-water quality across the United States, a large group of organic chemicals associated with agricultural, household, and industrial waste have been detected. These chemicals are referred to collectively as chemicals of emerging concern (CECs) and include prescription drugs and antibiotics, over-the-counter medications, reproductive hormones, personal-care products, detergent metabolites, and flame retardants.

  2. Health-related quality of life and post-traumatic stress disorder symptoms in accident and emergency attenders suffering from psychosocial crises: a longitudinal study

    Science.gov (United States)

    Senneseth, Mette; Alsaker, Kjersti; Natvig, Gerd Karin

    2012-01-01

    Aims This paper is a report of a study of health-related quality of life and post-traumatic stress disorder symptoms in patients attending an Accident and Emergency department because of psychosocial crises. Background Psychosocial crises are commonplace globally, but there is little knowledge about patients attending Accident and Emergency departments because of psychosocial crises. Methods Data were collected at an Accident and Emergency department in Norway from September 2008 to June 2009. A total of 99 adults participated in the baseline study and 41 of these participated at 2 months follow-up. The Short Form-36 Health Survey and the Post Traumatic Symptom Scale were used to obtain data. Findings Participants reported significantly lower scores in all health-related quality of life domains at baseline compared with the general Norwegian population. The mental health score was two standard deviations below the norm. Health-related quality of life scores were improved and post-traumatic stress disorder symptoms were reduced after 2 months. High levels of post-traumatic stress disorder symptoms were reported by 78% of the participants at baseline and 59% at follow-up. Participants with high levels of post-traumatic stress disorder symptoms at follow-up also reported low health-related quality of life scores. Conclusion This study suggests a need for an acute psychosocial intervention and an opportunity to receive follow-up support at Accident and Emergency departments. PMID:21740459

  3. Study on the mechanisms making the deep groundwater quality. Part 3

    Energy Technology Data Exchange (ETDEWEB)

    Ohara, Kin-ichi [CHISHITSU-KISO-KOGYO Co., Ltd. (Japan)

    1997-03-01

    We compiled geological data and chemical data of deep groundwater in the Joban Coal Field, and examined the qualities and the changes of groundwater by geochemical analysis and numerical simulation. On the chemical analysis, we classified the chemical type of the water which gathered in the coal mine tunnels, and clarified their distributions. Moreover we analyzed isotopes in the water which picked up from wells under running. As a consequence of these analysis, the origin of the groundwater character in the Joban Coal Field is inferred to be mostly mixed water with present sea water and fresh water. We detected some groundwater were mixed with fresh water in some ten years, while we recognized that some groundwater which were mixed clearly with fossilized sea water also exist. Concerning the numerical simulation, we set up the 3 dimensional model in this field which roughly represents the geological structures and physical conditions, and collected the data to inspect the analytical results. We simulated hydraulic conditions of this model for 100 years including three phases; those are the model with no tunnels, the model at mining, and abandoned mine model with re-submergence. In consequence, volume of influx water to the tunnels and restoration of water level after re-submergence are nearly represented, and we recognized the availability of this large-scale analysis. Moreover, we tried to simulate the very large 2 dimensional water system including the boundary of fresh water and sea water, and analyzed very long time change of the deep groundwater which was caused by sea level change. (author). 63 refs.

  4. Scanning ARM Cloud Radars Part II. Data Quality Control and Processing

    Energy Technology Data Exchange (ETDEWEB)

    Kollias, Pavlos [McGill Univ., Montreal, QC (Canada); Jo, Ieng [McGill Univ., Montreal, QC (Canada); Borque, Paloma [McGill Univ., Montreal, QC (Canada); Tatarevic, Aleksandra [McGill Univ., Montreal, QC (Canada); Lamer, Katia [McGill Univ., Montreal, QC (Canada); Bharadwaj, Nitin [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Widener, Kevin B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Johnson, Karen [Brookhaven National Lab. (BNL), Upton, NY (United States); Clothiaux, Eugene E. [Pennsylvania State Univ., State College, PA (United States)

    2013-10-04

    The Scanning ARM Cloud Radars (SACR’s) are the primary instruments for documenting the four-dimensional structure and evolution of clouds within a 20-30 km radius from the ARM fixed and mobile sites. Here, the post-processing of the calibrated SACR measurements is discussed. First, a feature mask algorithm that objectively determines the presence of significant radar returns is described. The feature mask algorithm is based on the statistical properties of radar receiver noise. It accounts for atmospheric emission and is applicable even for SACR profiles with few or no signal-free range gates. Using the nearest-in-time atmospheric sounding, the SACR radar reflectivities are corrected for gaseous attenuation (water vapor and oxygen) using a line-by-line absorption model. Despite having a high pulse repetition frequency, the SACR has a narrow Nyquist velocity limit and thus Doppler velocity folding is commonly observed. An unfolding algorithm that makes use of a first guess for the true Doppler velocity using horizontal wind measurements from the nearest sounding is described. The retrieval of the horizontal wind profile from the Hemispherical Sky – Range Height Indicator SACR scan observations and/or nearest sounding is described. The retrieved horizontal wind profile can be used to adaptively configure SACR scan strategies that depend on wind direction. Several remaining challenges are discussed, including the removal of insect and second-trip echoes. The described algorithms significantly enhance SACR data quality and constitute an important step towards the utilization of SACR measurements for cloud research.

  5. Physics and quality assurance for brachytherapy - Part II: Low dose rate and pulsed dose rate

    International Nuclear Information System (INIS)

    Williamson, Jeffrey F.

    1997-01-01

    Purpose: A number of recent developments have revitalized brachytherapy including remote afterloading, implant optimization, increasing use of 3D imaging, and advances in dose specification and basic dosimetry. However, the core physical principles underlying the classical methods of dose calculation and arrangement of multiple sources remain unchanged. The purpose of this course is to review these principles and their applications to low dose-rate interstitial and intracavitary brachytherapy. Emphasis will be placed upon the classical implant systems along with classical and modern methods of dose specification. The level of presentation is designed for radiation oncology residents and beginning clinical physicists. A. Basic Principles (1) Radium-substitute vs. low-energy sealed sources (2) Dose calculation principles (3) The mysteries of source strength specification revealed: mgRaEq, mCi and air-kerma strength B. Interstitial Brachytherapy (1) Target volume, implanted volume, dose specification in implants and implant optimization criteria (2) Classical implant systems: Manchester Quimby and Paris a) Application of the Manchester system to modern brachytherapy b) Comparison of classical systems (3) Permanent interstitial implants a) Photon energy and half life b) Dose specification and pre-operative planning (4) The alphabet soup of dose specification: MCD (mean central dose), minimum dose, MPD (matched peripheral dose), MPD' (minimum peripheral dose) and DVH (dose-volume histogram) quality indices C. Intracavitary Brachytherapy for Carcinoma of the Cervix (1) Basic principles a) Manchester System: historical foundation of U.S. practice patterns b) Principles of applicator design (2) Dose specification and treatment prescription a) mg-hrs, reference points, ICRU Report 38 reference volume -- Point A dose vs mg-hrs and IRAK (Integrated Reference Air Kerma) -- Tissue volume treated vs mg-hrs and IRAK b) Practical methods of treatment specification and prescription

  6. Fortifying pork liver mixture: Evaluation of protein quality and iron bioavailability – Part 2

    Directory of Open Access Journals (Sweden)

    Silvana Mariana SREBERNICH

    Full Text Available ABSTRACT Objective To evaluate the protein quality and iron bioavailability of a fortifying mixture based on pork liver. Methods Determinations of protein efficiency ratio, net protein utilization, true digestibility and hemoglobin regeneration efficiency by depletion and repletion were performed. In the depletion phase, the animals (male Wistar rats received an iron-free AIN–93G diet and in the repletion phase they received the following diets: standard AIN–93G diet, fortifying mixture and standard diet containing heptahydrated ferrous sulfate for comparison. Results For standard AIN–93G diet and fortifying mixture the results were 3.75 and 4.04 for protein efficiency ratio and 3.53 and 3.63 for net protein retention, showing that the presence of pork liver in the diet promoted an increase in protein efficiency ratio and net protein retention (not statistically significant. True digestibility results obtained with the fortifying mixture (97.16% were higher than those obtained with the standard AIN–93G diet (casein, but without significant difference. The hemoglobin regeneration efficiency values obtained for standard AIN–93G diet, fortifying mixture and standard diet containing heptahydrated ferrous sulfate were 50.69, 31.96 and 29.96%, respectively, showing a statistically significant difference between the control (standard AIN–93G diet and test (fortifying mixture and standard diet containing heptahydrated ferrous sulfate samples, but not between the test samples. Conclusion The fortifying mixture showed a high protein efficiency ratio value of 4.04 and a high relative biological value (108% and it can be added to soups, creams and meats in day-care centers for the prevention of iron-deficiency in children of school age.

  7. System for verifiable CT radiation dose optimization based on image quality. part II. process control system.

    Science.gov (United States)

    Larson, David B; Malarik, Remo J; Hall, Seth M; Podberesky, Daniel J

    2013-10-01

    To evaluate the effect of an automated computed tomography (CT) radiation dose optimization and process control system on the consistency of estimated image noise and size-specific dose estimates (SSDEs) of radiation in CT examinations of the chest, abdomen, and pelvis. This quality improvement project was determined not to constitute human subject research. An automated system was developed to analyze each examination immediately after completion, and to report individual axial-image-level and study-level summary data for patient size, image noise, and SSDE. The system acquired data for 4 months beginning October 1, 2011. Protocol changes were made by using parameters recommended by the prediction application, and 3 months of additional data were acquired. Preimplementation and postimplementation mean image noise and SSDE were compared by using unpaired t tests and F tests. Common-cause variation was differentiated from special-cause variation by using a statistical process control individual chart. A total of 817 CT examinations, 490 acquired before and 327 acquired after the initial protocol changes, were included in the study. Mean patient age and water-equivalent diameter were 12.0 years and 23.0 cm, respectively. The difference between actual and target noise increased from -1.4 to 0.3 HU (P process control chart identified several special causes of variation. Implementation of an automated CT radiation dose optimization system led to verifiable simultaneous decrease in image noise variation and SSDE. The automated nature of the system provides the opportunity for consistent CT radiation dose optimization on a broad scale. © RSNA, 2013.

  8. Physics and quality assurance for brachytherapy - Part II: Low dose rate and pulsed dose rate

    International Nuclear Information System (INIS)

    Williamson, Jeffrey F.

    1996-01-01

    Purpose: A number of recent developments have revitalized brachytherapy including remote afterloading, implant optimization, increasing use of 3D imaging, and advances in dose specification and basic dosimetry. However, the core physical principles underlying the classical methods of dose calculation and arrangement of multiple sources remain unchanged. The purpose of this course is to review these principles and their applications to low dose-rate interstitial and intracavitary brachytherapy. Emphasis will be placed upon the classical implant systems along with classical and modern methods of dose specification. The level of presentation is designed for radiation oncology residents and beginning clinical physicists. A. Basic Principles (1) Radium-substitute vs. low-energy sealed sources (2) Dose calculation principles (3) The mysteries of source strength specification revealed: mgRaEq, mCi and air-kerma strength B. Interstitial Brachytherapy (1) Target volume, implanted volume, dose specification in implants and implant optimization criteria (2) Classical implant systems: Manchester Quimby and Paris a) Application of the Manchester system to modern brachytherapy b) Comparison of classical systems (3) Permanent interstitial implants a) Photon energy and half life b) Dose specification and pre-operative planning (4) The alphabet soup of dose specification: MCD (mean central dose), minimum dose, MPD (matched peripheral dose), MPD' (minimum peripheral dose) and DVH (dose-volume histogram) quality indices C. Intracavitary Brachytherapy for Carcinoma of the Cervix (1) Basic principles a) Manchester System: historical foundation of U.S. practice patterns b) Principles of applicator design (2) Dose specification and treatment prescription a) mg-hrs, reference points, ICRU Report 38 reference volume --Point A dose vs mg-hrs and IRAK (Integrated Reference Air Kerma) --Tissue volume treated vs mg-hrs and IRAK b) Practical methods of treatment specification and prescription

  9. Streptococcus suis: a re-emerging pathogen associated with occupational exposure to pigs or pork products. Part I - Epidemiology.

    Science.gov (United States)

    Dutkiewicz, Jacek; Sroka, Jacek; Zając, Violetta; Wasiński, Bernard; Cisak, Ewa; Sawczyn, Anna; Kloc, Anna; Wójcik-Fatla, Angelina

    2017-12-23

    Streptococcus suis (ex Elliot 1966, Kilpper-Bälz & Schleifer 1987) is a facultatively anaerobic Gram-positive ovoid or coccal bacterium surrounded by a polysaccharide capsule. Based on the antigenic diversity of the capsule, S. suis strains are classified serologically into 35 serotypes. Streptococcus suis is a commensal of pigs, commonly colonizing their tonsils and nasal cavities, mostly in weaning piglets between 4-10 weeks of age. This species occurs also in cattle and other mammals, in birds and in humans. Some strains, mostly those belonging to serotype 2, are also pathogenic for pigs, as well as for other animals and humans. Meningitis is the primary disease syndrome caused by S. suis, both in pigs and in humans. It is estimated that meningitis accounted for 68.0% of all cases of human disease reported until the end of 2012, followed by septicaemia (including life-threatening condition described as 'streptococcal toxic shock-like syndrome' - STSLS), arthritis, endocarditis, and endophthalmitis. Hearing loss and/or ves tibular dysfunction are the most common sequelae after recovery from meningitis caused by S. suis, occurring in more than 50% of patients. In the last two decades, the number of reported human cases due to S. suis has dramatically increased, mostly due to epidemics recorded in China in 1998 and 2005, and the fulminant increase in morbidity in the countries of south-eastern Asia, mostly Vietnam and Thailand. Out of 1,642 cases of S. suis infections identified between 2002-2013 worldwide in humans, 90.2% occurred in Asia, 8.5% in Europe and 1.3% in other parts of the globe. The human disease has mostly a zoonotic and occupational origin and occurs in pig breeders, abattoir workers, butchers and workers of meat processing facilities, veterinarians and meat inspectors. Bacteria are transmitted to workers by close contact with pigs or pig products, usually through contamination of minor cuts or abrasions on skin of hands and/or arms, or by pig bite

  10. Streptococcus suis: a re-emerging pathogen associated with occupational exposure to pigs or pork products. Part I – Epidemiology

    Directory of Open Access Journals (Sweden)

    Jacek Dutkiewicz

    2017-12-01

    Full Text Available Streptococcus suis (ex Elliot 1966, Kilpper-Bälz & Schleifer 1987 is a facultatively anaerobic Gram-positive ovoid or coccal bacterium surrounded by a polysaccharide capsule. Based on the antigenic diversity of the capsule, S. suis strains are classified serologically into 35 serotypes. Streptococcus suis is a commensal of pigs, commonly colonizing their tonsils and nasal cavities, mostly in weaning piglets between 4–10 weeks of age. This species occurs also in cattle and other mammals, in birds and in humans. Some strains, mostly those belonging to serotype 2, are also pathogenic for pigs, as well as for other animals and humans. Meningitis is the primary disease syndrome caused by S. suis , both in pigs and in humans. It is estimated that meningitis accounted for 68.0% of all cases of human disease reported until the end of 2012, followed by septicaemia (including life-threatening condition described as ‘streptococcal toxic shock-like syndrome’ – STSLS, arthritis, endocarditis, and endophthalmitis. Hearing loss and/or ves tibular dysfunction are the most common sequelae after recovery from meningitis caused by S. suis , occurring in more than 50% of patients. In the last two decades, the number of reported human cases due to S. suis has dramatically increased, mostly due to epidemics recorded in China in 1998 and 2005, and the fulminant increase in morbidity in the countries of south-eastern Asia, mostly Vietnam and Thailand. Out of 1,642 cases of S. suis infections identified between 2002–2013 worldwide in humans, 90.2% occurred in Asia, 8.5% in Europe and 1.3% in other parts of the globe. The human disease has mostly a zoonotic and occupational origin and occurs in pig breeders, abattoir workers, butchers and workers of meat processing facilities, veterinarians and meat inspectors. Bacteria are transmitted to workers by close contact with pigs or pig products, usually through contamination of minor cuts or abrasions on skin of

  11. An alternative method for noise analysis using pixel variance as part of quality control procedures on digital mammography systems

    International Nuclear Information System (INIS)

    Bouwman, R; Broeders, M; Van Engen, R; Young, K; Lazzari, B; Ravaglia, V

    2009-01-01

    According to the European Guidelines for quality assured breast cancer screening and diagnosis, noise analysis is one of the measurements that needs to be performed as part of quality control procedures on digital mammography systems. However, the method recommended in the European Guidelines does not discriminate sufficiently between systems with and without additional noise besides quantum noise. This paper attempts to give an alternative and relatively simple method for noise analysis which can divide noise into electronic noise, structured noise and quantum noise. Quantum noise needs to be the dominant noise source in clinical images for optimal performance of a digital mammography system, and therefore the amount of electronic and structured noise should be minimal. For several digital mammography systems, the noise was separated into components based on the measured pixel value, standard deviation (SD) of the image and the detector entrance dose. The results showed that differences between systems exist. Our findings confirm that the proposed method is able to discriminate systems based on their noise performance and is able to detect possible quality problems. Therefore, we suggest to replace the current method for noise analysis as described in the European Guidelines by the alternative method described in this paper.

  12. The neural network as a part of decision support system for quality management for production objects in machining process

    Directory of Open Access Journals (Sweden)

    Cherepanska I.Yu.

    2017-04-01

    Full Text Available The research discusses the use of artificial neural networks (ANN as components of a decision support system (DSS to automate quality control manufacturing facilities machining business at the production, which should be focused on the analysis of large amounts of heterogeneous information. The necessity to use ANN as a part of DSS is justified by the fact that quality control during production is multistage and time-consuming process that is formalized difficult, and moreover requires considerable information and material costs for the efficiency of manufacturing operations performed. Taking into account the existing experience of successful use of ANN to solve difficult formal problems associated with handling large volumes of diverse and rapidly changing information, the authors synthesized ANN for automated determination of the causes deterioration of the quality of production objects (PO in the performance of manufacturing operations application. Particular attention is paid to the definition of the dimension of the hidden layer ANN synthesized due to the fact that today still there is no analytical expression to determine the dimension of the hidden layer ANN and size of the latter is determined only by the experimental results of ANN several different structures by comparison the results, in particular the value of mean square error.

  13. Emergency radiology

    International Nuclear Information System (INIS)

    Keats, T.E.

    1986-01-01

    This book is the German, translated version of the original published in 1984 in the U.S.A., entitled 'Emergency Radiology'. The publication for the most part is made up as an atlas of the radiological images presenting the findings required for assessment of the emergency cases and their first treatment. The test parts' function is to explain the images and give the necessary information. The material is arranged in seven sections dealing with the skull, the facial part of the skull, the spine, thorax, abdominal region, the pelvis and the hip, and the limbs. With 690 figs [de

  14. Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 2: methodological quality and effects.

    Science.gov (United States)

    Johansen, Monika Alise; Berntsen, Gro K Rosvold; Schuster, Tibor; Henriksen, Eva; Horsch, Alexander

    2012-10-03

    We conducted in two parts a systematic review of randomized controlled trials (RCTs) on electronic symptom reporting between patients and providers to improve health care service quality. Part 1 reviewed the typology of patient groups, health service innovations, and research targets. Four innovation categories were identified: consultation support, monitoring with clinician support, self-management with clinician support, and therapy. To assess the methodological quality of the RCTs, and summarize effects and benefits from the methodologically best studies. We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles between 1990 and November 2011. Risk of bias and feasibility were judged according to the Cochrane recommendation, and theoretical evidence and preclinical testing were evaluated according to the Framework for Design and Evaluation of Complex Interventions to Improve Health. Three authors assessed the risk of bias and two authors extracted the effect data independently. Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions. Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of participants and personnel. We excluded 12

  15. Emergent technologies: 25 years

    Science.gov (United States)

    Rising, Hawley K.

    2013-03-01

    This paper will talk about the technologies that have been emerging over the 25 years since the Human Vision and Electronic Imaging conference began that the conference has been a part of, and that have been a part of the conference, and will look at those technologies that are emerging today, such as social networks, haptic technologies, and still emerging imaging technologies, and what we might look at for the future.Twenty-five years is a long time, and it is not without difficulty that we remember what was emerging in the late 1980s. Yet to be developed: The first commercial digital still camera was not yet on the market, although there were hand held electronic cameras. Personal computers were not displaying standardized images, and image quality was not something that could be talked about in a standardized fashion, if only because image compression algorithms were not standardized yet for several years hence. Even further away were any standards for movie compression standards, there was no personal computer even on the horizon which could display them. What became an emergent technology and filled many sessions later, image comparison and search, was not possible, nor the current emerging technology of social networks- the world wide web was still several years away. Printer technology was still devising dithers and image size manipulations which would consume many years, as would scanning technology, and image quality for both was a major issue for dithers and Fourier noise.From these humble beginnings to the current moves that are changing computing and the meaning of both electronic devices and human interaction with them, we will see a course through the changing technology that holds some features constant for many years, while others come and go.

  16. Improvement of the reliability of the emergency diesel generators and their protections as a part of the modernization program for units 5 and 6 of the Kozloduy NPP

    International Nuclear Information System (INIS)

    Bogdanov, D.

    2003-01-01

    The measure 'Improvement of the reliability of the emergency diesel generators and their protections' 28411 is part of the modernization program for Units 5 and 6 of Kozloduy NPP. The scope of the measure includes complete change of the I and C system, the local control panels, the technological and electrical protections of the DG set, the excitation system and some of the power distribution switchboards. The new I and C system will be Teleperm XS type, produced by Framatome ANP, the power distribution switchboards type Sivacon, the excitation system Thyripart, and the electrical protection and synchronization system will be provided by Siemens. The purpose of the measure is to increase the availability, maintainability and to improve the reliability of the DG sets

  17. Calendar year 1995 groundwater quality report for the Beak Creek Hydrogeologic Regime, Y-12 Plant, Oak Ridge, Tennessee. Part 2: 1995 groundwater quality data interpretations

    International Nuclear Information System (INIS)

    1996-08-01

    This annual groundwater quality report (GWQR) contains an evaluation of the groundwater and surface water monitoring data obtained during the 1995 calendar year (CY) for several hazardous and nonhazardous waste management facilities associated with the US DOE Y-12 Plant. The sites addressed by this document are located in Bear Creek Valley (BCV) west of the Y-12 Plant complex within the Bear Creek Hydrogeologic Regime. The Bear Creek Regime is one of three hydrogeologic regimes defined for the purposes of groundwater and surface water quality monitoring at the Y-12 Plant. The purpose of the GWPP is to characterize the hydrogeology and to monitor groundwater quality at the Y-12 Plant and surrounding area to provide for protection of groundwater resources consistent with federal, state, and local requirements. Each annual Part 2 GWQR addresses RCRA interim status reporting requirements regarding assessment of the horizontal and vertical extent of groundwater contamination. This report includes background information regarding the extent of groundwater and surface water contamination in the Bear Creek Regime based on the conceptual models described in the remedial investigation report (Section 2); a summary of the groundwater and surface water monitoring activities performed during CY 1995 (Section 3.0); analysis and interpretation of the CY 1995 monitoring data for groundwater (Section 4.0) and surface water (Section 5.0); a summary of conclusions and recommendations (Section 6.0); and a list of cited references (Section 7.0). Appendices contain diagrams, graphs, data tables, and summaries and the evaluation and decision criteria for data screening

  18. Calendar year 1995 groundwater quality report for the Beak Creek Hydrogeologic Regime, Y-12 Plant, Oak Ridge, Tennessee. Part 2: 1995 groundwater quality data interpretations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-08-01

    This annual groundwater quality report (GWQR) contains an evaluation of the groundwater and surface water monitoring data obtained during the 1995 calendar year (CY) for several hazardous and nonhazardous waste management facilities associated with the US DOE Y-12 Plant. The sites addressed by this document are located in Bear Creek Valley (BCV) west of the Y-12 Plant complex within the Bear Creek Hydrogeologic Regime. The Bear Creek Regime is one of three hydrogeologic regimes defined for the purposes of groundwater and surface water quality monitoring at the Y-12 Plant. The purpose of the GWPP is to characterize the hydrogeology and to monitor groundwater quality at the Y-12 Plant and surrounding area to provide for protection of groundwater resources consistent with federal, state, and local requirements. Each annual Part 2 GWQR addresses RCRA interim status reporting requirements regarding assessment of the horizontal and vertical extent of groundwater contamination. This report includes background information regarding the extent of groundwater and surface water contamination in the Bear Creek Regime based on the conceptual models described in the remedial investigation report (Section 2); a summary of the groundwater and surface water monitoring activities performed during CY 1995 (Section 3.0); analysis and interpretation of the CY 1995 monitoring data for groundwater (Section 4.0) and surface water (Section 5.0); a summary of conclusions and recommendations (Section 6.0); and a list of cited references (Section 7.0). Appendices contain diagrams, graphs, data tables, and summaries and the evaluation and decision criteria for data screening.

  19. SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy

    International Nuclear Information System (INIS)

    Hoffman, D; Chung, E; Hess, C; Stern, R; Benedict, S

    2015-01-01

    Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patient treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements upstream

  20. SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, D; Chung, E; Hess, C; Stern, R; Benedict, S [UC Davis Cancer Center, Sacramento, CA (United States)

    2015-06-15

    Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patient treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements upstream

  1. Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures.

    Science.gov (United States)

    Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager

    2013-08-09

    Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. A number of articles addresses this study's objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, "patients left without being seen" (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and

  2. A survey of the quality of nursing services for brain trauma patients in the emergency wards of hospitals in Guilan Province, Iran (2012).

    Science.gov (United States)

    Majidi, Seyed Ali; Ayoubian, Ali; Mardani, Sheida; Hashemidehaghi, Zahra

    2014-01-01

    Head trauma is the main cause of disabilities and death among young people, and the side effects of head trauma pose some of the greatest medical challenges. Rapid diagnosis and the use of proper treatments can prevent more severe brain damage. The purpose of this research was to determine the quality of nursing services provided to brain trauma patients in hospitals in Guilan Province, Iran. The study was conducted as a descriptive, cross-sectional study in the emergency wards of selected hospitals in Guilan in 2012. The research population was comprised of all the brain trauma patients in these hospitals. We developed a two-section questionnaire, ascertained its validity, and determined that it had a reliability of 88% (Cronbach's alpha). Subsequently, we used the questionnaire for gathering data. The data were analyzed using SPSS statistical software, and descriptive analysis tests (frequency rate and average) and deductive analyses tests (chi-squared) also were used. The results showed that the quality of health services provided to brain-trauma patients in the emergency ward was at the moderate level of 58.8% of the cases and at a low level in 41.2% of the cases. Based on the results that showed that the services were of moderate quality, the staff members in the emergency ward were required to update their knowledge and use the required measures to minimize or prevent side effects in brain-trauma patients; clearly, mastery of such measures was a real need among the emergency ward's staff.

  3. Compatible Rhizosphere-Competent Microbial Consortium Adds Value to the Nutritional Quality in Edible Parts of Chickpea.

    Science.gov (United States)

    Yadav, Sudheer K; Singh, Surendra; Singh, Harikesh B; Sarma, Birinchi K

    2017-08-02

    Chickpea is used as a high-energy and protein source in diets of humans and livestock. Moreover, chickpea straw can be used as alternative of forage in ruminant diets. The present study evaluates the effect of beneficial microbial inoculation on enhancing the nutritional values in edible parts of chickpea. Two rhizosphere-competent compatible microbes (Pseudomonas fluorescens OKC and Trichoderma asperellum T42) were selected and applied to seeds either individually or in consortium before sowing. Chickpea seeds treated with the microbes showed enhanced plant growth [88.93% shoot length at 60 days after sowing (DAS)] and biomass accumulation (21.37% at 120 DAS). Notably, the uptake of mineral nutrients, viz., N (90.27, 91.45, and 142.64%), P (14.13, 58.73, and 56.84%), K (20.5, 9.23, and 35.98%), Na (91.98, 101.66, and 36.46%), Ca (16.61, 29.46, and 16%), and organic carbon (28.54, 17.09, and 18.54%), was found in the seed, foliage, and pericarp of the chickpea plants, respectively. Additionally, nutritional quality, viz., total phenolic (59.7, 2.8, and 17.25%), protein (9.78, 18.53, and 7.68%), carbohydrate content (26.22, 30.21, and 26.63%), total flavonoid content (3.11, 9.15, and 7.81%), and reducing power (112.98, 75.42, and 111.75%), was also found in the seed, foliage, and pericarp of the chickpea plants. Most importantly, the microbial-consortium-treated plants showed the maximum increase of nutrient accumulation and enhancement in nutritional quality in all edible parts of chickpea. Nutritional partitioning in different edible parts of chickpea was also evident in the microbial treatments compared to their uninoculated ones. The results thus clearly demonstrated microbe-mediated enhancement in the dietary value of the edible parts of chickpea because seeds are consumed by humans, whereas pericarp and foliage (straw) are used as an alternative of forage and roughage in ruminant diets.

  4. Void Measurements in the Regions of Sub-Cooled and Low-Quality Boiling. Part 2. Higher Mass Velocities

    Energy Technology Data Exchange (ETDEWEB)

    Rouhani, S Z

    1966-07-15

    This report consists mostly of tables of experimental data obtained in void measurements. It is a continuation and the completing part of a previous report with the same title. The data are from the measurements in a vertical annular channel with 25 mm O.D. and 12 mm I.D. at a heated length of 1090 mm. These experiments covered pressures from 10 to 50 bars, mass velocities from 650 to 1450 kg/m -sec., heat fluxes from 60 to 120 W/cm{sup 2}, sub-coolings from 30 to 0 C, and steam qualities from 0 to 12 %. The tables include the inlet temperatures and measured wall super-heat.

  5. Emergence and Evolution of Meaning: The General Definition of Information (GDI Revisiting Program—Part I: The Progressive Perspective: Top-Down

    Directory of Open Access Journals (Sweden)

    Rainer E. Zimmermann

    2012-09-01

    Full Text Available In this first part of the paper, the category of meaning is traced starting from the origin of the Universe itself as well as its very grounding in pre-geometry (the second part deals with an appropriate bottom-up approach. In contrast to many former approaches in the theories of information and also in biosemiotics, we will show that the forms of meaning emerge simultaneously (alongside with information and energy. Hence, information can be visualized as being always meaningful (in a sense to be explicated rather than visualizing meaning as a later specification of information within social systems only. This perspective taken has two immediate consequences: (1 We follow the GDI as defined by Floridi, though we modify it somehow as to the aspect of truthfulness. (2 We can conceptually solve Capurro’s trilemma. Hence, what we actually do is to follow the strict (i.e., optimistic line of UTI in the sense of Hofkirchner’s. While doing this, we treat energy and information as two different categorial aspects of one and the same underlying primordial structure. We thus demonstrate the presently developing convergence of physics, biology, and computer science (as well as the various theories of information in some detail and draft out a line of argument eventually leading up to the further unification of UTI and biosemiotics.

  6. Assessment of tobacco heating product THP1.0. Part 4: Characterisation of indoor air quality and odour.

    Science.gov (United States)

    Forster, Mark; McAughey, John; Prasad, Krishna; Mavropoulou, Eleni; Proctor, Christopher

    2018-03-01

    The tobacco heating product THP1.0, which heats but does not burn tobacco, was tested as part of a modified-risk tobacco product assessment framework for its impacts on indoor air quality and residual tobacco smoke odour. THP1.0 heats the tobacco to less than 240 °C ± 5 °C during puffs. An environmentally controlled room was used to simulate ventilation conditions corresponding to residential, office and hospitality environments. An analysis of known tobacco smoke constituents, included CO, CO 2 , NO, NO 2 , nicotine, glycerol, 3-ethenyl pyridine, sixteen polycyclic aromatic hydrocarbons, eight volatile organic compounds, four carbonyls, four tobacco-specific nitrosamines and total aerosol particulate matter. Significant emissions reductions in comparison to conventional cigarettes were measured for THP1.0. Levels of nicotine, acetaldehyde, formaldehyde and particulate matter emitted from THP1.0 exceeded ambient air measurements, but were more than 90% reduced relative to cigarette smoke emissions within the laboratory conditions defined Residual tobacco smoke odour was assessed by trained sensory panels after exposure of cloth, hair and skin to both mainstream and environmental emissions from the test products. Residual tobacco smoke odour was significantly lower from THP1.0 than from a conventional cigarette. These data show that using THP1.0 has the potential to result in considerably reduced environmental emissions that affect indoor air quality relative to conventional cigarettes. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Thermodynamic analyses of hydrogen production from sub-quality natural gas. Part I: Pyrolysis and autothermal pyrolysis

    Science.gov (United States)

    Huang, Cunping; T-Raissi, Ali

    Sub-quality natural gas (SQNG) is defined as natural gas whose composition exceeds pipeline specifications of nitrogen, carbon dioxide (CO 2) and/or hydrogen sulfide (H 2S). Approximately one-third of the U.S. natural gas resource is sub-quality gas [1]. Due to the high cost of removing H 2S from hydrocarbons using current processing technologies, SQNG wells are often capped and the gas remains in the ground. We propose and analyze a two-step hydrogen production scheme using SQNG as feedstock. The first step of the process involves hydrocarbon processing (via steam-methane reformation, autothermal steam-methane reformation, pyrolysis and autothermal pyrolysis) in the presence of H 2S. Our analyses reveal that H 2S existing in SQNG is stable and can be considered as an inert gas. No sulfur dioxide (SO 2) and/or sulfur trioxide (SO 3) is formed from the introduction of oxygen to SQNG. In the second step, after the separation of hydrogen from the main stream, un-reacted H 2S is used to reform the remaining methane, generating more hydrogen and carbon disulfide (CS 2). Thermodynamic analyses on SQNG feedstock containing up to 10% (v/v) H 2S have shown that no H 2S separation is required in this process. The Part I of this paper includes only thermodynamic analyses for SQNG pyrolysis and autothermal pyrolysis.

  8. Pacific Northwest Laboratory annual report for 1988 to the Assistant Secretary for Environment, Safety, and Health: Part 5, Environment, safety, health, and quality assurance

    Energy Technology Data Exchange (ETDEWEB)

    Faust, L.G.; Pennell, W.T.; Selby, J.M.

    1989-02-01

    This document summarizes the research programs now underway at Battelle's Pacific Northwest Laboratory in the areas of environmental safety, health, and quality assurance. Topics include internal irradiation, emergency plans, dose equivalents, risk assessment, dose equivalents, surveys, neutron dosimetry, and radiation accidents. (TEM)

  9. Pacific Northwest Laboratory annual report for 1988 to the Assistant Secretary for Environment, Safety, and Health: Part 5, Environment, safety, health, and quality assurance

    International Nuclear Information System (INIS)

    Faust, L.G.; Pennell, W.T.; Selby, J.M.

    1989-02-01

    This document summarizes the research programs now underway at Battelle's Pacific Northwest Laboratory in the areas of environmental safety, health, and quality assurance. Topics include internal irradiation, emergency plans, dose equivalents, risk assessment, dose equivalents, surveys, neutron dosimetry, and radiation accidents

  10. Research on the surface water quality in mining influenced area in north-western part of Romania

    Directory of Open Access Journals (Sweden)

    Smical Irina

    2015-01-01

    Full Text Available The paper highlights the current situation of the quality of surface water in the areas influenced by mining activities in the north-western part of Romania. In this respect a series of investigations have been conducted regarding the contamination with heavy metals of the water of the Someş and Tisa hydro- graphic Basins, which cover the northern part of Maramures County and the south-western area of Maramures County, respectively. The results of the comparative research refer to the period between 1999 and 2011 and reveal the specific heavy metal ions of mining activity: Fe, Mn, Zn, Cu, Pb Cd and Ni, as well as the water pH. The presented values as annual average values reveal an increase in several heavy metals after the closure of mines, which is due to the lack of effectiveness of the closure and of the conservation of the mine galleries, as well as of the impaired functioning of the mining wastewater treatment plants.

  11. A concept paper: using the outcomes of common surgical conditions as quality metrics to benchmark district surgical services in South Africa as part of a systematic quality improvement programme.

    Science.gov (United States)

    Clarke, Damian L; Kong, Victor Y; Handley, Jonathan; Aldous, Colleen

    2013-07-31

    The fourth, fifth and sixth Millennium Development Goals relate directly to improving global healthcare and health outcomes. The focus is to improve global health outcomes by reducing maternal and childhood mortality and the burden of infectious diseases such as HIV/AIDS, tuberculosis and malaria. Specific targets and time frames have been set for these diseases. There is, however, no specific mention of surgically treated diseases in these goals, reflecting a bias that is slowly changing with emerging consensus that surgical care is an integral part of primary healthcare systems in the developing world. The disparities between the developed and developing world in terms of wealth and social indicators are reflected in disparities in access to surgical care. Health administrators must develop plans and strategies to reduce these disparities. However, any strategic plan that addresses deficits in healthcare must have a system of metrics, which benchmark the current quality of care so that specific improvement targets may be set.This concept paper outlines the role of surgical services in a primary healthcare system, highlights the ongoing disparities in access to surgical care and outcomes of surgical care, discusses the importance of a systems-based approach to healthcare and quality improvement, and reviews the current state of surgical care at district hospitals in South Africa. Finally, it proposes that the results from a recently published study on acute appendicitis, as well as data from a number of other common surgical conditions, can provide measurable outcomes across a healthcare system and so act as an indicator for judging improvements in surgical care. This would provide a framework for the introduction of collection of these outcomes as a routine epidemiological health policy tool.

  12. Pacific Northwest Laboratory annual report for 1981 to the DOE Office of the Assistant Secretary for Environmental Protection, Safety and Emergency Preparedness. Part 5. Environmental and occupational protection, assessment, and engineering

    International Nuclear Information System (INIS)

    Glass, W.A.

    1982-02-01

    This report describes research in environment, health, and safety conducted during fiscal year 1981. The five parts of the report are oriented to particular segments of the program. Parts 1 to 4 report on research performed for the DOE Office of Health and Environmental Research in the Office of Energy Research. Part 5 reports progress on all research performed for the Office of the Assistant Secretary for Environmental Protection, Safety and Emergency Preparedness. The parts are: Part 1: Biomedical Sciences under Program Manager, H. Drucker; Part 2: Ecological Sciences, under Program Manager, B.E. Vaughan; Part 3: Atmospheric Sciences under Program Manager, C.E. Elderkin; Part 4: Physical Sciences under Program Manager, J.M. Nielsen; and Part 5: Environmental and Occupational Protection, Assessment, and Engineering under Program Managers, D.L. Hessel, S. Marks, and W.A. Glass

  13. The importance of quality control in validating concentration of contaminants of emerging concern in source and treated drinking water samples.

    Data.gov (United States)

    U.S. Environmental Protection Agency — Overview of the quality assurance and quality control that supports the data analysis across all papers. This dataset is associated with the following publication:...

  14. The future of emergency medicine.

    Science.gov (United States)

    Schneider, Sandra M; Gardner, Angela F; Weiss, Larry D; Wood, Joseph P; Ybarra, Michael; Beck, Dennis M; Stauffer, Arlen R; Wilkerson, Dean; Brabson, Thomas; Jennings, Anthony; Mitchell, Mark; McGrath, Roland B; Christopher, Theodore A; King, Brent; Muelleman, Robert L; Wagner, Mary J; Char, Douglas M; McGee, Douglas L; Pilgrim, Randy L; Moskovitz, Joshua B; Zinkel, Andrew R; Byers, Michelle; Briggs, William T; Hobgood, Cherri D; Kupas, Douglas F; Krueger, Jennifer; Stratford, Cary J; Jouriles, Nicholas J

    2010-08-01

    The specialty of emergency medicine (EM) continues to experience a significant workforce shortage in the face of increasing demand for emergency care. In July 2009, representatives of the leading EM organizations met in Dallas for the Future of Emergency Medicine Summit. Attendees at the Future of Emergency Medicine Summit agreed on the following: 1) Emergency medical care is an essential community service that should be available to all; 2) An insufficient emergency physician workforce also represents a potential threat to patient safety; 3) Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA)-accredited EM residency training and American Board of Medical Specialties/AOA EM board certification is the recognized standard for physician providers currently entering a career in emergency care; 4) Physician supply shortages in all fields contribute to-and will continue to contribute to-a situation in which providers with other levels of training may be a necessary part of the workforce for the foreseeable future; 5) A maldistribution of EM residency-trained physicians persists, with few pursuing practice in small hospital or rural settings; 6) Assuring that the public receives high quality emergency care while continuing to produce highly skilled EM specialists through EM training programs is the challenge for EM's future; 7) It is important that all providers of emergency care receive continuing postgraduate education. Copyright 2010. Published by Elsevier Inc.

  15. Effect of Air Pollution on the Emergency Admissions of Cardiovascular and Respiratory Patients, Using the Air Quality Model: A Study in Tehran, 2005-2014

    Directory of Open Access Journals (Sweden)

    Majid Kermani

    2016-04-01

    Full Text Available Background: Air pollution is one of the most important factors threatening the health of citizens. It increases the prevalence of cardiovascular and respiratory diseases as well as emergency admissions to hospitals in the polluted metropolitan cities. The present study was conducted using Air Quality (AirQ model and aimed to investigate the effects of air pollution on the number of emergency cardiovascular and respiratory patients admissions in Tehran hospitals during 2005-2014. Materials and Methods: This was cross-sectional study. First, the needed hourly information was received from the Bureau of Air Quality Control, and the Environmental Protection Agency of Tehran City. Then, the information was validated according to WHO criteria, and the statistical indicators and the stages required to quantify the harmful effects of air pollutants were calculated by using appropriate application. Results: According to the results, the number of cases admitted to the emergency ward of hospitals due to heart diseases (by exposure to particulate matter during the years 2005 to 2014 were respectively 1797, 1280, 1766, 1980, 2132, 2703, 2389, 2594, 2158, and 2291 cases, totaling 20990 persons, and for respiratory diseases (due to exposure to particulate matter during the same years were respectively 4643, 3301, 4650, 5117, 5511, 6999, 6180, 6452, 5577, and 5922 cases, totaling 54352 people. Also, the number of cases admitted to the emergency wards of hospitals due to chronic obstructive pulmonary disease caused by exposure to emissions of pollutants such as sulfur dioxide, nitrogen dioxide, and ozone were respectively, 1806, 2454, and 2941 cases. Conclusion: Air pollution in Tehran increases the load of emergency visits to hospitals and increases the risk of respiratory and heart diseases. Therefore, measures to reduce and control air pollution and to prepare, equip, and mobilize hospitals, particularly emergency wards, are among important priorities that

  16. The relationship between workplace violence, perceptions of safety, and Professional Quality of Life among emergency department staff members in a Level 1 Trauma Centre.

    Science.gov (United States)

    Copeland, Darcy; Henry, Melissa

    2018-02-02

    Emergency department staff members are frequently exposed to workplace violence which may have physical, psychological, and workforce related consequences. The purpose of this study was to examine the relationships between exposure to workplace violence, tolerance to violence, expectations of violence, perceptions of workplace safety, and Professional Quality of Life (compassion satisfaction - CS, burnout - BO, secondary traumatic stress - STS) among emergency department staff members. A cross-sectional design was used to survey all emergency department staff members from a suburban Level 1 Trauma Centre in the western United States. All three dimensions of Professional Quality of Life were associated with exposure to non-physical patient violence including: general threats (CS p = .012, BO p = .001, STS p = .035), name calling (CS p = .041, BO p = .021, STS p = .018), and threats of lawsuit (CS p = .001, BO p = .001, STS p = .02). Tolerance to violence was associated with BO (p = .004) and CS (p = .001); perception of safety was associated with BO (p = .018). Exposure to non-physical workplace violence can significantly impact staff members' compassion satisfaction, burnout and secondary traumatic stress. Greater attention should be paid to the effect of non-physical workplace violence. Additionally, addressing tolerance to violence and perceptions of safety in the workplace may impact Professional Quality of Life. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Quality assurance and assessment of preparedness at DAE-ERCs for handling radiological emergencies in public domain

    International Nuclear Information System (INIS)

    Sharma, R.; Murali, S.; Singh, Rajvir; Pradeepkumar, K.S.

    2014-01-01

    The radiological emergencies are very rare in occurrence the mechanism to improve the preparedness can be ensured through conducting mock exercises/drills. Emergency kit comprises of adequate number of radiation monitoring equipments and PPEs required for response is kept in readiness at ERC. There is a need of training modules on radiological emergencies for all stake holders e.g. district officials, Local Police, Medical professionals and National Disaster Response Force (NDRF) to improve the knowledge and response capability. The adaptability to situations is important for ERTs based on the lessons learned from emergency at Mayapuri, Delhi. The role and responsibility of different agencies have been identified and drafted in the preparedness plan to meet the challenges during response

  18. Quality

    International Nuclear Information System (INIS)

    Burnett, N.; Jeffries, J.; Mach, J.; Robson, M.; Pajot, D.; Harrigan, J.; Lebsack, T.; Mullen, D.; Rat, F.; Theys, P.

    1993-01-01

    What is quality? How do you achieve it? How do you keep it once you have got it. The answer for industry at large is the three-step hierarchy of quality control, quality assurance and Total quality Management. An overview is given of the history of quality movement, illustrated with examples from Schlumberger operations, as well as the oil industry's approach to quality. An introduction of the Schlumberger's quality-associated ClientLink program is presented. 15 figs., 4 ills., 16 refs

  19. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

    Energy Technology Data Exchange (ETDEWEB)

    Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  20. Could Innovation also Emerge from the Public Sector? Creating an ISO-like Judiciary Quality Management Standard.

    Directory of Open Access Journals (Sweden)

    Rodrigo Murillo

    2013-10-01

    Full Text Available This paper explores the conceptual differences between the GICA-Justicia Project initiative and other available models, process performance guidelines, and tools. Comparison was basically carried out through a review of specialized literature, papers, and reports; semi-structured interviews and focus groups with experts in the judicial quality assurance field from different countries; and applying the authors’ experience as technical counterparts in the GICA-Justicia Project (co-authoring a Quality Management Standard and training/auditing during the Quality Management System deployment and accreditation stages.  The paper is meant to unveil how the GICA-Justicia Quality Management Model and the GICA-Justicia Quality Management Standard, as  GICA-Justicia Project by-products, combine to create an innovative process performance approach to quality assurance in judicial environments.

  1. Clinimetric quality of the fire fighting simulation test as part of the Dutch fire fighters Workers' Health Surveillance

    Directory of Open Access Journals (Sweden)

    Sluiter Judith K

    2010-02-01

    Full Text Available Abstract Background Clinimetric data for the fire fighting simulation test (FFST, a new test proposed for the Workers' Health Surveillance (WHS of Dutch fire fighters, were evaluated. Methods Twenty-one fire fighters took the FFST three times with one and three weeks between testing. Clinimetric quality was determined by means of reliability, agreement and validity. For reliability and agreement, the intraclass correlation coefficient (ICC, and standard error of measurement (SEM, were analysed. For construct validity, the tests from 45 fire fighters were correlated with their own and their supervisors' rated work ability. Results The ICCs were 0.56 and 0.79 at the one-week and three-week test-retest periods, respectively. Testing times ranged from 9 to 17 minutes; the SEMs were 70 s at the one-week and 40 s at the three-week test-retest periods. The construct validity was moderate (-0.47 ≤ r ≤ -0.33; p Conclusions The FFST was reliable with acceptable agreement after three weeks. Construct validity was moderate. We recommend using FFST as a part of the WHS for Dutch fire fighters. It is advised that fire fighters should perform the FFST once as a trial before judging their performance in testing time during the second performance.

  2. Thermodynamic analyses of hydrogen production from sub-quality natural gas. Part II: Steam reforming and autothermal steam reforming

    Science.gov (United States)

    Huang, Cunping; T-Raissi, Ali

    Part I of this paper analyzed sub-quality natural gas (SQNG) pyrolysis and autothermal pyrolysis. Production of hydrogen via direct thermolysis of SQNGs produces only 2 mol of hydrogen and 1 mol of carbon per mole of methane (CH 4). Steam reforming of SQNG (SRSQNG) could become a more effective approach because the processes produce two more moles of hydrogen via water splitting. A Gibbs reactor unit operation in the AspenPlus™ chemical process simulator was employed to accomplish equilibrium calculations for the SQNG + H 2O and SQNG + H 2O + O 2 systems. The results indicate that water and oxygen inlet flow rates do not significantly affect the decomposition of hydrogen sulfide (H 2S) at temperatures lower than 1000 °C. The major co-product of the processes is carbonyl sulfide (COS) while sulfur dimer (S 2) and carbon disulfide (CS 2) are minor by-products within this temperature range. At higher temperatures (>1300 °C), CS 2 and S 2 become major co-products. No sulfur dioxide (SO 2) or sulfur trioxide (SO 3) is formed during either SRSQNG or autothermal SRSQNG processes, indicating that no environmentally harmful acidic gases are generated.

  3. Emergency preparedness

    International Nuclear Information System (INIS)

    1997-01-01

    In 1996 the Nuclear Regulatory Authority of the Slovak Republic (NRA SR) continued in systematic development of its activities in the field of emergency planning according to the concept adopted by the Authority and according to the concept for building Emergency headquarters (EH) adopted after establishing of Emergency Response Centre (ERC). Major efforts were focused not only on building up a quality EH, but also tasks associated with completion and incorporation of ERC into emergency planning and emergency managing. An important role in building ERC was played by international missions. Significant position among these missions was taken by missions from Great Britain, which in the past years made a significant contribution to building up ERC. These missions focused on review of newly created standard procedures, preparation and implementation of first emergency exercises of the EH. The emergency exercises in which NRA SR took place in 1996 are reviewed. In order to make the co-operation of the Authority with the selected Army units of SR more effective in solving extraordinary situations in nuclear energy, an agreement was signed between NRA SR and the Headquarters of the Army of SR, which will help significantly to the objective

  4. Developing an integrated 3D-hydrodynamic and emerging contaminant model for assessing water quality in a Yangtze Estuary Reservoir.

    Science.gov (United States)

    Xu, Cong; Zhang, Jingjie; Bi, Xiaowei; Xu, Zheng; He, Yiliang; Gin, Karina Yew-Hoong

    2017-12-01

    An integrated 3D-hydrodynamic and emerging contaminant model was developed for better understanding of the fate and transport of emerging contaminants in Qingcaosha Reservoir. The reservoir, which supplies drinking water for nearly half of Shanghai's population, is located in Yangtze Delta. The integrated model was built by Delft3D suite, a fully integrated multidimensional modeling software. Atrazine and Bisphenol A (BPA) were selected as two representative emerging contaminants for the study in this reservoir. The hydrodynamic model was calibrated and validated against observations from 2011 to 2015 while the integrated model was calibrated against observations from 2014 to 2015 and then applied to explore the potential risk of high atrazine concentrations in the reservoir driven by agriculture activities. Our results show that the model is capable of describing the spatial and temporal patterns of water temperature, salinity and the dynamic distributions of two representative emerging contaminants (i.e. atrazine and BPA) in the reservoir. The physical and biodegradation processes in this study were found to play a crucial role in determining the fate and transport of atrazine and BPA in the reservoir. The model also provides an insight into the potential risk of emerging contaminants and possible mitigation thresholds. The integrated approach can be a very useful tool to support policy-makers in the future management of Qingcaosha Reservoir. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1 : ASC software quality engineering practices version 1.0.

    Energy Technology Data Exchange (ETDEWEB)

    Minana, Molly A.; Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Forsythe, Christi A.; Schofield, Joseph Richard, Jr.; Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2005-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in DOE/AL Quality Criteria (QC-1) as conformance to customer requirements and expectations. This quality plan defines the ASC program software quality practices and provides mappings of these practices to the SNL Corporate Process Requirements (CPR 1.3.2 and CPR 1.3.6) and the Department of Energy (DOE) document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines (GP&G). This quality plan identifies ASC management and software project teams' responsibilities for cost-effective software engineering quality practices. The SNL ASC Software Quality Plan establishes the signatories commitment to improving software products by applying cost-effective software engineering quality practices. This document explains the project teams opportunities for tailoring and implementing the practices; enumerates the practices that compose the development of SNL ASC's software products; and includes a sample assessment checklist that was developed based upon the practices in this document.

  6. Emergency procedures

    International Nuclear Information System (INIS)

    Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

    2004-01-01

    The following subjects are discussed - Emergency Procedures: emergency equipment, emergency procedures; emergency procedure involving X-Ray equipment; emergency procedure involving radioactive sources

  7. Effects of highway-deicer application on ground-water quality in a part of the Calumet Aquifer, northwestern Indiana

    Science.gov (United States)

    Watson, Lee R.; Bayless, E. Randall; Buszka, Paul M.; Wilson, John T.

    2002-01-01

    The effects of highway-deicer application on ground-water quality were studied at a site in northwestern Indiana using a variety of geochemical indicators. Site characteristics such as high snowfall rates; large quantities of applied deicers; presence of a high-traffic highway; a homogeneous, permeable, and unconfined aquifer; a shallow water table; a known ground-water-flow direction; and minimal potential for other sources of chloride and sodium to complicate source interpretation were used to select a study area where ground water was likely to be affected by deicer application. Forty-three monitoring wells were installed in an unconfined sand aquifer (the Calumet aquifer) near Beverly Shores in northwestern Indiana. Wells were installed along two transects that approximately paralleled groundwater flow in the Calumet aquifer and crossed US?12. US?12 is a highway that receives Indiana?s highest level of maintenance to maintain safe driving conditions. Ground-water quality and water-level data were collected from the monitoring wells, and precipitation and salt-application data were compiled from 1994 through 1997. The water-quality data indicated that chloride was the most easily traced indicator of highway deicers in ground water. Concentration ratios of chloride to iodide and chloride to bromide and Stiff diagrams of major element concentrations indicated that the principal source of chloride and sodium in ground water from the uppermost one-third to one-half of the Calumet relative electromagnetic conductivity defined a distinct plume of deicer-affected water in the uppermost 8 feet of aquifer at about 9 feet horizontally from the paved roadway edge and a zone of higher conductivity than background in the lower one-third of the aquifer. Chloride and sodium in the deep parts of the aquifer originated from natural sources. Chloride and sodium from highway deicers were present in the aquifer throughout the year. The highest concentrations of chloride and sodium

  8. An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil.

    Science.gov (United States)

    Tallo, Fernando Sabia; Campos Vieira Abib, Simone de; Baitello, André Luciano; Lopes, Renato Delascio

    2014-09-01

    To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital

  9. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals.

    Science.gov (United States)

    Maaløe, N; Sorensen, B L; Onesmo, R; Secher, N J; Bygbjerg, I C

    2012-04-01

    To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Two Tanzanian rural mission hospitals. Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  10. Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 1: state of the art.

    Science.gov (United States)

    Johansen, Monika Alise; Henriksen, Eva; Horsch, Alexander; Schuster, Tibor; Berntsen, Gro K Rosvold

    2012-10-03

    Over the last two decades, the number of studies on electronic symptom reporting has increased greatly. However, the field is very heterogeneous: the choices of patient groups, health service innovations, and research targets seem to involve a broad range of foci. To move the field forward, it is necessary to build on work that has been done and direct further research to the areas holding most promise. Therefore, we conducted a comprehensive review of randomized controlled trials (RCTs) focusing on electronic communication between patient and provider to improve health care service quality, presented in two parts. Part 2 investigates the methodological quality and effects of the RCTs, and demonstrates some promising benefits of electronic symptom reporting. To give a comprehensive overview of the most mature part of this emerging field regarding (1) patient groups, (2) health service innovations, and (3) research targets relevant to electronic symptom reporting. We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles published from 1990 to November 2011. Inclusion criteria were RCTs of interventions where patients or parents reported health information electronically to the health care system for health care purposes and were given feedback. Of 642 records identified, we included 32 articles representing 29 studies. The included articles were published from 2002, with 24 published during the last 5 years. The following five patient groups were represented: respiratory and lung diseases (12 studies), cancer (6), psychiatry (6), cardiovascular (3), and diabetes (1). In addition to these, 1 study had a mix of three groups. All included studies, except 1, focused on long-term conditions. We identified four categories of health service innovations: consultation support (7 studies), monitoring with clinician support (12), self-management with clinician support (9

  11. The effect of establishing a new, reorganized emergency department on quality of clinical healthcare and patient satisfaction

    DEFF Research Database (Denmark)

    Mattsson, Maria Søe

    2015-01-01

    in Denmark is seen. The quasi-experimental design of this study makes it difficult to conclude whether the observed improvement is directly related to the establishment of the new emergency department; however, significant results seems to be associated to the specific initiatives in the reorganization...

  12. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan part 2 mappings for the ASC software quality engineering practices, version 2.0.

    Energy Technology Data Exchange (ETDEWEB)

    Heaphy, Robert; Sturtevant, Judith E.; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR001.3.2 and CPR001.3.6 and to a Department of Energy document, ''ASCI Software Quality Engineering: Goals, Principles, and Guidelines''. This document also identifies ASC management and software project teams' responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  13. Application of the ROC method to assessment of image quality issues in mammography. Part 2. Comparative evaluation of image quality and radiation dose to thick body sections

    International Nuclear Information System (INIS)

    Klein, R.; Saebel, M.

    2000-01-01

    For the experimental comparative assessment reported, the following radiation qualities were compared for radiation dose applied and image quality: molydenum anode, 30mum molybdenum filter, X-ray tube potential differences of 26-32 kV; molybdenum anode, 25 mum rhodium filter, X-ray tube potential differences of 26-32 kV; tungsten anode, 50 mum rhodium filter, X-ray tube potential differences of 26-32 kV. The results show that in the differentiated assessment according to the various radiation qualities, significant deviations in imaging quality of the different detail types are possible. (orig./CB) [de

  14. Radiological Emergency Response Data

    Data.gov (United States)

    U.S. Environmental Protection Agency — Quality Data Asset includes all current and historical emergency radiological response event and incident of national significance data and surveillance, monitoring,...

  15. Emergency Nurses Association

    Science.gov (United States)

    ... menu Join ENA Today! Membership in the Emergency Nurses Association offers a variety of benefits and allows ... a part of more than 42,000 emergency nurses working together to promote safe practice and safe ...

  16. Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability?An Emerging Framework

    OpenAIRE

    Holve, Erin

    2013-01-01

    Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four ?pillars? of sustainability are discussed based on the experiences of...

  17. Amperometric Gas Sensors as a Low Cost Emerging Technology Platform for Air Quality Monitoring Applications: A Review.

    Science.gov (United States)

    Baron, Ronan; Saffell, John

    2017-11-22

    This review examines the use of amperometric electrochemical gas sensors for monitoring inorganic gases that affect urban air quality. First, we consider amperometric gas sensor technology including its development toward specifically designed air quality sensors. We then review recent academic and research organizations' studies where this technology has been trialed for air quality monitoring applications: early studies showed the potential of electrochemical gas sensors when colocated with reference Air Quality Monitoring (AQM) stations. Spatially dense networks with fast temporal resolution provide information not available from sparse AQMs with longer recording intervals. We review how this technology is being offered as commercial urban air quality networks and consider the remaining challenges. Sensors must be sensitive, selective, and stable; air quality monitors/nodes must be electronically and mechanically well designed. Data correction is required and models with differing levels of sophistication are being designed. Data analysis and validation is possibly the biggest remaining hurdle needed to deliver reliable concentration readings. Finally, this review also considers the roles of companies, urban infrastructure requirements, and public research in the development of this technology.

  18. ADSA Foundation Scholar Award: Trends in culture-independent methods for assessing dairy food quality and safety: emerging metagenomic tools.

    Science.gov (United States)

    Yeung, Marie

    2012-12-01

    Enhancing the quality and safety of dairy food is critical to maintaining the competitiveness of dairy products in the food and beverage market and in reinforcing consumer confidence in the dairy industry. Raw milk quality has a significant effect on finished product quality. Several microbial groups found in raw milk have been shown to adversely affect the shelf life of pasteurized milk. Current microbiological criteria used to define milk quality are based primarily on culture-dependent methods, some of which are perceived to lack the desired sensitivity and specificity. To supplement traditional methods, culture-independent methods are increasingly being used to identify specific species or microbial groups, and to detect indicator genes or proteins in raw milk or dairy products. Some molecular subtyping techniques have been developed to track the transmission of microbes in dairy environments. The burgeoning "-omics" technologies offer new and exciting opportunities to enhance our understanding of food quality and safety in relation to microbes. Metagenomics has the potential to characterize microbial diversity, detect nonculturable microbes, and identify unique sequences or other factors associated with dairy product quality and safety. In this review, fluid milk will be used as the primary example to examine the adequacy and validity of conventional methods, the current trend of culture-independent methods, and the potential applications of metagenomics in dairy food research. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  19. Momentary Desire for Sexual Intercourse and Momentary Emotional Intimacy Associated With Perceived Relationship Quality and Physical Intimacy in Heterosexual Emerging Adult Couples.

    Science.gov (United States)

    Shrier, Lydia A; Blood, Emily A

    2015-11-25

    Sexual desire and emotional intimacy are central to relationships, yet little is known about how these feelings vary within and between partners or relate to dyad functioning. We explored magnitude and stability of momentary sexual desire and emotional intimacy in relation to quality and functioning of heterosexual relationships. After reporting perceived relationship quality and physical intimacy enjoyment, members of 18 emerging adult heterosexual couples reported momentary partner-specific sexual desire and emotional intimacy several times a day for two weeks (2,224 reports). Mean and mean squared successive difference (MSSD) characterized magnitude and stability, respectively, of the momentary states. Regression models of relationship outcomes examined influence of the male versus female partner having greater or more stable desire and intimacy. Sexual desire and emotional intimacy magnitude and stability were associated with relationship quality and physical intimacy enjoyment differently for men versus women. Gender-specific differences between partners also predicted relationship outcomes. Men particularly perceived higher relationship quality and enjoyed physical intimacy more when they had higher and more stable sexual desire and their female partners had more stable emotional intimacy. Partner differences in momentary sexual desire and emotional intimacy may contribute to understanding quality and functioning of heterosexual relationships.

  20. Natural gas quality for the future. Part 1. Technical/economical inventory of consequences of natural gas quality variations for final consumers

    International Nuclear Information System (INIS)

    Levinsky, H.B.; Van Rij, M.L.D.

    2011-01-01

    By request of various market parties (suppliers and users of natural gas), the Dutch Ministry of Economic Affairs, Agriculture and Innovation (ELI) took a leading role in anticipating the future changes in gas quality. ELI requested an inventory of the consequences of variations in natural gas quality for end users. [nl

  1. Maltreatment and Affective and Behavioral Problems in Emerging Adults With and Without Oppositional Defiant Disorder Symptoms: Mediation by Parent-Child Relationship Quality.

    Science.gov (United States)

    McKinney, Cliff; Stearns, Melanie; Szkody, Erica

    2018-03-01

    The current study examined the indirect effect of maternal and paternal emotional and physical maltreatment on affective and behavioral symptoms of oppositional defiant disorder (ODD) through parent-child relationship quality; gender and overall ODD symptoms were examined as moderators. Participants included 2,362 emerging adults who completed questionnaires about parental emotional and physical maltreatment, parent-child relationship quality, and affective and behavioral ODD symptoms. These characteristics were compared across parent and child gender (i.e., maternal and paternal effects as well as male and female differences) as well as participants reporting high and low ODD symptoms. In the low ODD group, indirect effects of emotional maltreatment occurred in all parent-child dyads except the mother-son dyad, whereas in the high ODD group, indirect effects occurred only in the father-son dyad. Indirect effects of physical maltreatment occurred only in the father-son dyad in the low ODD group, and only in the mother-daughter dyad on behavioral ODD symptoms in the high ODD group. The results suggest that specific parent-child gender dyads respond differently, warranting further investigation of gender effects. Moreover, emerging adults in the low ODD symptoms group demonstrated a positive association between parental maltreatment and ODD symptoms and a negative association between parent-child relationship quality and ODD symptoms, whereas those high in the high ODD symptoms group did not demonstrate these associations. That is, emerging adults reporting high ODD symptoms demonstrated no relationship between their ODD symptoms and harsh parenting, suggesting an ineffective coercive process.

  2. National audit of the quality of pain relief provided in emergency departments in Aotearoa, New Zealand: The PRiZED 1 Study.

    Science.gov (United States)

    2017-04-01

    Pain is a common feature of ED presentations and the timely provision of adequate analgesia is important for patient care. However, there is currently no New Zealand data with respect to this indicator of care quality. The present study aimed to provide a baseline for the quality of care with respect to the provision of timely and adequate analgesia in New Zealand EDs. The present study is a secondary analysis of data initially collected for the Shorter Stays in Emergency Department Study, using a retrospective chart review of 1685 randomly selected ED presentations (2006-2012) from 26 New Zealand public hospital EDs. Of the 1685 charts randomly selected, 1547 (91%) were reviewed from 21 EDs. There were 866 ED presentations with painful conditions, of whom 132 (15%) did not have pain recorded, 205 (24%) did not receive pain relief and 19 (2%) did not have time of analgesia documented leaving 510 (59%) for the analysis of time to analgesia. Four hundred and fifty-seven (53%) did not have pain well documented sufficiently to assess adequacy, leaving 277 (32%) for the analysis of adequacy of analgesia. The median (interquartile range) time to analgesia was 62 (30-134) min and the provision of adequate analgesia was 141/277 (51%, 95% CI: 45-57%); however, there was some variation between hospitals for both outcomes. Although these outcomes are on a par with other countries, this baseline audit has shown both poor documentation and variation in the provision of timely and adequate pain relief in New Zealand EDs, with room for improvement with respect to this quality indicator. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  3. Anorectal emergencies

    Science.gov (United States)

    Lohsiriwat, Varut

    2016-01-01

    Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up. PMID:27468181

  4. Ordered Probit Analysis of Consumers’ Preferences for Milk and Meat Quality Attributes in the Emerging Cities of Southern India

    Directory of Open Access Journals (Sweden)

    S. PRIYADHARSINI

    2017-09-01

    Full Text Available In order to assess consumer preferences for milk and meat quality attributes, a study was carried out in two Second-Tier cities of Tamil Nadu. Personal interviews were done to collect the data from 160 respondents chosen through a multistage sampling procedure in each of the two cities selected for this study. Ordered Probit model fitted for the attributes of milk showed that: family size had a significant positive preference towards texture, low fat and low price of milk, educated consumers paid greater attention to taste, safety, flavour, packaging and low fat attributes of milk and low income consumers paid less importance on most of the attributes of milk. Ordered Probit model for meat revealed that as the family size increased, the consumers were likely to give more importance to ageing and tenderness and less importance to leanness of meat. Male consumers paid greater attention to colour and females were none concerned with tenderness, cooking quality and price. As the education level increased, the consumers became more and more quality and price conscious. Households having children paid more importance to tenderness and taste attributes of meat, whereas the household having aged people opted for colour, taste, tenderness, cooking quality, leanness and price attributes. Low income consumers paid less importance to quality attributes and the respondents performing more physical activity paid lesser attention towards leanness and more importance to price of the meat. This suggests the need for enhancing the production of quality livestock products, together by developing a well-organized distribution system.

  5. Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability-An Emerging Framework.

    Science.gov (United States)

    Holve, Erin

    2013-01-01

    Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four "pillars" of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two "foundational considerations," adaptive capacity and policy levers, are also discussed.

  6. Quality Improvement Initiatives in Sepsis in an Emerging Country: Does the Institution's Main Source of Income Influence the Results? An Analysis of 21,103 Patients.

    Science.gov (United States)

    Machado, Flavia R; Ferreira, Elaine M; Sousa, Juliana Lubarino; Silva, Carla; Schippers, Pierre; Pereira, Adriano; Cardoso, Ilusca M; Salomão, Reinaldo; Japiassu, Andre; Akamine, Nelson; Mazza, Bruno F; Assunção, Murillo S C; Fernandes, Haggeas S; Bossa, Aline; Monteiro, Mariana B; Caixeita, Noemi; Azevedo, Luciano C P; Silva, Eliezer

    2017-10-01

    We aimed to assess the results of a quality improvement initiative in sepsis in an emerging setting and to analyze it according to the institutions' main source of income (public or private). Retrospective analysis of the Latin American Sepsis Institute database from 2005 to 2014. Brazilian public and private institutions. Patients with sepsis admitted in the participant institutions. The quality improvement initiative was based on a multifaceted intervention. The institutions were instructed to collect data on 6-hour bundle compliance and outcomes in patients with sepsis in all hospital settings. Outcomes and compliance was measured for eight periods of 6 months each, starting at the time of the enrollment in the intervention. The primary outcomes were hospital mortality and compliance with 6-hour bundle. We included 21,103 patients; 9,032 from public institutions and 12,071 from private institutions. Comparing the first period with the eigth period, compliance with the 6-hour bundle increased from 13.5% to 58.2% in the private institutions (p < 0.0001) and from 7.4% to 15.7% in the public institutions (p < 0.0001). Mortality rates significantly decreased throughout the program in private institutions, from 47.6% to 27.2% in the eighth period (adjusted odds ratio, 0.45; 95% CI, 0.32-0.64). However, in the public hospitals, mortality diminished significantly only in the first two periods. This quality improvement initiative in sepsis in an emerging country was associated with a reduction in mortality and with improved compliance with quality indicators. However, this reduction was sustained only in private institutions.

  7. Modeling natural emissions in the Community Multiscale Air Quality (CMAQ model – Part 2: Modifications for simulating natural emissions

    Directory of Open Access Journals (Sweden)

    S. F. Mueller

    2011-01-01

    Full Text Available The Community Multiscale Air Quality (CMAQ model version 4.6 has been revised with regard to the representation of chlorine (HCl, ClNO2 and sulfur (dimethylsulfide, or DMS, and H2S, and evaluated against observations and earlier published models. Chemistry parameterizations were based on published reaction kinetic data and a recently developed cloud chemistry model that includes heterogeneous reactions of organic sulfur compounds. Evaluation of the revised model was conducted using a recently enhanced data base of natural emissions that includes ocean and continental sources of DMS, H2S, chlorinated gases and lightning NOx for the continental United States and surrounding regions. Results using 2002 meteorology and emissions indicated that most simulated "natural" (plus background chemical and aerosol species exhibit the expected seasonal variations at the surface. Ozone exhibits a winter and early spring maximum consistent with ozone data and an earlier published model. Ozone distributions reflect the influences of atmospheric dynamics and pollutant background levels imposed on the CMAQ simulation by boundary conditions derived from a global model. A series of model experiments reveals that the consideration of gas-phase organic sulfur chemistry leads to sulfate aerosol increases over most of the continental United States. Cloud chemistry parameterization changes result in widespread decreases in SO2 across the modeling domain and both increases and decreases in sulfate. Most cloud-mediated sulfate increases occurred mainly over the Pacific Ocean (up to about 0.1 μg m−3 but also over and downwind from the Gulf of Mexico (including parts of the eastern US. Geographic variations in simulated SO2 and sulfate are due to the link between DMS/H2S and their byproduct SO2, the heterogeneity of cloud cover and precipitation (precipitating clouds act as

  8. Quality control of CarboEurope flux data - Part 1: Coupling footprint analyses with flux data quality assessment to evaluate sites in forest ecosystems

    DEFF Research Database (Denmark)

    Göckede, M.; Foken, T.; Aubinet, M.

    2008-01-01

    We applied a site evaluation approach combining Lagrangian Stochastic footprint modeling with a quality assessment approach for eddy-covariance data to 25 forested sites of the CarboEurope-IP network. The analysis addresses the spatial representativeness of the flux measurements, instrumental...... of the surrounding terrain, while the latent heat flux is subject to instrumentation-related problems. The Planar-Fit coordinate rotation proved to be a reliable tool for the majority of the sites using only a single set of rotation angles. Overall, we found a high average data quality for the CarboEurope-IP network...... effects on data quality, spatial patterns in the data quality, and the performance of the coordinate rotation method. Our findings demonstrate that application of a footprint filter could strengthen the CarboEurope-IP flux database, since only one third of the sites is situated in truly homogeneous...

  9. Emerging technology to measure habitat quality and behavior of grouse: Examples from studies of greater sage-grouse

    Science.gov (United States)

    Jennifer Sorensen Forbey; Gail L. Patricelli; Donna M. Delparte; Alan H. Krakauer; Peter J. Olsoy; Marcella R. Fremgen; Jordan D. Nobler; Lucas P. Spaete; Lisa A. Shipley; Janet L. Rachlow; Amy K. Dirksen; Anna Perry; Bryce A. Richardson; Nancy F. Glenn

    2017-01-01

    An increasing number of threats, both natural (e.g. fires, drought) and anthropogenic (e.g. agriculture, infrastructure development), are likely to affect both availability and quality of plants that grouse rely on for cover and food. As such, there is an increasing need to monitor plants and their use by grouse over space and time to better predict how changes in...

  10. High-quality patents for emerging science and technology through external actors: Community scientific experts and knowledge societies

    NARCIS (Netherlands)

    Kica, Evisa; Groenendijk, Nico; Rodriguez, V.F.; Bonaccorsi, A.; Borras, S.

    2010-01-01

    This article explores one type of administrative mechanism to achieve high-quality patents: Article 115 of the European Patent Convention, which permits the inclusion of third parties to provide input to the prior art search and to communicate relevant information to the examiner in charge. Our

  11. Calendar year 1993 groundwater quality report for the Chestnut Ridge Hydrogeologic Regime, Y-12 Plant, Oak Ridge, Tennessee. 1993 groundwater quality data and calculated rate of contaminant migration, Part 1

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    This annual groundwater report contains groundwater quality data obtained during the 1993 calendar year (CY) at several hazardous and non-hazardous waste-management facilities associated with the US Department of Energy (DOE) Y-12 Plant located on the DOE Oak Ridge Reservation (ORR) southeast of Oak Ridge, Tennessee. These sites are located south of the Y-12 Plant in the Chestnut Ridge Hydrogeologic Regime (Chestnut Ridge Regime), which is one of three regimes defined for the purposes of groundwater quality monitoring at the Y-12 Plant. The Environmental Management Department of the Y-12 Plant Health, Safety, Environment, and Accountability Organization manages the groundwater monitoring activities in each regime as part of the Y-12 Plant Groundwater Protection Program (GWPP). The annual groundwater report for the Chestnut Ridge Regime is completed in two-parts; Part 1 (this report) containing the groundwater quality data and Part 2 containing a detailed evaluation of the data. The primary purpose of this report is to serve as a reference for the groundwater quality data obtained each year under the lead of the Y-12 Plant GWPP. However, because it contains information needed to comply with Resource Conservation and Recovery Act (RCRA) interim status assessment monitoring and reporting requirements, this report is submitted to the Tennessee Department of Health and Environment (TDEC) by the RCRA reporting deadline.

  12. The Impact of Combat Deployment on Health Care Provider Burnout in a Military Emergency Department: A Cross-Sectional Professional Quality of Life Scale V Survey Study.

    Science.gov (United States)

    Cragun, Joshua N; April, Michael D; Thaxton, Robert E

    2016-08-01

    Compassion fatigue is a problem for many health care providers manifesting as physical, mental, and spiritual exhaustion. Our objective was to evaluate the association between prior combat deployment and compassion fatigue among military emergency medicine providers. We conducted a nonexperimental cross-sectional survey of health care providers assigned to the San Antonio Military Medical Center, Department of Emergency Medicine. We used the Professional Quality of Life Scale V survey instrument that evaluates provider burnout, secondary traumatic stress, and compassion satisfaction. Outcomes included burnout, secondary traumatic stress, and compassion satisfaction raw scores. Scores were compared between providers based on previous combat deployments using two-tailed independent sample t tests and multiple regression models. Surveys were completed by 105 respondents: 42 nurses (20 previously deployed), 30 technicians (11 previously deployed), and 33 physicians (16 previously deployed). No statistically significant differences in burnout, secondary traumatic stress, or compassion satisfaction scores were detected between previously deployed providers versus providers not previously deployed. There was no association between previous combat deployment and emergency department provider burnout, secondary traumatic stress, or compassion satisfaction scores. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  13. Pilot Water Quality Monitoring Station in Dublin Bay North Bank Monitoring Station (NBMS): MATSIS Project Part I

    OpenAIRE

    O Donnell, G.; Joyce, E.; O Boyle, S.; McGovern, E.

    2008-01-01

    The lack of short-term temporal resolution associated with traditional spot sampling for monitoring water quality of dynamic coastal and estuarine waters has meant that many organisations are interesting in autonomous monitoring technologies to provide near real-time semi-continuous data. Such approaches enable capturing short term episodic events (which may be missed or alternatively skew datasets when using spot samples) and provide early warning of water quality problems. New policy driver...

  14. Quality Control of Laser-Beam-Melted Parts by a Correlation Between Their Mechanical Properties and a Three-Dimensional Surface Analysis

    Science.gov (United States)

    Grimm, T.; Wiora, G.; Witt, G.

    2017-03-01

    Good correlations between three-dimensional surface analyses of laser-beam-melted parts of nickel alloy HX and their mechanical properties were found. The surface analyses were performed with a confocal microscope, which offers a more profound surface data basis than a conventional, two-dimensional tactile profilometry. This new approach results in a wide range of three-dimensional surface parameters, which were each evaluated with respect to their feasibility for quality control in additive manufacturing. As a result of an automated surface analysis process by the confocal microscope and an industrial six-axis robot, the results are an innovative approach for quality control in additive manufacturing.

  15. American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations

    Directory of Open Access Journals (Sweden)

    Michael P. Wilson

    2017-05-01

    Full Text Available Introduction: The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED, usually termed “medical clearance,” often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP, consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. Methods: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Results: Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term “medical clearance,” and the need for better science in this area. Conclusion: The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.

  16. American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations.

    Science.gov (United States)

    Wilson, Michael P; Nordstrom, Kimberly; Anderson, Eric L; Ng, Anthony T; Zun, Leslie S; Peltzer-Jones, Jennifer M; Allen, Michael H

    2017-06-01

    The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED), usually termed "medical clearance," often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP), consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term "medical clearance," and the need for better science in this area. The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.

  17. Adapting protocols of CT imaging in a pediatric emergency department. Evaluation of image quality and dose; Adaptacion de los protocolos de adquisicion de imagenes de TC pediatricos en un servicio de urgencia. Valoracion de la calidad de imagen y dosis

    Energy Technology Data Exchange (ETDEWEB)

    Batista Arce, A.; Gonzalez Lopez, S.; Catalan Acosta, A.; Casares Magaz, O.; Hernandez Armas, O.; Hernandez Armas, J.

    2011-07-01

    The purpose of this study was to assess qualitatively the picture quality in relation to the radiation dose delivered in CT studies of computer tomograph Pediatric Emergency Department of Hospital Universitario de Canarias (HUC) in order to optimize the technical parameters used these radiological examinations so as to obtain optimal image quality at the lowest possible dose.

  18. [Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators].

    Science.gov (United States)

    Richard Espiga, Fernando; Mòdol Deltell, Josep María; Martín-Sánchez, Francisco Javier; Fernández Sierra, Abel; Fernández Pérez, Cristina; Pastor, Antoni Juan

    2017-06-01

    The primary aim was to study the impact that creating a short-stay unit (SSU) had on clinical management and quality of care indicators of a hospital overall and its conventional wards. The secondary aim was to establish values for those indicators and determine the level of satisfaction of patients admitted to the SSU. Quasi-experimental before-after study of the impact of establishing a SSU in a tertiary care teaching hospital. The first period (without the SSU) was in 2012, the second (with the SSU) was from 2013 through 2015. To meet the first objective we selected cases in 2012 in which patients were hospitalized for problems related to the 5 diagnosis-related groups most often admitted to the SSU in the second period. To meet the second objective, we studied all patients admitted to the SSU in the second period Data related to quality of care and clinical management were analyzed retrospectively. and asked them to complete a questionnaire on patient satisfaction. A total of 76 241 admissions were included: 19 090 in the first period and 57 151 in the second (2705 admissions were to the SSU). The mean hospital stay decreased in the second period (incidence rate ratio [IRR], 0.93; 95% CI, 0.91-0.95); the mean stay also decreased on medical wards (IRR, 0.94; 95% CI, 0.92-0.96) with no impact on adverse outcomes. The mean stay in the SSU was under 3 days in spite of an increase in the weighted mean (IRR,1.08; 95% CI, 1.05-1.11). A total of 320 questionnaires were received (11.8% response rate); all aspects were assessed very highly. Our experience suggests that opening a SSU could improve clinical management and quality of care indicators for a hospital overall and for its conventional wards in the context of the GRDs that most frequently lead to admissions.

  19. Implementation of Quality Systems in Nuclear Medicine: Why It Matters. An Outcome Analysis (Quality Management Audits in Nuclear Medicine Part III).

    Science.gov (United States)

    Dondi, Maurizio; Paez, Diana; Torres, Leonel; Marengo, Mario; Delaloye, Angelika Bischof; Solanki, Kishor; Van Zyl Ellmann, Annare; Lobato, Enrique Estrada; Miller, Rodolfo Nunez; Giammarile, Francesco; Pascual, Thomas

    2018-05-01

    The International Atomic Energy Agency (IAEA) developed a comprehensive program-Quality Management Audits in Nuclear Medicine (QUANUM). This program covers all aspects of nuclear medicine practices including, but not limited to, clinical practice, management, operations, and services. The QUANUM program, which includes quality standards detailed in relevant checklists, aims at introducing a culture of comprehensive quality audit processes that are patient oriented, systematic, and outcome based. This paper will focus on the impact of the implementation of QUANUM on daily routine practices in audited centers. Thirty-seven centers, which had been externally audited by experts under IAEA auspices at least 1 year earlier, were invited to run an internal audit using the QUANUM checklists. The external audits also served as training in quality management and the use of QUANUM for the local teams, which were responsible of conducting the internal audits. Twenty-five out of the 37 centers provided their internal audit report, which was compared with the previous external audit. The program requires that auditors score each requirement within the QUANUM checklists on a scale of 0-4, where 0-2 means nonconformance and 3-4 means conformance to international regulations and standards on which QUANUM is based. Our analysis covering both general and clinical areas assessed changes on the conformance status on a binary manner and the level of conformance scores. Statistical analysis was performed using nonparametric statistical tests. The evaluation of the general checklists showed a global improvement on both the status and the levels of conformances (P Assurance system (checklist 6); Imaging Equipment Quality Assurance or Quality Control (checklist 7); General Diagnostic (checklist 9); General Therapeutic (checklist 12); Radiopharmacy Level 1 (checklist 14); and Radiopharmacy Level 2 (checklist 15). Analysis of results related to clinical activities showed an overall positive

  20. Framework for pharmacy services quality improvement--a bridge to cross the quality chasm. Part I. The opportunity and the tool.

    Science.gov (United States)

    Curtiss, Frederic R; Fry, Richard N; Avey, Steven G

    2004-01-01

    To review the literature on the subject of quality improvement principles and methods applied to pharmacy services and to describe a framework for current and future efforts in pharmacy services quality improvement and effective drug therapy management. The Academy of Managed Care Pharmacy produced the Catalog of Pharmacy Quality Indicators in 1997, followed by the Summary of National Pharmacy Quality Measures in February 1999. In April 2002, AMCP introduced Pharmacy's Framework for Drug Therapy Management in the 21st Century. The Framework documents include a self-assessment tool that details more than 250 specific "components" that describe tasks, behaviors, skills, functions, duties, and responsibilities that contribute to meeting customer expectations for effective drug therapy management. There are many opportunities for quality improvement in clinical, service, and cost outcomes related to drug therapy management. These may include patient safety; incidence of medical errors; adverse drug events; patient adherence to therapy; attainment of target goals of blood pressure, glucose, and lipid levels; risk reduction for adverse cardiac events and osteoporotic-related fractures; patient satisfaction; risk of hospitalization or mortality; and cost of care. Health care practitioners can measure improvements in health care quality in several ways including (a) a better patient outcome at the same cost, (b) the same patient outcome at lower cost, (c) a better patient outcome at lower cost, or (d) a significantly better patient outcome at moderately higher cost. Measurement makes effective management possible. A framework of component factors (e.g., tasks) is necessary to facilitate changes in the key processes and critical factors that will help individual practitioners and health care systems meet customer expectations in regard to drug therapy, thus improving these outcomes. Quality improvement in health care services in the United States will be made in incremental

  1. Design of Cycle 3 of the National Water-Quality Assessment Program, 2013-23: Part 2: Science plan for improved water-quality information and management

    Science.gov (United States)

    Rowe, Gary L.; Belitz, Kenneth; Demas, Charlie R.; Essaid, Hedeff I.; Gilliom, Robert J.; Hamilton, Pixie A.; Hoos, Anne B.; Lee, Casey J.; Munn, Mark D.; Wolock, David W.

    2013-01-01

    This report presents a science strategy for the third decade of the National Water-Quality Assessment (NAWQA) Program, which since 1991, has been responsible for providing nationally consistent information on the quality of the Nation's streams and groundwater; how water quality is changing over time; and the major natural and human factors that affect current water quality conditions and trends. The strategy is based on an extensive evaluation of the accomplishments of NAWQA over its first two decades, the current status of water-quality monitoring activities by USGS and its partners, and an updated analysis of stakeholder priorities. The plan is designed to address priority issues and national needs identified by NAWQA stakeholders and the National Research Council (2012) irrespective of budget constraints. This plan describes four major goals for the third decade (Cycle 3), the approaches for monitoring, modeling, and scientific studies, key partnerships required to achieve these goals, and products and outcomes that will result from planned assessment activities. The science plan for 2013–2023 is a comprehensive approach to meet stakeholder priorities for: (1) rebuilding NAWQA monitoring networks for streams, rivers, and groundwater, and (2) upgrading models used to extrapolate and forecast changes in water-quality and stream ecosystem condition in response to changing climate and land use. The Cycle 3 plan continues approaches that have been central to the Program’s long-term success, but adjusts monitoring intensities and study designs to address critical information needs and identified data gaps. Restoration of diminished monitoring networks and new directions in modeling and interpretative studies address growing and evolving public and stakeholder needs for water-quality information and improved management, particularly in the face of increasing challenges related to population growth, increasing demands for water, and changing land use and climate

  2. Bioassay battery interlaboratory investigation of emerging contaminants in spiked water extracts - Towards the implementation of bioanalytical monitoring tools in water quality assessment and monitoring.

    Science.gov (United States)

    Di Paolo, Carolina; Ottermanns, Richard; Keiter, Steffen; Ait-Aissa, Selim; Bluhm, Kerstin; Brack, Werner; Breitholtz, Magnus; Buchinger, Sebastian; Carere, Mario; Chalon, Carole; Cousin, Xavier; Dulio, Valeria; Escher, Beate I; Hamers, Timo; Hilscherová, Klára; Jarque, Sergio; Jonas, Adam; Maillot-Marechal, Emmanuelle; Marneffe, Yves; Nguyen, Mai Thao; Pandard, Pascal; Schifferli, Andrea; Schulze, Tobias; Seidensticker, Sven; Seiler, Thomas-Benjamin; Tang, Janet; van der Oost, Ron; Vermeirssen, Etienne; Zounková, Radka; Zwart, Nick; Hollert, Henner

    2016-11-01

    Bioassays are particularly useful tools to link the chemical and ecological assessments in water quality monitoring. Different methods cover a broad range of toxicity mechanisms in diverse organisms, and account for risks posed by non-target compounds and mixtures. Many tests are already applied in chemical and waste assessments, and stakeholders from the science-police interface have recommended their integration in regulatory water quality monitoring. Still, there is a need to address bioassay suitability to evaluate water samples containing emerging pollutants, which are a current priority in water quality monitoring. The presented interlaboratory study (ILS) verified whether a battery of miniaturized bioassays, conducted in 11 different laboratories following their own protocols, would produce comparable results when applied to evaluate blinded samples consisting of a pristine water extract spiked with four emerging pollutants as single chemicals or mixtures, i.e. triclosan, acridine, 17α-ethinylestradiol (EE2) and 3-nitrobenzanthrone (3-NBA). Assays evaluated effects on aquatic organisms from three different trophic levels (algae, daphnids, zebrafish embryos) and mechanism-specific effects using in vitro estrogenicity (ER-Luc, YES) and mutagenicity (Ames fluctuation) assays. The test battery presented complementary sensitivity and specificity to evaluate the different blinded water extract spikes. Aquatic organisms differed in terms of sensitivity to triclosan (algae > daphnids > fish) and acridine (fish > daphnids > algae) spikes, confirming the complementary role of the three taxa for water quality assessment. Estrogenicity and mutagenicity assays identified with high precision the respective mechanism-specific effects of spikes even when non-specific toxicity occurred in mixture. For estrogenicity, although differences were observed between assays and models, EE2 spike relative induction EC 50 values were comparable to the literature, and E2/EE2

  3. Making sense of traumatic memories: memory qualities and psychological symptoms in emerging adults with and without abuse histories.

    Science.gov (United States)

    Follmer Greenhoot, Andrea; Sun, Shengkai; Bunnell, Sarah L; Lindboe, Katherine

    2013-01-01

    This study explored the connections between multiple measures of meaning making and psychological adjustment in people with and without histories of abuse. Young adults (n =177), recollected their three most stressful memories and rated them on importance and emotional and sensory qualities. We analysed the narratives for lexical markers of meaning making and explicit references to meaning or meaning-making attempts. There was little overlap between self-reported qualities and narrative content, and they were differentially predictive of psychological symptoms and transient emotional reactions. Consistent with the PTSD literature, more salient self-report memory characteristics (e.g., visceral emotions), and negative emotion and sensation terms predicted more symptoms. The narrative indices provided the best prediction to psychological adjustment, with several meaning indices (e.g., references to positive impact) predicting reduced symptoms, particularly for the Abuse group. Contrary to meaning-making models, resolutions predicted more symptoms, suggesting that aversive feelings during memory telling may trigger on-the-spot sense making to cope with distress.

  4. Emergency management of patients with ST-segment elevation myocardial infarction in Eastern Austria: a descriptive quality control study.

    Science.gov (United States)

    Trimmel, Helmut; Bayer, Thomas; Schreiber, Wolfgang; Voelckel, Wolfgang G; Fiedler, Lukas

    2018-05-09

    Myocardial infarction is a time-critical condition and its outcome is determined by appropriate emergency care. Thus we assessed the efficacy of a supra-regional ST-segment elevation myocardial infarction (STEMI) network in Easternern Austria. The Eastern Austrian STEMI network serves a population of approx. 766.000 inhabitants within a region of 4186 km 2 . Established in 2007, it now comprises 20 pre-hospital emergency medical service (EMS) units (10 of these physician-staffed), 4 hospitals and 3 cardiac intervention centres. Treatment guidelines were updated in 2012 and documentation within a web-based STEMI registry became mandatory. For this retrospective qualitative control study, data from February 2012-April 2015 was assessed. A total of 416 STEMI cases were documented, and 99% were identified by EMS within 6 (4.0-8.0) minutes after arrival. Median time loss between onset of pain and EMS call was 54 (20-135) minutes; response, pre-hospital and door-to-balloon times were 14 (10-20), 46 (37-59) and 45 (32-66) minutes, respectively. When general practitioners were involved, time between onset of pain and balloon inflation significantly increased from 180 (135-254) to 218 (155-348) minutes (p < .001). A pre-hospital time < 30 min was achieved in 25.8% of all patients during the day vs. 11.6% during the night (p < .001). Three hundred forty-five patients (83%) were subjected to primary percutaneous coronary intervention (PPCI), and 6.5% were thrombolysed by EMS. Pre-hospital complication rate was 18% (witnessed cardiac arrest 7%, threatening arrhythmias 6%, cardiogenic shock 5%). Twenty-four hours and hospital mortality rate were 1.2 and 2.8%, respectively. Optimal patient care and subsequently outcome of STEMI is strongly determined by a short patient-decision time to call EMS and by the first medical contact to balloon time (FMCBT). Supra-regional networks are key in order to increase the efficacy and efficiency of health care. The goal of 120

  5. Diabetic Emergencies

    Science.gov (United States)

    ... Campaigns Share this! EmergencyCareForYou » Emergency 101 » Diabetic Emergencies Diabetic Emergencies It is estimated that more than 20 ... they have it. The best way to prevent diabetic emergencies is to effectively manage the disease through ...

  6. Characterization of Coffee ringspot virus-Lavras: A model for an emerging threat to coffee production and quality

    Energy Technology Data Exchange (ETDEWEB)

    Ramalho, T.O.; Figueira, A.R.; Sotero, A.J. [Universidade Federal de Lavras, Departamento de Fitopatologia, Caixa Postal 3037, CEP 37200-000 Lavras, MG (Brazil); Wang, R. [Department of Plant Pathology, University of Kentucky, Lexington, KY 40546 (United States); Geraldino Duarte, P.S. [Universidade Federal de Lavras, Departamento de Fitopatologia, Caixa Postal 3037, CEP 37200-000 Lavras, MG (Brazil); Farman, M. [Department of Plant Pathology, University of Kentucky, Lexington, KY 40546 (United States); Goodin, M.M., E-mail: mgoodin@uky.edu [Department of Plant Pathology, University of Kentucky, Lexington, KY 40546 (United States)

    2014-09-15

    The emergence of viruses in Coffee (Coffea arabica and Coffea canephora), the most widely traded agricultural commodity in the world, is of critical concern. The RNA1 (6552 nt) of Coffee ringspot virus is organized into five open reading frames (ORFs) capable of encoding the viral nucleocapsid (ORF1p), phosphoprotein (ORF2p), putative cell-to-cell movement protein (ORF3p), matrix protein (ORF4p) and glycoprotein (ORF5p). Each ORF is separated by a conserved intergenic junction. RNA2 (5945 nt), which completes the bipartite genome, encodes a single protein (ORF6p) with homology to RNA-dependent RNA polymerases. Phylogenetic analysis of L protein sequences firmly establishes CoRSV as a member of the recently proposed Dichorhavirus genus. Predictive algorithms, in planta protein expression, and a yeast-based nuclear import assay were used to determine the nucleophillic character of five CoRSV proteins. Finally, the temperature-dependent ability of CoRSV to establish systemic infections in an initially local lesion host was quantified. - Highlights: • We report genome sequence determination for Coffee ringspot virus (CoRSV). • CoRSV should be considered a member of the proposed Dichorhavirus genus. • We report temperature-dependent systemic infection of an initially local lesion host. • We report in planta protein and localization data for five CoRSV proteins. • In silico predictions of the CoRSV proteins were validated using in vivo assays.

  7. Characterization of Coffee ringspot virus-Lavras: A model for an emerging threat to coffee production and quality

    International Nuclear Information System (INIS)

    Ramalho, T.O.; Figueira, A.R.; Sotero, A.J.; Wang, R.; Geraldino Duarte, P.S.; Farman, M.; Goodin, M.M.

    2014-01-01

    The emergence of viruses in Coffee (Coffea arabica and Coffea canephora), the most widely traded agricultural commodity in the world, is of critical concern. The RNA1 (6552 nt) of Coffee ringspot virus is organized into five open reading frames (ORFs) capable of encoding the viral nucleocapsid (ORF1p), phosphoprotein (ORF2p), putative cell-to-cell movement protein (ORF3p), matrix protein (ORF4p) and glycoprotein (ORF5p). Each ORF is separated by a conserved intergenic junction. RNA2 (5945 nt), which completes the bipartite genome, encodes a single protein (ORF6p) with homology to RNA-dependent RNA polymerases. Phylogenetic analysis of L protein sequences firmly establishes CoRSV as a member of the recently proposed Dichorhavirus genus. Predictive algorithms, in planta protein expression, and a yeast-based nuclear import assay were used to determine the nucleophillic character of five CoRSV proteins. Finally, the temperature-dependent ability of CoRSV to establish systemic infections in an initially local lesion host was quantified. - Highlights: • We report genome sequence determination for Coffee ringspot virus (CoRSV). • CoRSV should be considered a member of the proposed Dichorhavirus genus. • We report temperature-dependent systemic infection of an initially local lesion host. • We report in planta protein and localization data for five CoRSV proteins. • In silico predictions of the CoRSV proteins were validated using in vivo assays

  8. Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad.

    LENUS (Irish Health Repository)

    Mc Laughlin, Patrick

    2012-04-01

    Tablet devices have recently been used in radiological image interpretation because they have a display resolution comparable to desktop LCD monitors. We identified a need to examine tablet display performance prior to their use in preliminary interpretation of radiological images. We compared the spatial and contrast resolution of a commercially available tablet display with a diagnostic grade 2 megapixel monochrome LCD using a contrast detail phantom. We also recorded reporting discrepancies, using the ACR RADPEER system, between preliminary interpretation of 100 emergency CT brain examinations on the tablet display and formal review on a diagnostic LCD. The iPad display performed inferiorly to the diagnostic monochrome display without the ability to zoom. When the software zoom function was enabled on the tablet device, comparable contrast detail phantom scores of 163 vs 165 points were achieved. No reporting discrepancies were encountered during the interpretation of 43 normal examinations and five cases of acute intracranial hemorrhage. There were seven RADPEER2 (understandable) misses when using the iPad display and 12 with the diagnostic LCD. Use of software zoom in the tablet device improved its contrast detail phantom score. The tablet allowed satisfactory identification of acute CT brain findings, but additional research will be required to examine the cause of "understandable" reporting discrepancies that occur when using tablet devices.

  9. A study with ESI PAM-STAMP® on the influence of tool deformation on final part quality during a forming process

    Science.gov (United States)

    Vrolijk, Mark; Ogawa, Takayuki; Camanho, Arthur; Biasutti, Manfredi; Lorenz, David

    2018-05-01

    As a result from the ever increasing demand to produce lighter vehicles, more and more advanced high-strength materials are used in automotive industry. Focusing on sheet metal cold forming processes, these materials require high pressing forces and exhibit large springback after forming. Due to the high pressing forces deformations occur in the tooling geometry, introducing dimensional inaccuracies in the blank and potentially impact the final springback behavior. As a result the tool deformations can have an impact on the final assembly or introduce cosmetic defects. Often several iterations are required in try-out to obtain the required tolerances, with costs going up to as much as 30% of the entire product development cost. To investigate the sheet metal part feasibility and quality, in automotive industry CAE tools are widely used. However, in current practice the influence of the tool deformations on the final part quality is generally neglected and simulations are carried out with rigid tools to avoid drastically increased calculation times. If the tool deformation is analyzed through simulation it is normally done at the end of the drawing prosses, when contact conditions are mapped on the die structure and a static analysis is performed to check the deflections of the tool. But this method does not predict the influence of these deflections on the final quality of the part. In order to take tool deformations into account during drawing simulations, ESI has developed the ability to couple solvers efficiently in a way the tool deformations can be real-time included in the drawing simulation without high increase in simulation time compared to simulations with rigid tools. In this paper a study will be presented which demonstrates the effect of tool deformations on the final part quality.

  10. Hydro-geochemistry and application of water quality index (WQI) for groundwater quality assessment, Anna Nagar, part of Chennai City, Tamil Nadu, India

    Science.gov (United States)

    Krishna kumar, S.; Logeshkumaran, A.; Magesh, N. S.; Godson, Prince S.; Chandrasekar, N.

    2015-12-01

    In the present study, the geochemical characteristics of groundwater and drinking water quality has been studied. 24 groundwater samples were collected and analyzed for pH, electrical conductivity, total dissolved solids, carbonate, bicarbonate, chloride, sulphate, nitrate, calcium, magnesium, sodium, potassium and total hardness. The results were evaluated and compared with WHO and BIS water quality standards. The studied results reveal that the groundwater is fresh to brackish and moderately high to hard in nature. Na and Cl are dominant ions among cations and anions. Chloride, calcium and magnesium ions are within the allowable limit except few samples. According to Gibbs diagram, the predominant samples fall in the rock-water interaction dominance and evaporation dominance field. The piper trilinear diagram shows that groundwater samples are Na-Cl and mixed CaMgCl type. Based on the WQI results majority of the samples are falling under excellent to good category and suitable for drinking water purposes.

  11. Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.

  12. Quality control of CarboEurope flux data – Part 1: Coupling footprint analyses with flux data quality assessment to evaluate sites in forest ecosystems

    Czech Academy of Sciences Publication Activity Database

    Göckede, M.; Foken, T.; Aubinet, M.; Aurela, M.; Banza, J.; Bernhofer, C.; Bonnefond, J. M.; Brunet, Y.; Carrara, A.; Clement, R.; Dellwik, E.; Elbers, J.; Eugster, W.; Fuhrer, J.; Granier, A.; Grünwald, T.; Heinesch, B.; Janssens, I. A.; Knohl, A.; Koeble, R.; Laurila, T.; Longdoz, B.; Manca, G.; Marek, Michal V.; Markkanen, T.; Mateus, J.; Matteucci, G.; Mauder, M.; Migliavacca, M.; Minerbi, S.; Moncrieff, J.; Montagnani, L.; Moors, E.; Ourcival, J.M.; Papale, D.; Pereira, J.; Pilegaard, K.; Pita, G.; Rambal, S.; Rebmann, C.; Rodrigues, A.; Rotenberg, E.; Sanz, M. J.; Sedlák, Pavel; Seufert, G.; Siebicke, L.; Soussana, J. F.; Valentini, R.; Vesala, T.; Verbeeck, H.; Yakir, D.

    2008-01-01

    Roč. 5, č. 2 (2008), s. 433-450 ISSN 1726-4170 Grant - others:CarboEurope-IP(XE) GOCE-CT-2003-505572 Institutional research plan: CEZ:AV0Z30420517; CEZ:AV0Z60870520 Keywords : Eddy covariance * Quality assurance * Footprint modelling * Heterogeneity Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 3.445, year: 2008 http://www.biogeosciences.net/5/433/2008/

  13. Emergency CT head and neck imaging: effects of swimmer's position on dose and image quality

    Energy Technology Data Exchange (ETDEWEB)

    Mueck, Fabian G.; Roesch, Sebastian; Geyer, Lucas; Scherr, Michael; Seidenbusch, Michael; Stahl, Robert; Deak, Zsuzsanna; Wirth, Stefan [LMU Klinikum Universitaet Muenchen (Germany). Inst. fuer Klinische Radiologie

    2014-05-15

    To compare the effects of different arm positions on dose exposure and image quality (IQ) in cervical spine CT after trauma in different patient groups. Patients in standard (STD = 126) and in swimmer's position (SWIM = 254) were included. Body mass index (BMI subgroup 1 = underweight to subgroup 4 = obese), anterior-posterior diameter (AP), left-right diameter (LR), area of an ellipse (AoE) and angle between the humeral heads (optimal STD < 3 , optimal SWIM > 10 ) were used as grouping criteria. Computed tomography dose index (CTDI) was documented. Two radiologists rated the IQ at three levels (CV1/2, CV4/5, CV7/T1) using a semi-quantitative scale (0 = not diagnostic, 1 = diagnostic with limitations, 2 = diagnostic without limitations). The Mann-Whitney U test correlations of grouping criteria with dose effects and intra-class correlation (ICC) were calculated. ICC was 0.87. BMI grouping showed the strongest correlation with dose effects: CTDI of optimal STD versus optimal SWIM positioning was 3.17 mGy versus 2.46 mGy (subgroup 1), 5.47 mGy versus 3.97 mGy (subgroup 2), 7.35 mGy versus 5.96 mGy (subgroup 3) and 8.71 mGy versus 8.18 mGy (subgroup 4). Mean IQ at CV7/T1 was 1.65 versus 1.23 (subgroup 1), 1.27 versus 1.46 (subgroup 2), 1.06 versus 1.46 (subgroup 3), 0.79 versus 1.5 (subgroup 4). Patients with a BMI > 20 kg/m{sup 2} benefited from both potential dose reduction and improved image quality at the critical cervicothoracic junction when swimmer's position was used. (orig.)

  14. The development of an interdepartmental audit as part of a physics quality assurance programme for external beam therapy

    International Nuclear Information System (INIS)

    Bonnett, D.E.; Jaukett, R.J.; Mills, J.A.; Martin-Smith, P.

    1994-01-01

    A cost-effective audit system has been developed that will both detect systematic error in data and procedures, and evaluate the quality assurance programme provided by a physics department for radiotherapy. The audit has been developed for external beam radiotherapy and assesses one modality and one treatment machine per year. The method of assessing the quality assurance programme and the schedule of measurements are described. The process is illustrated using the results of trial audits between the medical physics department at Coventry and Leicester. (author)

  15. Selecting a Dynamic Simulation Modeling Method for Health Care Delivery Research—Part 2: Report of the ISPOR Dynamic Simulation Modeling Emerging Good Practices Task Force

    NARCIS (Netherlands)

    Marshall, Deborah A.; Burgos-Liz, Lina; IJzerman, Maarten Joost; Crown, William; Padula, William V.; Wong, Peter K.; Pasupathy, Kalyan S.; Higashi, Mitchell K.; Osgood, Nathaniel D.

    2015-01-01

    In a previous report, the ISPOR Task Force on Dynamic Simulation Modeling Applications in Health Care Delivery Research Emerging Good Practices introduced the fundamentals of dynamic simulation modeling and identified the types of health care delivery problems for which dynamic simulation modeling

  16. Report on Health Manpower and Programs in Ohio: Part Two. Allied Health, Area Health Education Centers, Dentistry, Emergency Medical Services, Nursing, Optometry, Pharmacy, Podiatry, and Veterinary Medicine.

    Science.gov (United States)

    Ohio Board of Regents, Columbus.

    Information on health occupations educational programs in Ohio and current and projected employment needs for health professionals are presented. The following health fields are examined: allied health, dentistry, emergency medical service, nursing, optometry, pharmacy, podiatry, and veterinary medicine. Issues and trends affecting each field are…

  17. Water-quality assessment of part of the upper Mississippi River basin, Minnesota and Wisconsin - Ground-water quality in an urban part of the Twin Cities Metropolitan area, Minnesota, 1996

    Science.gov (United States)

    Andrews, W.J.; Fong, A.L.; Harrod, Leigh; Dittes, M.E.

    1998-01-01

    In the spring of 1996, the Upper Mississippi River Basin Study Unit of the National Water-Quality Assessment Program drilled 30 shallow monitoring wells in a study area characterized by urban residential and commercial land uses. The monitoring wells were installed in sandy river-terrace deposits adjacent to the Mississippi River in Anoka and Hennepin Counties, Minnesota, in areas where urban development primarily occurred during the past 30 years.

  18. [Degree of compliance with health care quality criteria in the treatment of lower airway obstruction in Spanish pediatric emergency departments, reasons for noncompliance, and recommendations for improvement].

    Science.gov (United States)

    Claret Teruel, Gemma; Solé Ribalta, Anna; González Balenciaga, María; Paniagua Calzón, Natalia Marta; Korta Murua, Javier

    2016-06-01

    To determine the degree of compliance with health care quality criteria in the treatment of patients with lower airway obstruction in Spanish pediatric emergency departments (PEDs), to explore the reasons for noncompliance, and to make recommendations for improvement. We carried out a retrospective, cross-sectional study of a series of patients under the age of 14 years to determine the degree of compliance with 5 quality indicators. The patients were attended in 22 PEDs on days 1 and 15 of each month in 2013. We also distributed a questionnaire to chiefs of department to discover possible reasons for noncompliance. Finally, a group of experts followed a process to produce consensus-based recommendations to improve quality of care through compliance with the indicators. We included 2935 patients with a median (interquartile range) age of 2.8 (1.4-5.1) years. The overall rates of compliance were 39.8% for assessment of severity, 0.1% for measurement of peak flow, 64.4% for delay in attending a patient with severe shortness of breath, 59.1% for checking oxygen saturation and respiratory frequency, and 34.3% for treatment with inhalers and a spacer. The most common reasons for noncompliance were lack of time or material and the absence of the recommendation in protocols. The following improvement steps were recommended: reassess the usefulness of peak flow measurement in PEDs, reformulate the criteria for delay in attending patients with severe dyspnea, and adopt new indicators and templates that facilitate the recording of vital constants and scores on severity scales. An acceptable level of compliance was not achieved on any of the health care quality indicators for a variety of reasons. A series of steps should be taken to improve compliance.

  19. Effects of ractopamine hydrochloride and immunological castration in pigs. Part 2: belly quality characteristics and fatty acid composition

    Directory of Open Access Journals (Sweden)

    Letícia Cristina COSTA E SILVA

    Full Text Available Abstract The effects of immunocastration and ractopamine in the diet on the belly quality were investigated from two crossbred pigs under different conditions of production, diet, management, and slaughter arranged in factorial design using two levels of addition of ractopamine in the diet, 0 and 7.5 ppm, and three genders (gilts, immunocastrated and barrows. The quality of bellies were analyzed for chemical composition, pH, meat and fat color, backfat thickness and fatty acid profile of the fat. The addition of ractopamine showed no significant influence on pH, color and chemical composition in two crossbred pigs. The immunocastrated had thicker belly backfat compared to the bellies of the gilts. The contents of fatty acids polyunsaturated, linoleic, linoleic, arachidonic, total omega 3 and omega 6 were higher for immunocastrated pigs, as well as presenting values greater than 0.4 for the PUFA:SFA ratio, thus, providing bellies with better nutritional quality. The bellies of the gilts and immunocastrated pigs had higher concentrations of iodine value, indicative of higher unsaturated fat content. The results indicated that the addition of ractopamine and immunocastration had little influence on the quality of bellies as well as in their fatty acid profiles, suggesting the continuity of implementation of these techniques.

  20. 40 CFR Appendix A to Part 58 - Quality Assurance Requirements for SLAMS, SPMs and PSD Air Monitoring

    Science.gov (United States)

    2010-07-01

    ... Administrator, or his or her representative. The quality system will be reviewed during the systems audits.... Environmental Protection Agency in Research Triangle Park, North Carolina. 2.5Technical Systems Audit Program. Technical systems audits of each ambient air monitoring organization shall be conducted at least every 3...

  1. Quality of equine veterinary care. Part 2: Client satisfaction in equine top sports medicine in The Netherlands

    NARCIS (Netherlands)

    Loomans, J.B.A.; Waaijer, P.G.; Maree, J.T.M.; Weeren, van P.R.; Barneveld, A.

    2009-01-01

    The aim of this study was to evaluate systematically the quality of equine veterinary top sports medicine in The Netherlands and the degree to which the expectations in the field are met. Focus was on structure, process and outcome of care. The structure of care is generally satisfactory but there

  2. 40 CFR Appendix A to Part 132 - Great Lakes Water Quality Initiative Methodologies for Development of Aquatic Life Criteria and...

    Science.gov (United States)

    2010-07-01

    .... If the acute toxicity of the material to aquatic animals has been shown to be related to a water... material to aquatic animals has been shown to be related to a water quality characteristic such as hardness... a material in the water column to which an aquatic community can be exposed briefly without...

  3. How Compliance Measures, Behavior Modification, and Continuous Quality Improvement Led to Routine HIV Screening in an Emergency Department in Brooklyn, New York.

    Science.gov (United States)

    Isaac, Jermel Kyri; Sanchez, Travis H; Brown, Emily H; Thompson, Gina; Sanchez, Christina; Fils-Aime, Stephany; Maria, Jose

    2016-01-01

    New York State adopted a new HIV testing law in 2010 requiring medical providers to offer an HIV test to all eligible patients aged 13-64 years during emergency room or ambulatory care visits. Since then, Wyckoff Heights Medical Center (WHMC) in Brooklyn, New York, began implementing routine HIV screening organization-wide using a compliance, behavior-modification, and continuous quality-improvement process. WHMC first implemented HIV screening in the emergency department (ED) and evaluated progress with the following monthly indicators: HIV tests offered, HIV tests accepted, HIV tests ordered (starting in December 2013), HIV tests administered, positive HIV tests, and linkage to HIV care. Compliance with the delivery of HIV testing was determined by the proportion of patients who, after accepting a test, received one. During August 2013 through July 2014, of 57,852 eligible patients seen in the WHMC ED, a total of 31,423 (54.3%) were offered an HIV test. Of those, 8,229 (26.2%) patients accepted a test. Of those, 6,114 (74.3%) underwent a test. A total of 26 of the 6,114 patients tested (0.4%) had a positive test, and 24 of the 26 HIV-positive patients were linked to HIV medical care. By July 2014, the monthly proportion of patients offered a test was 62%; the proportion of those offered a test who had a test ordered was 98%, and the proportion of those with a test ordered who were tested was 81%. Testing compliance increased substantially at the WHMC ED, from 77% in December 2013 to >98% in July 2014. Using compliance-monitoring, behavior-modification, and continuous quality-improvement processes produced substantial increases in offers and HIV test completion. WHMC is replicating this approach across departments, and other hospitals implementing routine HIV screening programs should consider this approach as well.

  4. Current External Beam Radiation Therapy Quality Assurance Guidance: Does It Meet the Challenges of Emerging Image-Guided Technologies?

    International Nuclear Information System (INIS)

    Palta, Jatinder R.; Liu, Chihray; Li, Jonathan G.

    2008-01-01

    The traditional prescriptive quality assurance (QA) programs that attempt to ensure the safety and reliability of traditional external beam radiation therapy are limited in their applicability to such advanced radiation therapy techniques as three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, inverse treatment planning, stereotactic radiosurgery/radiotherapy, and image-guided radiation therapy. The conventional QA paradigm, illustrated by the American Association of Physicists in Medicine Radiation Therapy Committee Task Group 40 (TG-40) report, consists of developing a consensus menu of tests and device performance specifications from a generic process model that is assumed to apply to all clinical applications of the device. The complexity, variation in practice patterns, and level of automation of high-technology radiotherapy renders this 'one-size-fits-all' prescriptive QA paradigm ineffective or cost prohibitive if the high-probability error pathways of all possible clinical applications of the device are to be covered. The current approaches to developing comprehensive prescriptive QA protocols can be prohibitively time consuming and cost ineffective and may sometimes fail to adequately safeguard patients. It therefore is important to evaluate more formal error mitigation and process analysis methods of industrial engineering to more optimally focus available QA resources on process components that have a significant likelihood of compromising patient safety or treatment outcomes

  5. Quality of extra virgin olive oils produced in an emerging olive growing area in north-western Spain.

    Science.gov (United States)

    Reboredo-Rodríguez, P; González-Barreiro, C; Cancho-Grande, B; Simal-Gándara, J

    2014-12-01

    Systematic studies of physico-chemical and stability-related properties, and chemical composition, of extra virgin olive oils (EVOOs) obtained from drupes cropped in specific regions are of special agricultural interest. This is particularly so with new production areas, where careful selection of the most suitable olive varieties for EVOO production is required. This paper reports the first comprehensive chemical characterisation of EVOOs obtained from three different olive varieties (viz., Picual, Morisca and Manzanilla de Sevilla) grown in a new cultivation area in Galicia (NW Spain). The Morisca variety was that providing the highest industrial oil yield (21%). However, the three types of EVOO exhibited no statistically significant differences in standard quality-related indices other than acidity. Morisca EVOO was that with the lowest content in oleic acid (mean=68%) and highest content in linoleic acid (mean=13%). Also, Morisca EVOO exhibited the highest sterol levels (mean=1,616 mg/kg) and Picual EVOO the lowest (mean=1,160 mg/kg). Picual EVOO contained greater amounts of the phenolic compounds luteolin and pinoresinol than both Morisca and Manzanilla de Sevilla EVOOs. Finally, Manzanilla de Sevilla EVOO exhibited differential attributes, with banana and olive fruit aromatic series prevailing predominantly over bitter-like, pungent-like and leaf series. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Annual Report for 1981 to the DOE Office of the Assistant Secretary for Environmental Protection, Safety, and Emergency Preparedness. Part 2. Ecological Sciences

    International Nuclear Information System (INIS)

    Vaughan, B.E.

    1982-02-01

    Separate abstracts were prepared for the 38 reports for this Pacific Northwest Laboratory Annual Report for 1981 to the DOE Office of Energy Research. This part dealt with research conducted in the ecological sciences

  7. Annual Report for 1981 to the DOE Office of the Assistant Secretary for Environmental Protection, Safety, and Emergency Preparedness. Part 2. Ecological Sciences. [Lead abstract

    Energy Technology Data Exchange (ETDEWEB)

    Vaughan, B.E.

    1982-02-01

    Separate abstracts were prepared for the 38 reports for this Pacific Northwest Laboratory Annual Report for 1981 to the DOE Office of Energy Research. This part dealt with research conducted in the ecological sciences.

  8. Children's mental health emergencies-part 1: challenges in care: definition of the problem, barriers to care, screening, advocacy, and resources.

    Science.gov (United States)

    Baren, Jill M; Mace, Sharon E; Hendry, Phyllis L; Dietrich, Ann M; Grupp-Phelan, Jacqueline; Mullin, Jacqueline

    2008-06-01

    At a time when there has been a reduction in mental health resources nationwide, the incidence of mental health disorders in children has seen a dramatic increase for many reasons. A review of the literature was done to identify the epidemiology, barriers to care, useful emergency department (ED) screening methods, and resources regarding pediatric mental health disorders in the ED. Although there are many challenges to the provision of care for children with mental health emergencies, some resources are available. Furthermore, ED screening and intervention may be effective in improving patient outcomes. Collaborative efforts with multidisciplinary services can create a continuum of care, promote better identification of children and adolescents with mental health disorders, and promote early recognition and intervention, which are key to effective referral and treatment.

  9. [Level of completion of the prehospital care and transfer record as a quality indicator in an emergency medical service].

    Science.gov (United States)

    Ballestros Peña, Sendoa; Lorrio Palomino, Sergio; Ariz Zubiaur, Mónica

    2012-11-01

    BASICS: A Prehospital Care and Transfer Recording (PCTR) is an out-of-hospital medical recording. This paper was made to assess and compare the level of fulfillment of the basic parameters of the PCTR developed by the Life Support Units with nurses (Life Support Units with Nurse, LSUwN and without nurses (Basic Life Support Units, BLSU) from SAMUR Bilbao in 2010. A descriptive, retrospective and comparative study was performed by analysing a randomized sample of 660 PCTR (precision 3%), aiming to check the fulfillment of the basic data. 98.33% of total recordings were readable. In overall, fulfillment rate was 90.31% (CI 89.24- 97.3 71%) of all basic parameters for LSUwN PCTR and 84.81% (CI 83.56 to 86%) for BLSU. 34.1% of PCTR were completely and correctly fulfilled. The LSUwN scored significantly better (p < 0.000). There were recording failures in "date and time", "address" and "physical examination". There were differences between the recording of clinical and administrative information (88.64% vs 86.72%, p = 0.02). In order to consider a parameter has optimal, it has to reach 100% of fulfillment. If it doesn't, and its score reaches no more than 80%, it should be reviewed. In this case, the results would be considered acceptable, but the administrative items of BLSU records, and allergies in both units should be strengthened. LSUwN has obtained better scores. The need of recording clinical information must be instilled as evidence of quality care.

  10. Evaluation of wedge-shaped phantoms for assessment of scanner display as a part of quality control of scanner performance

    International Nuclear Information System (INIS)

    Bergmann, H.; Havlik, E.

    1981-01-01

    Image manipulation in modern rectilinear scanners comprises background subtraction and contrast enhancement facilities. It has been the aim of this investigation to develop simple quality assurance methods suitable for checking the function of these features on a routine basis. Several types of phantoms have been investigated: an absorption step wedge, an emission step wedge and an emission continuous wedge. The absorption step wedge when used with a usual gamma-camera checking source gave the least satisfactory results. The emission step wedge is best suited for test procedures for background subtraction of the colour printer display and for contrast enhancement of the photo display, whereas the emission continuous wedge gave best results in testing the contrast enhancement of the colour printer display. An evaluation of the relative merits of the phantoms indicates that the emission step wedge is best suited for quality assurance tests. (author)

  11. Void Measurements in the Regions of Sub-Cooled and Low-Quality Boiling. Part 1. Low Mass Velocities

    Energy Technology Data Exchange (ETDEWEB)

    Rouhani, S Z

    1966-07-15

    By the application of the ({gamma}, n) reaction to boiling heavy water, void volume fractions have been measured in a vertical annular channel with 25 mm O.D. and 12 mm I.D. at a heated length of 1090 mm. The experiments covered pressures from 10 to 50 bars, mass velocities from 50 to 1450 kg/m-sec, heat fluxes from 30 to 90 W/cm{sup 2}, sub coolings from 30 to 0 C, and steam qualities from 0 to 15 %. The results indicate noticeable effects of pressure, heat flux and even mass velocity upon the variations of void with subcooling and steam quality. A novel explanation of the mechanism of their effects has been found and proved by qualitative analysis.

  12. Construction of quality-assured infant feeding process of care data repositories: Construction of the perinatal repository (Part 2).

    Science.gov (United States)

    García-de-León-Chocano, Ricardo; Muñoz-Soler, Verónica; Sáez, Carlos; García-de-León-González, Ricardo; García-Gómez, Juan M

    2016-04-01

    This is the second in a series of two papers regarding the construction of data quality (DQ) assured repositories, based on population data from Electronic Health Records (EHR), for the reuse of information on infant feeding from birth until the age of two. This second paper describes the application of the computational process of constructing the first quality-assured repository for the reuse of information on infant feeding in the perinatal period, with the aim of studying relevant questions from the Baby Friendly Hospital Initiative (BFHI) and monitoring its deployment in our hospital. The construction of the repository was carried out using 13 semi-automated procedures to assess, recover or discard clinical data. The initial information consisted of perinatal forms from EHR related to 2048 births (Facts of Study, FoS) between 2009 and 2011, with a total of 433,308 observations of 223 variables. DQ was measured before and after the procedures using metrics related to eight quality dimensions: predictive value, correctness, duplication, consistency, completeness, contextualization, temporal-stability, and spatial-stability. Once the predictive variables were selected and DQ was assured, the final repository consisted of 1925 births, 107,529 observations and 73 quality-assured variables. The amount of discarded observations mainly corresponds to observations of non-predictive variables (52.90%) and the impact of the de-duplication process (20.58%) with respect to the total input data. Seven out of thirteen procedures achieved 100% of valid births, observations and variables. Moreover, 89% of births and ~98% of observations were consistent according to the experts׳ criteria. A multidisciplinary approach along with the quantification of DQ has allowed us to construct the first repository about infant feeding in the perinatal period based on EHR population data. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Ractopamine hydrochloride and immunological castration in pigs. Part 1: fresh belly characteristics for bacon processing and quality

    Directory of Open Access Journals (Sweden)

    Letícia Cristina COSTA E SILVA

    Full Text Available Abstract The effects of ractopamine and immunological castration on belly characteristics, processing yield, physicochemical and sensory quality of bacon were investigated from two crossbred pigs under different conditions of animal production, diet, management and slaughter arranged in factorial design using 2 ractopamine levels (0 and 7.5 ppm and 3 genders (barrows, immunocastrated and gilts. Before processing, belly firmness, weight, length, width and thickness were measured, and then, bacon processing yield evaluated. After processing, bacon slices were digitally imaged and analyzed for lean meat and fat areas, pH, instrumental color of meat and fat, cooking loss and sensory quality. The ractopamine did not alter belly characteristics, but significantly increased the process yield and decreased cooking loss. Barrows and immunocastrated pigs showed firmer bellies, which could be advantageous for bacon processing and slicing. Barrows presented the highest total area of bacon slices. The results of this study indicate that both techniques ractopamine in the finishing diets and immunocastration of pigs can be combined with no further consequences for belly processing and to bacon quality and with some advantages.

  14. High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training.

    Science.gov (United States)

    Wheeler, Derek S; Geis, Gary; Mack, Elizabeth H; LeMaster, Tom; Patterson, Mary D

    2013-06-01

    In situ simulation training is a team-based training technique conducted on actual patient care units using equipment and resources from that unit, and involving actual members of the healthcare team. We describe our experience with in situ simulation training in a major children's medical centre. In situ simulations were conducted using standardised scenarios approximately twice per month on inpatient hospital units on a rotating basis. Simulations were scheduled so that each unit participated in at least two in situ simulations per year. Simulations were conducted on a revolving schedule alternating on the day and night shifts and were unannounced. Scenarios were preselected to maximise the educational experience, and frequently involved clinical deterioration to cardiopulmonary arrest. We performed 64 of the scheduled 112 (57%) in situ simulations on all shifts and all units over 21 months. We identified 134 latent safety threats and knowledge gaps during these in situ simulations, which we categorised as medication, equipment, and/or resource/system threats. Identification of these errors resulted in modification of systems to reduce the risk of error. In situ simulations also provided a method to reinforce teamwork behaviours, such as the use of assertive statements, role clarity, performance of frequent updating, development of a shared mental model, performance of independent double checks of high-risk medicines, and overcoming authority gradients between team members. Participants stated that the training programme was effective and did not disrupt patient care. In situ simulations can identify latent safety threats, identify knowledge gaps, and reinforce teamwork behaviours when used as part of an organisation-wide safety programme.

  15. Emergency Communication

    Science.gov (United States)

    : Environmental Documents, Reports LANL Home Calendar Search Contacts Resources » Emergency Communication Emergency Communication Stay informed of emergencies, weather delays, closures, other alerts. Find links to

  16. Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department.

    Science.gov (United States)

    Ong, Marcus Eng Hock; Quah, Joy Li Juan; Annathurai, Annitha; Noor, Noorkiah Mohamed; Koh, Zhi Xiong; Tan, Kenneth Boon Kiat; Pothiawala, Sohil; Poh, Ah Ho; Loy, Chye Khiaw; Fook-Chong, Stephanie

    2013-04-01

    Determine if implementing cardiac arrest teams trained with a 'pit-crew' protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10min of resuscitation. A phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge. After implementation, mean total NFR for the first 5min decreased from 0.42 to 0.27 (decrease=0.15, 95% CI 0.10-0.19, pCPR ratio increased from 46.4% to 88.4% (increase=41.9%, 95% CI 36.9-46.9, pTraining cardiac arrest teams in a 'pit-crew' protocol may improve the quality of CPR at the ED. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. State of emergency medicine in Azerbaijan.

    Science.gov (United States)

    Sule, Harsh; Kazimov, Shirin; Shahmaliyev, Oktay; Sirois, Adam

    2008-04-01

    There has been no previous study into the state of emergency medicine in Azerbaijan. As a legacy of the Soviet Semashko system, the "specialty" model of emergency medicine and integrated emergency departments do not exist here. Instead, pre-hospital emergency care is delivered by ambulance physicians and in-hospital care by individual departments, often in specialty hospitals. Emergency care is therefore fragmented, highly specialized and inefficient. The Emergency Medicine Development Initiative (EMDI) of the International Medical Corps (IMC) was designed to improve the quality of emergency care in four pilot regional centers in Azerbaijan. The objective of this study was to assess the baseline emergency medical capacity of these four centers. EMDI staff conducted a four-part baseline survey in April 2006 to assess emergency care in Ganja (the second largest city in Azerbaijan), Kurdamir, Shamkir and Yevlakh. Data collection involved interviews with relevant personnel and a retrospective records review in each city. Pre-hospital: The number of ambulance teams per 10,000 inhabitants is below the number required by local regulations. On average, 45% of 27 medications and 37% of 17 pieces of critical equipment were available. Of the emergency procedures, 21% could be performed in the pre-hospital setting. In-hospital: Admission rates were near 100% for the admissions department-an area that is supposed to function as an emergency department would. On average 57% of 40 medications and 42% of 22 pieces of critical equipment were available. Of the emergency procedures, 62% could be performed in the in-hospital setting. The emergency medical system surveyed in Azerbaijan is inefficiently organized, under-financed, poorly equipped and lacks adequately trained staff. Reforms need to be directed towards achieving international standards, while adapting new models for service delivery into the existing framework and improving system capacity as highlighted by this baseline

  18. Initial clinical experience with a 64-MDCT whole-body scanner in an emergency department: better time management and diagnostic quality?

    Science.gov (United States)

    Rieger, Michael; Czermak, Benedikt; El Attal, Rene; Sumann, Günther; Jaschke, Werner; Freund, Martin

    2009-03-01

    The objective of this study was to assess time management and diagnostic quality when using a 64-multidetector-row computed tomography (MDCT) whole-body scanner to evaluate polytraumatized patients in an emergency department. Eighty-eight consecutive polytraumatized patients with injury severity score (ISS) > or = 18 (mean ISS = 29) were included in this study. Documented and evaluated data were crash history, trauma mechanism, number and pattern of injuries, injury severity, diagnostics, time flow, and missed diagnoses. Data were stored in our hospital information system. Seven time intervals were evaluated. In particular, attention was paid to the "acquisition interval," the "reformatting and evaluation time" as well as the "CT time" (time from CT start to preliminary diagnosis). A standardized whole-body CT was performed. The acquired CT data together with automatically generated multiplanar reformatted images ("direct MPR") were transferred to a 3D rendering workstation. Diagnostic quality was determined on the basis of missed diagnoses. Head-to-toe scout images were possible because volume coverage was up to 2 m. Experienced radiologists at an affiliated workstation performed radiologic evaluation of the acquired datasets immediately after acquisition. The "acquisition interval" was 12 minutes +/- 4.9 minutes, the "reformatting and evaluation interval" 7.0 minutes +/- 2.1 minutes, and the "CT time" 19 minutes +/- 6.1 minutes. Altogether, 7 of 486 lesions were recognized but not communicated in the "reformatting and evaluation interval", and 10 injuries were initially missed and detected during follow-up. This study indicates that 64-MDCT saves time, especially in the "reformatting and evaluation interval." Diagnostic quality is high, as reflected by the small number of missed diagnoses.

  19. Mentoring. A quality assurance tool for dentists. Part 6: Outcomes: patient care, professional development and personal growth. Authentic happiness for dentists.

    Science.gov (United States)

    Holt, Vernon P; Ladwa, Russ

    2010-01-01

    This paper is the last in a series of six papers that have described different aspects of mentoring. It considers the impact of mentoring when it is used in general dental practice, applying the technique of learning through positive psychology. The first part of the paper considers this approach from a patient's perspective, the second from the perspective of a dentist. Because the impact on the quality of care for the patient is largely mediated through the personality of the dentist, the quality of the dentist's own performance, during his/her professional relationship with the patient, is a critical ingredient. The way that this critical ingredient impacts on quality of care is considered and parallels are drawn between roles assumed in dental practice and those found in industry. The paper also considers the way in which mentoring, as a part of a professional development programme, can enhance dentists' personal skills and performance. It is an opportunity for great personal growth, with increased levels of job and life satisfaction, leading to greater levels of authentic happiness for all those involved, not least for dentists and the dental team.

  20. Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays.

    Science.gov (United States)

    Bion, Julian; Aldridge, Cassie P; Girling, Alan; Rudge, Gavin; Beet, Chris; Evans, Tim; Temple, R Mark; Roseveare, Chris; Clancy, Mike; Boyal, Amunpreet; Tarrant, Carolyn; Sutton, Elizabeth; Sun, Jianxia; Rees, Peter; Mannion, Russell; Chen, Yen-Fu; Watson, Samuel Ian; Lilford, Richard

    2017-12-22

    The mortality associated with weekend admission to hospital (the 'weekend effect') has for many years been attributed to deficiencies in quality of hospital care, often assumed to be due to suboptimal senior medical staffing at weekends. This protocol describes a case note review to determine whether there are differences in care quality for emergency admissions (EAs) to hospital at weekends compared with weekdays, and whether the difference has reduced over time as health policies have changed to promote 7-day services. Cross-sectional two-epoch case record review of 20 acute hospital Trusts in England. Anonymised case records of 4000 EAs to hospital, 2000 at weekends and 2000 on weekdays, covering two epochs (financial years 2012-2013 and 2016-2017). Admissions will be randomly selected across the whole of each epoch from Trust electronic patient records. Following training, structured implicit case reviews will be conducted by consultants or senior registrars (senior residents) in acute medical specialities (60 case records per reviewer), and limited to the first 7 days following hospital admission. The co-primary outcomes are the weekend:weekday admission ratio of errors per case record, and a global assessment of care quality on a Likert scale. Error rates will be analy