Sample records for providing high quality

  1. Providing high-quality HIV care in a deeply rural setting – the ...

    African Journals Online (AJOL)

    Providing high-quality HIV care in a deeply rural setting – the Zithulele experience. C Young, B Gaunt. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · · AJOL African Journals Online. HOW TO ...

  2. Providing high-quality care in primary care settings: how to make trade-offs. (United States)

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


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

  3. CESAME: Providing High Quality Professional Development in Science and Mathematics for K-12 Teachers (United States)

    Hickman, Paul


    It is appropriate that after almost half a century of Science and Mathematics education reform we take a look back and a peek forward to understand the present state of this wonderfully complex system. Each of the components of this system including teaching, professional development, assessment, content and the district K-12 curriculum all need to work together if we hope to provide quality science, mathematics and technology education for ALL students. How do the state and national standards drive the system? How do state policies on student testing and teacher licensure come into play? How do we improve the preparation, retention and job satisfaction of our K-12 teachers? What initiatives have made or are making a difference? What else needs to be done? What can the physics community do to support local efforts? This job is too big for any single organization or individual but we each can contribute to the effort. Our Center at Northeastern University, with support from the National Science Foundation, has a sharply defined focus: to get high quality, research-based instructional materials into the hands of K-12 classroom teachers and provide the support they need to use the materials effectively in their classrooms.

  4. Physicians' assessments of their ability to provide high-quality care in a changing health care system. (United States)

    Reschovsky, J; Reed, M; Blumenthal, D; Landon, B


    With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptions. Bivariate and multivariate analyses of the Community Tracking Study Physician Survey, a cross-sectional, nationally representative telephone survey of 12,385 patient-care physicians conducted in 1996/1997. The response rate was 65%. Physicians who provide direct patient care for > or =20 h/wk, excluding federal employees and those in selected specialties. Level of agreement with 4 statements: 1 regarding overall ability to provide high-quality care and 3 regarding aspects of care delivery associated with quality. Between 21% and 31% of physicians disagreed with the quality statements. Specialists were generally 50% more likely than primary care physicians to express concerns about their ability to provide quality care. Generally, the number of managed care contracts, but not the percent of practice revenue from managed care, was negatively associated with perceived quality. Market-level managed care penetration independently affected physicians' perceptions. Practice setting affected perceptions of quality, with physicians in group settings less likely to express concerns than physicians in solo and 2-physician practices. Specific financial incentives and care management tools had limited positive or negative associations with perceived quality. Managed care involvement is only modestly associated with reduced perceptions of quality among physicians, with some specific tools enhancing perceived quality. Physicians may be able to moderate some negative effects of managed care by altering their practice arrangements.

  5. A feedback system in residency to evaluate CanMEDS roles and provide high-quality feedback : Exploring its application

    NARCIS (Netherlands)

    Renting, Nienke; Gans, Rijk O. B.; Borleffs, Jan C. C.; Van Der Wal, Martha A.; Jaarsma, A. Debbie C.; Cohen-Schotanus, Janke

    Introduction: Residents benefit from regular, high quality feedback on all CanMEDS roles during their training. However, feedback mostly concerns Medical Expert, leaving the other roles behind. A feedback system was developed to guide supervisors in providing feedback on CanMEDS roles. We analyzed

  6. Physicians cite hurdles ranging from lack of coverage to poor communication in providing high-quality care to latinos. (United States)

    Vargas Bustamante, Arturo; Chen, Jie


    We surveyed physicians about their ability to provide high-quality care to patients from diverse ethnic backgrounds. Primarily, we wanted to explore the challenges faced by physicians treating Latino patients compared to physicians whose patients were primarily white and non-Latino. We found that physicians treating Latinos, particularly those who worked in primary care in comparison to specialists, were less likely than physicians treating primarily white patients to believe in their ability to provide high-quality care. They cited problems of inadequate time with patients, patients' ability to pay, patients' nonadherence to recommended treatment, difficulties communicating with patients, relative lack of specialist availability, and lack of timely transmission of reports among physicians. Insurance expansions and complementary reforms mandated by the Affordable Care Act of 2010 and other recent legislation should aid physicians in closing some of these gaps in quality.

  7. SEAFOODplus - how to provide health promoting, safe seafood of high eating quality to consumers

    DEFF Research Database (Denmark)

    Børresen, Torger


    of raw materials from aquaculture and from traditional fisheries. The aquaculture component will study the effects of dietary modulation, husbandry, fish physiology, genetics and pre-slaughter conditions. Validated traceability systems are assessed to make it possible to apply a total chain approach from......, by identifying risk factors and avoiding risks caused by viral and bacterial contamination and biogenic amines in seafood. The total value chain is addressed by developing consumer driven tailor-made, functional seafood products to improve health and to ensure nutritional quality and safety by full utilisation...

  8. Software project estimation the fundamentals for providing high quality information to decision makers

    CERN Document Server

    Abran, Alain


    Software projects are often late and over-budget and this leads to major problems for software customers. Clearly, there is a serious issue in estimating a realistic, software project budget. Furthermore, generic estimation models cannot be trusted to provide credible estimates for projects as complex as software projects. This book presents a number of examples using data collected over the years from various organizations building software. It also presents an overview of the non-for-profit organization, which collects data on software projects, the International Software Benchmarking Stan

  9. Frequency of high-quality communication behaviors used by primary care providers of heterozygous infants after newborn screening. (United States)

    Farrell, Michael H; Christopher, Stephanie A


    To examine the quality of communication likely to be experienced by parents when being first informed about how newborn screening identified heterozygous "carrier" status for cystic fibrosis or sickle cell disease. Primary care providers (PCPs) of infants found to have carrier status were telephoned over a 48-month period, and asked to rehearse with a standardized patient how they would inform the infants' parent(s). 214 rehearsal transcripts were abstracted using explicit criteria methods to measure the frequency of five categories of high-quality communication behaviors. Overall, PCPs used large amounts of jargon and failed to use high quality communication behaviors. On average, PCPs used 18.6 total jargon words (8.7 unique words), but explained 2.4 jargon words. The most frequent assessment of understanding was the close-ended version, although it was only seen in 129 of 214 transcripts. The most common organizing behavior was importance emphasis (121/214). Precautionary empathy was rare; the most frequent behavior was "instruction about emotion" (33/214). The limited use of high-quality communication behaviors in rehearsals raises concern about parental understanding, decision-making, and psychosocial outcomes after newborn screening. Measurement of specific behaviors may help PCPs to improve communication, and thereby improve the patient experience. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Providing High Quality Care in Low-Income Areas of Maryland: Definitions, Resources, and Challenges from Parents and Child Care Providers' Perspectives. Publication #2012-45 (United States)

    Forry, Nicole; Simkin, Shana; Wessel, Julia; Rodrigues, Katherine


    Early life experiences are critical to a child's development. Research has shown that, for a variety of reasons, children born into low-income families are at a disadvantage when compared to their higher-income peers. Fortunately, research has also shown a positive association between high quality child care and the academic and social-emotional…

  11. Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. (United States)

    Ngo-Metzger, Quyen; Sorkin, Dara H; Phillips, Russell S; Greenfield, Sheldon; Massagli, Michael P; Clarridge, Brian; Kaplan, Sherrie H


    Provider-patient language discordance is related to worse quality care for limited English proficient (LEP) patients who speak Spanish. However, little is known about language barriers among LEP Asian-American patients. We examined the effects of language discordance on the degree of health education and the quality of interpersonal care that patients received, and examined its effect on patient satisfaction. We also evaluated how the presence/absence of a clinic interpreter affected these outcomes. Cross-sectional survey, response rate 74%. A total of 2,746 Chinese and Vietnamese patients receiving care at 11 health centers in 8 cities. Provider-patient language concordance, health education received, quality of interpersonal care, patient ratings of providers, and the presence/absence of a clinic interpreter. Regression analyses were used to adjust for potential confounding. Patients with language-discordant providers reported receiving less health education (beta = 0.17, p interpreter. Patients with language-discordant providers also reported worse interpersonal care (beta = 0.28, p interpreter did not mitigate these effects and in fact exacerbated disparities in patients' perceptions of their providers. Language barriers are associated with less health education, worse interpersonal care, and lower patient satisfaction. Having access to a clinic interpreter can facilitate the transmission of health education. However, in terms of patients' ratings of their providers and the quality of interpersonal care, having an interpreter present does not serve as a substitute for language concordance between patient and provider.

  12. Continuous Renal Replacement Therapy: Reviewing Current Best Practice to Provide High-Quality Extracorporeal Therapy to Critically Ill Patients. (United States)

    Connor, Michael J; Karakala, Nithin


    Continuous renal replacement therapy (CRRT) use continues to expand globally. Despite improving technology, CRRT remains a complex intervention. Delivery of high-quality CRRT requires close collaboration of a multidisciplinary team including members of the critical care medicine, nephrology, nursing, pharmacy, and nutrition support teams. While significant gaps in medical evidence regarding CRRT persist, the growing evidence base supports evolving best practice and consensus to define high-quality CRRT. Unfortunately, there is wide variability in CRRT operating characteristics and limited uptake of these best practices. This article will briefly review the current best practice on important aspects of CRRT delivery including CRRT dose, anticoagulation, dialysis vascular access, fluid management, and drug dosing in CRRT. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  13. Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries. (United States)

    Kwag, Koren Hyogene; González-Lorenzo, Marien; Banzi, Rita; Bonovas, Stefanos; Moja, Lorenzo


    The complexity of modern practice requires health professionals to be active information-seekers. Our aim was to review the quality and progress of point-of-care information summaries-Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (PUptoDate scored the highest across all dimensions, while others that were marketed as evidence

  14. A high-quality carrot genome assembly provides new insights into carotenoid accumulation and asterid genome evolution. (United States)

    Iorizzo, Massimo; Ellison, Shelby; Senalik, Douglas; Zeng, Peng; Satapoomin, Pimchanok; Huang, Jiaying; Bowman, Megan; Iovene, Marina; Sanseverino, Walter; Cavagnaro, Pablo; Yildiz, Mehtap; Macko-Podgórni, Alicja; Moranska, Emilia; Grzebelus, Ewa; Grzebelus, Dariusz; Ashrafi, Hamid; Zheng, Zhijun; Cheng, Shifeng; Spooner, David; Van Deynze, Allen; Simon, Philipp


    We report a high-quality chromosome-scale assembly and analysis of the carrot (Daucus carota) genome, the first sequenced genome to include a comparative evolutionary analysis among members of the euasterid II clade. We characterized two new polyploidization events, both occurring after the divergence of carrot from members of the Asterales order, clarifying the evolutionary scenario before and after radiation of the two main asterid clades. Large- and small-scale lineage-specific duplications have contributed to the expansion of gene families, including those with roles in flowering time, defense response, flavor, and pigment accumulation. We identified a candidate gene, DCAR_032551, that conditions carotenoid accumulation (Y) in carrot taproot and is coexpressed with several isoprenoid biosynthetic genes. The primary mechanism regulating carotenoid accumulation in carrot taproot is not at the biosynthetic level. We hypothesize that DCAR_032551 regulates upstream photosystem development and functional processes, including photomorphogenesis and root de-etiolation.

  15. Health Provider Networks, Quality and Costs

    NARCIS (Netherlands)

    Boone, J.; Schottmuller, C.


    We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider

  16. Health provider networks, quality and costs

    NARCIS (Netherlands)

    Boone, Jan; Schottmuller, C.


    We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider

  17. Providing High-Quality Support Services to Home-Based Child Care: A Conceptual Model and Literature Review (United States)

    Bromer, Juliet; Korfmacher, Jon


    Research Findings: Home-based child care accounts for a significant proportion of nonparental child care arrangements for young children in the United States. Yet the early care and education field lacks clear models or pathways for how to improve quality in these settings. The conceptual model presented here articulates the components of…

  18. Providing better indoor environmental quality brings economicbenefits

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William; Seppanen, Olli


    This paper summarizes the current scientific evidence that improved indoor environmental quality can improve work performance and health. The review indicates that work and school work performance is affected by indoor temperature and ventilation rate. Pollutant source removal can sometimes improve work performance. Based on formal statistical analyses of existing research results, quantitative relationships are provided for the linkages of work performance with indoor temperature and outdoor air ventilation rate. The review also indicates that improved health and related financial savings are obtainable from reduced indoor tobacco smoking, prevention and remediation of building dampness, and increased ventilation. Example cost-benefit analyses indicate that many measures to improve indoor temperature control and increase ventilation rates will be highly cost effective, with benefit-cost ratios as high as 80 and annual economic benefits as high as $700 per person.

  19. Nurse-midwifery education through graduate programs to provide a sufficient number of high quality nurse-midwives

    Directory of Open Access Journals (Sweden)

    Kyung Hye Lee


    Full Text Available There is a decrease in the number of new midwives, resulting from the shutdown of midwifery education program in hospitals due to a decrease in birthrate in the Republic of Korea. To solve this problem, the current medical laws on midwifery education system in Korea should be revised; nurse-midwifery specialist programs must be established in educational institutes with nursing programs. To support this argument, the midwifery education programs of America, Europe, Australia, and Japan have been discussed, and a nurse-midwifery specialist curriculum at the master s level, based on the nurse-practitioner system of Korea, has been suggested. Since this assertion is very important and urgent for solving the future population problem of Korea and providing health care for women and children, it should be realized into action immediately.

  20. Applying high-frequency surrogate measurements and a wavelet-ANN model to provide early warnings of rapid surface water quality anomalies. (United States)

    Shi, Bin; Wang, Peng; Jiang, Jiping; Liu, Rentao


    It is critical for surface water management systems to provide early warnings of abrupt, large variations in water quality, which likely indicate the occurrence of spill incidents. In this study, a combined approach integrating a wavelet artificial neural network (wavelet-ANN) model and high-frequency surrogate measurements is proposed as a method of water quality anomaly detection and warning provision. High-frequency time series of major water quality indexes (TN, TP, COD, etc.) were produced via a regression-based surrogate model. After wavelet decomposition and denoising, a low-frequency signal was imported into a back-propagation neural network for one-step prediction to identify the major features of water quality variations. The precisely trained site-specific wavelet-ANN outputs the time series of residual errors. A warning is triggered when the actual residual error exceeds a given threshold, i.e., baseline pattern, estimated based on long-term water quality variations. A case study based on the monitoring program applied to the Potomac River Basin in Virginia, USA, was conducted. The integrated approach successfully identified two anomaly events of TP variations at a 15-minute scale from high-frequency online sensors. A storm event and point source inputs likely accounted for these events. The results show that the wavelet-ANN model is slightly more accurate than the ANN for high-frequency surface water quality prediction, and it meets the requirements of anomaly detection. Analyses of the performance at different stations and over different periods illustrated the stability of the proposed method. By combining monitoring instruments and surrogate measures, the presented approach can support timely anomaly identification and be applied to urban aquatic environments for watershed management. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Legislation should support optimal breastfeeding practices and access to low-cost, high-quality complementary foods: Indonesia provides a case study. (United States)

    Soekarjo, Damayanti; Zehner, Elizabeth


    It is important to support women to exclusively breastfeed for 6 months and continue breastfeeding for 24 months and beyond. It is also necessary to provide the poor with access to affordable ways to improve the quality of complementary foods. Currently, many countries do not have the legal and policy environment necessary to support exclusive and continued breastfeeding. Legislative and policy changes are also necessary for introducing complementary food supplements, allowing them to be marketed to those who need them, and ensuring that marketing remains appropriate and in full compliance with the International Code of Marketing of Breastmilk Substitutes. This paper aims to illustrate the above with examples from Indonesia and to identify legislative requirements for supporting breastfeeding and enabling appropriate access to high-quality complementary food supplements for children 6-24 months of age. Requirements include improved information, training, monitoring and enforcement systems for the International Code of Marketing of Breastmilk Substitutes; implementation and monitoring of the Baby-Friendly Hospital Initiative; establishment of a registration category for complementary food supplements to enhance availability of high-quality, low-cost fortified products to help improve young child feeding; clear identification and marketing of these products as complementary food supplements for 6-24-month-olds so as to promote proper use and not interfere with breastfeeding. © 2011 Blackwell Publishing Ltd.

  2. A high-quality genome assembly of quinoa provides insights into the molecular basis of salt bladder-based salinity tolerance and the exceptional nutritional value (United States)

    Zou, Changsong; Chen, Aojun; Xiao, Lihong; Muller, Heike M; Ache, Peter; Haberer, Georg; Zhang, Meiling; Jia, Wei; Deng, Ping; Huang, Ru; Lang, Daniel; Li, Feng; Zhan, Dongliang; Wu, Xiangyun; Zhang, Hui; Bohm, Jennifer; Liu, Renyi; Shabala, Sergey; Hedrich, Rainer; Zhu, Jian-Kang; Zhang, Heng


    Chenopodium quinoa is a halophytic pseudocereal crop that is being cultivated in an ever-growing number of countries. Because quinoa is highly resistant to multiple abiotic stresses and its seed has a better nutritional value than any other major cereals, it is regarded as a future crop to ensure global food security. We generated a high-quality genome draft using an inbred line of the quinoa cultivar Real. The quinoa genome experienced one recent genome duplication about 4.3 million years ago, likely reflecting the genome fusion of two Chenopodium parents, in addition to the γ paleohexaploidization reported for most eudicots. The genome is highly repetitive (64.5% repeat content) and contains 54 438 protein-coding genes and 192 microRNA genes, with more than 99.3% having orthologous genes from glycophylic species. Stress tolerance in quinoa is associated with the expansion of genes involved in ion and nutrient transport, ABA homeostasis and signaling, and enhanced basal-level ABA responses. Epidermal salt bladder cells exhibit similar characteristics as trichomes, with a significantly higher expression of genes related to energy import and ABA biosynthesis compared with the leaf lamina. The quinoa genome sequence provides insights into its exceptional nutritional value and the evolution of halophytes, enabling the identification of genes involved in salinity tolerance, and providing the basis for molecular breeding in quinoa. PMID:28994416

  3. A high-quality genome assembly of quinoa provides insights into the molecular basis of salt bladder-based salinity tolerance and the exceptional nutritional value. (United States)

    Zou, Changsong; Chen, Aojun; Xiao, Lihong; Muller, Heike M; Ache, Peter; Haberer, Georg; Zhang, Meiling; Jia, Wei; Deng, Ping; Huang, Ru; Lang, Daniel; Li, Feng; Zhan, Dongliang; Wu, Xiangyun; Zhang, Hui; Bohm, Jennifer; Liu, Renyi; Shabala, Sergey; Hedrich, Rainer; Zhu, Jian-Kang; Zhang, Heng


    Chenopodium quinoa is a halophytic pseudocereal crop that is being cultivated in an ever-growing number of countries. Because quinoa is highly resistant to multiple abiotic stresses and its seed has a better nutritional value than any other major cereals, it is regarded as a future crop to ensure global food security. We generated a high-quality genome draft using an inbred line of the quinoa cultivar Real. The quinoa genome experienced one recent genome duplication about 4.3 million years ago, likely reflecting the genome fusion of two Chenopodium parents, in addition to the γ paleohexaploidization reported for most eudicots. The genome is highly repetitive (64.5% repeat content) and contains 54 438 protein-coding genes and 192 microRNA genes, with more than 99.3% having orthologous genes from glycophylic species. Stress tolerance in quinoa is associated with the expansion of genes involved in ion and nutrient transport, ABA homeostasis and signaling, and enhanced basal-level ABA responses. Epidermal salt bladder cells exhibit similar characteristics as trichomes, with a significantly higher expression of genes related to energy import and ABA biosynthesis compared with the leaf lamina. The quinoa genome sequence provides insights into its exceptional nutritional value and the evolution of halophytes, enabling the identification of genes involved in salinity tolerance, and providing the basis for molecular breeding in quinoa.

  4. Do mobile clinics provide high-quality antenatal care? A comparison of care delivery, knowledge outcomes and perception of quality of care between fixed and mobile clinics in central Haiti. (United States)

    Phillips, Erica; Stoltzfus, Rebecca J; Michaud, Lesly; Pierre, Gracia Lionel Fils; Vermeylen, Francoise; Pelletier, David


    Antenatal care (ANC) is an important health service for women in developing countries, with numerous proven benefits. Global coverage of ANC has steadily increased over the past 30 years, in part due to increased community-based outreach. However, commensurate improvements in health outcomes such as reductions in the prevalence of maternal anemia and infants born small-for-gestational age have not been achieved, even with increased coverage, indicating that quality of care may be inadequate. Mobile clinics are one community-based strategy used to further improve coverage of ANC, but their quality of care delivery has rarely been evaluated. To determine the quality of care of ANC in central Haiti, we compared adherence to national guidelines between fixed and mobile clinics by performing direct observations of antenatal care consultations and exit interviews with recipients of care using a multi-stage random sampling procedure. Outcome variables were eight components of care, and women's knowledge and perception of care quality. There were significant differences in the predicted proportion or probability of recommended services for four of eight care components, including intake, laboratory examinations, infection control, and supplies, iron folic acid supplements and Tetanus Toxoid vaccine provided to women. These care components were more likely performed in fixed clinics, except for distribution of supplies, iron-folic acid supplements, and Tetanus Toxoid vaccine, more likely provided in mobile clinics. There were no differences between clinic type for the proportion of total physical exam procedures performed, health and communication messages delivered, provider communication or documentation. Women's knowledge about educational topics was poor, but women perceived extremely high quality of care in both clinic models. Although adherence to guidelines differed by clinic type for half of the care components, both clinics had a low percentage of overall services

  5. Saving mothers and newborns in communities: strengthening community midwives to provide high quality essential newborn and maternal care in Baluchistan, Pakistan in a financially sustainable manner. (United States)

    Mumtaz, Zubia; Cutherell, Andrea; Bhatti, Afshan


    To address it's persistently high maternal mortality rate of 276/100,000 live births, the government of Pakistan created a new cadre of community based midwives (CMW). One expectation is that CMWs will improve access to maternal health services for underserved women. Recent research shows the CMWs have largely failed to establish midwifery practices, because CMW's lack of skills, both clinical and entrepreneurial and funds necessary to develop their practice infrastructure and logistics. Communities also lack trust in their competence to conduct safe births. To address these issues, the Saving Mothers and Newborn (SMNC) intervention will implement three key elements to support the CMWs to establish their private practices: (1) upgrade CMW clinical skills (2) provide business-skills training and small loans (3) generate demand for CMW services using cellular phone SMS technology and existing women's support groups. This 3-year project aims to investigate whether CMWs enrolled in this initiative are providing the essential maternal and newborn health care to women and children living in districts of Quetta, and Gwadar in a financially self-sustaining manner. Specifically the research will use quasi-experimental impact assessment to document whether the SMNC initiative is having an impact on CMW services uptake, financial analysis to assess if the initiative enabled CMWs to develop financially self-sustainable practices and observation methods to assess the quality of care the CMWs are providing. A key element of the SMNC initiative - the provision of business skills training and loans to establish private practices - is an innovative initiative in Pakistan and little is known about its effectiveness. This research will provide emperic evidence of the effectiveness of the intervention as well as contribute to the body of evidence around potential solutions to improve sustainable coverage of high impact Maternal, Neonatal and Child Health interventions in vulnerable

  6. Provide good air quality for people and improve their productivity

    DEFF Research Database (Denmark)

    Fanger, Povl Ole


    Three recent independent studies have documented that the quality of indoor air has a significant and positive influence on the productivity of office workers. A combined analysis of the results of the three studies shows a significant relationship between productivity and perceived indoor air...... quality. The impact on productivity justifies a much higher indoor air quality than the minimum levels prescribed in present standards and guidelines. One way of providing air of high quality for people to breathe, without involving excessive ventilation rates and energy use, is to provide "personalized...

  7. Provider communication and HPV vaccination: The impact of recommendation quality (United States)

    Gilkey, Melissa B.; Calo, William A.; Moss, Jennifer L.; Shah, Parth D.; Marciniak, Macary W.; Brewer, Noel T.


    Background Receiving a healthcare provider’s recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents. Methods In 2014, we conducted a national, online survey of 1,495 parents of 11- to 17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥1 dose), follow through (3 doses, among initiators), refusal, and delay. Results Almost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR=9.31, 95% CI, 7.10–12.22) and over three times the odds of follow through (17% vs. 44%, OR=3.82, 95% CI, 2.39–6.11). Low-quality recommendations were more modestly associated with initiation (OR=4.13, 95% CI, 2.99–5.70), but not follow through. Parents who received high-versus low-quality recommendations less often reported HPV vaccine refusal or delay. Conclusions High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents. PMID:26812078

  8. The Roots of Quality Care: Strengths of Master Providers. (United States)

    Weaver, Ruth Harding


    Reviews research on characteristics and resources of family child caregivers providing high quality care. Focuses on regulation, lifelong learning in early childhood education, psychological well-being, commitment to child care, supportive child care connections, and a solid financial foundation. Maintains that consumer education can help parents…

  9. Acute high-grade acromioclavicular joint injuries treatment: Arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF. (United States)

    Natera-Cisneros, L; Sarasquete-Reiriz, J; Escolà-Benet, A; Rodriguez-Miralles, J


    Treatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related-injuries. Arthroscopy-assisted procedures compared to open-metal hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the Quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24 months or more after their shoulder injury. A retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. Thirty-one patients were included: 20 arthroscopy-group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate-group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25-52] year-old for the ARTH group and 41 [19-55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, Pgrade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. Level IV therapeutic; retrospective comparative study

  10. Quality Perception within Corporate E-Learning Providers in Catalonia (United States)

    Sangra, Albert; Fernandez-Michels, Pedro


    Purpose: The paper seeks to describe the Catalan corporate e-learning providers from the perspective of quality perception, quality assessment and quality control. Design/methodology/approach: A literature review reveals key aspects of the definition of quality in e-learning. The results of the review constitute the basis for exploratory research…

  11. Privately Provided Accommodation Service Quality and Customer Satisfaction

    National Research Council Canada - National Science Library

    Joshua Mugambwa; George William Mugerwa; Wilson Williams Mutumba; Claire Muganzi; Bridget Namubiru; Yusuf Waswa; Isaac Newton Kayongo


    .... This research took a case study of Nsamizi Training Institute of Social Development (NTISD) to determine the relationship between privately provided accommodation service quality and customer satisfaction...

  12. Healthcare quality management in Switzerland--a survey among providers. (United States)

    Kaderli, Reto; Pfortmueller, Carmen A; Businger, Adrian P


    In the last decade assessing the quality of healthcare has become increasingly important across the world. Switzerland lacks a detailed overview of how quality management is implemented and of its effects on medical procedures and patients' concerns. This study aimed to examine the systematics of quality management in Switzerland by assessing the providers and collected parameters of current quality initiatives. In summer 2011 we contacted all of the medical societies in Switzerland, the Federal Office of Public Health, the Swiss Medical Association (FMH) and the head of Swiss medical insurance providers, to obtain detailed information on current quality initiatives. All quality initiatives featuring standardised parameter assessment were included. Of the current 45 initiatives, 19 were powered by medical societies, five by hospitals, 11 by non-medical societies, two by the government, two by insurance companies or related institutions and six by unspecified institutions. In all, 24 medical registers, five seals of quality, five circles of quality, two self-assessment tools, seven superior entities, one checklist and one combined project existed. The cost of treatment was evaluated by four initiatives. A data report was released by 24 quality initiatives. The wide variety and the large number of 45 recorded quality initiatives provides a promising basis for effective healthcare quality management in Switzerland. However, an independent national supervisory authority should be appointed to provide an effective review of all quality initiatives and their transparency and coordination.

  13. Man-Made Closed Ecological Systems as Model of Natural Ecosystems and as Means to Provide High Quality of Human Life in Adverse Environment (United States)

    Gitelson, I. I.; Harper, Lynn (Technical Monitor)


    For its more than thirty year long history, the experimental creation of closed ecological systems has from its very sources been distinctly and strongly motivated by the development of human life-support systems for space. As the trend developed its fundamental significance and broad opportunities of terrestrial applications of the technologies under development were coming to the foreground. Nowadays, it can be argued that development of closed ecosystems is experimental foundation of a new branch of ecology biospherics, the goal of which is to comprehend the regularities of existence of the biosphere as a unique in the Universe (in that part of it that we know, at least) closed ecosystem. Closed technologies can be implemented in life-support systems under adverse conditions of life on the Earth - in Arctic and Antarctic latitudes, deserts, high mountains or deep in the ocean, as well as under the conditions of polluted water and air. In space where the environment is hostile for life all around the cell of life should be sealed and the life-support system as close to the ideally closed cyclic turnover of the matter as possible. Under terrestrial conditions designers should strive for maximum closure of the limiting factor: water - in deserts, oxygen - in high mountains, energy - in polar latitudes, etc. Essential closure of a life-support systems withstands also pollution of the environment by the wastes of human vital activity. This is of particular importance for the quarantine of visited planets, and on the Earth under the conditions of deficient heat in high latitudes and water in and areas. The report describes experimental ecosystem 'BIOS' and exohabitats being designed on its basis, which are adapted to various conditions, described capacities of the Center for Closed Ecosystems in Drasnoyarsk for international collaboration in research and education in this field.

  14. Evaluation of patients ' satisfaction with quality of care provided at ...

    African Journals Online (AJOL)

    Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patientsf satisfaction with quality of care provided ...

  15. Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden. (United States)

    Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas


    Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

  16. Providing quality palliative care in end-stage Alzheimer disease. (United States)

    Yeaman, Paul A; Ford, James L; Kim, Kye Y


    Providing quality palliative care is a daunting task profoundly impacted by diminished patient capacity at the end of life. Alzheimer disease (AD) is a disorder that erases our memories and is projected to increase dramatically for decades to come. By the time the patients with AD reach the end stage of the disease, the ability of patients to provide pertinent subjective complaints of pain and discomfort would have vanished. Historical perspectives of palliative care, exploration of the AD process, ethical issues, and crucial clinical considerations are provided to improve the understanding of disease progression and quality of care for patients with end-stage AD.

  17. Privately Provided Accommodation Service Quality and Customer Satisfaction

    Directory of Open Access Journals (Sweden)

    Joshua Mugambwa


    Full Text Available Privately provided accommodation is a growing service in Uganda’s higher education sector due to education liberalization and demand for education. This research took a case study of Nsamizi Training Institute of Social Development (NTISD to determine the relationship between privately provided accommodation service quality and customer satisfaction. Specifically, the objectives of the study were (a to find out the relationship between security and NTISD students’ satisfaction with privately provided accommodation, and (b to find out the hierarchical level of importance of NTISD student satisfaction of the three service quality dimensions (reliability, security, and tangibles with privately provided accommodation. Using quantitative and qualitative modes of data analysis and a sample of 300 students from 20 private hostels, this study established a strong positive significant relationship between security and satisfaction regarding privately provided accommodation. This implies that accommodation service providers should increase the quality of security so as to increase the satisfaction of students regarding privately provided accommodation. The study established the hierarchical order of importance from the most important service quality dimension, respectively, as follows: reliability, security, and tangibles. Therefore, private accommodation service managers should pay extra attention to the dimensions in the same order.

  18. Provider diversity in the NHS: impact on quality and innovation


    Bartlett, Will; Allen, Pauline; Pérotin, Virginie; Turner, Simon; Zamora, Bernarda; Matchaya, Greenwell; Roberts, Jennifer


    The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers.\\ud The study u...

  19. Endorsing good quality assurance practices in molecular pathology: risks and recommendations for diagnostic laboratories and external quality assessment providers. (United States)

    Tembuyser, Lien; Dequeker, Elisabeth M C


    Quality assurance is an indispensable element in a molecular diagnostic laboratory. The ultimate goal is to warrant patient safety. Several risks that can compromise high quality procedures are at stake, from sample collection to the test performed by the laboratory, the reporting of test results to clinicians, and the organization of effective external quality assessment schemes. Quality assurance should therefore be safeguarded at each level and should imply a holistic multidisciplinary approach. This review aims to provide an overview of good quality assurance practices and discusses certain risks and recommendations to promote and improve quality assurance for both diagnostic laboratories and for external quality assessment providers. The number of molecular targets is continuously rising, and new technologies are evolving. As this poses challenges for clinical implementation and increases the demand for external quality assessment, the formation of an international association for improving quality assurance in molecular pathology is called for.

  20. Provider communication quality: influence of patients' weight and race. (United States)

    Wong, Michelle S; Gudzune, Kimberly A; Bleich, Sara N


    To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Agents for change: nonphysician medical providers and health care quality. (United States)

    Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S


    Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.

  2. Abortion providers, stigma and professional quality of life. (United States)

    Martin, Lisa A; Debbink, Michelle; Hassinger, Jane; Youatt, Emily; Harris, Lisa H


    The Providers Share Workshop (PSW) provides abortion providers safe space to discuss their work experiences. Our objectives were to assess changes in abortion stigma over time and explore how stigma is related to aspects of professional quality of life, including compassion satisfaction, burnout and compassion fatigue for providers participating in the workshops. Seventy-nine providers were recruited to the PSW study. Surveys were completed prior to, immediately following and 1 year after the workshops. The outcome measures were the Abortion Provider Stigma Survey and the Professional Quality of Life (ProQOL) survey. Baseline ProQOL scores were compared to published averages using t tests. Changes in abortion stigma and aspects of professional quality of life were assessed by fitting a two-level random-effects model with repeated measures at level 1 (period-level) and static measures (e.g., demographic data) at level 2 (person-level). Potential covariates included age, parenting status, education, organizational tenure, job type and clinic type (stand-alone vs. hospital-based clinics). Compared to other healthcare workers, abortion providers reported higher compassion satisfaction (t=2.65, p=.009) and lower burnout (t=5.13, pabortion stigma as a significant predictor of lower compassion satisfaction, higher burnout and higher compassion fatigue. Participants in PSW reported a reduction in abortion stigma over time. Further, stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue, suggesting that interventions aimed at supporting the abortion providing workforce should likely assess abortion stigma. Stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue among abortion care providers. Therefore, strengthening human resources for abortion care requires stigma reduction efforts. Participants in the PSWs show reductions in stigma over time. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Quality of reproductive healthcare for adolescents: A nationally representative survey of providers in Mexico.

    Directory of Open Access Journals (Sweden)

    Aremis Villalobos

    Full Text Available Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world's adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents.This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015.At the national level 13.9% (95%CI: 6.9-26.0 of healthcare units provide low quality, 68.6% (95%CI: 58.4-77.3 medium quality and 17.5% (95%CI: 11.9-25.0 high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best.The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care.

  4. Should bus commuting be subsidized for providing quality transport ...

    Indian Academy of Sciences (India)

    e-mail: Abstract. Urban transport has ... (ii) Should bus prices be subsidized in order to provide a quality public transport system? (iii) How large is the modal shift in favour ..... been derived through a speed-flow relationship function, with a car free flow speed of 45 km/h, peak traffic speed of 24 km/h and ...

  5. Metabolomics Provides Quality Characterization of Commercial Gochujang (Fermented Pepper Paste

    Directory of Open Access Journals (Sweden)

    Gyu Min Lee


    Full Text Available To identify the major factors contributing to the quality of commercial gochujang (fermented red pepper paste, metabolites were profiled by mass spectrometry. In principal component analysis, cereal type (wheat, brown rice, and white rice and species of hot pepper (Capsicum annuum, C. annuum cv. Chung-yang, and C. frutescens affected clustering patterns. Relative amino acid and citric acid levels were significantly higher in wheat gochujang than in rice gochujang. Sucrose, linoleic acid, oleic acid, and lysophospholipid levels were high in brown-rice gochujang, whereas glucose, maltose, and γ-aminobutyric acid levels were high in white-rice gochujang. The relative capsaicinoid and luteolin derivative contents in gochujang were affected by the hot pepper species used. Gochujang containing C. annuum cv. Chung-yang and C. frutescens showed high capsaicinoid levels. The luteolin derivative level was high in gochujang containing C. frutescens. These metabolite variations in commercial gochujang may be related to different physicochemical phenotypes and antioxidant activity.

  6. High-quality Indonesian condoms. (United States)


    A Japanese technical team visiting the condom plant at Banjaran, Indonesia, as part of the Japanese Overseas Economic Cooperation Fund project which funded the plant, found locally produced condoms of superior quality. The marketing expert on the team predicted that family planning services provided by private practitioners and paid for by clients will account for over 50% of family planning acceptors in Indonesia by 2000. Now only 10% receive private services. Condoms are in use by 3.9% of acceptors nationwide, although as many as 15% use condoms in the capitol city. Indonesians need to be informed of the high quality of domestic condoms; marketing them for a fee will encourage this view. It is expected that in Indonesia, 2 social movements will encourage family planning, the "Posyandu" an integrated family planning and health scheme established in villages by the National Family Planning Coordinating Board, and "Arisan," a traditional system for mutual help by which villagers pool food and money to provide medicines.

  7. Quality of Services and Quality of Life from Service Providers' Perspectives: Analysis with Focus Groups (United States)

    Jenaro, C.; Vega, V.; Flores, N.; Cruz, M.


    Background: Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this…

  8. Recent history provides sustainable African water quality project insight. (United States)

    Holm, Rochelle H


    Small-scale projects to provide clean drinking water undertaken in the developing world can contribute to significantly improving the livelihood of rural communities. There has been a historical tendency to poorly plan such projects leading to an unsustainable future. Recent history indicates three simple steps to ensuring successful and enduring clean water projects. First, identification of need by the indigenous community provides ownership in the project. Second, a partnership between key individuals in the indigenous community with the donor provides for ambassadors on both sides of the project. Finally, an exit strategy by the donors for the indigenous communities ensures local sustainability for the future. The study site is the village of Geisha in northern Malawi, Africa. Sustainable implementation approaches are discussed in this case study as well as the various lessons learned. Improved project processes ensure sustainable small-scale water quality projects by donor organizations in developing countries. © 2011, The Author(s). Ground Water © 2011, National Ground Water Association.

  9. Cultural competency: providing quality care to diverse populations. (United States)

    Betancourt, Joseph R


    The goal of this paper is to define cultural competence and present a practical framework to address crosscultural challenges that emerge in the clinical encounter, with a particular focus on the issue of nonadherence. English-language literature, both primary and reports from various agencies, and the author's personal experiences in clinical practice. Relevant literature on patient-centered care and cultural competence. There is a growing literature that delineates the impact of sociocultural factors, race, ethnicity, and limited-English proficiency on health and clinical care. The field of cultural competence focuses on addressing these issues. Health care providers need a practical set of tools and skills that will enable them to provide quality care to patients during a brief encounter, whatever differences in background that may exist. Cultural competence has evolved from the gathering of information and making of assumptions about patients on the basis of their sociocultural background to the development of skills to implement the principles of patient-centered care. This patient-based approach to cross-cultural care consists of first, assessing core cross-cultural issues; second, exploring the meaning of the illness to the patient; third, determining the social context in which the patient lives; and fourth, engaging in negotiation with the patient to encourage adherence. Addressing adherence is a particularly challenging issue, the determinants of which are multifactorial, and the ESFT (explanatory/social/fears/treatment) model--derived from the patient-based approach--is a tool that identifies barriers to adherence and provides strategies to address them. It obviously is impossible to learn everything about every culture and that should not be expected. Instead, we should learn about the communities we care for. More important, we should have a framework that allows us to provide appropriate care for any patient--one that deals with issues of adherence

  10. Impact of quality assurance program: providing practice assessment. (United States)

    Saporito, R A; Feldman, C A; Stewart, D C; Echoldt, H; Buchanan, R N


    Participation in a self-administered quality assessment (SAQA) program led to changes in New Jersey dentists' perceptions of practice quality. Ninety-four percent indicated they discovered practice deficiencies. This study suggests that using a self-administered quality assessment program, such as the SAQA program, can lead to a better understanding of a practice's strengths and weaknesses.

  11. Measuring parental satisfaction of care quality provided in hospitalized children

    Directory of Open Access Journals (Sweden)

    Spyridoula Tsironi


    Full Text Available Introduction: Measuring parental satisfaction is of major importance for pediatric hospitals and the key component of evaluating the quality of services provided to health services. Aim: To assess the degree of parental satisfaction from the care provided to their hospitalized children.Methodology: A descriptive study conducted using a convenience sample of parents of hospitalized children in two public pediatric hospitals in Athens. Data collection was completed in a period of 3 months. 352 questionnaires were collected (response rate 88%. The Pyramid Questionnaire for parents of hospitalized children was used which estimates the degree of parental satisfaction from the care provided to their hospitalized child.Results: More parents were satisfied with health care professionals’ behavior (81,9%, the supplied care (78,2% and the information provision to parents regarding the hospitalized child’s disease (71,9%. In contrast, less parents were satisfied with their hospitalized child’s involvement in care (52,3% and the accessibility to the hospital (39,5%. The overall parental satisfaction ranged in very good level (76,8% and it was higher on hospital A (78,8%, among married parents (77,4% and those not al all concerned or concerned less for child’s illness (83,1%. Logistic regression model showed that hospitalization in hospital B and the great concern for child’s illness and its complications decreased ovewrall satisfaction by 24% and 17% respectively. Conclusions: The assessment of the degree of parental satisfaction is the most important indicator of hospitals’ proper functioning. From our study certain areas need improvement, such as: the parental involvement in child’s care, information provision, the accessibility to the hospital, the communication and the interpersonal health care in order greater satisfaction to be achieved.

  12. Quality in Family Child Care Networks: An Evaluation of All Our Kin Provider Quality (United States)

    Porter, Toni; Reiman, Kayla; Nelson, Christina; Sager, Jessica; Wagner, Janna


    This article presents findings from a quasi-experimental evaluation of quality with a sample of 28 family child care providers in the All Our Kin Family Child Care Network, a staffed family child care network which offers a range of services including relationship-based intensive consultation, and 20 family child care providers who had no…

  13. Adopting Quality Criteria for Websites Providing Medical Information About Rare Diseases. (United States)

    Pauer, Frédéric; Göbel, Jens; Storf, Holger; Litzkendorf, Svenja; Babac, Ana; Frank, Martin; Lührs, Verena; Schauer, Franziska; Schmidtke, Jörg; Biehl, Lisa; Wagner, Thomas Of; Ückert, Frank; Graf von der Schulenburg, Johann-Matthias; Hartz, Tobias


    The European Union considers diseases to be rare when they affect less than 5 in 10,000 people. It is estimated that there are between 5000 and 8000 different rare diseases. Consistent with this diversity, the quality of information available on the Web varies considerably. Thus, quality criteria for websites about rare diseases are needed. The objective of this study was to generate a catalog of quality criteria suitable for rare diseases. First, relevant certificates and quality recommendations for health information websites were identified through a comprehensive Web search. Second, all considered quality criteria of each certification program and catalog were examined, extracted into an overview table, and analyzed by thematic content. Finally, an interdisciplinary expert group verified the relevant quality criteria. We identified 9 quality certificates and criteria catalogs for health information websites with 304 single criteria items. Through this, we aggregated 163 various quality criteria, each assigned to one of the following categories: thematic, technical, service, content, and legal. Finally, a consensus about 13 quality criteria for websites offering medical information on rare diseases was determined. Of these categories, 4 (data protection concept, imprint, creation and updating date, and possibility to contact the website provider) were identified as being the most important for publishing medical information about rare diseases. The large number of different quality criteria appearing within a relatively small number of criteria catalogs shows that the opinion of what is important in the quality of health information differs. In addition, to define useful quality criteria for websites about rare diseases, which are an essential source of information for many patients, a trade-off is necessary between the high standard of quality criteria for health information websites in general and the limited provision of information about some rare diseases

  14. The Quality of Care Provided to Patients with Chronic Non ...

    African Journals Online (AJOL)

    BACKGROUND: Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in ...


    Directory of Open Access Journals (Sweden)

    Hasan SERİN, Alper AYTEKİN


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

  16. Tadpole begging reveals high quality. (United States)

    Dugas, M B; Strickler, S A; Stynoski, J L


    Parents can benefit from allocating limited resources nonrandomly among offspring, and offspring solicitation (i.e. begging) is often hypothesized to evolve because it contains information valuable to choosy parents. We tested the predictions of three 'honest begging' hypotheses - Signal of Need, Signal of Quality and Signal of Hunger - in the tadpoles of a terrestrial frog (Oophaga pumilio). In this frog, mothers provision tadpoles with trophic eggs, and when mothers visit, tadpoles perform a putative begging signal by stiffening their bodies and vibrating rapidly. We assessed the information content of intense tadpole begging with an experimental manipulation of tadpole condition (need/quality) and food deprivation (hunger). This experiment revealed patterns consistent with the Signal of Quality hypothesis and directly counter to predictions of Signal of Need and Signal of Hunger. Begging effort and performance were higher in more developed and higher condition tadpoles and declined with food deprivation. Free-living mothers were unlikely to feed tadpoles of a nonbegging species experimentally cross-fostered with their own, and allocated larger meals to more developed tadpoles and those that vibrated at higher speed. Mother O. pumilio favour their high-quality young, and because their concurrent offspring are reared in separate nurseries, must do so by making active allocation decisions. Our results suggest that these maternal choices are based at least in part on offspring signals, indicating that offspring solicitation can evolve to signal high quality. © 2017 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2017 European Society For Evolutionary Biology.

  17. Quality of language intervention provided to primary-grade students with language impairment. (United States)

    Biancone, Tricia L; Farquharson, Kelly; Justice, Laura M; Schmitt, Mary Beth; Logan, Jessica A R


    This study had two aims: (a) to describe the quality of language intervention provided by school-based speech-language pathologists (SLPs) to children with language impairment in the primary grades with respect to the quality of emotional support, instructional support, and proactive management during SLP-child interactions, and (b) to determine if key characteristics of the SLPs are predictors of variance in intervention quality. Participants were 174 children nested within 40 SLPs' caseloads from various districts in two Midwestern states involved in a larger study of speech-language therapy practices in the public schools. A total of 208 videotaped language intervention sessions were coded for emotional support, instructional support, and proactive management using the Classroom Assessment Scoring System (CLASS; Pianta, La Paro, & Hamre, 2008). The quality of language intervention varied widely and was generally mid-range to high with respect to emotional support and proactive management, and low to mid-range in terms of instructional support. The quality of interactions varied and a large percentage of the observed variance in quality was attributed to SLPs. Time pressure was a strong predictor of the quality of emotional support, instructional support, and proactive management, and job satisfaction was a significant predictor of instructional support and proactive management. This descriptive information about school-based language intervention highlights the impact of the individual SLP in terms of the quality of the interactions taking place and the potential need to ease job pressures and promote job satisfaction. Readers will be able to: (1) identify and define three aspects of SLP-child interaction quality during intervention as framed in this study using the CLASS observation tool (Pianta, La Paro, et al., 2008); (2) discuss the relevance of those three aspects of quality to children with LI; and (3) identify SLP-level factors that significantly predict

  18. Qualities of care managers in chronic disease management: patients and providers' expectations. (United States)

    Dejesus, Ramona S; Vickers, Kristin S; Howell, Lisa A; Stroebel, Robert J


    The collaborative care model has been shown in studies to be effective in achieving sustained treatment outcomes in chronic disease management. Its success is highly dependent on active patient engagement, provider endorsement and effective care management. This study sought to ask patients and providers what qualities they look for in a care manager. A questionnaire with 3 open ended questions was mailed out randomly to 1000 patients residing in Olmsted County, MN identified through the registry to have type 2 diabetes mellitus. Forty-two primary care providers received similar questionnaire with 2 open ended questions. Answers were qualitatively analyzed using coding and identification of major themes. One hundred seventy-five patients and 22 providers responded. Both groups listed being knowledgeable, having good communication skills and certain personality traits as common themes on what are desirable qualities in a care manager. Patients felt that a care manager would be most helpful by being accessible. Providers listed undesirable qualities to include not being a team player and not knowing practice limitations. Both patients and providers have clear expectations of a care manager which carry significant implications in recruiting and training care managers for chronic disease management. Copyright © 2012 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  19. Customized power quality service provided by converter interfaced microgrids — Voltage harmonics as a study case

    DEFF Research Database (Denmark)

    Meng, Lexuan; Chaudhary, Sanjay K.; Guerrero, Josep M.


    Customers may have different power quality requirements, thus, the economic operational strategy can try to provide them with distinctive quality levels as customized service. An optimization based method is proposed in this paper to realize this functionality, offering the possibility...

  20. Providing Behavioral Feedback to Students in an Alternative High School Setting (United States)

    Whitcomb, Sara A.; Hefter, Sheera; Barker, Elizabeth


    This column provides an example method for improving the consistency and quality of daily behavioral feedback provided to students in an alternative high school setting. Often, homeroom or advisory periods are prime points in the day for students to review their behavior from the previous day and set goals for a successful day to come. The method…

  1. 'Quality signposting': the role of online information prescription in providing patient information. (United States)

    Brewster, Liz; Sen, Barbara


      Information prescriptions (IPs) are part of a Department of Health (DH) initiative to improve patient care. IPs aim to meet health information needs by providing personalised, high quality patient information about conditions and treatment.   This paper identifies current online IP provision and evaluates a sample of IP websites against the original DH aims of IP provision; British Medical Association usability criteria; and information seeking vignettes.   Five UK and one international IP website were randomly selected as a sample. Two checklists designed to appraise the websites were used to review each IP provider. Two patient information seeking vignettes were developed to enable the websites to be assessed from a patient-centred perspective.   Information prescriptions currently vary in content, accessibility and quality. National IP websites score more highly than local IP websites, which are often weak on content for specific conditions and poorly designed but strong on signposting to local services.   Guidelines for IP provision need to be improved to ensure higher quality, more easily accessible information is available. A synthesis of expertise included in national and local websites would improve usability for patients. IP websites should conform to standards of web design and accessibility. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

  2. Developing Indicators of Service Quality Provided for Cardiovascular Patients Hospitalized in Cardiac Care Unit

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash


    Full Text Available Introduction: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU in Iran. Methods: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. Results: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts’ panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. Conclusion: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.

  3. Provider perspectives on barriers to family planning quality in Uganda: a qualitative study. (United States)

    Mugisha, John Frank; Reynolds, Heidi


    Provider perspectives on the quality of family planning services have been overlooked in quality of care research and interventions. This qualitative study was carried out in four districts in Uganda, a country where lack of access to quality family planning services remains a challenge. Using four focus group discussions, 16 provider in-depth interviews and nine manager in-depth interviews, this study documented providers' perceptions of quality of care and of barriers to quality services at the organisational and societal levels. To guide study development, analysis and interpretation, the authors relied on an ecological framework where providers' abilities are shaped by the larger organisational and societal environments in which providers live and work. Providers felt that organisational factors, such as supply availability, workload and their own knowledge and skills, affected their abilities to offer quality care. At the same time, providers were challenged by societal factors such as male partner participation, financial constraints, misconceptions and leadership support. While making changes to the elements of quality care that clients experience is important, it is not sufficient in view of the organisational and social barriers. Across the different levels of the ecological framework, providers face barriers to providing quality family planning services that are synergistic. Solutions to improve quality of care must address also limitations at the organisational and societal levels since efforts to overcome a particular constraint are less likely to be successful if this interdependence is not taken into account.

  4. Information provided for ecological quality management of production on microeconomic level under conditions of sustainable development

    Directory of Open Access Journals (Sweden)

    Zamula I.V.


    Full Text Available Nowadays, economic development is characterized by increasing of contradictions between ecological and economic systems. As a result, the necessity of unity achievement is growing in the existence of ecological and economic values as one of the main conditions of the concept of sustainable development. For this purpose it is important to implement and create an ecological and economic management system at the enterprise to ensure ecological and economic efficiency. There is a need to improve accounting as a system of measuring economic phenomena and processes for a high level of ecological and economic management. The research is aimed at the development of theoretical and methodological approaches to accounting management for ecological quality of products based on the definition of the essence of the concept as an object of management under conditions of sustainable development, identification and systematization of factors of increasing the ecological quality of products and their management features, accounting identification of costs for ecological quality of products. According to the results of the research, it is established that the ecological quality of products is a combination of properties, which ensure excellent performance of assigned functions and the presence in products of those properties and characteristics that promote the maximum satisfaction of consumer needs and inquiries. The existing order of organization of accounting in Ukraine does not provide the provision of necessary information for the management of the ecological quality of products. The proposed directions of development of elements of the expense accounting method for the ecological quality of products will promote the expansion of information support for the adoption of substantiated and effective management decisions regarding the activities of business entities in accordance with the provisions of the concept of sustainable development.

  5. Provider-Payer Partnerships as an Engine for Continuous Quality Improvement. (United States)

    Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay


    The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

  6. Primary Care Provider Perceptions of Colorectal Cancer Screening Barriers: Implications for Designing Quality Improvement Interventions

    Directory of Open Access Journals (Sweden)

    Jennifer M. Weiss


    Full Text Available Aims. Colorectal cancer (CRC screening is underutilized. Increasing CRC screening rates requires interventions targeting multiple barriers at each level of the healthcare organization (patient, provider, and system. We examined groups of primary care providers (PCPs based on perceptions of screening barriers and the relationship to CRC screening rates to inform approaches for conducting barrier assessments prior to designing and implementing quality improvement interventions. Methods. We conducted a retrospective cohort study linking EHR and survey data. PCPs with complete survey responses for questions addressing CRC screening barriers were included (N=166 PCPs; 39,430 patients eligible for CRC screening. Cluster analysis identified groups of PCPs. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for predictors of membership in one of the PCP groups. Results. We found two distinct groups: (1 PCPs identifying multiple barriers to CRC screening at patient, provider, and system levels (N=75 and (2 PCPs identifying no major barriers to screening (N=91. PCPs in the top half of CRC screening performance were more likely to identify multiple barriers than the bottom performers (OR, 4.14; 95% CI, 2.43–7.08. Conclusions. High-performing PCPs can more effectively identify CRC screening barriers. Targeting high-performers when conducting a barrier assessment is a novel approach to assist in designing quality improvement interventions for CRC screening.

  7. Availability of high quality weather data measurements

    DEFF Research Database (Denmark)

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

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

  8. Providing Internet Access to High-Resolution Mars Images (United States)

    Plesea, Lucian


    The OnMars server is a computer program that provides Internet access to high-resolution Mars images, maps, and elevation data, all suitable for use in geographical information system (GIS) software for generating images, maps, and computational models of Mars. The OnMars server is an implementation of the Open Geospatial Consortium (OGC) Web Map Service (WMS) server. Unlike other Mars Internet map servers that provide Martian data using an Earth coordinate system, the OnMars WMS server supports encoding of data in Mars-specific coordinate systems. The OnMars server offers access to most of the available high-resolution Martian image and elevation data, including an 8-meter-per-pixel uncontrolled mosaic of most of the Mars Global Surveyor (MGS) Mars Observer Camera Narrow Angle (MOCNA) image collection, which is not available elsewhere. This server can generate image and map files in the tagged image file format (TIFF), Joint Photographic Experts Group (JPEG), 8- or 16-bit Portable Network Graphics (PNG), or Keyhole Markup Language (KML) format. Image control is provided by use of the OGC Style Layer Descriptor (SLD) protocol. The OnMars server also implements tiled WMS protocol and super-overlay KML for high-performance client application programs.

  9. Providing Internet Access to High-Resolution Lunar Images (United States)

    Plesea, Lucian


    The OnMoon server is a computer program that provides Internet access to high-resolution Lunar images, maps, and elevation data, all suitable for use in geographical information system (GIS) software for generating images, maps, and computational models of the Moon. The OnMoon server implements the Open Geospatial Consortium (OGC) Web Map Service (WMS) server protocol and supports Moon-specific extensions. Unlike other Internet map servers that provide Lunar data using an Earth coordinate system, the OnMoon server supports encoding of data in Moon-specific coordinate systems. The OnMoon server offers access to most of the available high-resolution Lunar image and elevation data. This server can generate image and map files in the tagged image file format (TIFF) or the Joint Photographic Experts Group (JPEG), 8- or 16-bit Portable Network Graphics (PNG), or Keyhole Markup Language (KML) format. Image control is provided by use of the OGC Style Layer Descriptor (SLD) protocol. Full-precision spectral arithmetic processing is also available, by use of a custom SLD extension. This server can dynamically add shaded relief based on the Lunar elevation to any image layer. This server also implements tiled WMS protocol and super-overlay KML for high-performance client application programs.

  10. Fast High-Quality Noise

    DEFF Research Database (Denmark)

    Frisvad, Jeppe Revall; Wyvill, Geoff


    At the moment the noise functions available in a graphics programmer's toolbox are either slow to compute or they involve grid-line artifacts making them of lower quality. In this paper we present a real-time noise computation with no grid-line artifacts or other regularity problems. In other wor...

  11. Glaucoma patient-provider communication about vision quality-of-life. (United States)

    Sleath, Betsy; Sayner, Robyn; Vitko, Michelle; Carpenter, Delesha M; Blalock, Susan J; Muir, Kelly W; Giangiacomo, Annette L; Hartnett, Mary Elizabeth; Robin, Alan L


    The purpose of this study was to: (a) describe the extent to which ophthalmologists and glaucoma patients discuss vision quality-of-life during office visits, and (b) examine the association between patient and ophthalmologist characteristics and provider-patient communication about vision quality-of-life. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits were video-tape recorded and quality-of-life communication variables were coded. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Specific glaucoma quality-of-life domains were discussed during only 13% of visits. Older patients were significantly more likely to discuss one or more vision quality-of-life domains than younger patients. African American patients were significantly less likely to make statements about their vision quality-of-life and providers were less likely to ask them one or more vision quality-of-life questions than non-African American patients. Eye care providers and patients infrequently discussed the patient's vision quality-of-life during glaucoma visits. African American patients were less likely to communicate about vision quality-of-life than non-African American patients. Eye care providers should make sure to discuss vision quality-of-life with glaucoma patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Method for providing a low density high strength polyurethane foam (United States)

    Whinnery, Jr., Leroy L.; Goods, Steven H.; Skala, Dawn M.; Henderson, Craig C.; Keifer, Patrick N.


    Disclosed is a method for making a polyurethane closed-cell foam material exhibiting a bulk density below 4 lbs/ft.sup.3 and high strength. The present embodiment uses the reaction product of a modified MDI and a sucrose/glycerine based polyether polyol resin wherein a small measured quantity of the polyol resin is "pre-reacted" with a larger quantity of the isocyanate in a defined ratio such that when the necessary remaining quantity of the polyol resin is added to the "pre-reacted" resin together with a tertiary amine catalyst and water as a blowing agent, the polymerization proceeds slowly enough to provide a stable foam body.

  13. Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda.

    Directory of Open Access Journals (Sweden)

    Agnes Nanyonjo

    Full Text Available OBJECTIVE: To compare caretakers' perceived quality of care (PQC for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs and primary health facility workers (PHFWs. METHODS: Caretaker rated PQC for children aged (2-59 months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419 and clinic (399 records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR for PQC-service provider association were modeled in a "modified" Poisson regression model. RESULTS: Mean (SD overall PQC was significantly higher for CHWs 0.58 (0 .66 compared to PHFWs -0.58 (0.94, p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8. In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity. CONCLUSION: PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.

  14. [Quality of service provided to heart surgery patients of the Unified Health System-SUS]. (United States)

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


    To evaluate the service quality provided to heart surgery patients during their hospital stay, identifying the patient's expectations and perceptions. To associate service quality with: gender, age and the use of extracorporeal circulation. We studied 82 elective heart surgery patients (52.4% females and 47.6% males), operated by midsternal thoracotomy, age: 31 to 83 years (60.4 +/- 13.2 years); period: March to September 2006. Service quality was evaluated in two instances: the expectations at pre-operative and the perceptions of the service received on the 6th post-operative; through the application of the modified SERVQUAL scale (SERVQUAL-Card). The result was obtained by the difference of the sum of the scores on perception minus those of the expectations, and through statistical analysis. The SERVQUAL-Card scale was statistically validated, showing adequate level of internal consistency. We found a higher frequency of myocardial revascularization 55 (67.0%); first heart surgery 72 (87.8%) and the use of ECC 69 (84.1%). We noticed high mean values for expectations and perceptions with significant results (PSERVQUAL scale.

  15. Professional quality of life of Japanese nurses/midwives providing abortion/childbirth care. (United States)

    Mizuno, Maki; Kinefuchi, Emiko; Kimura, Rumiko; Tsuda, Akiko


    This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. Between October 2011 and January 2012, questionnaires that included questions concerning eight stress factors, the Professional Quality of Life Scale, and the Japanese version of the Frankfurt Emotional Work Scale, were answered by 255 nurses and midwives working in abortion and childbirth services. Professional Quality of Life scores (compassion fatigue, compassion satisfaction, burnout) were significantly associated with stress factors and emotion work. Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors "thinking that the aborted fetus deserved to live" and "difficulty in controlling emotions during abortion care" were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives.

  16. Provider category and quality of care in the Norwegian nursing home industry

    Directory of Open Access Journals (Sweden)

    Astri Drange Hole


    Full Text Available This paper examines empirically if there is a link between quality of care in the Norwegian nursing home industry and exposure of the industry to competition. Exposing public care to competition implies that the responsibility for providing care services is shared between public authorities and private actors. In Norway, exposure to competition means tender competition. Suppliers bid for a contract issued by the Norwegian authorities for a limited number of years. Quality of care in an institution is the major competitive factor. The provider categories of elderly care are: 1 care provided by institutions run by municipalities, 2 care provided by institutions run by private companies, which have won a tender competition, 3 care provided by institutions run by private companies owned by private families, voluntary religious or idealistic organizations. Nurse-to-patient ratio is used as a proxy for quality of care. The regression analysis indicates a relationship between quality of care and exposure to competition. The quality of care in provider category 2 is significantly lower than in provider category 1, but there are more variations in the quality of care in provider category 1 than in provider category 2. We find the lowest quality of care in provider category 1. There is also a relationship between the quality of care in an institution and the educational level of the staff, the location, the workforce, and the size of an institution. Finally, there is a relationship between the quality of care in an institution and the real and the required capacity, and the financial status in a region.

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  19. Large performance incentives had the greatest impact on providers whose quality metrics were lowest at baseline. (United States)

    Greene, Jessica; Hibbard, Judith H; Overton, Valerie


    This study examined the impact of Fairview Health Services' primary care provider compensation model, in which 40 percent of compensation was based on clinic-level quality outcomes. Fairview Health Services is a Pioneer accountable care organization in Minnesota. Using publicly reported performance data from 2010 and 2012, we found that Fairview's improvement in quality metrics was not greater than the improvement in other comparable Minnesota medical groups. An analysis of Fairview's administrative data found that the largest predictor of improvement over the first two years of the compensation model was primary care providers' baseline quality performance. Providers whose baseline performance was in the lowest tertile improved three times more, on average, across the three quality metrics studied than those in the middle tertile, and almost six times more than those in the top tertile. As a result, there was a narrowing of variation in performance across all primary care providers at Fairview and a narrowing of the gap in quality between providers who treated the highest-income patient panels and those who treated the lowest-income panels. The large quality incentive fell short of its overall quality improvement aim. However, the results suggest that payment reform may help narrow variation in primary care provider performance, which can translate into narrowing socioeconomic disparities. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Monolayer-crystal streptavidin support films provide an internal standard of cryo-EM image quality

    Energy Technology Data Exchange (ETDEWEB)

    Han, Bong-Gyoon [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Watson, Zoe [Univ. of California, Berkeley, CA (United States); Cate, Jamie H. D. [Univ. of California, Berkeley, CA (United States); Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Glaeser, Robert M. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)


    Analysis of images of biotinylated Escherichia coli 70S ribosome particles, bound to streptavidin affinity grids, demonstrates that the image-quality of particles can be predicted by the image-quality of the monolayer crystalline support film. Also, the quality of the Thon rings is a good predictor of the image-quality of particles, but only when images of the streptavidin crystals extend to relatively high resolution. When the estimated resolution of streptavidin was 5 Å or worse, for example, the ribosomal density map obtained from 22,697 particles went to only 9.5 Å, while the resolution of the map reached 4.0 Å for the same number of particles, when the estimated resolution of streptavidin crystal was 4 Å or better. It thus is easy to tell which images in a data set ought to be retained for further work, based on the highest resolution seen for Bragg peaks in the computed Fourier transforms of the streptavidin component. The refined density map obtained from 57,826 particles obtained in this way extended to 3.6 Å, a marked improvement over the value of 3.9 Å obtained previously from a subset of 52,433 particles obtained from the same initial data set of 101,213 particles after 3-D classification. These results are consistent with the hypothesis that interaction with the air-water interface can damage particles when the sample becomes too thin. Finally, streptavidin monolayer crystals appear to provide a good indication of when that is the case.

  1. The Association of Perceived Provider-Patient Communication and Relationship Quality with Colorectal Cancer Screening (United States)

    Underhill, Meghan L.; Kiviniemi, Marc T.


    Background: Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patient communication and characteristics of the patient-provider relationship may relate to screening behavior. Methods: The association of provider communication quality, relationship, and colorectal cancer screening…

  2. Effectiveness of UK provider financial incentives on quality of care: a systematic review. (United States)

    Mandavia, Rishi; Mehta, Nishchay; Schilder, Anne; Mossialos, Elias


    Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK. © British Journal of General Practice 2017.

  3. Method for synthesis of high quality graphene (United States)

    Lanzara, Alessandra [Piedmont, CA; Schmid, Andreas K [Berkeley, CA; Yu, Xiaozhu [Berkeley, CA; Hwang, Choonkyu [Albany, CA; Kohl, Annemarie [Beneditkbeuern, DE; Jozwiak, Chris M [Oakland, CA


    A method is described herein for the providing of high quality graphene layers on silicon carbide wafers in a thermal process. With two wafers facing each other in close proximity, in a first vacuum heating stage, while maintained at a vacuum of around 10.sup.-6 Torr, the wafer temperature is raised to about C., whereby silicon evaporates from the wafer leaving a carbon rich surface, the evaporated silicon trapped in the gap between the wafers, such that the higher vapor pressure of silicon above each of the wafers suppresses further silicon evaporation. As the temperature of the wafers is raised to about C. or more, the carbon atoms self assemble themselves into graphene.

  4. Key Factors of Quality in the Sector of Tourism Services Providers: Case Study: Czech Republic

    Directory of Open Access Journals (Sweden)

    Ida Vajčnerová


    Full Text Available The paper summarizes main results of partial research aimed at detection of the key factors affecting quality in the sector of tourism services providers, namely tour operators and travel agencies. A primary questionnaire survey was conducted; the researched factors were distributed in the context of service quality dimensions (Grönroos model; the dimensions were tested in relation to sex, age and education of the respondents (ANOVA; Brown-Forsythe test. Assurance was identified as the most important dimension. The output of the study is determining the significance of individual quality factors from the perspective of a potential customer when selecting a service provider.

  5. Quality of assistance provided to children with sickle cell disease by primary healthcare services

    Directory of Open Access Journals (Sweden)

    Ludmila Mourão Xavier Gomes


    Full Text Available OBJECTIVE: To evaluate the quality of healthcare provided to sickle cell disease children by primary healthcare services in a region of high prevalence. METHODS: A cross-sectional, descriptive study was performed by interviewing members of families with sickle cell disease children. The children had been identified from the Neonatal Screening Program in Minas Gerais state over the last 12 years in towns of the Montes Claros-Bocaiuva microregion. A structured questionnaire specially developed for this study and based on three axes was used: indicators of the child's health (immunization, growth and development, prophylaxis antibiotic therapy, perception of care by the family (health education and accessibility and knowledge of the family about the disease. RESULTS: Sixty-three of 71 families with children identified as having sickle cell disease were interviewed. The predominant genotypes were Hb SS (44.4% and Hb SC (41.2%. Adequate monitoring of growth and development was recorded for the first year of life in 23 children (36.6% and for the second year of life in 18 children (28.6%. The basic vaccination schedule was completed by 44 children (69.8% but 62 vaccination record cards (98.4% identified delays of special vaccines. Regular use of prophylactic penicillin was reported by 55 caregivers (87.3%. The family's perception of the care provided suggests poor accessibility to health services and lack of opportunities to answer doubts. The average performance of families in knowledge testing was 59.8%. CONCLUSION: The quality of healthcare is unsatisfactory. The care provided to children with sickle cell disease in primary healthcare services needs improvements.

  6. Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study). (United States)

    Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise


    To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design

  7. Perceived quality in a dementia unit: patients' caregivers as information providers. (United States)

    López-Picazo, J J; de Dios Cánovas-García, J; Antúnez, C; Marín, J; Antequera, M M; Vivancos, L; Martínez, B; Legaz, A; Navarro, D; Leal, M


    Dementia units (DU) provide comprehensive and specialised care to patients with dementia. However, assessment in these units normally focuses on patient management. The aim of this study was to determine satisfaction of the caregivers of patients managed in a DU and how they rated DU care. We created a self-administered questionnaire which was completed by 236 caregivers visiting the DU in 2015. The questionnaire included 6 dimensions (accessibility, organisation, professionalism, relationship with staff, information, and facilities); data were analysed using problem rates. A total of 53.4% caregivers completed the questionnaire; most were women, patients' spouses, or first-degree relatives. The overall problem rates was 15.0% (95% CI, 13.9-16.1), with sizeable differences between dimensions: from 0.1% (95% CI, 0.0-0.4) for 'relationship with staff' and 'professionalism' to 49.3% (95% CI, 45.4-53.2) for 'information'. Waiting times over 30minutes were perceived as excessive. Information problems were not directly related to patient management. Satisfaction was scored 8.29/10 (median 8; SD 1.45); 77.3% (95% CI, 69.8-74.8) of respondents were highly satisfied. Ninety-nine percent of the caregivers stated that they would recommend the DU. This questionnaire provides interesting data on care quality as perceived by patients' caregivers. Our results have allowed us to identify problems and implement corrective actions. Our questionnaire has proved to be a useful tool for evaluating and improving care quality in DUs. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. How Do District Management and Implementation Strategies Relate to the Quality of the Professional Development That Districts Provide to Teachers? (United States)

    Desimone, Laura; Porter, Andrew C.; Birman, Beatrice F.; Garet, Michael S.; Yoon, Kwang Suk


    Examined policy mechanisms and processes that districts used to provide high quality inservice professional development to teachers. Data from a national probability sample of professional development coordinators in districts that received federal funding for professional development highlighted specific management and implementation strategies…

  9. Satisfaction of osteoarthritis patients with provided care is not related to the disease-specific quality of life.

    NARCIS (Netherlands)

    Rosemann, T.J.; Wensing, M.J.P.; Szecsenyi, J.; Grol, R.P.T.M.


    BACKGROUND: Osteoarthritis (OA) has a high prevalence in primary care. Patient satisfaction is an important indicator for the quality of care provided to OA patients. Little is known about satisfaction of patients with this condition in a primary care setting in Germany. The aim of the study was to


    Directory of Open Access Journals (Sweden)

    Dita Puruwita


    Full Text Available This research aims are to find out how well the service quality of PT Indosat Jakarta, how loyal are the customers, and how far the effect of the service quality toward the customers loyalty Indosat in Jakarta. The category of this research are descriptive and verification with surveys method by using a convenience sampling. The sample sizes is 120 respondents of Indosat customers. Therefore, the data collecting technique used are from secondary data, interview, observation and questionnaires. The result of this research based on hypothetical test indicates that there is a effect between the service quality and the customer loyalty. The conclusion of this research is that the performance of the service quality provided by Indosat is still under the customer expectation. It is suggested to the management of PT. Indosat, to improve and maintain their service quality in the dimension that is regard as important, as well the customer’s loyalty level.

  11. Value-added strategy models to provide quality services in senior health business. (United States)

    Yang, Ya-Ting; Lin, Neng-Pai; Su, Shyi; Chen, Ya-Mei; Chang, Yao-Mao; Handa, Yujiro; Khan, Hafsah Arshed Ali; Elsa Hsu, Yi-Hsin


    The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. A total of 33 senior health enterprises in Taiwan. Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. None. Core values and vision, organization structure, quality services provided, strategies for quality services. This study's results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service.

  12. Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014. (United States)

    Asefzadeh, Saeed; Gholami, Soheyla; Rajaee, Roya; Najafi, Marziye; Alijanzadeh, Mehran


    Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014. This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach's Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test. The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels. The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors.

  13. Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method. (United States)

    Ueda, Kayo; Ohtera, Shosuke; Kaso, Misato; Nakayama, Takeo


    In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012. The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.

  14. Highly Integrated Quality Assurance – An Empirical Case

    Energy Technology Data Exchange (ETDEWEB)

    Drake Kirkham; Amy Powell; Lucas Rich


    Highly Integrated Quality Assurance – An Empirical Case Drake Kirkham1, Amy Powell2, Lucas Rich3 1Quality Manager, Radioisotope Power Systems (RPS) Program, Idaho National Laboratory, P.O. Box 1625 M/S 6122, Idaho Falls, ID 83415-6122 2Quality Engineer, RPS Program, Idaho National Laboratory 3Quality Engineer, RPS Program, Idaho National Laboratory Contact: Voice: (208) 533-7550 Email: Abstract. The Radioisotope Power Systems Program of the Idaho National Laboratory makes an empirical case for a highly integrated Quality Assurance function pertaining to the preparation, assembly, testing, storage and transportation of 238Pu fueled radioisotope thermoelectric generators. Case data represents multiple campaigns including the Pluto/New Horizons mission, the Mars Science Laboratory mission in progress, and other related projects. Traditional Quality Assurance models would attempt to reduce cost by minimizing the role of dedicated Quality Assurance personnel in favor of either functional tasking or peer-based implementations. Highly integrated Quality Assurance adds value by placing trained quality inspectors on the production floor side-by-side with nuclear facility operators to enhance team dynamics, reduce inspection wait time, and provide for immediate, independent feedback. Value is also added by maintaining dedicated Quality Engineers to provide for rapid identification and resolution of corrective action, enhanced and expedited supply chain interfaces, improved bonded storage capabilities, and technical resources for requirements management including data package development and Certificates of Inspection. A broad examination of cost-benefit indicates highly integrated Quality Assurance can reduce cost through the mitigation of risk and reducing administrative burden thereby allowing engineers to be engineers, nuclear operators to be nuclear operators, and the cross-functional team to operate more efficiently. Applicability of this case

  15. Reparable, high-density microelectronic module provides effective heat sink (United States)

    Carlson, K. J.; Maytone, F. F.


    Reparable modular system is used for packaging microelectronic flat packs and miniature discrete components. This three-dimensional compartmented structure incorporates etched phosphor bronze sheets and frames with etched wire conductors. It provides an effective heat sink for electric power dissipation in the absence of convective cooling means.

  16. High-quality binary interactome mapping. (United States)

    Dreze, Matija; Monachello, Dario; Lurin, Claire; Cusick, Michael E; Hill, David E; Vidal, Marc; Braun, Pascal


    Physical interactions mediated by proteins are critical for most cellular functions and altogether form a complex macromolecular "interactome" network. Systematic mapping of protein-protein, protein-DNA, protein-RNA, and protein-metabolite interactions at the scale of the whole proteome can advance understanding of interactome networks with applications ranging from single protein functional characterization to discoveries on local and global systems properties. Since the early efforts at mapping protein-protein interactome networks a decade ago, the field has progressed rapidly giving rise to a growing number of interactome maps produced using high-throughput implementations of either binary protein-protein interaction assays or co-complex protein association methods. Although high-throughput methods are often thought to necessarily produce lower quality information than low-throughput experiments, we have recently demonstrated that proteome-scale interactome datasets can be produced with equal or superior quality than that observed in literature-curated datasets derived from large numbers of small-scale experiments. In addition to performing all experimental steps thoroughly and including all necessary controls and quality standards, careful verification of all interacting pairs and validation tests using independent, orthogonal assays are crucial to ensure the release of interactome maps of the highest possible quality. This chapter describes a high-quality, high-throughput binary protein-protein interactome mapping pipeline that includes these features. Copyright © 2010 Elsevier Inc. All rights reserved.

  17. High School Child Development Courses Provide a Valuable Apprenticeship (United States)

    McCombie, Sally M.


    The current media are laden with reports of the many significant problems facing today's youth. In fact, parenting has become a national topic of discussion. Parenting instruction, a responsibility that had previously rested in the home, has become part of educational curricula. Courses in child development are offered for high school students in…

  18. Quality and use of consumer information provided with home test kits: room for improvement. (United States)

    Grispen, Janaica E J; Ickenroth, Martine H P; de Vries, Nanne K; van der Weijden, Trudy; Ronda, Gaby


    Diagnostic self-tests (tests on body materials that are initiated by consumers with the aim of diagnosing a disorder or risk factor) are becoming increasingly available. Although the pros and cons of self-testing are currently not clear, it is an existing phenomenon that is likely to gain further popularity. To examine consumers' use of and needs for information about self-testing, and to assess the quality of consumer information provided with home test kits, as perceived by consumers and as assessed using a checklist of quality criteria. A cross-sectional Internet survey among 305 self-testers assessed their use of and needs for information and their perception of the quality of consumer information provided with self-test kits. A meta-search engine was used to identify Dutch and English consumer information for home diagnostic tests available online at the time of the study. The quality of this consumer information was evaluated using a checklist of quality criteria. The consumers' information needs were in line with the most frequently used information, and the information was perceived as being of moderate to good quality. The information was mostly in agreement with clinical practice guidelines, although information on reliability and follow-up behaviour was limited. Approximately half of the instruction leaflets did not include information on the target group of the test. Although generally of moderate to good quality, some aspects of the information provided were in many cases insufficient. European legislation concerning self-tests and accompanying information needs to be adapted and adhered to more closely. © 2012 John Wiley & Sons Ltd.

  19. Predictors of Quality and Commitment in Family Child Care: Provider Education, Personal Resources, and Support. (United States)

    Weaver, Ruth Harding


    Examined the personal characteristics and resources in 65 licensed family child care providers' lives that influence developmentally enhancing caregiving and professional commitment. Unique predictors to higher quality of care were higher levels of formal education and training, college coursework in early childhood education, higher psychological…

  20. Considerations of Administrative Licensure, Provider Type, and Leadership Quality: Recommendations for Research, Policy, and Practice (United States)

    Hackmann, Donald G.


    This article reviews U.S. administrative licensure regulations, focusing on type of school leader licensure, provider types, and leadership quality. Licensure obtained through university-based and alternative routes is examined. Due to limited research on alternative school administrative licensure, regulations in medicine, psychology,…

  1. Nurses' perception of the quality of care they provide to hospitalized drug addicts: testing the theory of reasoned action. (United States)

    Natan, Merav Ben; Beyil, Valery; Neta, Okev


    A correlational design was used to examine nursing staff attitudes and subjective norms manifested in intended and actual care of drug users based on the Theory of Reasoned Action. One hundred and thirty-five nursing staff from three central Israeli hospitals completed a questionnaire examining theory-based variables as well as sociodemographic and professional characteristics. Most respondents reported a high to very high level of actual or intended care of drug users. Nurses' stronger intentions to provide quality care to drug users were associated with more positive attitudes. Nursing staff members had moderately negative attitudes towards drug users. Nurses were found to hold negative stereotypes of drug addict patients and most considered the management of this group difficult. Positive attitudes towards drug users, perceived expectations of others and perceived correctness of the behaviour are important in their effect on the intention of nurses to provide high-quality care to hospitalized patients addicted to drugs.

  2. Pairs of cooperating cleaner fish provide better service quality than singletons. (United States)

    Bshary, Redouan; Grutter, Alexandra S; Willener, Astrid S T; Leimar, Olof


    Service providers may vary service quality depending on whether they work alone or provide the service simultaneously with a partner. The latter case resembles a prisoner's dilemma, in which one provider may try to reap the benefits of the interaction without providing the service. Here we present a game-theory model based on the marginal value theorem, which predicts that as long as the client determines the duration, and the providers cooperate towards mutual gain, service quality will increase in the pair situation. This prediction is consistent with field observations and with an experiment on cleaning mutualism, in which stable male-female pairs of the cleaner wrasse Labroides dimidiatus repeatedly inspect client fish jointly. Cleaners cooperate by eating ectoparasites off clients but actually prefer to cheat and eat client mucus. Because clients often leave in response to such cheating, the benefits of cheating can be gained by only one cleaner during a pair inspection. In both data sets, the increased service quality during pair inspection was mainly due to the smaller females behaving significantly more cooperatively than their larger male partners. In contrast, during solitary inspections, cleaning behaviour was very similar between the sexes. Our study highlights the importance of incorporating interactions between service providers to make more quantitative predictions about cooperation between species.

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

    DEFF Research Database (Denmark)

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


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

  4. Systems Engineering Provides Successful High Temperature Steam Electrolysis Project

    Energy Technology Data Exchange (ETDEWEB)

    Charles V. Park; Emmanuel Ohene Opare, Jr.


    This paper describes two Systems Engineering Studies completed at the Idaho National Laboratory (INL) to support development of the High Temperature Stream Electrolysis (HTSE) process. HTSE produces hydrogen from water using nuclear power and was selected by the Department of Energy (DOE) for integration with the Next Generation Nuclear Plant (NGNP). The first study was a reliability, availability and maintainability (RAM) analysis to identify critical areas for technology development based on available information regarding expected component performance. An HTSE process baseline flowsheet at commercial scale was used as a basis. The NGNP project also established a process and capability to perform future RAM analyses. The analysis identified which components had the greatest impact on HTSE process availability and indicated that the HTSE process could achieve over 90% availability. The second study developed a series of life-cycle cost estimates for the various scale-ups required to demonstrate the HTSE process. Both studies were useful in identifying near- and long-term efforts necessary for successful HTSE process deployment. The size of demonstrations to support scale-up was refined, which is essential to estimate near- and long-term cost and schedule. The life-cycle funding profile, with high-level allocations, was identified as the program transitions from experiment scale R&D to engineering scale demonstration.

  5. Electrolysis Propulsion Provides High-Performance, Inexpensive, Clean Spacecraft Propulsion (United States)

    deGroot, Wim A.


    An electrolysis propulsion system consumes electrical energy to decompose water into hydrogen and oxygen. These gases are stored in separate tanks and used when needed in gaseous bipropellant thrusters for spacecraft propulsion. The propellant and combustion products are clean and nontoxic. As a result, costs associated with testing, handling, and launching can be an order of magnitude lower than for conventional propulsion systems, making electrolysis a cost-effective alternative to state-of-the-art systems. The electrical conversion efficiency is high (>85 percent), and maximum thrust-to-power ratios of 0.2 newtons per kilowatt (N/kW), a 370-sec specific impulse, can be obtained. A further advantage of the water rocket is its dual-mode potential. For relatively high thrust applications, the system can be used as a bipropellant engine. For low thrust levels and/or small impulse bit requirements, cold gas oxygen can be used alone. An added innovation is that the same hardware, with modest modifications, can be converted into an energy-storage and power-generation fuel cell, reducing the spacecraft power and propulsion system weight by an order of magnitude.

  6. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration. (United States)

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A


    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. © The Author(s) 2014.

  7. Assuring quality in high-consequence engineering

    Energy Technology Data Exchange (ETDEWEB)

    Hoover, Marcey L.; Kolb, Rachel R.


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

  8. Providing Total Quality Fundamentals: 1995 Workshops for the NASA Lewis Research Center's Technical Services Directorate (United States)

    Antczak, Paul; Jacinto,Gilda; Simek, Jimmy


    The National Aeronautics and Space Administration's (NASA) agency-wide movement to cultivate a quality workplace is the basis for Lewis Research Center to implement Total Quality Fundamentals (TQF) initiatives. The Lewis Technical Services Directorate (TSD) introduced the Total Quality Fundamentals (TQF) workshops to its work force as an opportunity to introduce the concepts and principles of TQF. These workshops also provided the participants with the opportunity to dialogue with fellow TSD employees and managers. This report describes, through the perspective of the Lewis TSD TQF Coaches, how the TQF work- shop process was accomplished in TSD. It describes the structure for addressing the need, implementation process, input the TSD Coaches provided, common themes and concerns raised, conclusions, and recommendations. The Coaches concluded that these types of workshops could be the key to open the communication channels that are necessary to help everyone at Lewis understand where they fit in the organization. TQF workshops can strengthen the participant's connection with the Mission, Vision of the Center, and Vision of the Agency. Reconunendations are given based on these conclusions that can help the TSD Quality Board develop attainable measures towards a quality workplace.

  9. Quality dementia care: Prerequisites and relational ethics among multicultural healthcare providers. (United States)

    Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Jakobsen, Rita; Sørlie, Venke


    Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. The aim of this study is to illuminate multi-ethnic healthcare providers' lived experiences of their own working relationship, and its importance to quality care for people with dementia. The study is part of a greater participatory action research project: 'Hospice values in the care for persons with dementia'. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. Participants and research context: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. Ethical considerations: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. The results show that good working relationships, characterized by understanding each other's vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. The results are discussed in the light of Lögstrup's relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.

  10. [Do nursing homes with higher quality ratings provide a better quality of care? : Empirical study based on administrative data]. (United States)

    Przylog, Adam; Stroka, Magdalena A; Engel, Susanne; Linder, Roland


    In 2009 a new system for the objective evaluation of nursing homes was introduced in Germany. The so-called nursing transparency agreement (Pflege-Transparenzvereinbarungen) was introduced to provide a reliable tool for an objective comparison of inpatient (PTVS) and outpatient (PTVA) care; however, the new regulations have been the subject of a broad discussion regarding reliability, efficiency and objectivity. To overcome the lack of objective health outcomes, this study used administrative data from Germany's largest health insurance fund, the Techniker Krankenkasse, in order to analyze the association between the quality ratings and objective quality measures on an individual level. This is the first study that provides empirical evidence on this topic using administrative data. The administrative dataset contained information on several individual characteristics as well as data on injuries, poisoning and other extrinsic effects on care-dependent individuals over the age of 64 years who were living in a nursing home in 2009. Based on these data an objective measure was constructed to test whether higher quality ratings of nursing homes led to a better quality of care of the respective patients using non-linear regression models. The results of the estimated models showed no significant evidence of such a relationship, neither considering the probability nor the number of injuries, poisoning and other extrinsic effects. Significant effects were only observed for gender and specific diseases. The results of this study support the argument that the current rating procedure for nursing homes has to be refined. Using quality indicators in combination with the administrative data could possibly contribute to such an enhancement.

  11. Measuring the quality of provided services for patients with chronic kidney disease. (United States)

    Bahadori, Mohammadkarim; Raadabadi, Mehdi; Heidari Jamebozorgi, Majid; Salesi, Mahmood; Ravangard, Ramin


    The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction. This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014. This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test. The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P < 0.001). Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and

  12. Supporting diverse data providers in the open water data initiative: Communicating water data quality and fitness of use (United States)

    Larsen, Sara; Hamilton, Stuart; Lucido, Jessica M.; Garner, Bradley D.; Young, Dwane


    Shared, trusted, timely data are essential elements for the cooperation needed to optimize economic, ecologic, and public safety concerns related to water. The Open Water Data Initiative (OWDI) will provide a fully scalable platform that can support a wide variety of data from many diverse providers. Many of these will be larger, well-established, and trusted agencies with a history of providing well-documented, standardized, and archive-ready products. However, some potential partners may be smaller, distributed, and relatively unknown or untested as data providers. The data these partners will provide are valuable and can be used to fill in many data gaps, but can also be variable in quality or supplied in nonstandardized formats. They may also reflect the smaller partners' variable budgets and missions, be intermittent, or of unknown provenance. A challenge for the OWDI will be to convey the quality and the contextual “fitness” of data from providers other than the most trusted brands. This article reviews past and current methods for documenting data quality. Three case studies are provided that describe processes and pathways for effective data-sharing and publication initiatives. They also illustrate how partners may work together to find a metadata reporting threshold that encourages participation while maintaining high data integrity. And lastly, potential governance is proposed that may assist smaller partners with short- and long-term participation in the OWDI.

  13. [Data from automated external defibrillators provide important information on the quality of in-hospital resuscitation]. (United States)

    Vestergård, Lone Due; Løfgren, Bo; Krarup, Niels Henrik Vinther; Holm, Tina; Andersen, Lone Kærslund


    International guidelines recommend monitoring the outcome following in-hospital cardiac arrest. Using data from automatic external defibrillators (AED) prospectively collected during a three-year period in a regional hospital, we evaluated the treatment quality of resuscitation. Time to defibrillation was acceptable, but quality of chest compressions did not comply with current international recommendations. AED use led to a high fraction of time with no chest compressions. Survival to discharge was 11%. Consequently, training in basic and advanced life support of hospital staff has been modified.

  14. High quality image oriented telemedicine with multimedia technology. (United States)

    Takeda, H; Minato, K; Takahasi, T


    Researchers at Osaka and Kyoto University hospital performed three experiments, beginning in 1995, which looked at high quality-oriented telemedicine. This paper describes the system design for the three projects. Experiment 1 applied high-definition TV images and B-ISDN for distance learning and medical information exchange. Experiment 2 developed a super high-definition medical image filing system and the images were transmitted via B-ISDN for teleconferences and experiment 3 utilized digital, high-definition, TV images and communication satellites for teleconferences. Multimedia and communication technologies were considered to be fundamental components of telemedicine. The three projects were evaluated initially for quality of images, operability and utility. The experimental design and its implementation showed that it was possible to provide high quality image-oriented telemedicine in the health care environment. Obstacles to establishing practical telemedicine are also discussed.

  15. Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel. (United States)

    Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L


    Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.

  16. Development and Validation of Quality Criteria for Providing Patient- and Family-centered Injury Care. (United States)

    Boyd, Jamie M; Burton, Rachael; Butler, Barb L; Dyer, Dianne; Evans, David C; Felteau, Melissa; Gruen, Russell L; Jaffe, Kenneth M; Kortbeek, John; Lang, Eddy; Lougheed, Val; Moore, Lynne; Narciso, Michelle; Oxland, Peter; Rivara, Frederick P; Roberts, Derek; Sarakbi, Diana; Vine, Karen; Stelfox, Henry T


    The aim of this study was to develop and evaluate the content validity of quality criteria for providing patient- and family-centered injury care. Quality criteria have been developed for clinical injury care, but not patient- and family-centered injury care. Using a modified Research AND Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Methodology, a panel of 16 patients, family members, injury and quality of care experts serially rated and revised criteria for patient- and family-centered injury care identified from patient and family focus groups. The criteria were then sent to 384 verified trauma centers in the United States, Canada, Australia, and New Zealand for evaluation. A total of 46 criteria were rated and revised by the panel over 4 rounds of review producing 14 criteria related to clinical care (n = 4; transitions of care, pain management, patient safety, provider competence), communication (n = 3; information for patients/families; communication of discharge plans to patients/families, communication between hospital and community providers), holistic care (n = 4; patient hygiene, kindness and respect, family access to patient, social and spiritual support) and end-of-life care (n = 3; decision making, end-of-life care, family follow-up). Medical directors, managers, or coordinators representing 254 trauma centers (66% response rate) rated 12 criteria to be important (95% of responses) for patient- and family-centered injury care. Fewer centers rated family access to the patient (80%) and family follow-up after patient death (65%) to be important criteria. Fourteen-candidate quality criteria for patient- and family-centered injury care were developed and shown to have content validity. These may be used to guide quality improvement practices.

  17. Impact of Providing Compassion on Job Performance and Mental Health: The Moderating Effect of Interpersonal Relationship Quality. (United States)

    Chu, Li-Chuan


    To examine the relationships of providing compassion at work with job performance and mental health, as well as to identify the role of interpersonal relationship quality in moderating these relationships. This study adopted a two-stage survey completed by 235 registered nurses employed by hospitals in Taiwan. All hypotheses were tested using hierarchical regression analyses. The results show that providing compassion is an effective predictor of job performance and mental health, whereas interpersonal relationship quality can moderate the relationships of providing compassion with job performance and mental health. When nurses are frequently willing to listen, understand, and help their suffering colleagues, the enhancement engendered by providing compassion can improve the provider's job performance and mental health. Creating high-quality relationships in the workplace can strengthen the positive benefits of providing compassion. Motivating employees to spontaneously exhibit compassion is crucial to an organization. Hospitals can establish value systems, belief systems, and cultural systems that support a compassionate response to suffering. In addition, nurses can internalize altruistic belief systems into their own personal value systems through a long process of socialization in the workplace. © 2017 Sigma Theta Tau International.

  18. Health-related quality of life and working conditions among nursing providers


    Amanda Aparecida Silva; José Maria Pacheco de Souza; Flávio Notarnicola da Silva Borges; Frida Marina Fischer


    OBJECTIVE: To evaluate working conditions associated with health-related quality of life (HRQL) among nursing providers. METHODS: Cross-sectional study conducted in a university hospital in the city of São Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%), who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and hea...

  19. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

    Directory of Open Access Journals (Sweden)

    Sword Wendy


    Full Text Available Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of

  20. High Quality Virtual Reality for Architectural Exhibitions

    DEFF Research Database (Denmark)

    Kreutzberg, Anette


    This paper will summarise the findings from creating and implementing a visually high quality Virtual Reality (VR) experiment as part of an international architecture exhibition. It was the aim to represent the architectural spatial qualities as well as the atmosphere created from combining natural...... and artificial lighting in a prominent not yet built project. The outcome is twofold: Findings concerning the integration of VR in an exhibition space and findings concerning the experience of the virtual space itself. In the exhibition, an important aspect was the unmanned exhibition space, requiring the VR...... and quantitative methods at two different occasions and setups after the exhibition, both showing a high degree of immersion and experience of reality....

  1. Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries. (United States)

    Thompson, Joyce E; Land, Sandra; Camacho-Hubner, Alma Virginia; Fullerton, Judith T


    To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC) to 1) better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2) determine the need for more rigorous study of the issues. A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth) in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency) in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. The findings suggest that 1) the quality of maternal and newborn care and 2) the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.

  2. Do water quality criteria based on nonnative species provide appropriate protection for native species? (United States)

    Jin, Xiaowei; Wang, Zijian; Wang, Yeyao; Lv, Yibing; Rao, Kaifeng; Jin, Wei; Giesy, John P; Leung, Kenneth M Y


    The potential use of toxicity data for nonnative species to derive water quality criteria is controversial because it is sometimes questioned whether criteria based on species from one geographical region provide appropriate protection for species in a different region. However, this is an important concept for the development of Chinese water quality criteria or standards. Data were assembled on 38 chemicals for which values were available for both native and nonnative species. Sensitivities of these organisms were compared based on the 5% hazardous concentration values and the species sensitivity distribution from a literature review. Results of the present study's analysis showed that there is approximately 74% certainty that use of nonnative species to generate water quality criteria would be sufficiently protective of aquatic ecosystems in China. Without applying any assessment factor to the water quality criteria generated from nonnative species, the uncertainty would be 26% when the native Chinese species might be under protection. Applying an assessment factor of 10 would offer adequate protection to native Chinese species for approximately 90% of tested chemicals and thus reduce the uncertainty from 26% to 10%. © 2015 SETAC.

  3. High quality transportation fuels from renewable feedstock

    Energy Technology Data Exchange (ETDEWEB)

    Lindfors, Lars Peter


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

  4. The Impact of Quality Service Provided by SRM Hospital on Outpatients

    Directory of Open Access Journals (Sweden)

    Kenneth Amoah-Binfoh


    Full Text Available Consumer’s perceptions about the health care services play an important role when choosing a hospital. The quality of service is crucial to both the outpatients and the service providers. The dimensions of the service quality are reliability, responsiveness, assurance, empathy, and tangibles. Customer’s expectations and experiences vary with services. When there is a shortfall between expectation of service level and perception of actual service delivery, it is called customer gap. The causes of customer gap include; not knowing what customers expect, not selecting the right service designs and standards, not delivering to service standards and not matching performance to promises. This paper focuses on the level of service quality rendered by SRM’s hospital, the patient-physicians’ relationship and to examine the pre and post service of outpatients in the SRM’s hospital. A structured questionnaires and interviews were constructed to provide answers to the research questions using a sample size of 50 [employees and outpatients]. It was found out that some outpatients were satisfied with the services rendered by the hospital with reservations for more improvement. It was also found out that, there were gaps between the outpatients’ expectation and perception about the service rendered by the hospital. It was recommended that a competent marketing executive should be employed since marketing is the voice of the healthcare industry.

  5. Association of mandated language access programming and quality of care provided by mental health agencies. (United States)

    McClellan, Sean R; Snowden, Lonnie


    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  6. The quality of mobile phone services provided by Romanian operators, from consumers` perspective

    Directory of Open Access Journals (Sweden)

    Doru Alexandru Pleşea


    Full Text Available The mobile services are distinguished through their quality, either we speak about the way the client is approached and placed in the centre of the operator's actions, or about the services the client benefits in his capacity as a client. The Romanian mobile operators’ services have greatly evolved from their launch in 1997. Along these times, the mobile operators brought more value to these services, due to their need to meet the consumers' expectations with services of high quality and competitiveness. Usually the Romanian consumers place the price in the forefront of their service/mobile phone services acquisition, but an objective analyze of the quality of the mobile phone services has to take into account both technical aspects of the services and the interfacing services too. Therefore, this paper takes into account technical characteristics of the services such as national telephony coverage, data transmission services coverage, the signal quality, maximum speed of data transfer as well as related services such as distribution network, sales and support sales services, after-sales services, and range of available terminals. Based on mobile services comprehensive analysis made available to consumers by the major players on the Romanian market, this paper aims to highlight the main reasons of the consumers’ satisfaction and dissatisfaction.

  7. Impact of Provider Incentives on Quality and Value of Health Care. (United States)

    Doran, Tim; Maurer, Kristin A; Ryan, Andrew M


    The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

  8. Breeding and maintaining high-quality insects

    DEFF Research Database (Denmark)

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


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

  9. Cloud infrastructure for providing tools as a service: quality attributes and potential solutions

    DEFF Research Database (Denmark)

    Chauhan, Muhammad Aufeef; Ali Babar, Muhammad


    Cloud computing is being increasingly adopted in various domains for providing on-demand infrastructure and Software as a service (SaaS) by leveraging the utility computing model and virtualization technologies. One of the domains, where cloud computing is expected to gain huge traction is Global...... projects. Through an extensive review of the relevant literature on GSD and Cloud Computing, we have identified a set of quality attributes and potential architectural solutions for a cloud-based infrastructure that can provide TaaS to GSD teams. This paper outlines the promised benefits of TaaS to GSD...... efficiently and cost-effectively. Moreover, variations in tools available/used by different GSD team members can also pose challenges. We assert that providing Tools as a Service (TaaS) to GSD teams through a cloud-based infrastructure can be a promising solution to address the tools related challenges in GSD...

  10. Assessing quality of care provided by Indonesian village midwives with a confidential enquiry. (United States)

    D'Ambruoso, Lucia; Achadi, Endang; Adisasmita, Asri; Izati, Yulia; Makowiecka, Krystyna; Hussein, Julia


    to conduct a confidential enquiry to assess the quality of care provided by Indonesian village midwives and to identify opportunities for improvement. local health-care practitioners assessed village-based care in obstetric emergencies in 13 cases of maternal death and near-miss from rural villages in West Java. The study focused on clinical quality of care, but also investigated the influence of the health system and social factors. The reviews were based on transcripts of interviews with health-care providers, family and community members involved in the cases. Both favourable and adverse factors were identified in order to recognise positive contributions, where they occurred. At the end of a series of case reviews, recommendations for practice were generated and disseminated. in the cases reviewed, midwives facilitated referral effectively, reducing delays in reaching health facilities. Midwives' emergency diagnostic skills were accurate but they were less capable in the clinical management of complications. Coverage was poor; in some locations, midwives were responsible for up to five villages. Village midwives were also perceived as unacceptable to women and their families. Families and communities did not prepare for emergencies with finances or transport, partly due to a poorly understood health insurance system. The enquiry had learning effects for those involved. village midwives should: receive appropriate support for the management of obstetric emergencies; engage with communities to promote birth preparedness; and work in partnership with formal and informal providers in the community. The enquiry was a diagnostic tool to identify opportunities for improving care. Practitioners had a unique insight into factors that contribute to quality care and how feasible interventions might be made.

  11. Achieving High-Quality Multicultural Geriatric Care. (United States)


    As the ethnic diversity of the U.S. population increases, there is a growing awareness of healthcare disparities and the need to address them. This position statement that the American Geriatrics Society (AGS) Ethnogeriatrics Committee developed outlines healthcare disparities in the United States and the minimum quality indicators that healthcare organizations and healthcare providers should adopt to ensure that all older adults receive care that is culturally appropriate and takes into account level of health literacy. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  12. Providing Quality Therapeutics in Switzerland: Role of the Stakeholders and Recent Incentives for Further Improvements. (United States)

    Besson, Marie; Samer, Caroline; Rollason, Victoria; Dayer, Pierre; Desmeules, Jules


    Quality therapeutics play an important role in Switzerland's health care and economy. Switzerland holds a key position in the world of research and development, as well as in drug production. Recently, new emphasis has been placed on promoting clinical research and maintaining Switzerland's position as a center of excellence in the field. Recent revisions to the law regarding medical trials in human research allow for better allocation of regulatory resources and simplified procedures for drugs already authorized in Switzerland. The country has its own regulatory agency, the Swiss Agency for Therapeutic Products (Swissmedic), which is a public institution of the Swiss government. Swissmedic is responsible for ensuring safety in medicines, particularly regarding authorizations and market surveillance in the sector of medicinal products and medical devices. Although the centralized authorization procedure of the European Union for medicines does not apply to Switzerland, there are mutual recognition mechanisms between the Swiss medicine regulatory authority and the European Medicines Agency. Swissmedic is also in charge of postmarketing safety and oversees the national pharmacovigilance center, which collaborates closely with the World Health Organization center in Uppsala. In addition, university hospital-based clinical pharmacologists, who are involved in basic science and clinical research, regulatory affairs, ethics committees, and pharmacovigilance, promote quality therapeutics. This article discusses the role of the various stakeholders and the recent efforts made to provide a better allocation of resources aimed at further improving quality therapeutics in Switzerland. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

  13. Male facial attractiveness and masculinity may provide sex- and culture-independent cues to semen quality. (United States)

    Soler, C; Kekäläinen, J; Núñez, M; Sancho, M; Álvarez, J G; Núñez, J; Yaber, I; Gutiérrez, R


    Phenotype-linked fertility hypothesis (PLFH) predicts that male secondary sexual traits reveal honest information about male fertilization ability. However, PLFH has rarely been studied in humans. The aim of the present study was to test PLFH in humans and to investigate whether potential ability to select fertile partners is independent of sex or cultural background. We found that on the contrary to the hypothesis, facial masculinity was negatively associated with semen quality. As increased levels of testosterone have been demonstrated to impair sperm production, this finding may indicate a trade-off between investments in secondary sexual signalling (i.e. facial masculinity) and fertility or status-dependent differences in investments in semen quality. In both sexes and nationalities (Spanish and Colombian), ranked male facial attractiveness predicted male semen quality. However, Spanish males and females estimated facial images generally more attractive (gave higher ranks) than Colombian raters, and in both nationalities, males gave higher ranks than females. This suggests that male facial cues may provide culture- and sex-independent information about male fertility. However, our results also indicate that humans may be more sensitive to facial attractiveness cues within their own populations and also that males may generally overestimate the attractiveness of other men to females. © 2014 The Authors. Journal of Evolutionary Biology © 2014 European Society For Evolutionary Biology.

  14. Herbal therapy and quality of life in hypertension patients at health facilities providing complementary therapy

    Directory of Open Access Journals (Sweden)

    Nurhayati Nurhayati


    -sectional study used a of data from medical records in hypertension subjects health care facilities in provinces of: DKI Jakarta, Central Java, West Java, East Java, Bali, Banten, and South Sumatra which used complementary medicine for treatment patients. The interview and recording of patient medical records was done by 77 medical doctors who practicing herbal medicine. The quality of life based on Short Form 36 WHO questionnaire for getting data quality of life of hypertension patients. Risk factors that related to quality of life in hypertension patients were analyzed using Cox regression. Results: Total patients had been collected were 189 subjects. The proportion of those who had good quality of life were 51.9% (97/187. Dominant risk factors related to quality of life in hypertension patients were level of education and type of treatment. Compared with those who had low education level, those who had middle and high education level had 83% more risk to be good quality of life. Furthermore, in terms of type of treatment, those who had pharmaceutical and herbal/traditional had 29% more risk to be good quality of life. Conclusion: Hypertension subjects who had higher level of education and had pharmaceutical and herbal/traditional had more risk to be good quality of life. Keywords: quality of life, hypertension patients 

  15. The Nutritional Quality of Food Provided from Food Pantries: A Systematic Review of Existing Literature. (United States)

    Simmet, Anja; Depa, Julia; Tinnemann, Peter; Stroebele-Benschop, Nanette


    In many affluent countries, food-insecure households use food pantries to keep their family fed. The long-term dependence of many users on these programs calls for a systematic review of studies on the nutritional quality of food provided by food pantries. The purpose of this systematic review was to summarize the current scientific evidence about the nutritional quality of food bags distributed by food pantries. A systematic literature search was conducted in the electronic databases PubMed, PsycINFO, PsycARTICLES, and Psychology Behavioral Sciences Collection to identify cross-sectional, cohort, and intervention studies reporting baseline data conducted in high-income countries and published between 1980 and 2015, which reported the nutritional quality of food bags distributed by food pantries. Identified citations were screened in two stages and data were independently extracted by two authors using a predefined data sheet. The quality of included studies was evaluated using criteria of an adapted Ottawa Scale. The systematic review was reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Applying the two-stage screening, 9 of 1,546 articles were identified for inclusion. Nutritional quality of food bags varied widely between and within studies. Milk products, vitamins A and C, and calcium were provided in particularly low amounts. None of the studies were nationally representative and only a few studies controlled for the household composition of the recipients of food bags. Food pantries likely have a strong influence on users' diets, but the food pantries examined in the selected studies were largely unable to support healthy diets. The distribution of more perishable foods would increase users' diet quality and may have an immense potential to address malnutrition in vulnerable population groups. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  16. The effect of financial incentives on the quality of health care provided by primary care physicians. (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris


    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome


    Directory of Open Access Journals (Sweden)

    Yu. A. Rolik


    Full Text Available The problem of providing electric power quality in the electric power systems (EPS that are equipped with sufficiently long air or cable transmission lines is under consideration. This problem proved to be of particular relevance to the EPS in which a source of electrical energy is the generator of wind turbines since the wind itself is an instable primary energy source. Determination of the degree of automation of voltage regulation in the EPS is reduced to the choice of methods and means of regulation of power quality parameters. The concept of a voltage loss and the causes of the latter are explained by the simplest power system that is presented by a single-line diagram. It is suggested to regulate voltage by means of changing parameters of the network with the use of the method of reducing loss of line voltage by reducing its reactance. The latter is achieved by longitudinal capacitive compensation of the inductive reactance of the line. The effect is illustrated by vector diagrams of currents and voltages in the equivalent circuits of transmission lines with and without the use of longitudinal capacitive compensation. The analysis of adduced formulas demonstrated that the use of this method of regulation is useful only in the systems of power supply with a relatively low power factor (cosφ < 0.7 to 0.9. This power factor is typical for the situation of inclusion the wind turbine with asynchronous generator in the network since the speed of wind is instable. The voltage regulation fulfilled with the aid of the proposed method will make it possible to provide the required quality of the consumers’ busbars voltage in this situation. In is turn, it will make possible to create the necessary conditions for the economical transmission of electric power with the lowest outlay of reactive power and the lowest outlay of active power losses.

  18. Cultivar choice provides options for local production of organic and conventionally produced tomatoes with higher quality and antioxidant content. (United States)

    Aldrich, Heather Troxell; Salandanan, Karen; Kendall, Patricia; Bunning, Marisa; Stonaker, Frank; Külen, Oktay; Stushnoff, Cecil


    Tomatoes (Solanum lycopersicum L.) are widely consumed and well known for their health benefits, many of which have been associated with the high levels of antioxidants present in tomatoes. With a growing interest in local and organic foods, it would be helpful to determine whether farmers could naturally improve the quality and antioxidant content of tomatoes for sale in local markets. This study evaluated antioxidant properties, quality attributes, and yield for 10 tomato cultivars grown for 2 years using certified organic and conventional practices. Cultivar and year effects impacted (P < 0.05) all tests conducted, while growing method influenced (P < 0.05) yield, soluble solids content, ascorbic acid, and antioxidant radical scavenging capacity. Even when accounting for year-to-year variability, cultivars in the highest groups had 1.35- to 1.67-fold higher antioxidant levels than cultivars in the lowest groups. 'New Girl', 'Jet Star', 'Fantastic', and 'First Lady' were always in the highest groups, while 'Roma' and 'Early Girl' consistently had the lowest antioxidant content. Compared to production practices and environmental effects of years that are generally beyond the control of small-scale producers, choice of cultivar provides the simplest and most effective means of increasing antioxidant properties. Knowledge of tomato cultivars with naturally higher antioxidant levels could assist smaller-scale producers to grow fruit that may provide a competitive advantage and the opportunity to capitalize on the increasing popularity of locally grown, high-quality fresh produce. Copyright © 2010 Society of Chemical Industry.

  19. Two open access, high-quality datasets from anesthetic records. (United States)

    Cumin, David; Newton-Wade, Vanessa; Harrison, Michael J; Merry, Alan F


    To provide a set of high-quality time-series physiologic and event data from anesthetic cases formatted in an easy-to-use structure. With ethics committee approval, data from surgical operations under general anesthesia were collected, including physiologic data, drug administrations, events, and clinicians' comments. These data were de-identified, formatted in a combined CSV/XML structure and made publicly available. Two separate datasets were collected containing physiologic time-series data and time-stamped events for 34 patients. For 20 patients, the data included 400 physiologic signals collected over 20 h, 274 events, and 597 drug administrations. For 14 patients, the data included 23 physiologic signals collected over 69 h, with 286 time stamped comments. Data reuse potentially saves significant time and financial costs. However, there are few high-quality repositories for accessible physiologic data and clinical interventions from surgical cases. De-identifying records assists with overcoming problems of privacy and storing the data in a format which is easily manipulated with computing resources facilitates access by the wider research community. It is hoped that additional high-quality data will be added. Future work includes developing tools to explore and visualize the data more efficiently, and establishing quality control measures. An approach to collecting and storing high-quality datasets from surgical operations under anesthesia such that they can be easily accessed by others for use in research has been demonstrated.

  20. A guide to highly effective quality programs. (United States)

    Byrnes, John; Fifer, Joe


    To dramatically improve quality while decreasing costs, hospitals should: ensure all executives are vocal and visible supporters of quality improvement; focus the board of directors on quality as a strategic priority; strategically target quality resources to improve care for the majority of patients; use the finance system as the foundation for automated quality reporting; form a strong alliance between the CFO and chief quality officer, with each playing a leadership role in the quality program; rely on a well-executed quality program to improve efficiency and decrease the cost of care.

  1. The diet quality index evaluates the adequacy of energy provided by dietary macronutrients

    Directory of Open Access Journals (Sweden)

    Aline MENDES


    Full Text Available Objective To investigate the relationship between macronutrient intake adequacy and the national diet quality index score. Methods The study analyzed a representative sample of 1,662 individuals from the municipality of São Paulo who participated in a cross-sectional study called Health Survey-Capital (2008/2009. Two 24-hour recalls were collected. Habitual intake was determined by the Multiple Source Method. The Brazilian index was calculated as suggested, and macronutrient adequacy was given by the World Health Organization and Food and Agriculture Organization recommendations. A generalized linear model verified the relationship between the Brazilian index and macronutrient adequacy. All analyses with a descriptive level below 0.05 were considered significant. The analyses were performed by the software Stata 12.0, survey mode. Results The vast majority (91% of the population had inappropriate macronutrient intakes, and the total median Brazilian index score was 61.3 points (interquartile range=10.1. The total Brazilian index score of individuals with high lipid intake was worse than that of individuals with proper lipid intake (β=0,96; p=0,004, while those with high protein intake had a better score (β=1,10; p=0,003 than those with proper protein intake. Conclusion The revised Brazilian Healthy Eating Index assesses diet quality properly regarding high lipid intake, but it has some limitations regarding high protein intake according to the World Health Organization and Food and Agriculture Organization recommendations. New studies should investigate the possibility of adapting this index to the World Health Organization and Food and Agriculture Organization recommendations.

  2. Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians. (United States)

    Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J


    Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

  3. Privately Provided Accommodation Service Quality and Customer Satisfaction: The Case of Nsamizi Training Institute of Social Development

    National Research Council Canada - National Science Library

    Mugambwa, Joshua; Mugerwa, George William; Mutumba, Wilson Williams; Muganzi, Claire; Namubiru, Bridget; Waswa, Yusuf; Kayongo, Isaac Newton


    .... This research took a case study of Nsamizi Training Institute of Social Development (NTISD) to determine the relationship between privately provided accommodation service quality and customer satisfaction...

  4. The influence of system quality characteristics on health care providers' performance: Empirical evidence from Malaysia. (United States)

    Mohd Salleh, Mohd Idzwan; Zakaria, Nasriah; Abdullah, Rosni

    The Ministry of Health Malaysia initiated the total hospital information system (THIS) as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider's performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers' performance was expected when the system usage fits with patients' needs that eventually increased their productivity. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  5. Auto Spell Suggestion for High Quality Speech Synthesis in Hindi (United States)

    Kabra, Shikha; Agarwal, Ritika


    The goal of Text-to-Speech (TTS) synthesis in a particular language is to convert arbitrary input text to intelligible and natural sounding speech. However, for a particular language like Hindi, which is a highly confusing language (due to very close spellings), it is not an easy task to identify errors/mistakes in input text and an incorrect text degrade the quality of output speech hence this paper is a contribution to the development of high quality speech synthesis with the involvement of Spellchecker which generates spell suggestions for misspelled words automatically. Involvement of spellchecker would increase the efficiency of speech synthesis by providing spell suggestions for incorrect input text. Furthermore, we have provided the comparative study for evaluating the resultant effect on to phonetic text by adding spellchecker on to input text.

  6. Quality of integrated chronic disease care in rural South Africa: user and provider perspectives. (United States)

    Ameh, Soter; Klipstein-Grobusch, Kerstin; D'ambruoso, Lucia; Kahn, Kathleen; Tollman, Stephen M; Gómez-Olivé, Francesc Xavier


    The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients ≥18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian’s structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while

  7. High stakes and high emotions: providing safe care in Canadian emergency departments

    Directory of Open Access Journals (Sweden)

    Ali S


    Full Text Available Samina Ali,1,2 Denise Thomson,3 Timothy A D Graham,4 Sean E Rickard,3 Antonia S Stang5 1Women and Children’s Health Research Institute, 2Department of Pediatrics, 3Cochrane Child Health Field, Department of Pediatrics, University of Alberta, Edmonton, 4Department of Emergency Medicine, 5Section of Emergency Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, Canada Background: The high-paced, unpredictable environment of the emergency department (ED contributes to errors in patient safety. The ED setting becomes even more challenging when dealing with critically ill patients, particularly with children, where variations in size, weight, and form present practical difficulties in many aspects of care. In this commentary, we will explore the impact of the health care providers’ emotional reactions while caring for critically ill patients, and how this can be interpreted and addressed as a patient safety issue. Discussion: ED health care providers encounter high-stakes, high-stress clinical scenarios, such as pediatric cardiac arrest or resuscitation. This health care providers’ stress, and at times, distress, and its potential contribution to medical error, is underrepresented in the current medical literature. Most patient safety research is limited to error reporting systems, especially medication-related ones, an approach that ignores the effects of health care provider stress as a source of error, and limits our ability to learn from the event. Ways to mitigate this stress and avoid this type of patient safety concern might include simulation training for rare, high-acuity events, use of pre-determined clinical order sets, and post-event debriefing. Conclusion: While there are physiologic and anatomic differences that contribute to patient safety, we believe that they are insufficient to explain the need to address critical life-threatening event-related patient safety issues for both adults and, especially, children

  8. High Quality Data for Grid Integration Studies

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, Andrew; Draxl, Caroline; Sengupta, Manajit; Hodge, Bri-Mathias


    As variable renewable power penetration levels increase in power systems worldwide, renewable integration studies are crucial to ensure continued economic and reliable operation of the power grid. The existing electric grid infrastructure in the US in particular poses significant limitations on wind power expansion. In this presentation we will shed light on requirements for grid integration studies as far as wind and solar energy are concerned. Because wind and solar plants are strongly impacted by weather, high-resolution and high-quality weather data are required to drive power system simulations. Future data sets will have to push limits of numerical weather prediction to yield these high-resolution data sets, and wind data will have to be time-synchronized with solar data. Current wind and solar integration data sets are presented. The Wind Integration National Dataset (WIND) Toolkit is the largest and most complete grid integration data set publicly available to date. A meteorological data set, wind power production time series, and simulated forecasts created using the Weather Research and Forecasting Model run on a 2-km grid over the continental United States at a 5-min resolution is now publicly available for more than 126,000 land-based and offshore wind power production sites. The National Solar Radiation Database (NSRDB) is a similar high temporal- and spatial resolution database of 18 years of solar resource data for North America and India. The need for high-resolution weather data pushes modeling towards finer scales and closer synchronization. We also present how we anticipate such datasets developing in the future, their benefits, and the challenges with using and disseminating such large amounts of data.

  9. Narrative review of provider behavior in primary care behavioral health: How process data can inform quality improvement. (United States)

    Beehler, Gregory P; Lilienthal, Kaitlin R; Possemato, Kyle; Johnson, Emily M; King, Paul R; Shepardson, Robyn L; Vair, Christina L; Reyner, Jacqueline; Funderburk, Jennifer S; Maisto, Stephen A; Wray, Laura O


    Primary care behavioral health (PCBH) is a population-based approach to delivering mental and behavioral health care in the primary care setting. Implementation of the PCBH model varies across practice settings, which can impact how PCBH providers deliver services to patients and in turn may predict a variety of important outcomes. This article aims to characterize PCBH provider engagement in key processes of integrated care as demonstrated in results from empirical studies of real-world clinical practice. For this narrative review of published studies on PCBH provider engagement in processes of care, PubMed and PsycINFO databases were searched from January 1990 through May 2016 to identify relevant articles. Provider adherence to the brief, time-limited treatment model appears suboptimal. Common mental health conditions, such as depression, were often the primary focus of provider attention, with less consistent emphasis on behavioral medicine concerns. Whereas providers regularly conducted qualitative functional assessments with patients, routine use of standardized measures was low. Engagement in interprofessional collaboration with the primary care team was also low, but engagement in behaviors that fostered therapeutic relationships was high. This review identified several strengths and weaknesses of typical PCBH provider practices. Results are discussed in relation to their value as areas for future quality improvement initiatives that can improve PCBH service delivery and, ultimately, patient outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  10. Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care? (United States)

    Baji, Petra; Rubashkin, Nicholas; Szebik, Imre; Stoll, Kathrin; Vedam, Saraswathi


    In Central and Eastern Europe, many women make informal cash payments to ensure continuity of provider, i.e., to have a "chosen" doctor who provided their prenatal care, be present for birth. High rates of obstetric interventions and disrespectful maternity care are also common to the region. No previous study has examined the associations among informal payments, intervention rates, and quality of maternity care. We distributed an online cross-sectional survey in 2014 to a nationally representative sample of Hungarian internet-using women (N = 600) who had given birth in the last 5 years. The survey included items related to socio-demographics, type of provider, obstetric interventions, and experiences of care. Women reported if they paid informally, and how much. We built a two-part model, where a bivariate probit model was used to estimate conditional probabilities of women paying informally, and a GLM model to explore the amount of payments. We calculated marginal effects of the covariates (provider choice, interventions, respectful care). Many more women (79%) with a chosen doctor paid informally (191 euros on average) compared to 17% of women without a chosen doctor (86 euros). Based on regression analysis, the chosen doctor's presence at birth was the principal determinant of payment. Intervention and procedure rates were significantly higher for women with a chosen doctor versus without (cesareans 45% vs. 33%; inductions 32% vs. 19%; episiotomy 75% vs. 62%; epidural 13% vs. 5%), but had no direct effect on payments. Half of the sample (42% with a chosen doctor, 62% without) reported some form of disrespectful care, but this did not reduce payments. Despite reporting disrespect and higher rates of interventions, women rewarded the presence of a chosen doctor with informal payments. They may be unaware of evidence-based standards, and trust that their chosen doctor provided high quality maternity care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Reconhecimento dos aspectos tacêsicos para o cuidado afetivo e de qualidade ao idoso hospitalizado Reconocimiento de los aspectos de lenguaje del tacto para el cuidado afectivo y de calidad al anciano hospitalizado An approach to touching while providing high-quality affective health care to hospitalized elderly patients

    Directory of Open Access Journals (Sweden)

    Teresa Cristina Gioia Schimidt


    , revela la calidad de atención prestada.The aim of the present study was to verify the important factors of tacesics that should be observed while touching the elderly. This qualitative and exploratory field of study was developed using 117 undergraduate students and healthcare professionals who participated in a training course regarding nonverbal communication in gerontology. The results revealed that the majority of the participants were able to identify at least one care factor that must be respected when touching the elderly. The discourses allowed for the construction of nine categories indicating the conditions that are necessary for high-quality affective care provided within the tacesics context; these conditions included the authorization for the touch to occur, location of the touch, intensity of the touch, condition of the elderly person, intentionality and type of touch, duration of the touch, gender and age of the person who touches and of the person being touched, frequency of the touch, and characteristics of the hands that touch. Touch is part of the quotidian practice of healthcare professionals and expresses their dedication and its related emotions, thereby revealing the quality of the care that is provided.

  12. High Quality Test Pattern Generation and Boolean Satisfiability

    CERN Document Server

    Eggersglüß, Stephan


    This book provides an overview of automatic test pattern generation (ATPG) and introduces novel techniques to complement classical ATPG, based on Boolean Satisfiability (SAT).  A fast and highly fault efficient SAT-based ATPG framework is presented which is also able to generate high-quality delay tests such as robust path delay tests, as well as tests with long propagation paths to detect small delay defects. The aim of the techniques and methodologies presented in this book is to improve SAT-based ATPG, in order to make it applicable in industrial practice. Readers will learn to improve the performance and robustness of the overall test generation process, so that the ATPG algorithm reliably will generate test patterns for most targeted faults in acceptable run time to meet the high fault coverage demands of industry. The techniques and improvements presented in this book provide the following advantages: Provides a comprehensive introduction to test generation and Boolean Satisfiability (SAT); Describes a...

  13. Providing assistive technology in Italy: the perceived delivery process quality as affecting abandonment. (United States)

    Federici, Stefano; Borsci, Simone


    The study brings together three aspects rarely observed at once in assistive technology (AT) surveys: (i) the assessment of user interaction/satisfaction with AT and service delivery, (ii) the motivational analysis of AT abandonment, and (iii) the management/design evaluation of AT delivery services. 15 health professionals and 4 AT experts were involved in modelling and assessing four AT Local Health Delivery Service (Centres) in Italy through a SWOT analysis and a Cognitive Walkthrough. In addition 558 users of the same Centres were interviewed in a telephone survey to rate their satisfaction and AT use. The overall AT abandonment was equal to 19.09%. Different Centres' management strategies resulted in different percentages of AT disuse, with a range from 12.61% to 24.26%. A significant difference between the declared abandonment and the Centres' management strategies (p = 0.012) was identified. A strong effect on abandonment was also found due to professionals' procedures (p = 0.005) and follow-up systems (p = 0.002). The user experience of an AT is affected not only by the quality of the interaction with the AT, but also by the perceived quality of the Centres in support and follow-up. Implications for Rehabilitation AT abandonment surveys provide useful information for modelling AT assessment and delivery process. SWOT and Cognitive Walkthrough analyses have shown suitable methods for exploring limits and advantages in AT service delivery systems. The study confirms the relevance of person centredness for a successful AT assessment and delivery process.

  14. Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits. (United States)

    Schoenfeld, Adam J; Davies, Jason M; Marafino, Ben J; Dean, Mitzi; DeJong, Colette; Bardach, Naomi S; Kazi, Dhruv S; Boscardin, W John; Lin, Grace A; Duseja, Reena; Mei, Y John; Mehrotra, Ateev; Dudley, R Adams


    .4%). No statistically significant variation in guideline adherence by mode of communication (videoconference vs telephone vs webchat) was found. Significant variation in quality was found among companies providing virtual visits for management of common acute illnesses. More variation was found in performance for some conditions than for others, but no variation by mode of communication.

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

    DEFF Research Database (Denmark)

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

    and the necessary technical expertise. This quality manual was therefore developed to guide small- to medium-scale cassava in the design and implematation of Hazard Analysis Critical Control Point (HACCP) system and Good manufacturing Practices (GMP) plans for HQCF production. It describes the HQCF production...... methods, and explanins in practical terms the concept of HACCP/QACCP quality system and procedure for aplication to HQCF production. The procedures described in this manual should help cassava processing enterprises to implement the HACCP/QACCP system from the point of root delivery through every...

  16. Highly qualified does not equal high quality: A study of urban stakeholders' perceptions of quality in science teaching (United States)

    Miranda, Rommel Joseph

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

  17. Surgery and trauma care providers' perception of the impact of dual-practice employment on quality of care provided in an Andean country. (United States)

    LaGrone, L N; Isquith-Dicker, L N; Huaman Egoavil, E; Herrera-Matta, J J; Fuhs, A K; Ortega Checa, D; Revoredo, F; Rodriguez Castro, M J A; Mock, C N


    Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  18. Complementary ecosystem services provided by pest predators and pollinators increase quantity and quality of coffee yields. (United States)

    Classen, Alice; Peters, Marcell K; Ferger, Stefan W; Helbig-Bonitz, Maria; Schmack, Julia M; Maassen, Genevieve; Schleuning, Matthias; Kalko, Elisabeth K V; Böhning-Gaese, Katrin; Steffan-Dewenter, Ingolf


    Wild animals substantially support crop production by providing ecosystem services, such as pollination and natural pest control. However, the strengths of synergies between ecosystem services and their dependencies on land-use management are largely unknown. Here, we took an experimental approach to test the impact of land-use intensification on both individual and combined pollination and pest control services in coffee production systems at Mount Kilimanjaro. We established a full-factorial pollinator and vertebrate exclosure experiment along a land-use gradient from traditional homegardens (agroforestry systems), shaded coffee plantations to sun coffee plantations (total sample size = 180 coffee bushes). The exclusion of vertebrates led to a reduction in fruit set of ca 9%. Pollinators did not affect fruit set, but significantly increased fruit weight of coffee by an average of 7.4%. We found no significant decline of these ecosystem services along the land-use gradient. Pest control and pollination service were thus complementary, contributing to coffee production by affecting the quantity and quality of a major tropical cash crop across different coffee production systems at Mount Kilimanjaro.

  19. Can a mobile app improve the quality of patient care provided by trainee doctors? Analysis of trainees' case reports. (United States)

    Webb, Katie; Bullock, Alison; Dimond, Rebecca; Stacey, Mark


    To explore how a medical textbook app ('iDoc') supports newly qualified doctors in providing high-quality patient care. The iDoc project, funded by the Wales Deanery, provides new doctors with an app which gives access to key medical textbooks. Participants' submitted case reports describing self-reported accounts of specific instances of app use. The size of the data set enabled analysis of a subsample of 'complex' case reports. Of the 568 case reports submitted by Foundation Year 1s (F1s)/Year 2s (F2s), 142 (25%) detailed instances of diagnostic decision-making and were identified as 'complex'. We analysed these data against the Quality Improvement (QI) Framework using thematic content analysis. Clinical settings across Wales, UK. Newly qualified doctors (2012-2014; n=114), F1 and F2. The iDoc app, powered by Dr Companion software, provided newly qualified doctors in Wales with a selection of key medical textbooks via individuals' personal smartphone. Doctors' use of the iDoc app supported 5 of the 6 QI elements: efficiency, timeliness, effectiveness, safety and patient-centredness. None of the case reports were coded to the equity element. Efficiency was the element which attracted the highest number of case report references. We propose that the QI Framework should be expanding to include 'learning' as a 7th element. Access to key medical textbooks via an app provides trusted and valuable support to newly qualified doctors during a period of transition. On the basis of these doctors' self-reported accounts, our evidence indicates that the use of the app enhances efficiency, effectiveness and timeliness of patient-care in addition consolidating a safe, patient-centred approach. We propose that there is scope to extend the QI Framework by incorporating 'learning' as a 7th element in recognition of the relationship between providing high-quality care through educational engagement. Published by the BMJ Publishing Group Limited. For permission to use (where not

  20. Quality of Care in Contraceptive Services Provided to Young People in Two Ugandan Districts: A Simulated Client Study (United States)

    Nalwadda, Gorrette; Tumwesigye, Nazarius M.; Faxelid, Elisabeth; Byamugisha, Josaphat; Mirembe, Florence


    Background Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15–24 in two rural districts in Uganda. Methods Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed. Results Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy. Conclusions The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed. PMID:22132168

  1. Quality of healthcare services provided in disaster shelters: An integrative literature review. (United States)

    Veenema, Tener Goodwin; Rains, Adam B; Casey-Lockyer, Mary; Springer, Janice; Kowal, Mary


    Globally, shelters are a resource to promote critical health and safety in disasters, particularly for vulnerable populations (e.g., children, elderly, chronically ill). This study examines the nature and quality of healthcare services rendered in disaster and emergency shelters. To determine based upon systematic and accurate measurement the scope and quality of health care services rendered in disaster shelters and to describe the health outcomes experienced by shelter residents. An integrative review of English-language literature pertaining to the assessment, evaluation, and systematic measurement of healthcare quality and client outcomes in disaster and emergency shelters was undertaken. Articles were identified using a structured search strategy of six databases and indexing services (PubMed, CINAHL, EMBase, Scopus, Web of Science, and Google Scholar). Limited literature exists pertaining specifically to metrics for quality of health care in acute disaster and emergency shelters, and the literature that does exist is predominately U.S. based. Analysis of the existing evidence suggests that nurse staffing levels and staff preparedness, access to medications/medication management, infection control, referrals, communication, and mental health may be important concepts related to quality of disaster health care services. A small number of population-based and smaller, ad hoc outcomes-based evaluation efforts exist; however the existing literature regarding systematic outcomes-based quality assessment of disaster sheltering healthcare services is notably sparse. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Provider Knowledge of Trivalent Inactivated and High-Dose Influenza Vaccines


    Tewell, Chad; Wright, Patty W.; Talbot, H. Keipp


    The objective of this study was to assess provider knowledge about trivalent inactivated and high dose influenza vaccines. Hence, a 20 item survey was distributed to providers within the Internal Medicine department at an urban academic medical center.


    Directory of Open Access Journals (Sweden)

    Cristian Valentin HAPENCIUC


    Full Text Available Taking into account its pragmatic meaning, the success of a travel agency frequently relies on the activity of travel agents. In the process of promoting and selling flat voyages, customer service can be directly influenced by the interaction of factors such as: offer accuracy, sales representatives quality, employee timeliness, politeness of the travel agent, maintaining eye contact etc., all of which are components of the offered product. Thereby, we conducted, within the period 5 - 15 March 2015, a research based on interviews with 26 travel agents from 20 different units, in order to determine their awareness about potential factors that may have an influence on the quality of offered services. By the instrumentality of a questionnaire, we attempted to assess the integrity and loyalty of employees, their attitude regarding the activities they carry, their dissatisfaction, negative and  positive factors influencing service quality, and their positioning to the organization and brand.

  4. Combining QOF data with the care bundle approach may provide a more meaningful measure of quality in general practice

    Directory of Open Access Journals (Sweden)

    de Wet Carl


    Full Text Available Abstract Background A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the ‘care bundle’ concept as indicators of the reliability of specific (evidence-based care delivery tasks and improved outcomes. A care bundle consists of a number of time-specific interventions that should be delivered to every patient every time. We aimed to apply the care bundle concept to selected QOF data to measure the quality of evidence-based care provision. Methods Care bundles and components were selected from QOF indicators according to defined criteria. Five clinical conditions were suitable for care bundles: Secondary Prevention of Coronary Heart Disease (CHD, Stroke & Transient Ischaemic Attack (TIA, Chronic Kidney Disease (CKD, Chronic Obstructive Pulmonary Disease (COPD and Diabetes Mellitus (DM. Each bundle has 3-8 components. A retrospective audit was undertaken in a convenience sample of nine general medical practices in the West of Scotland. Collected data included delivery (or not of individual bundle components to all patients included on specific disease registers. Practice level and overall compliance with bundles and components were calculated in SPSS and expressed as a percentage. Results Nine practices (64.3% with a combined patient population of 56,948 were able to provide data in the format requested. Overall compliance with developed QOF-based care bundles (composite measures was as follows: CHD 64.0%, range 35.0-71.9%; Stroke/TIA 74.1%, range 51.6-82.8%; CKD 69.0%, range 64.0-81.4%; and COPD 82.0%, range 47.9-95.8%; and DM 58.4%, range 50.3-65.2%. Conclusions In this small study compliance with individual QOF-based care bundle components was high, but overall (‘all or nothing’ compliance was

  5. Do childcare menus meet nutrition guidelines? Quantity, variety and quality of food provided in New Zealand Early Childhood Education services. (United States)

    Gerritsen, Sarah; Dean, Brianna; Morton, Susan M B; Wall, Clare R


    To describe food provision and evaluate menus in New Zealand childcare services, determining associations with service characteristics and/or cost of menu. Licensed services in three regions of New Zealand participated in an online survey, uploading a weekly menu where applicable. Menus were scored for compliance with guidelines on quantity, variety and quality of foods served. Bivariate and multivariate associations between menu score and service characteristics were analysed. A total of 257 services participated (30% of 847 services invited). Food was provided daily in 56%, with 34% providing lunch and snacks daily. Of the 57 full menus analysed, only three (5%) met all 10 scoring criteria (mean score of 6.8/10). Higher menu scores were statistically associated with employing a cook, high and low (not medium) neighbourhood deprivation, the Heart Foundation's Healthy Heart Award program; there was no association with food costs. The Healthy Heart Award remained statistically associated with higher menu score after adjustment for other service characteristics. Most menus did not meet current nutrition guidelines for quantity, variety, and limiting 'sometimes' and 'occasional' foods. Implications for public health: This study provides a baseline for monitoring menu compliance in New Zealand and evidence for nutrition promotion and menu improvement programmes in early education. © 2017 The Authors.

  6. Can branding by health care provider organizations drive the delivery of higher technical and service quality? (United States)

    Snihurowych, Roman R; Cornelius, Felix; Amelung, Volker Eric


    Despite the widespread use of branding in nearly all other major industries, most health care service delivery organizations have not fully embraced the practices and processes of branding. Facilitating the increased and appropriate use of branding among health care delivery organizations may improve service and technical quality for patients. This article introduces the concepts of branding, as well as making the case that the use of branding may improve the quality and financial performance of organizations. The concepts of branding are reviewed, with examples from the literature used to demonstrate their potential application within health care service delivery. The role of branding for individual organizations is framed by broader implications for health care markets. Branding strategies may have a number of positive effects on health care service delivery, including improved technical and service quality. This may be achieved through more transparent and efficient consumer choice, reduced costs related to improved patient retention, and improved communication and appropriateness of care. Patient satisfaction may be directly increased as a result of branding. More research into branding could result in significant quality improvements for individual organizations, while benefiting patients and the health system as a whole.

  7. Leadership qualities when providing therapy for women who suffer from eating difficulties. (United States)

    Rørtveit, Kristine; Severinsson, Elisabeth


    The aim of this study was to reflect on aspects of mental health nursing leadership qualities with special focus on the therapeutic process for women who suffer from eating difficulties (ED). Therapy for patients with ED involves motivating them to make meaningful changes. Leadership qualities in MHN should focus on the relationship with the patient and positive empowerment processes. In-depth interviews were conducted with six women suffering from ED who had participated in art therapy. The interviews were analysed by means of an interpretative hermeneutic approach. A main theme 'The mental health nurse as a formative and mindful leader in a group therapeutic relationship' and two themes 'Leading sensitively towards awakening the patients' awareness of their pre-understanding' and 'Leading dialectically towards solving patients' existential dilemmas' were developed and comprised two aspects of leadership. The nurse-patient relationship is influenced by the patients' pre-understanding and existential dilemmas. Leadership qualities associated with being formative and mindful represent important aspects of this relationship and should be investigated and thematically described in greater detail in future research. The nurse-patient relationship should focus on clinical supervision, in order to strengthen the nurses' leadership qualities in terms of being aware and dialectical. © 2011 Blackwell Publishing Ltd.

  8. Quality of provided care in vascular surgery : outcome assessment & improvement strategies

    NARCIS (Netherlands)

    Flu, Hans Christiaan


    The aim of this thesis was to evaluate the quality of care in vascular surgery in end-stage renal disease (ESRD) and peripheral arterial occlusive disease (PAOD): intermittent claudication (IC) and critical lower limb ischaemia (CLI) patients. Therefore firstly it focused on the improvement of the

  9. Quality in Family Child Care: A Focus Group Study with Canadian Providers (United States)

    Doherty, Gillian


    A substantial proportion of American, Canadian and English preschoolers regularly participate in family child care making its quality of vital importance for the children concerned, their parents, the school system and the society in which they live. This article discusses the seven key caregiver behaviors and physical space characteristics…

  10. Construction of High-Quality Camel Immune Antibody Libraries. (United States)

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


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

  11. Evaluation of quality of life in caregivers who are providing home care to cancer patients. (United States)

    Cubukcu, Mahcube


    The author aimed to evaluate the quality of life and the factors affecting the caregivers of cancer patients receiving home care. This cross-sectional descriptive study was performed in 48 cancer patients who were served from home care unit and 48 caregivers between 01 and 28 February 2014. Patients' functional status was evaluated with Katz Index for Activities of Daily Living and the Lawton Scale for Instrumental Activities of Daily Living. The levels of quality of life of caregivers of patients with cancer were determined with Caregiver Quality of Life Index-Cancer (CQOLC). The mean age of forty-eight patients was 69.79 ± 16.09 years; 62.5% of them were female. The mean duration of home care was 5.99 ± 5.26 years; 25% of patients were fully dependent on the bed. 83.3% of caregivers were female, mean age of caregivers was 50.75 ± 14.89 years, and 77.1% of them were family members. The mean CQOLC score was 74.43 ± 24.45. The highest score was detected in the financial distress and the lowest score was detected in the positive adaptation. The quality of life is increasing as the length of care is reduced and income status increased. The quality of life of caregivers is very low. Each characteristic of the caregiver will affect the care he/she gives. From this point of view, it is important to consider the characteristics of caregivers in improving the care given to cancer patients. In this respect, there is a need to support caregivers both materially and spiritually.

  12. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease

    NARCIS (Netherlands)

    Sneeuw, Kommer C. A.; Sprangers, Mirjam A. G.; Aaronson, Neil K.


    Health-related quality of life (HRQL) studies sometimes rely, in part, on proxy information obtained from patients' significant others (spouse or close companion) or health care providers. This review: (1) provides a quantitative analysis of the results that have been reported in recent studies

  13. The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

    DEFF Research Database (Denmark)

    Meacock, R.; Kristensen, Søren Rud; Sutton, M.


    , and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the 13m pound total programme costs. By generating approximately 5200 quality-adjusted life years and 4.4m......Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered......, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost-effectiveness need to consider who the residual claimant is on any cost savings, the possibility of positive and negative spillovers...

  14. Evaluating Quality Management of Acute Low Back Problems Provided By Air Force Nurse Practitioners (United States)


    in males less that 20 years old and abdominal aortic aneurysms are to be contemplated if the patient is older than 50 years old. If any critical...resources limited by cost. Bergman (1995) discussed how financial objectives can be achieved without compromising the quality of care in the pediatric arena...Although his article focused on the pediatric population, the issues discussed apply to medical practice in general. The author stated how the

  15. Indoor Air Quality in High Performance Schools (United States)

    High performance schools are facilities that improve the learning environment while saving energy, resources, and money. The key is understanding the lifetime value of high performance schools and effectively managing priorities, time, and budget.

  16. Patient satisfaction with the quality of dental treatment provided by interns

    Directory of Open Access Journals (Sweden)

    Kun-Tsung Lee


    Conclusion: Medical centers should guide interns in clinical cases and provide structured training. These measures could enhance the public's confidence in interns and improve patient satisfaction with interns through improved clinical skills, and provide an excellent work force for the dental field.

  17. Providing better thermal and air quality conditions in school classrooms would be cost-effective

    DEFF Research Database (Denmark)

    Wargocki, Pawel; Wyon, David Peter


    codes stipulate that they should be. This is sometimes because financial resources for the maintenance and upgrade of school buildings are inadequate, but it is also because schools are increasingly allowing classroom temperatures to drift above the recommended range of 20–22 °C in warm weather......This paper is an overall summary of research by the authors on how classroom conditions affect the performance of schoolwork by children, motivated by the fact that the thermal and air quality conditions in school classrooms are now almost universally worse than the relevant standards and building...

  18. Simulation of High Quality Ultrasound Imaging

    DEFF Research Database (Denmark)

    Hemmsen, Martin Christian; Kortbek, Jacob; Nikolov, Svetoslav Ivanov


    This paper investigates if the influence on image quality using physical transducers can be simulated with an sufficient accuracy to reveal system performance. The influence is investigated in a comparative study between Synthetic Aperture Sequential Beamformation (SASB) and Dynamic Receive Focus...... is modeled by incorporating measured element pulse echo responses into the simulation software. Validation is performed through measurements on a water phantom with three metal wires, each with a diameter of 0.07 mm. Results show that when comparing measurement and simulation, the lateral beam profile using...

  19. Production of high-quality fish oil from herring byproducts

    NARCIS (Netherlands)

    Aidos, I.M.F.


    In this work, the feasibility of producing high-quality fish oil from herring byproducts was evaluated in various ways. With this, a contribution has been made to a more efficient usage of natural resources while yielding a high-quality product. Crude oil extracted from herring byproducts

  20. Looking for High Quality Accreditation in Higher Education in Colombia (United States)

    Pérez Gama, Jesús Alfonso; Vega Vega, Anselmo


    We look for the High Quality Accreditation of tertiary education in two ways: one, involving large amount of information, including issues such as self-assessment, high quality, statistics, indicators, surveys, and field work (process engineering), during several periods of time; and the second, in relation to the information contained there about…

  1. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective.

    Directory of Open Access Journals (Sweden)

    Alex Filby

    Full Text Available Quality of care is essential for further progress in reducing maternal and newborn deaths. The integration of educated, trained, regulated and licensed midwives into the health system is associated with improved quality of care and sustained decreases in maternal and newborn mortality. To date, research on barriers to quality of care for women and newborns has not given due attention to the care provider's perspective. This paper addresses this gap by presenting the findings of a systematic mapping of the literature of the social, economic and professional barriers preventing midwifery personnel in low and middle income countries (LMICs from providing quality of care.A systematic search of five electronic databases for literature published between January 1990 and August 2013. Eligible items included published and unpublished items in all languages. Items were screened against inclusion and exclusion criteria, yielding 82 items from 34 countries. 44% discussed countries or regions in Africa, 38% in Asia, and 5% in the Americas. Nearly half the articles were published since 2011. Data was extracted and presented in a narrative synthesis and tables. Items were organized into three categories; social; economic and professional barriers, based on an analytical framework. Barriers connected to the socially and culturally constructed context of childbirth, although least reported, appear instrumental in preventing quality midwifery care.Significant social and cultural, economic and professional barriers can prevent the provision of quality midwifery care in LMICs. An analytical framework is proposed to show how the overlaps between the barriers reinforce each other, and that they arise from gender inequality. Links are made between burn out and moral distress, caused by the barriers, and poor quality care. Ongoing mechanisms to improve quality care will need to address the barriers from the midwifery provider perspective, as well as the underlying

  2. Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine. (United States)

    Luck, J; Peabody, J W; DeMaria, L M; Alvarado, C S; Menon, R


    Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies

  3. 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. (United States)

    Johansen, Monika Alise; Berntsen, Gro K Rosvold; Schuster, Tibor; Henriksen, Eva; Horsch, Alexander


    articles showing high risk or unclear risk for both selective reporting and blinding of outcome assessment from the effect assessment. The authors' hypothesis was confirmed for 13 (65%) of the 20 remaining articles. Articles on self-management support were of higher quality, allowing us to assess effects in a larger proportion of studies. All except one self-management interventions were equally effective to or better than the control option. The self-management articles document substantial benefits for patients, and partly also for health professionals and the health care system. Electronic symptom reporting between patients and providers is an exciting area of development for health services. However, the research generally is of low quality. The field would benefit from increased focus on methods for conducting and reporting RCTs. It appears particularly important to improve blinding of outcome assessment and to precisely define primary outcomes to avoid selective reporting. Supporting self-management seems to be especially promising, but consultation support also shows encouraging results.

  4. A haemovigilance team provides both significant financial and quality benefits in a University Hospital. (United States)

    Decadt, Ine; Costermans, Els; Van de Poel, Maai; Kesteloot, Katrien; Devos, Timothy


    Haemovigilance is the process of surveillance of blood transfusion procedures including unexpected hazards and reactions during the transfusion pathway in both donors and recipients. The haemovigilance team aims to increase blood transfusion safety and to decrease both morbidity and mortality in donors and recipients. The team collects data about transfusion reactions and incidents, instructs the involved health workers and assures the tracing of blood components. The haemovigilance team at the University Hospitals Leuven has played a pioneering role in the development of haemovigilance in Belgium Although the literature about safety and quality improvements by haemovigilance systems is abundant, there are no published data available measuring their financial impact in a hospital. Therefore, we studied the costs and returns of the haemovigilance team at the University Hospitals Leuven. This study has a descriptive explorative design. Research of the current costs and returns of the haemovigilance team were based upon data from the Medical Administration of the hospital. Data were analyzed descriptively. The haemovigilance team of the University Hospitals Leuven is financially viable: the direct costs are covered by the annual financial support of the National Public Health Service. The indirect returns come from two important tasks of the haemovigilance team itself: correction of the electronic registration of administered blood component and improvement of the return of conform preserved blood components to the blood bank. Besides safety and quality improvement, which are obviously their main goals, the haemovigilance team also implies a financial benefit for the hospital. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Develop high quality nursing service and normalize management of neonatal ward

    Directory of Open Access Journals (Sweden)

    Hua YANG


    Full Text Available Objective: To tamp basic neonatal care, provide high quality nursing service, improve the quality of neonatal care, guarantee the safety of nursing care, achieve satisfactory project. Methods:Adjust the staff of the neonatal ward , optimize schedule; strengthen the training and knowledge; strengthen the supervision and ensure the basic nursing; the nursing quality management group work out the rate of incidence of high quality nursing service, the incidence rate of hospital infection of the newborn as well as the satisfaction of their families. Results: The different data between the control group and observation group was statistically significant ( P < 0.05 . Conclusion: Develop the neonatal ward of high quality nursing service, ensure the basic nursing implement, significantly improve the quality of nursing, reduce nursing adverse events and neonatal hospital infection incidence to" zero defects and zero tolerance", and that ensures nursing safety, and achieve the goal of " quality care demonstration project" --- patient satisfaction, social satisfaction, and government satisfaction.

  6. Perception of CPR quality: Influence of CPR feedback, Just-in-Time CPR training and provider role. (United States)

    Cheng, Adam; Overly, Frank; Kessler, David; Nadkarni, Vinay M; Lin, Yiqun; Doan, Quynh; Duff, Jonathan P; Tofil, Nancy M; Bhanji, Farhan; Adler, Mark; Charnovich, Alex; Hunt, Elizabeth A; Brown, Linda L


    Many healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions. We conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm. Participants overestimated achieving adequate chest compression depth (mean difference range: 16.1-60.6%) and rate (range: 0.2-51%), and underestimated chest compression fraction (0.2-2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth (pPerception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p=0.043) when using real-time feedback. Healthcare providers' visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Stanka Preskar


    Full Text Available With Slovenia joining the EU the need for higher quality and faster transit transport of goods through customs procedures has increased. This paper presents the recent logistics approach, which allows a better link between transportation and freight forwarding. Modern computer programs used by forwarding companies have contributed to this. Forwarder companies may have a role of organizer or a place using the transport services of customs clearance of goods at the entry / exit to / from the European Union. Each type of transport has a role to play, but gets even stronger when combined under one category. This is a multimodal transport. As an example we use logistic work in a logistic company. Here the work is divided in to transit of goods, customs clearance of goods, but also touching the law and the ranking of goods by tariff codes.

  8. Effectively teaching self-assessment: preparing the dental hygiene student to provide quality care. (United States)

    Jackson, Sarah C; Murff, Elizabeth J Tipton


    Literature on self-assessment presents substantial evidence regarding the impact of self-assessment on dental practitioners and quality of care. Related dental hygiene research documents a need to enhance self-assessment curricula; however, no published curriculum module exists to effectively teach self-assessment. The purpose of this study was to explore the impact of a self-assessment educational module for dental hygiene curricula designed using adult learning principles. This module was implemented with thirty-three dental hygiene students in their junior year using a one-group, pretest-posttest design. Results analyzed using matched pairs Wilcoxon signed-rank test indicated the self-assessment module was effective (pforms was also enhanced after module implementation (peffective. Findings indicate a self-assessment educational module enhanced these dental hygiene students' self-assessment perceptions and skills.

  9. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective (United States)

    McConville, Fran; Portela, Anayda


    Background Quality of care is essential for further progress in reducing maternal and newborn deaths. The integration of educated, trained, regulated and licensed midwives into the health system is associated with improved quality of care and sustained decreases in maternal and newborn mortality. To date, research on barriers to quality of care for women and newborns has not given due attention to the care provider’s perspective. This paper addresses this gap by presenting the findings of a systematic mapping of the literature of the social, economic and professional barriers preventing midwifery personnel in low and middle income countries (LMICs) from providing quality of care. Methods and Findings A systematic search of five electronic databases for literature published between January 1990 and August 2013. Eligible items included published and unpublished items in all languages. Items were screened against inclusion and exclusion criteria, yielding 82 items from 34 countries. 44% discussed countries or regions in Africa, 38% in Asia, and 5% in the Americas. Nearly half the articles were published since 2011. Data was extracted and presented in a narrative synthesis and tables. Items were organized into three categories; social; economic and professional barriers, based on an analytical framework. Barriers connected to the socially and culturally constructed context of childbirth, although least reported, appear instrumental in preventing quality midwifery care. Conclusions Significant social and cultural, economic and professional barriers can prevent the provision of quality midwifery care in LMICs. An analytical framework is proposed to show how the overlaps between the barriers reinforce each other, and that they arise from gender inequality. Links are made between burn out and moral distress, caused by the barriers, and poor quality care. Ongoing mechanisms to improve quality care will need to address the barriers from the midwifery provider perspective

  10. Generation of High Quality Laser Accelerated Ion Beams


    Esirkepov, T. Zh.; Bulanov, S. V.; Nishihara, K.; Tajima, T.; Pegoraro, F.; Khoroshkov, V. S.; Mima, K.; Daido, H.; Kato, Y.; Kitagawa, Y.; Nagai, K.; Sakabe, S.


    In order to achieve a high quality, i. e. monoergetic, intense ion beam, we propose the use of a double layer target. The first layer, at the target front, consists of high-Z atoms, while the second (rear) layer is a thin coating of low-Z atoms. The high quality proton beams from the double layer target, irradiated by an ultra-intense laser pulse, are demonstrated with three dimensional Particle-in-Cell simulations.

  11. Nurses and Dietitians Differ in Food Safety Information Provided to Highly Susceptible Clients (United States)

    Buffer, Janet; Kendall, Patricia; Medeiros, Lydia; Schroeder, Mary; Sofos, John


    Objective: To determine content, education channels, and motivational factors that influence what health professionals teach about safe food handling to populations who are highly susceptible for foodborne illnesses. To assess the differences in information provided by health professionals to highly susceptible populations. Design: Descriptive,…

  12. Parallel experimental design and multivariate analysis provides efficient screening of cell culture media supplements to improve biosimilar product quality. (United States)

    Brühlmann, David; Sokolov, Michael; Butté, Alessandro; Sauer, Markus; Hemberger, Jürgen; Souquet, Jonathan; Broly, Hervé; Jordan, Martin


    Rational and high-throughput optimization of mammalian cell culture media has a great potential to modulate recombinant protein product quality. We present a process design method based on parallel design-of-experiment (DoE) of CHO fed-batch cultures in 96-deepwell plates to modulate monoclonal antibody (mAb) glycosylation using medium supplements. To reduce the risk of losing valuable information in an intricate joint screening, 17 compounds were separated into five different groups, considering their mode of biological action. The concentration ranges of the medium supplements were defined according to information encountered in the literature and in-house experience. The screening experiments produced wide glycosylation pattern ranges. Multivariate analysis including principal component analysis and decision trees was used to select the best performing glycosylation modulators. Subsequent D-optimal quadratic design with four factors (three promising compounds and temperature shift) in shake tubes confirmed the outcome of the selection process and provided a solid basis for sequential process development at a larger scale. The glycosylation profile with respect to the specifications for biosimilarity was greatly improved in shake tube experiments: 75% of the conditions were equally close or closer to the specifications for biosimilarity than the best 25% in 96-deepwell plates. Biotechnol. Bioeng. 2017;114: 1448-1458. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  13. Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data. (United States)

    Englot, Dario J; Hassnain, Kevin H; Rolston, John D; Harward, Stephen C; Sinha, Saurabh R; Haglund, Michael M


    Drug-resistant epilepsy is a devastating disorder associated with diminished quality of life (QOL). Surgical resection leads to seizure freedom and improved QOL in many epilepsy patients, but not all individuals are candidates for resection. In these cases, neuromodulation-based therapies such as vagus nerve stimulation (VNS) are often used, but most VNS studies focus exclusively on reduction of seizure frequency. QOL changes and predictors with VNS remain poorly understood. Using the VNS Therapy Patient Outcome Registry, we examined 7 metrics related to QOL after VNS for epilepsy in over 5000 patients (including over 3000 with ≥12months follow-up), as subjectively assessed by treating physicians. Trends and predictors of QOL changes were examined and related to post-operative seizure outcome and likelihood of VNS generator replacement. After VNS therapy, physicians reported patient improvement in alertness (58-63%, range over follow-up period), post-ictal state (55-62%), cluster seizures (48-56%), mood change (43-49%), verbal communication (38-45%), school/professional achievements (29-39%), and memory (29-38%). Predictors of net QOL improvement included shorter time to implant (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6), generalized seizure type (OR, 1.2; 95% CI, 1.0-1.4), female gender (OR, 1.2; 95% CI, 1.0-1.4), and Caucasian ethnicity (OR, 1.3; 95% CI, 1.0-1.5). No significant trends were observed over time. Patients with net QOL improvement were more likely to have favorable seizure outcomes (chi square [χ 2 ]=148.1, pmetrics subjectively rated by physicians. QOL improvement is associated with favorable seizure outcome and a higher likelihood of generator replacement, suggesting satisfaction with therapy. It is important to consider QOL metrics in neuromodulation for epilepsy, given the deleterious effects of seizures on patient QOL. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment. (United States)

    Locatelli, Sara M; LaVela, Sherri L


    Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress.


    Directory of Open Access Journals (Sweden)

    Y. L. Anokhin


    Full Text Available Introduction. Determination of power quality indices in high-voltage power grids allows to find the reasons for the deterioration of the power quality. The relevant national and International Standards for power quality contain relevant norms of quality indices and requirements for their accuracy measurement. Problem. The most complicated part in the process of measuring the power quality indices at high voltage is the selection of the corresponding high-voltage scale voltage converters. Therefore, comparing the requirements of IEC 61000-4-30 to high voltage scale voltage converters is an important task. Goal. Analysis of the International Standard IEC 61000-4-30 requirements feasibility for measuring the indices of power quality in high-voltage electrical networks using different types of high-voltage scale voltage converters. Methodology. Comparison of the requirements of IEC 61000-4-30 Standard to high-voltage scale voltage converters, when measuring power quality indices, with the characteristics of high voltage electromagnetic transformers used in Ukraine, and with promising developments of high-voltage converters of other types. Results. It is shown in the study that in order to fulfill some of the requirements for class A of IEC 61000-4-30, the characteristics of electromagnetic voltage transformers should be determined in the substation conditions using mobile calibration high-voltage laboratories. To meet all the requirements for Class A IEC 61000-4-30, it is recommended to use broadband high-voltage dividers of resistive-capacitive type. Originality. In study it is shown firstly that all the requirements of the IEC 61000-4-30 Standard for high-voltage scale voltage converters can be performed on the basis of the use of broadband resistive-capacitive damped voltage dividers. Practical value. Expositions of specific types of resistive-capacitive high-voltage dividers are presented, their parameters are confirmed by the results of state

  16. Providing informal home care for pressure ulcer patients: how it affects carers' quality of life and burden. (United States)

    Rodrigues, Alexandre M; Ferreira, Pedro L; Ferré-Grau, Carmen


    To evaluate the quality of life of informal caregivers of patients with pressure ulcer; to assess their levels of burden; to analyse the variables influencing both their quality of life and burden. Informal caregivers of pressure ulcer patients, besides coping with the natural dependency of these patients, deal with the specificity of caring these types of wounds. This situation has an impact on not only the quality of life and burden felt by informal caregivers but also on individual and familiar dynamics. Descriptive and correlational study. This study focused on 145 informal caregivers providing home care. Measurement instruments were: SF-36v2 and the Burden Interview Scale. Descriptive analysis of the quantitative variables was carried out according to measures of central tendency, and the qualitative variables were described using absolute and relative frequencies. The relationships or associations between variables were explored through correlational analysis and, whenever the data allowed, multivariate techniques were used. Informal caregivers showed low levels of quality of life and, most of them, significant burden. Quality of life decreased with overload, with the increasing number of pressure ulcer and with less experience of informal caregivers, with lack of financial remuneration, with unemployment, with patient positioning and with the direct care of the wound. The burden increased with the number of pressure ulcer in each patient and with the lack of financial remuneration. These informal caregivers have low quality of life and are overburdened. Both situations are positively and negatively influenced by factors related to the pressure ulcer and to the patients' sociodemographic data. The results of this study allow more effective monitoring by health professionals of levels of burden and quality of life encountered in pressure ulcer informal caregivers, as well as direct interventions to inhibit the factors inducing burden and enhance those that

  17. Relating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals. (United States)

    Mahrous, Mohamed Saad


    This study aims to identify the satisfaction levels of the family members of patients in intensive care units. This is a cross-sectional analytical study. General intensive care units offer a variety of services to clinical and surgical patients. For the purpose of this study, a trained interviewer communicated with the families of patients, either before or after visiting hours. The study included 208 participants: 119 (57.2%) males and 89 (42.8%) females. Seventy-three (35.1%) of the patients attended a private hospital, and 135 (64.9%) attended a public hospital in the city of Al Madinah Al- Munawarah. All of the participants were either family members or friends of patients admitted to the intensive care units at the hospitals. The responses of both groups yielded low scores on the satisfaction index. However, a relatively high score was noted in response to questions 2, 6, and 10, which concerned the care that was extended by the hospital staff to their patients, the courteous attitude of intensive care unit staff members towards patients, and patients' satisfaction with the medical care provided, respectively. A very low score was obtained for item 11, which was related to the possibility for improvements to the medical care that the patients received. Overall, greater satisfaction with the services offered by the public intensive care units was reported compared to the satisfaction with the services offered by the private intensive care units. An overall low score on the satisfaction index was obtained, and further studies are recommended to assess the current situation and improve the satisfaction and quality of care provided by intensive care units.

  18. Towards organizational development for sustainable high-quality medical teaching. (United States)

    Engbers, Rik; de Caluwé, Léon I A; Stuyt, Paul M J; Fluit, Cornelia R M G; Bolhuis, Sanneke


    Literature shows that faculty development programmes are not organizationally embedded in academic hospitals. This leaves medical teaching a low and informal status. The purpose of this article is to explore how organizational literature can strengthen our understanding of embedding faculty development in organizational development, and to provide a useful example of organizational development with regards to medical teaching and faculty development. Constructing a framework for organizational development from the literature, based on expert brainstorming. This framework is applied to a case study. A framework for organizational development is described. Applied in a context of medical teaching, these organizational insights show the process (and progress) of embedding faculty development in organizational development. Organizational development is a necessary condition for assuring sustainable faculty development for high-quality medical teaching. Organizational policies can only work in an organization that is developing. Recommendations for further development and future research are discussed.

  19. High-quality single crystals for neutron experiments

    Indian Academy of Sciences (India)

    To make headway on any problem in physics, high-quality single crystals are required. In this talk, special emphasis ... produces crystals of superior quality, circumventing many of the problems associated with, for example, flux growth from the melt. .... In these materials, it is possible to control the electric polarization by the ...

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

    African Journals Online (AJOL)

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

  1. Ensuring that the Sentinel-3A altimeter provides climate-quality data (United States)

    Quartly, G. D.; Nencioli, F.; Labroue, S.; Femenias, P.; Scharroo, R.; Abdalla, S.; Bonnefond, P.; Cancet, M.; Frery, M.-L.; Raynal, M.; Baker, S.; Muir, A.; Brockley, D.; Shepherd, A.; Garcia, P.; Roca, M.; Calmant, S.; Cretaux, J.-F.


    Sentinel-3A, launched in February 2016, is part of ESA's long-term commitment to climate monitoring from space. Its suite of instruments for measuring surface topography includes a Microwave Radiometer (MWR) and SRAL, the first delay-Doppler instrument to provide global coverage. SRAL promises fine spatial resolution and reduced noise levels that should together lead to improved performance over all Earth surfaces. The Sentinel-3 Mission Performance Centre (S3MPC) has been developing the methodology to evaluate the accuracy of retrievals, monitor any changes and develop solutions to known problems. The S3MPC monitors internal temperatures, path delays and the shape of the generated pulses to assess the instruments health. The MWR records over known reference surfaces are compared with those from other spaceborne instruments. Over the ocean the SRAL's return pulses are analysed to give range to the sea surface, wave height and signal strength (which can be interpreted as wind speed). The metocean data are regularly contrasted with records from in situ measurements and the output from meteorological models, which rapidly highlights the effects of any changes in processing. Range information is used to give surface elevation, which is assessed in three ways. First, flights over a dedicated radar transponder provide an estimate of path delay to within 10 mm (r.m.s.). Second, measurements are compared to GPS-levelled surfaces near Corsica and over Lake Issyk-kul. Third, there are consistency checks between ascending and descending passes and with other missions. Further waveform analysis techniques are being developed to improve the retrieval of information over sea-ice, land-ice and inland waters.

  2. Basic methodological preconditions for high quality research

    Directory of Open Access Journals (Sweden)

    Ševkušić Slavica


    Full Text Available The paper considers basic methodological preconditions for the qualitative oriented research, in other words, the approaches which in the study of social phenomena rely on theoretical and methodological as well as epistemological premises of a new scientific paradigm. The paper draws special attention to the discussion of criteria of verifiability in qualitative research, which are significantly different from the criteria of positivist approaches. Interpretative research paradigms in social studies have a long history and numerous sources and the very concept of "interpretative shift" consists of a number of different research approaches unified under the name of qualitative methodology. The aim of the paper is not to prove that traditional and new paradigms and quantitative and qualitative research approaches based on them are incompatible in the process of discovering pedagogical reality. The intention is to demonstrate that the complexity of social phenomena requires a complex methodology meaning a complementary use of methods and techniques from both research approaches. The study of qualitative methodological approaches and their application in research, discovery and change of pedagogical reality are particularly important because they may provide new insights into pedagogical reality and a new view of old problems. .

  3. The patient-provider relationship as experienced by a diverse sample of highly adherent HIV-infected people. (United States)

    Brion, John


    Qualitative interviews with 23 HIV-infected people who self-reported high-level adherence to antiretroviral therapy were used to examine the process by which they came to accept their HIV infection and engage in high-level adherence behaviors. A major theme that emerged during data analysis was the importance of the patient-provider relationship. The quality of the relationship between patient and provider emerged as an important component of working through early struggles with diagnosis and the on-going struggles of living with a chronic illness. A variety of factors impacting the patient-provider relationship emerged as subthemes. What can be taken from this study is the importance of the patient-provider relationship in the effective self-management of HIV infection. Additionally, several specific behaviors can enhance the patient-provider relationship and help assure movement toward patient acceptance of the illness and engagement in high-level adherence behaviors. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

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

    NARCIS (Netherlands)

    Stracke, Christian M.


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

  5. Innovative and high quality education through Open Education and OER

    NARCIS (Netherlands)

    Stracke, Christian M.


    Online presentation and webinar by Stracke, C. M. (2017, 18 December) on "Innovative and high quality education through Open Education and OER" for the Belt and Road Open Education Learning Week by the Beijing Normal University, China.



    Zorica Lazic


    Answers to the questions of how and in what way the quality of life of students, resilience and ICT support affects the quality of high education we will get through this work where main objective is to define a network of processes and process management ensuring more quality and more innovative managing and service provision, therefore satisfying the needs of service users - in this case the students of the university. To collect the relevant data in the thematic analysis of this paper, the...

  7. Letter to Editor: Electronic Medical Record, Step toward Improving the Quality of Healthcare Services and Treatment Provided to Patients

    Directory of Open Access Journals (Sweden)

    Elahe Gozali


    Full Text Available Information technology can increase the quality of medical care and is a target for many of the pioneers in the development of clinical or medical information. Electronic medical record (EMR, one of such technologies, is a well-known and valuable system to access patient information in hospitals. Electronic medical records which are used for the purpose of providing basic health care are available through a network of computers. All units of the hospital such as examination room, conference room, emergency, patient care units, nursing stations, operating rooms, recovery units, laboratory, radiology, pharmacy and medical records should have access to it. Among its advantages are improved quality of care provided to patients, better organized information, improvement in the timeliness of the process, accuracy and completeness of documentation, patient access to electronic copies of records, prevention of medication errors and allergies, reduced medical errors, immediate access to information in different places, decision support technology and improvement in the process of doing . S urely the use of electronic medical records has created a new dimension to patient care and clinical practice and will provide a comprehensive system to support people in the community and enhance the quality of services provided to them.

  8. The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care. (United States)

    Reddy, Ashok; Pollack, Craig E; Asch, David A; Canamucio, Anne; Werner, Rachel M


    Primary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care. To measure the effect of PCP turnover on patient experiences of care and ambulatory care quality. Observational, retrospective cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA). We included all patients enrolled in primary care at the VHA between 2010 and 2012 included in 1 of 2 national data sets used to measure our outcome variables: 326,374 patients in the Survey of Healthcare Experiences of Patients (SHEP; used to measure patient experience of care) associated with 8441 PCPs and 184,501 patients in the External Peer Review Program (EPRP; used to measure ambulatory care quality) associated with 6973 PCPs. Whether a patient experienced PCP turnover, defined as a patient whose provider (physician, nurse practitioner, or physician assistant) had left the VHA (ie, had no patient encounters for 12 months). Five patient care experience measures (from SHEP) and 11 measures of quality of ambulatory care (from EPRP). Nine percent of patients experienced a PCP turnover in our study sample. Primary care provider turnover was associated with a worse rating in each domain of patient care experience. Turnover was associated with a reduced likelihood of having a positive rating of their personal physician of 68.2% vs 74.6% (adjusted percentage point difference, -5.3; 95% CI, -6.0 to -4.7) and a reduced likelihood of getting care quickly of 36.5% vs 38.5% (adjusted percentage point difference, -1.1; 95% CI, -2.1 to -0.1). In contrast, PCP turnover was not associated with lower quality of ambulatory care except for a lower likelihood of controlling blood pressure of 78.7% vs 80.4% (adjusted percentage point difference, -1.44; 95% CI, -2.2 to -0.7). In 9 measures of ambulatory care quality, the difference between patients who experienced no

  9. Genome sequencing of the high oil crop sesame provides insight into oil biosynthesis. (United States)

    Wang, Linhai; Yu, Sheng; Tong, Chaobo; Zhao, Yingzhong; Liu, Yan; Song, Chi; Zhang, Yanxin; Zhang, Xudong; Wang, Ying; Hua, Wei; Li, Donghua; Li, Dan; Li, Fang; Yu, Jingyin; Xu, Chunyan; Han, Xuelian; Huang, Shunmou; Tai, Shuaishuai; Wang, Junyi; Xu, Xun; Li, Yingrui; Liu, Shengyi; Varshney, Rajeev K; Wang, Jun; Zhang, Xiurong


    Sesame, Sesamum indicum L., is considered the queen of oilseeds for its high oil content and quality, and is grown widely in tropical and subtropical areas as an important source of oil and protein. However, the molecular biology of sesame is largely unexplored. Here, we report a high-quality genome sequence of sesame assembled de novo with a contig N50 of 52.2 kb and a scaffold N50 of 2.1 Mb, containing an estimated 27,148 genes. The results reveal novel, independent whole genome duplication and the absence of the Toll/interleukin-1 receptor domain in resistance genes. Candidate genes and oil biosynthetic pathways contributing to high oil content were discovered by comparative genomic and transcriptomic analyses. These revealed the expansion of type 1 lipid transfer genes by tandem duplication, the contraction of lipid degradation genes, and the differential expression of essential genes in the triacylglycerol biosynthesis pathway, particularly in the early stage of seed development. Resequencing data in 29 sesame accessions from 12 countries suggested that the high genetic diversity of lipid-related genes might be associated with the wide variation in oil content. Additionally, the results shed light on the pivotal stage of seed development, oil accumulation and potential key genes for sesamin production, an important pharmacological constituent of sesame. As an important species from the order Lamiales and a high oil crop, the sesame genome will facilitate future research on the evolution of eudicots, as well as the study of lipid biosynthesis and potential genetic improvement of sesame.

  10. Quality of information about success rates provided on assisted reproductive technology clinic websites in Australia and New Zealand. (United States)

    Hammarberg, Karin; Prentice, Tess; Purcell, Isabelle; Johnson, Louise


    Many factors influence the chance of having a baby with assisted reproductive technologies (ART). A 2016 Australian Competition and Consumer Commission (ACCC) investigation concluded that ART clinics needed to improve the quality of information they provide about chance of ART success. To evaluate changes in the quality of information about success rates provided on the websites of ART clinics in Australia and New Zealand before and after the ACCC investigation. Desktop audits of websites of ART clinics in Australia and New Zealand were conducted in 2016 and 2017 and available information about success rates was scored using a matrix with eight variables and a possible range of scores of 0-9. Of the 54 clinic websites identified in 2016, 32 had unique information and were eligible to be audited. Of these, 29 were also eligible to be audited in 2017. While there was a slight improvement in the mean score from 2016 to 2017 (4.93-5.28), this was not statistically significantly different. Of the 29 clinics, 14 had the same score on both occasions, 10 had a higher and five a lower information quality score in 2017. To allow people who consider ART to make informed decisions about treatment they need comprehensive and accurate information about what treatment entails and what the likely outcomes are. As measured by a scoring matrix, most ART clinics had not improved the quality of the information about success rates following the ACCC investigation. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.


    Directory of Open Access Journals (Sweden)

    Larisa N. Paskhalova


    Full Text Available The aim of the investigation is to generalize the experience on implementation of the Program of development of educational institution that allows providing high quality of education in the conditions of introduction of Federal Educational Standards of New Generation. Methods. Traditional psychological and pedagogical methods involve: stating, developing and control. Analysis of the average data and dynamics of educational results, an expert estimation, interrogations and questioning are used. Results. Transition of a gymnasium to educational institution of new type has become result of introduction of the Program of development. The unique profile of establishment is created and priority positions are taken in the educational environment of the region; in response to an implementation of the program of the development focused on the social procurement. Efficiency of the Program is confirmed with intermediate results of monitoring concerning all subjects of educational space: trained, teachers and parents. The program allows all participants of educational process to be involved in process of introduction of new quality of education via the mechanism of realization of system. The program represents improvement of activity of structures of educational space of a gymnasium, development of resource base, and also a control system as a factor of ensuring stability of functioning and innovative development of a gymnasium. Scientific novelty. The possibility of implementation of the Program of development of educational institution through introduction of system-activity and project-based approach which connected nine sub-programmes in one complex (structured in three modules is shown. It includes introduction of Federal State Educational Standard (FSES, an international exam, development of a progymnasium, formation of the personality, ongoing support to gifted children, extension of innovative culture of teachers, efficiency of management and

  12. High-fidelity multiactor emergency preparedness training for patient care providers. (United States)

    Scott, Lancer A; Maddux, P Tim; Schnellmann, Jennifer; Hayes, Lauren; Tolley, Jessica; Wahlquist, Amy E


    Providing comprehensive emergency preparedness training (EPT) for patient care providers is important to the future success of emergency preparedness operations in the United States. Disasters are rare, complex events involving many patients and environmental factors that are difficult to reproduce in a training environment. Few EPT programs possess both competency-driven goals and metrics to measure life-saving performance during a multiactor simulated disaster. The development of an EPT curriculum for patient care providers-provided first to medical students, then to a group of experienced disaster medical providers-that recreates a simulated clinical disaster using a combination of up to 15 live actors and six high-fidelity human simulators is described. Specifically, the authors detail the Center for Health Professional Training and Emergency Response's (CHPTER's) 1-day clinical EPT course including its organization, core competency development, medical student self-evaluation, and course assessment. Two 1-day courses hosted by CHPTER were conducted in a university simulation center. Students who completed the course improved their overall knowledge and comfort level with EPT skills. The authors believe this is the first published description of a curriculum method that combines high-fidelity, multiactor scenarios to measure the life-saving performance of patient care providers utilizing a clinical disaster scenario with > 10 patients at once. A larger scale study, or preferably a multicenter trial, is needed to further study the impact of this curriculum and its potential to protect provider and patient lives.

  13. Provider knowledge of trivalent inactivated and high-dose influenza vaccines. (United States)

    Tewell, Chad; Wright, Patty W; Talbot, H Keipp


    The objective of this study was to assess provider knowledge about trivalent inactivated and high dose influenza vaccines. Hence, a 20-item survey was distributed to providers within the Internal Medicine department at an urban academic medical center. Two hundred and eighty-one (24.5%) providers responded. The correct response rate was 63.2%. The highest performing subspecialties were infectious diseases (80.5%), endocrinology (69.2%), and pulmonary (68%). Those who received an influenza vaccine during the most recent season scored significantly higher than those who did not (63.6% vs. 43.6%, p=.001). Areas where respondents did poorly included questions pertaining to contraindications to immunizations (27.4%), common adverse events after immunization (29.2%), target antigen (73.5%), number of strains in the trivalent inactivated vaccine (62.9%), and time to immunity (61.4%). High dose vaccine knowledge was poor, with 37% of providers unaware of its existence. Significant gaps in provider knowledge exist regarding both trivalent inactivated and high dose influenza vaccines. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Providing wireless bandwidth for high-speed rail operations : final report. (United States)


    This project examined the possibility of providing wireless communication for train control systems on American high-speed trains. In this : study, the key issue is that the frequencies allocated for rail operations in the U.S. and the frequencies us...

  15. Approaches in breeding for high quality protein maize

    Directory of Open Access Journals (Sweden)

    Denić Miloje


    Full Text Available Maize is the principal crop and major staple food in the most African and South American countries. The main problem in human nutrition in developing countries, and in livestock feed in developed countries, is insufficient production and poor quality of cereal proteins. In the case of maize, due to the very low content of essential amino acids lysine and tryptophan in grain endosperm, biological value is very low, which is main limiting factor of common maize in human nutrition and feeding of monogastric animals. Quality protein maize (QPM can help in solving of this problem. Maize production also faces serious constraints caused by agro-ecological conditions and poor socio-economic situation. To alleviate the effect of the constraints, selected genotypes with more desirable traits and appropriate field-plot techniques to create multiple-stress conditions, were used. It was found that, in downy mildew nursery distance up to 35 m from spreader plot is providing sufficient down load of spores for plant infection, provided that the testing breeding materials are planted towards to down-stream direction of the dominant wind. Using these breeding approaches large number of early, white and flint synthetics, composites and inbred lines were created with resistance or tolerance to downy mildew (DMR, maize streak virus (SR and drought (DT. Created genotypes exhibited very good kernel modification and yield potential under low and normal inputs. In the case of synthetics and composites, besides tolerance to multiple stress factors, they were competing in yield with local QPM and normal maize checks. In the case of created inbred lines high combining ability was exhibited both in non-conventional and conventional maize hybrids. Trial data revealed that in the most cases the best entries were over-yielding the best checks.

  16. Critical Analysis of the Quality, Readability, and Technical Aspects of Online Information Provided for Neck-Lifts. (United States)

    Rayess, Hani; Zuliani, Giancarlo F; Gupta, Amar; Svider, Peter F; Folbe, Adam J; Eloy, Jean Anderson; Carron, Michael A


    The number of patients using the internet to obtain health information is growing. This material is unregulated and heterogeneous and can influence patient decisions. To compare the quality, readability, and technical aspects of online information about neck-lifts provided by private practice websites vs academic medical centers and reference sources. In this cross-sectional analysis conducted between November 2015 and January 2016, a Google search of the term neck-lift was performed, and the first 45 websites were evaluated. The websites were categorized as private practice vs other. Private websites (PWs) included sites created by private practice physicians. Other websites (OWs) were created by academic medical centers or reference sources. Quality, readability, and technical aspects of online websites related to neck-lifts. Quality was assessed using the DISCERN criteria and the Health on the Net principles (HONcode). Readability was assessed using 7 validated and widely used criteria. Consensus US reading grade level readability was provided by a website ( Twelve technical aspects were evaluated based on criteria specified by medical website creators. Forty-five websites (8 OWs [18%] and 37 PWs [82%]) were analyzed. There was a significant difference in quality between OWs and PWs based on the DISCERN criteria and HONcode principles. The DISCERN overall mean (SD) scores were 2.3 (0.5) for OWs and 1.3 (0.3) for PWs (P analysis, the mean (SD) was 8.6 (1.8) (range, 5-11) for OW, and the mean (SD) was 5.8 (1.7) (range, 2-9) for PW. The mean (SD) readability consensus reading grade level scores were 11.7 (1.9) for OWs and 10.6 (1.9) for PWs. Of a total possible score of 12, the mean (SD) technical scores were 6.3 (1.8) (range, 4-9) for OWs and 6.4 (1.5) (range, 3-9) for PWs. Compared with PWs, OWs had a significantly higher quality score based on both the DISCERN criteria and HONcode principles. The mean readability for OWs and PWs was

  17. A Procedure for High Resolution Satellite Imagery Quality Assessment

    Directory of Open Access Journals (Sweden)

    Mattia Crespi


    Full Text Available Data products generated from High Resolution Satellite Imagery (HRSI are routinely evaluated during the so-called in-orbit test period, in order to verify if their quality fits the desired features and, if necessary, to obtain the image correction parameters to be used at the ground processing center. Nevertheless, it is often useful to have tools to evaluate image quality also at the final user level. Image quality is defined by some parameters, such as the radiometric resolution and its accuracy, represented by the noise level, and the geometric resolution and sharpness, described by the Modulation Transfer Function (MTF. This paper proposes a procedure to evaluate these image quality parameters; the procedure was implemented in a suitable software and tested on high resolution imagery acquired by the QuickBird, WorldView-1 and Cartosat-1 satellites.

  18. Key factors for a high-quality VR experience (United States)

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


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

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

    Energy Technology Data Exchange (ETDEWEB)



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

  20. The High Flying Leadership Qualities: What Matters the Most (United States)


    which is an important leadership quality … If it’s important to the supervisor to develop skills and education in both them- selves and employees, it...IATIO N THE HIGH FLYING Leadership Qualities: What Matters the Most? Col Robert L. Tremaine, USAF (Ret.) Like many U.S. companies, the Department...every DoD organization invests in leadership development the same way. The ones that do think more deeply about their future have thoughtful and

  1. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices. (United States)

    Steele, Joseph R; Schomer, Don F


    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  2. Does Web-Based Role-Play Establish a High Quality Learning Environment? Design versus Evaluation (United States)

    Ludewig, Alexandra; Ludewig-Rohwer, Iris


    Online role-plays have been celebrated for providing an environment which allows for high quality learning. Innovative approaches have been embraced in foreign language studies, especially in countries where a great distance to the target country needs to be overcome, not only to expose students to the target language but also to provide them with…

  3. Assessment of the impact of quality improvement interventions on the quality of sick child care provided by Health Extension Workers in Ethiopia. (United States)

    Miller, Nathan P; Amouzou, Agbessi; Hazel, Elizabeth; Legesse, Hailemariam; Degefie, Tedbabe; Tafesse, Mengistu; Black, Robert E; Bryce, Jennifer


    Ethiopia has scaled up integrated community case management of childhood illness (iCCM), including several interventions to improve the performance of Health Extension Workers (HEWs). We assessed associations between interventions to improve iCCM quality of care and the observed quality of care among HEWs. We assessed iCCM implementation strength and quality of care provided by HEWs in Ethiopia. Multivariate logistic regression analyses were performed to assess associations between interventions to improve iCCM quality of care and correct management of iCCM illnesses. Children who were managed by an HEW who had attended a performance review and clinical mentoring meeting (PRCMM) had 8.3 (95% confidence interval (CI) 2.34-29.51) times the odds of being correctly managed, compared to children managed by an HEW who did not attend a PRCMM. Management by an HEW who received follow-up training also significantly increased the odds of correct management (odds ratio (OR) = 2.09, 95% CI 1.05-4.18). Supervision on iCCM (OR = 0.63, 95% CI 0.23-1.72) did not significantly affect the odds of receiving correct care. These results suggest PRCMM and follow-up training were effective interventions, while implementation of supportive supervision needs to be reviewed to improve impact.

  4. Adoption and Usage of mHealth Technology on Quality and Experience of Care Provided by Frontline Workers: Observations From Rural India. (United States)

    Kaphle, Sangya; Chaturvedi, Sharad; Chaudhuri, Indrajit; Krishnan, Ram; Lesh, Neal


    mHealth apps are deployed with the aim of improving access, quality, and experience of health care. It is possible that any mHealth intervention can yield differential impacts for different types of users. Mediating and determining factors, including personal and socioeconomic factors, affect technology adoption, the way health workers leverage and use the technology, and subsequently the quality and experience of care they provide. To develop a framework to assess whether mHealth platforms affect the quality and experience of care provided by frontline workers, and whether these effects on quality and experience are different depending on the level of technology adoption and individual characteristics of the health worker. Literacy, education, age, and previous mobile experience are identified as individual factors that affect technology adoption and use, as well as factors that affect the quality and experience of care directly and via the technology. Formative research was conducted with 15 community health workers (CHWs) using CommCare, an mHealth app for maternal and newborn care, in Bihar, India. CHWs were first classified on the level of CommCare adoption using data from CommCareHQ and were then shadowed on home visits to evaluate their levels of technology proficiency, and the quality and experience of care provided. Regression techniques were employed to test the relationships. Out of all the CHWs, 2 of them refused to participate in the home visits, however, we did have information on their levels of technology adoption and background characteristics, which were included in the analysis as relevant. Level of technology adoption was important for both quality and experience of care. The quality score for high users of CommCare was higher by 33.4% (P=.04), on average, compared to low users of CommCare. Those who scored higher on CommCare proficiency also provided significantly higher quality and experience of care, where an additional point in Comm

  5. The role of young, recently disturbed upland hardwood forest as high quality food patches (United States)

    Cathryn H. Greenberg; Roger W. Perry; Craig A. Harper; Douglas J. Levey; John M. McCord


    Young (1-10 year post-disturbance) upland hardwood forests function as high-quality food patches by providing abundant fruit, and nutritious foliage and flowers that attract pollinating and foliar arthropods and support high populations of small mammals that, in turn, are prey for numerous vertebrate predators. Reductions in basal area increase light penetration to the...

  6. Next Generation High Quality Videoconferencing Service for the LHC

    CERN Multimedia

    CERN. Geneva


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

  7. Health-risk behaviors among high school athletes and preventive services provided during sports physicals. (United States)

    Johnson, Karen E; McRee, Annie-Laurie


    Preparticipation examinations (PPEs), or sports physicals, present opportunities for health care providers to identify and discuss common adolescent health-risk behaviors. We sought to examine the prevalence of health-risk behaviors among high school athletes and the proportion of providers who address these behaviors during PPEs. For this descriptive study we used data from two statewide surveys: a survey of adolescents (n = 46,492) and a survey of nurse practitioners and physicians (n = 561). The most prevalent risk behaviors reported by student athletes were low levels of physical activity (70%), bullying perpetration (41%), and alcohol use (41%). Most providers (≥75%) addressed many common risk behaviors during PPEs but fewer addressed bullying, violence, and prescription drug use. Topics discussed differed by provider type and patient population. Many providers addressed critical threats to adolescent health during PPEs, but findings suggest potential disconnects between topics addressed during PPEs and behaviors of athletes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  8. Effect of Skin Cancer Training Provided to Maritime High School Students on Their Knowledge and Behaviour. (United States)

    Sümen, Adem; Öncel, Selma


    This study was conducted with the purpose of evaluating the effect of skin cancer training provided to maritime high school students on their knowledge and behaviour. The study had a quasi-experimental design with pre-test and post-test intervention and control groups. Two maritime high schools located in the city of Antalya were included within the scope of the study between March and June 2013, covering a total of 567 students. While the knowledge mean scores of students regarding skin cancer and sun protection did not vary in the pre-test (6.2 ± 1.9) and post-test (6.8 ± 1.9) control group, the knowledge mean scores of students in the experimental group increased from 6.0 ± 2.3 to 10.6 ± 1.2 after the provided training. Some 25.4% of students in the experimental group had low knowledge level and 62.2% had medium knowledge level in the pre-test; whereas no students had low knowledge level and 94.3% had high knowledge level in the post-test. It was determined that tenth grade students, those who had previous knowledge on the subject, who considered themselves to be protecting from the sun better, had higher knowledge levels and their knowledge levels increased as the risk level increased. It was found that the provided training was effective and increased positively the knowledge, attitude and behaviour levels of students in the experimental group in terms of skin cancer and sun protection. Along with the provided training which started to form a lifestyle, appropriate attitudes and behaviours concerning skin cancer and sun protection could be brought to students who will work in outdoor spaces and are members of the maritime profession within the risk group.

  9. Providing Our Fellows in Training with Education on Inflammatory Bowel Disease Health Maintenance to Improve the Quality of Care in Our Health Care System. (United States)

    Lee, Ann Joo; Kraemer, Dale F; Smotherman, Carmen; Eid, Emely


    Inflammatory bowel disease (IBD) quality measures were established in an effort to standardize IBD health care. Despite effort to improve clinical performance, considerable variations in practice still exist. To further improve IBD health care, we propose incorporating an in-service educational session on IBD health maintenance to provide trainees with increasing awareness and knowledge on IBD management. Fifty electronic medical charts were randomly selected, and the level of quality documentation was assessed for 15 core IBD quality measures. Data were reported as the percentage of charts meeting audit criteria (compliance score). Fellows then attended an in-service educational session to review IBD quality measures and reinforce practice expectations. A second audit was then performed on an additional 50 patient charts to determine whether documentation practices improved after the educational session. We found a positive correlation between an in-service educational session and fellows' compliance with IBD health maintenance. Overall, the fellows' compliance score increased by 18% (before intervention, 65%; after intervention, 83%; P training level. Although the magnitude of improvement was comparable, the mean compliance score was highest in year 2 at 81% (year 1: 72% [P = 0.019] and year 3: 70% [P = 0.002]). Fellows expressed a high degree of satisfaction with the educational intervention and emphasized the value in reviewing the conceptual bases for IBD health maintenance. Incorporating a standard curriculum on IBD health maintenance provides fellows in training with increased awareness and guidance on managing the unique preventive care needs of patients with IBD.

  10. Surgical innovation-enhanced quality and the processes that assure patient/provider safety: A surgical conundrum. (United States)

    Bruny, Jennifer; Ziegler, Moritz


    Innovation is a crucial part of surgical history that has led to enhancements in the quality of surgical care. This comprises both changes which are incremental and those which are frankly disruptive in nature. There are situations where innovation is absolutely required in order to achieve quality improvement or process improvement. Alternatively, there are innovations that do not necessarily arise from some need, but simply are a new idea that might be better. All change must assure a significant commitment to patient safety and beneficence. Innovation would ideally enhance patient care quality and disease outcomes, as well stimulate and facilitate further innovation. The tensions between innovative advancement and patient safety, risk and reward, and demonstrated effectiveness versus speculative added value have created a contemporary "surgical conundrum" that must be resolved by a delicate balance assuring optimal patient/provider outcomes. This article will explore this delicate balance and the rules that govern it. Recommendations are made to facilitate surgical innovation through clinical research. In addition, we propose options that investigators and institutions may use to address competing priorities. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Production of high-quality fish oil from herring byproducts


    Aidos, I.M.F.


    In this work, the feasibility of producing high-quality fish oil from herring byproducts was evaluated in various ways. With this, a contribution has been made to a more efficient usage of natural resources while yielding a high-quality product. Crude oil extracted from herring byproducts is relatively rich in essentialw-3 PUFAs such as EPA and DHA, and is relatively stable during storage. The main conclusions of this study were: herring byprodu...


    Directory of Open Access Journals (Sweden)

    Zorica Lazic


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

  13. Latest Technologies and Equipment to Obtain High Quality Drinking Water

    Directory of Open Access Journals (Sweden)

    Goncharuk, V.V.


    Full Text Available A principally new concept of providing the Ukrainian population with quality drinking water have been proposed. It is based on a system of autonomous complexes for water purification in places of direct consumption. Water treatment autonomous complexes for collective and individual use with biotesting and analytical quality control of drinking water have been developed. The choice of the cleaning methods of tap and other waters up to the quality of genetic safe is performed in accordance with its composition and is based on a block concept that provides the possibility of varying the number of units depending on the composition of the source water. The proposed technology and equipment at cost and complex problems to be solved have no analogues in the world. Over thousand of modular installations «Vega» and disinfecting vehicles «Promin» are implemented in many settlement in all regions of Ukraine.

  14. Trifocal intraocular lenses: a comparison of the visual performance and quality of vision provided by two different lens designs

    Directory of Open Access Journals (Sweden)

    Gundersen KG


    Full Text Available Kjell G Gundersen,1 Rick Potvin2 1IFocus Øyeklinikk AS, Haugesund, Norway; 2Science in Vision, Akron, NY, USA Purpose: To compare two different diffractive trifocal intraocular lens (IOL designs, evaluating longer-term refractive outcomes, visual acuity (VA at various distances, low contrast VA and quality of vision.Patients and methods: Patients with binocularly implanted trifocal IOLs of two different designs (FineVision [FV] and Panoptix [PX] were evaluated 6 months to 2 years after surgery. Best distance-corrected and uncorrected VA were tested at distance (4 m, intermediate (80 and 60 cm and near (40 cm. A binocular defocus curve was collected with the subject’s best distance correction in place. The preferred reading distance was determined along with the VA at that distance. Low contrast VA at distance was also measured. Quality of vision was measured with the National Eye Institute Visual Function Questionnaire near subset and the Quality of Vision questionnaire.Results: Thirty subjects in each group were successfully recruited. The binocular defocus curves differed only at vergences of −1.0 D (FV better, P=0.02, −1.5 and −2.00 D (PX better, P<0.01 for both. Best distance-corrected and uncorrected binocular vision were significantly better for the PX lens at 60 cm (P<0.01 with no significant differences at other distances. The preferred reading distance was between 42 and 43 cm for both lenses, with the VA at the preferred reading distance slightly better with the PX lens (P=0.04. There were no statistically significant differences by lens for low contrast VA (P=0.1 or for quality of vision measures (P>0.3.Conclusion: Both trifocal lenses provided excellent distance, intermediate and near vision, but several measures indicated that the PX lens provided better intermediate vision at 60 cm. This may be important to users of tablets and other handheld devices. Quality of vision appeared similar between the two lens designs

  15. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Borycki


    Full Text Available This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic health records and mobile health applications. Such technologies can be harnessed to improve patient safety; however, if not used properly they can negatively impact on patient safety. In this issue we focus on advances in training that can improve patient safety and the optimal use of new technologies in healthcare. For example, use of clinical simulations and online computer based training can be employed both to facilitate learning about new clinical discoveries as well as to integrate technology into day to day healthcare practices. In this issue we are publishing papers that describe advances in healthcare provider and patient training to improve patient safety as it relates to the use of educational technologies, health information technology and on-line health resources. In addition, in the special issue we describe new approaches to training and patient safety including, online communities, clinical simulations, on-the-job training, computer based training and health information systems that educate about and support safer patient care in real-time (i.e. when health professionals are providing care to patients. These educational and technological initiatives can be aimed at health professionals (i.e. students and those who are currently working in the field. The outcomes of this work are significant as they lead to safer care for patients and their family members. The issue has both theoretical and applied papers that describe advances in patient

  16. Research on customer satisfaction with the quality of services provided by public utilities of the city of Belgrade

    Directory of Open Access Journals (Sweden)

    Živković Radmila


    Full Text Available Monopoly market conditions, in which public companies used to operate ten to twenty years ago, substantially dictated the way of considering and creating business of public companies in Serbia. However, introduction of changes to the environment, such as more intensive competition and changes of needs and demands of the customers requires abandoning old orientations to business. Public companies are in position to create and offer a higher level of service quality, based on better and more intensified communication with their customers. Public enterprises are monitored by public authorities, especially in the areas of restrictions on the choice of business strategies, pricing and price restrictions, selection of suppliers and the like. On the other hand, there is a branch competition occurring, on which public companies must count. In such an environment, creating effective services should be the key strategic objective for the development of public utility companies of the city of Belgrade. Service companies should be modern service companies, able to actively participate in the market, looking upon customers - citizens as users of their services. The aim of the research is to determine the perception of value and customer satisfaction with the services provided by the public utilities of Belgrade. The results of the study indicate that respondents are not satisfied with provided services and do not have clearly defined attitudes towards key aspects of public enterprises, which are supposed to be important for positioning and improving the quality of services in the market.

  17. Dissemination Approaches to Participating Primary Care Providers in a Quality Improvement Program Addressing Opioid Use in Central Appalachia. (United States)

    Cardarelli, Roberto; Workman, Charlotte Sue; Weatherford, Sarah; Whanger, Stacey; King, Dana E


    Practice-based research networks (PBRNs) have been described as new clinical laboratories for primary care research and dissemination. PBRNs, however, have struggled to disseminate research results in a meaningful way to participating providers and clinics. The Central Appalachia Inter-Professional Pain Education Collaborative was developed to work with PBRN clinics using quality improvement methods, deliver statewide continuing education activities to address the issue of opioid use in patients with chronic pain, and develop a multimodal mechanism to disseminate project results to clinics and participating providers. Successful change in the delivery of chronic pain care was dependent on the clinic's commitment to a team-based, patient-centered approach. Statistically significant improvements were shown in 10 of 16 process measures, and 80% of the participants agreed that the quality improvement process activity increased their knowledge and would improve their performance in managing patients with chronic pain, as well as patient outcomes in their practice. The Central Appalachia Inter-Professional Pain Education Collaborative project used an extensive and innovative dissemination plan under the rubric of "continual dissemination." Unlike traditional dissemination efforts that focus on summary presentations, this initiative used a continual dissemination approach that updated participants quarterly through multiple means throughout the project, which improved engagement in the project.

  18. A model program: neonatal nurse practitioners providing community health care for high-risk infants. (United States)

    Vasquez, Elias Provencio; Pitts, Kathleen; Mejia, Nilson Enrique


    Perinatal drug exposure costs our communities millions of dollars each year in hospital fees and in services such as foster care, child protection, and drug treatment. Infants and their families in this group require substantial long-term health care and community resources. Neonatal health care providers should take an active role in developing and implementing home visitation programs to support early hospital discharge and continuity of care for these high-risk infants and their families. Neonatal nurse practitioners should prepare in the future to practice not only in secondary-- and tertiary--level neonatal centers, but also in follow-up clinics, long-term developmental centers, and the community This article describes a home intervention program delivered by neonatal nurse practitioners for high-risk infants and their mothers. The target population is infants exposed prenatally to drugs and/or alcohol.

  19. Perils of providing visual health information overviews for consumers with low health literacy or high stress (United States)

    Miller, Trudi


    This pilot study explores the impact of a health topics overview (HTO) on reading comprehension. The HTO is generated automatically based on the presence of Unified Medical Language System terms. In a controlled setting, we presented health texts and posed 15 questions for each. We compared performance with and without the HTO. The answers were available in the text, but not always in the HTO. Our study (n=48) showed that consumers with low health literacy or high stress performed poorly when the HTO was available without linking directly to the answer. They performed better with direct links in the HTO or when the HTO was not available at all. Consumers with high health literacy or low stress performed better regardless of the availability of the HTO. Our data suggests that vulnerable consumers relied solely on the HTO when it was available and were misled when it did not provide the answer. PMID:20190068

  20. Negative Binomial charts for monitoring high-quality processes

    NARCIS (Netherlands)

    Albers, Willem/Wim

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

  1. Learning Disabilities and Achieving High-Quality Education Standards (United States)

    Gartland, Debi; Strosnider, Roberta


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

  2. Coming soon to your clinic: high-quality ART.

    NARCIS (Netherlands)

    Empel, IW van; Nelen, W.L.D.M.; Hermens, R.P.M.G.; Kremer, J.A.M.


    The concept of 'patient-friendly' medically assisted reproduction includes a robust set of clinical practice principles, to improve the quality of subfertility care. This concept is an important move away from the sole focus on effectiveness and high pregnancy rates in assisted reproduction

  3. The High-Quality School: Thoughtful vs. Technocratic Leadership. Draft. (United States)

    Webb, Clark

    Four ideas or theses about schooling and leadership together form a coherent approach to teaching and learning in the high-quality school. They form the basis, if not for large-scale reform, at least for individual consideration and adoption. The first thesis is that humans are creatures of perspective or viewpoint. The second thesis is that the…

  4. 36 CFR 910.31 - High architectural quality. (United States)


    ... architectural quality. Development must maintain a uniformly high standard of architecture, representative of the best contemporary design and planning concepts. Great care and sensitivity must be shown in the... GENERAL GUIDELINES AND UNIFORM STANDARDS FOR URBAN PLANNING AND DESIGN OF DEVELOPMENT WITHIN THE...

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

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

    Malawi has high rates of maternal mortality despite concerted efforts to increase the rate of births at health facilities. In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve the quality of health services. Similar initiatives have proven ...

  6. Supplementation of quality protein to high producing Jersey cows ...

    African Journals Online (AJOL)


    The milk yield potential of 500 kg cows grazing ryegrass pasture, with no supplementation, is 16 to. 17 litres a day (Dugmore, 1995). The aim of the study was to determine whether grazing cows that are receiving maize supplementation, with minerals included, would respond to the addition of a high quality protein source,.

  7. The Nature of Spontaneity in High Quality Mathematics Learning Experiences (United States)

    Williams, Gaye


    Spontaneity has been linked to high quality learning experiences in mathematics (Csikszentmihalyi & Csikszentmihalyi, 1992; Williams, 2002).This paper shows how spontaneity can be identified by attending to the nature of social elements in the process of abstracting (Dreyfus, Hershkowitz, & Schwarz, 2001). This process is elaborated…

  8. High quality digital holographic reconstruction on analog film (United States)

    Nelsen, B.; Hartmann, P.


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

  9. Defining the essential anatomical coverage provided by military body armour against high energy projectiles. (United States)

    Breeze, John; Lewis, E A; Fryer, R; Hepper, A E; Mahoney, Peter F; Clasper, Jon C


    Body armour is a type of equipment worn by military personnel that aims to prevent or reduce the damage caused by ballistic projectiles to structures within the thorax and abdomen. Such injuries remain the leading cause of potentially survivable deaths on the modern battlefield. Recent developments in computer modelling in conjunction with a programme to procure the next generation of UK military body armour has provided the impetus to re-evaluate the optimal anatomical coverage provided by military body armour against high energy projectiles. A systematic review of the literature was undertaken to identify those anatomical structures within the thorax and abdomen that if damaged were highly likely to result in death or significant long-term morbidity. These structures were superimposed upon two designs of ceramic plate used within representative body armour systems using a computerised representation of human anatomy. Those structures requiring essential medical coverage by a plate were demonstrated to be the heart, great vessels, liver and spleen. For the 50th centile male anthropometric model used in this study, the front and rear plates from the Enhanced Combat Body Armour system only provide limited coverage, but do fulfil their original requirement. The plates from the current Mark 4a OSPREY system cover all of the structures identified in this study as requiring coverage except for the abdominal sections of the aorta and inferior vena cava. Further work on sizing of plates is recommended due to its potential to optimise essential medical coverage. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  10. Epidemiology of tuberculosis in a high HIV prevalence population provided with enhanced diagnosis of symptomatic disease.

    Directory of Open Access Journals (Sweden)

    Elizabeth L Corbett


    Full Text Available Directly observed treatment short course (DOTS, the global control strategy aimed at controlling tuberculosis (TB transmission through prompt diagnosis of symptomatic smear-positive disease, has failed to prevent rising tuberculosis incidence rates in Africa brought about by the HIV epidemic. However, rising incidence does not necessarily imply failure to control tuberculosis transmission, which is primarily driven by prevalent infectious disease. We investigated the epidemiology of prevalent and incident TB in a high HIV prevalence population provided with enhanced primary health care.Twenty-two businesses in Harare, Zimbabwe, were provided with free smear- and culture-based investigation of TB symptoms through occupational clinics. Anonymised HIV tests were requested from all employees. After 2 y of follow-up for incident TB, a culture-based survey for undiagnosed prevalent TB was conducted. A total of 6,440 of 7,478 eligible employees participated. HIV prevalence was 19%. For HIV-positive and -negative participants, the incidence of culture-positive tuberculosis was 25.3 and 1.3 per 1,000 person-years, respectively (adjusted incidence rate ratio = 18.8; 95% confidence interval [CI] = 10.3 to 34.5: population attributable fraction = 78%, and point prevalence after 2 y was 5.7 and 2.6 per 1,000 population (adjusted odds ratio = 1.7; 95% CI = 0.5 to 6.8: population attributable fraction = 14%. Most patients with prevalent culture-positive TB had subclinical disease when first detected.Strategies based on prompt investigation of TB symptoms, such as DOTS, may be an effective way of controlling prevalent TB in high HIV prevalence populations. This may translate into effective control of TB transmission despite high TB incidence rates and a period of subclinical infectiousness in some patients.

  11. Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services. (United States)

    Ngangue, Patrice; Gagnon, Marie-Pierre; Bedard, Emmanuelle


    The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala's district hospitals. Two primary data collection methods supported by the Donabedian's model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals' lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program.

  12. Compact pulley-type microring resonator with high quality factor (United States)

    Cai, Dong-Po; Lu, Jyun-Hong; Chen, Chii-Chang; Lee, Chien-Chieh; Lin, Chu-En; Yen, Ta-Jen


    A pulley-type microring resonator with ultra-small dimensions and ultra-high quality factor on a silicon-on-insulator wafer is fabricated and characterized. Simulation results show that the bending loss of the pulley-type microring resonator can be diminished by wrapping the curved waveguide around the microring, and that the energy loss from the output port can be decreased by tuning the width of the bus waveguide to achieve destructive interference. A quality factor of 1.73 × 105 is obtained in this experiment. The compact size of the pulley-type microring resonator with low bending loss is suitable for an integrated optical circuit.

  13. Integration study of high quality teaching resources in universities

    Directory of Open Access Journals (Sweden)

    Honglu Liu


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

  14. High-quality weather data for grid integration studies (United States)

    Draxl, C.


    As variable renewable power penetration levels increase in power systems worldwide, renewable integration studies are crucial to ensure continued economic and reliable operation of the power grid. In this talk we will shed light on requirements for grid integration studies as far as wind and solar energy are concerned. Because wind and solar plants are strongly impacted by weather, high-resolution and high-quality weather data are required to drive power system simulations. Future data sets will have to push limits of numerical weather prediction to yield these high-resolution data sets, and wind data will have to be time-synchronized with solar data. Current wind and solar integration data sets will be presented. The Wind Integration National Dataset (WIND) Toolkit is the largest and most complete grid integration data set publicly available to date. A meteorological data set, wind power production time series, and simulated forecasts created using the Weather Research and Forecasting Model run on a 2-km grid over the continental United States at a 5-min resolution is now publicly available for more than 126,000 land-based and offshore wind power production sites. The Solar Integration National Dataset (SIND) is available as time synchronized with the WIND Toolkit, and will allow for combined wind-solar grid integration studies. The National Solar Radiation Database (NSRDB) is a similar high temporal- and spatial resolution database of 18 years of solar resource data for North America and India. Grid integration studies are also carried out in various countries, which aim at increasing their wind and solar penetration through combined wind and solar integration data sets. We will present a multi-year effort to directly support India's 24x7 energy access goal through a suite of activities aimed at enabling large-scale deployment of clean energy and energy efficiency. Another current effort is the North-American-Renewable-Integration-Study, with the aim of providing

  15. Impact of a service provider incentive payment scheme on quality of reproductive and child-health services in Egypt. (United States)

    Huntington, Dale; Zaky, Hassan H M; Shawky, Sherine; Fattah, Faten Abdel; El-Hadary, Eman


    A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a performance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other districts in Egypt.

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

    DEFF Research Database (Denmark)

    Landex, Alex; Kaas, Anders H.


    The examination of operation quality for high-frequent operation requires other approaches than the typical evaluation of punctuality (trains on time) and reliability (operated trains). This is because passengers in high-frequent railway systems do not necessarily notice train delays as they just...... take the first train in their direction. The article examines four different approaches to examine operation quality for high-frequent operation that are based on the experiences of the passengers. These approaches are the service frequency of the operation, travel time extension, a combination...... operation simulation software. Combining the passenger delay model with simulation software gives the possibility to forecast future infrastructure and operation scenarios which make it possible to improve the planning....

  17. High quality early childhood education in the United States

    Directory of Open Access Journals (Sweden)

    Mercedes Varona Alabern


    Full Text Available The United States education system, K-12 produced impressive results for most of the 20th century. We trace its origins back to the end of the 19th century, when the America’s social and economical needs and its circumstances were very different from the ones today. Nowadays, American society is far more complex and demands highly qualified citizens, a requirement which inevitably starts with high quality early childhood education, as we will illustrate below. Therefore, experts are currently requesting all public administrations and private sector to take further steps to ensure high quality preschool education for everyone in order to improve Americans’ skills and the United States’ economy, as well as to overcome the existing inequalities.

  18. Analysis and proposed model of family caregivers' relationships with home health providers and perceptions of the quality of formal services. (United States)

    Funk, Laura; Stajduhar, Kelli


    Relationships between families and home health nurses promote effective care and service access for those at end of life, positive caregiver experiences, and satisfaction with care. This study explores family caregivers' accounts of relationships with home care nurses; findings inform a model of relationships and satisfaction with home health services. Ethnographic, qualitative interviews were conducted with 26 bereaved caregivers in one Western Canadian regional health agency. Data analysis was informed by symbolic interactionism. Participants described their relationships with home care nurses and spoke about their assessments of the care provided. Findings highlighted the importance of the length, frequency, and continuity of contact, conversation, socializing, and sharing information. Participants were cognizant of their own and care recipients' roles in building relationship. Nurse behaviors demonstrating affection, acknowledgment, commitment, and understanding were appreciated. A model links relationship preconditions, relational demonstrations, and perceived care quality and may be used to identify points of intervention.

  19. Is the Internet Bad News? The Online News Era and the Market for High-Quality News


    Frijters, Paul; Velamuri, Malathi


    We review and model the impact of the internet on the production and uptake of high- quality news. Our review of trends in the market for news suggests 3 stylized facts: i) particular quality news markets are dominated by merely a few providers, ii) demand for quality news appears stable, but provision of news has become specialized; mainstream news is decoupled from quality news, and iii) the dominant business model of internet news mirrors that of radio, television, and newsp...

  20. Conducting high quality writing intervention research: Twelve recommendations

    Directory of Open Access Journals (Sweden)

    Steve Graham


    Full Text Available Writing intervention research can enhance our knowledge about writing, its development, and how to teach it effectively. Despite the importance of such research, many of the writing intervention studies conducted previously were of poor quality, as documented by Graham and colleagues in a series of meta-analyses (Graham, McKeown, Kiuhara, & Harris, 2012; Graham & Perin, 2007; Rogers & Graham, 2008. In this article, we offer 12 recommendations for conducting high quality intervention research, recommendations that draw on those meta-analyses as well as previous work on improving the quality of intervention research (Pressley & Harris, 1994a, 1994b and our experiences as writing intervention researchers and editors of journals that publish intervention research (including the Journal of Writing Research . The recommendations address issues and actions involved in designing, conducting, and reporting such research.

  1. Sports Cardiology: Core Curriculum for Providing Cardiovascular Care to Competitive Athletes and Highly Active People. (United States)

    Baggish, Aaron L; Battle, Robert W; Beckerman, James G; Bove, Alfred A; Lampert, Rachel J; Levine, Benjamin D; Link, Mark S; Martinez, Matthew W; Molossi, Silvana M; Salerno, Jack; Wasfy, Meagan M; Weiner, Rory B; Emery, Michael S


    The last few decades have seen substantial growth in the populations of competitive athletes and highly active people (CAHAP). Although vigorous physical exercise is an effective way to reduce the risk of cardiovascular (CV) disease, CAHAP remain susceptible to inherited and acquired CV disease, and may be most at risk for adverse CV outcomes during intense physical activity. Traditionally, multidisciplinary teams comprising athletic trainers, physical therapists, primary care sports medicine physicians, and orthopedic surgeons have provided clinical care for CAHAP. However, there is increasing recognition that a care team including qualified CV specialists optimizes care delivery for CAHAP. In recognition of the increasing demand for CV specialists competent in the care of CAHAP, the American College of Cardiology has recently established a Sports and Exercise Council. An important primary objective of this council is to define the essential skills necessary to practice effective sports cardiology. Copyright © 2017. Published by Elsevier Inc.

  2. Quality and efficiency in high dimensional Nearest neighbor search

    KAUST Repository

    Tao, Yufei


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

  3. Can high resolution 3D topographic surveys provide reliable grain size estimates in gravel bed rivers? (United States)

    Pearson, E.; Smith, M. W.; Klaar, M. J.; Brown, L. E.


    High resolution topographic surveys such as those provided by Structure-from-Motion (SfM) contain a wealth of information that is not always exploited in the generation of Digital Elevation Models (DEMs). In particular, several authors have related sub-metre scale topographic variability (or 'surface roughness') to sediment grain size by deriving empirical relationships between the two. In fluvial applications, such relationships permit rapid analysis of the spatial distribution of grain size over entire river reaches, providing improved data to drive three-dimensional hydraulic models, allowing rapid geomorphic monitoring of sub-reach river restoration projects, and enabling more robust characterisation of riverbed habitats. However, comparison of previously published roughness-grain-size relationships shows substantial variability between field sites. Using a combination of over 300 laboratory and field-based SfM surveys, we demonstrate the influence of inherent survey error, irregularity of natural gravels, particle shape, grain packing structure, sorting, and form roughness on roughness-grain-size relationships. Roughness analysis from SfM datasets can accurately predict the diameter of smooth hemispheres, though natural, irregular gravels result in a higher roughness value for a given diameter and different grain shapes yield different relationships. A suite of empirical relationships is presented as a decision tree which improves predictions of grain size. By accounting for differences in patch facies, large improvements in D50 prediction are possible. SfM is capable of providing accurate grain size estimates, although further refinement is needed for poorly sorted gravel patches, for which c-axis percentiles are better predicted than b-axis percentiles.

  4. Providing high-quality HIV care in a deeply rural setting – the ...

    African Journals Online (AJOL)

    facilities within the programme borders, but also in and out of the geographical area due to migrant labour. A uniform system that works effectively across all sites and that is easy for patients to access from any programme facility has been critical to avoid confusion and to ensure continuity of care. • Drug supply: In common ...

  5. Family Perspectives on High-Quality Pediatric Subspecialty Referrals. (United States)

    Ray, Kristin N; Ashcraft, Laura Ellen; Kahn, Jeremy M; Mehrotra, Ateev; Miller, Elizabeth


    Although children are frequently referred to subspecialist physicians, many inadequacies in referral processes have been identified from physician and system perspectives. Little is known, however, about how to comprehensively measure or improve the quality of the referral systems from a family-centered perspective. To foster family-centered improvements to pediatric subspecialty referrals, we sought to develop a framework for high-quality, patient-centered referrals from the perspectives of patients and their families. We used stakeholder-informed qualitative analysis of parent, caregiver, and patient interviews to identify outcomes, processes, and structures of high-quality pediatric subspecialty referrals as perceived by patients and their family members. We interviewed 21 informants. Informants identified 5 desired outcomes of subspecialty referrals: improved functional status or symptoms; improved long-term outcomes; improved knowledge of their disease; informed expectations; and reduced anxiety about the child's health status. Processes that informants identified as supporting these outcomes centered around 6 key steps in subspecialty referrals, including the referral decision, previsit information transfer, appointment scheduling, subspecialist visit, postvisit information transfer, and ongoing care integration and communication. Health care delivery structures identified by informants as supporting these processes included physical infrastructure, human resources, and information technology systems. We identified family-centered outcomes, processes, and structures of high-quality pediatric subspecialty referrals. These domains can be used not only to improve measurement of the quality of existing referral systems but also to inform future interventions to improve patient-centered outcomes for children in need of specialty care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  6. Training Sessional Academic Staff to Provide Quality Feedback on University Students' Assessment: Lessons from a Faculty of Law Learning and Teaching Project (United States)

    Richards, Kelly; Bell, Tamara; Dwyer, Angela


    The quality of feedback provided to university students has long been recognised as the most important predictor of student learning and satisfaction. However, providing quality feedback to students is challenging in the current context, in which universities increasingly rely on casualised and inexperienced academic staff to assess undergraduate…

  7. The use of microbead-based spoligotyping for Mycobacterium tuberculosis complex to evaluate the quality of the conventional method: Providing guidelines for Quality Assurance when working on membranes

    Directory of Open Access Journals (Sweden)

    Garzelli Carlo


    Full Text Available Abstract Background The classical spoligotyping technique, relying on membrane reverse line-blot hybridization of the spacers of the Mycobacterium tuberculosis CRISPR locus, is used world-wide (598 references in Pubmed on April 8th, 2011. However, until now no inter-laboratory quality control study had been undertaken to validate this technique. We analyzed the quality of membrane-based spoligotyping by comparing it to the recently introduced and highly robust microbead-based spoligotyping. Nine hundred and twenty-seven isolates were analyzed totaling 39,861 data points. Samples were received from 11 international laboratories with a worldwide distribution. Methods The high-throughput microbead-based Spoligotyping was performed on CTAB and thermolyzate DNA extracted from isolated Mycobacterium tuberculosis complex (MTC strains coming from the genotyping participating centers. Information regarding how the classical Spoligotyping method was performed by center was available. Genotype discriminatory analyses were carried out by comparing the spoligotypes obtained by both methods. The non parametric U-Mann Whitney homogeneity test and the Spearman rank correlation test were performed to validate the observed results. Results Seven out of the 11 laboratories (63 %, perfectly typed more than 90% of isolates, 3 scored between 80-90% and a single center was under 80% reaching 51% concordance only. However, this was mainly due to discordance in a single spacer, likely having a non-functional probe on the membrane used. The centers using thermolyzate DNA performed as well as centers using the more extended CTAB extraction procedure. Few centers shared the same problematic spacers and these problematic spacers were scattered over the whole CRISPR locus (Mostly spacers 15, 14, 18, 37, 39, 40. Conclusions We confirm that classical spoligotyping is a robust method with generally a high reliability in most centers. The applied DNA extraction procedure (CTAB

  8. Wellbeing Understanding in High Quality Healthcare Informatics and Telepractice. (United States)

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


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

  9. Brayton Power Conversion Unit Tested: Provides a Path to Future High-Power Electric Propulsion Missions (United States)

    Mason, Lee S.


    Closed-Brayton-cycle conversion technology has been identified as an excellent candidate for nuclear electric propulsion (NEP) power conversion systems. Advantages include high efficiency, long life, and high power density for power levels from about 10 kWe to 1 MWe, and beyond. An additional benefit for Brayton is the potential for the alternator to deliver very high voltage as required by the electric thrusters, minimizing the mass and power losses associated with the power management and distribution (PMAD). To accelerate Brayton technology development for NEP, the NASA Glenn Research Center is developing a low-power NEP power systems testbed that utilizes an existing 2- kWe Brayton power conversion unit (PCU) from previous solar dynamic technology efforts. The PCU includes a turboalternator, a recuperator, and a gas cooler connected by gas ducts. The rotating assembly is supported by gas foil bearings and consists of a turbine, a compressor, a thrust rotor, and an alternator on a single shaft. The alternator produces alternating-current power that is rectified to 120-V direct-current power by the PMAD unit. The NEP power systems testbed will be utilized to conduct future investigations of operational control methods, high-voltage PMAD, electric thruster interactions, and advanced heat rejection techniques. The PCU was tested in Glenn s Vacuum Facility 6. The Brayton PCU was modified from its original solar dynamic configuration by the removal of the heat receiver and retrofitting of the electrical resistance gas heater to simulate the thermal input of a steady-state nuclear source. Then, the Brayton PCU was installed in the 3-m test port of Vacuum Facility 6, as shown. A series of tests were performed between June and August of 2002 that resulted in a total PCU operational time of about 24 hr. An initial test sequence on June 17 determined that the reconfigured unit was fully operational. Ensuing tests provided the operational data needed to characterize PCU

  10. Combining tissue-phantom ratios to provide a beam-quality specifier for flattening filter free photon beams. (United States)

    Dalaryd, Mårten; Knöös, Tommy; Ceberg, Crister


    mean square deviation (RMSD) of 0.0028 with a maximum deviation of 0.0043 (0.39%) from Monte Carlo calculated values. For all beams in this study, the RMSD between the proposed model and the Monte Carlo calculated values was 0.0006 with a maximum deviation of 0.0013 (0.1%). Using an earlier proposed relationship [Xiong and Rogers, Med. Phys. 35, 2104-2109 (2008)] between %dd(10)x and L̄/ρair (water) gave a RMSD of 0.0018 with a maximum deviation of 0.0029 (0.26%) for all beams in this study (compared to RMSD 0.0015 and a maximum deviation of 0.0048 (0.47%) for the relationship used in AAPM TG-51 published by Almond et al. [Med. Phys. 26, 1847-1870 (1999)]). Using TPR20,10 as a beam-quality specifier, for the flattening filter free beams used in this study, gave a maximum difference of 0.39% between L̄/ρair (water) predicted using IAEA TRS-398 and Monte Carlo calculations. An additional parameter for determining L̄/ρair (water) has been presented. This parameter is easy to measure; it requires only an additional dose measurement at 5 cm depth with SSD 95 cm, and provides information for accurate determination of the L̄/ρair (water) ratio for beams both with and without a flattening filter at the investigated energies.

  11. A decision tree model to estimate the value of information provided by a groundwater quality monitoring network (United States)

    Khader, A. I.; Rosenberg, D. E.; McKee, M.


    Groundwater contaminated with nitrate poses a serious health risk to infants when this contaminated water is used for culinary purposes. To avoid this health risk, people need to know whether their culinary water is contaminated or not. Therefore, there is a need to design an effective groundwater monitoring network, acquire information on groundwater conditions, and use acquired information to inform management options. These actions require time, money, and effort. This paper presents a method to estimate the value of information (VOI) provided by a groundwater quality monitoring network located in an aquifer whose water poses a spatially heterogeneous and uncertain health risk. A decision tree model describes the structure of the decision alternatives facing the decision-maker and the expected outcomes from these alternatives. The alternatives include (i) ignore the health risk of nitrate-contaminated water, (ii) switch to alternative water sources such as bottled water, or (iii) implement a previously designed groundwater quality monitoring network that takes into account uncertainties in aquifer properties, contaminant transport processes, and climate (Khader, 2012). The VOI is estimated as the difference between the expected costs of implementing the monitoring network and the lowest-cost uninformed alternative. We illustrate the method for the Eocene Aquifer, West Bank, Palestine, where methemoglobinemia (blue baby syndrome) is the main health problem associated with the principal contaminant nitrate. The expected cost of each alternative is estimated as the weighted sum of the costs and probabilities (likelihoods) associated with the uncertain outcomes resulting from the alternative. Uncertain outcomes include actual nitrate concentrations in the aquifer, concentrations reported by the monitoring system, whether people abide by manager recommendations to use/not use aquifer water, and whether people get sick from drinking contaminated water. Outcome costs

  12. A decision tree model to estimate the value of information provided by a groundwater quality monitoring network

    Directory of Open Access Journals (Sweden)

    A. I. Khader


    Full Text Available Groundwater contaminated with nitrate poses a serious health risk to infants when this contaminated water is used for culinary purposes. To avoid this health risk, people need to know whether their culinary water is contaminated or not. Therefore, there is a need to design an effective groundwater monitoring network, acquire information on groundwater conditions, and use acquired information to inform management options. These actions require time, money, and effort. This paper presents a method to estimate the value of information (VOI provided by a groundwater quality monitoring network located in an aquifer whose water poses a spatially heterogeneous and uncertain health risk. A decision tree model describes the structure of the decision alternatives facing the decision-maker and the expected outcomes from these alternatives. The alternatives include (i ignore the health risk of nitrate-contaminated water, (ii switch to alternative water sources such as bottled water, or (iii implement a previously designed groundwater quality monitoring network that takes into account uncertainties in aquifer properties, contaminant transport processes, and climate (Khader, 2012. The VOI is estimated as the difference between the expected costs of implementing the monitoring network and the lowest-cost uninformed alternative. We illustrate the method for the Eocene Aquifer, West Bank, Palestine, where methemoglobinemia (blue baby syndrome is the main health problem associated with the principal contaminant nitrate. The expected cost of each alternative is estimated as the weighted sum of the costs and probabilities (likelihoods associated with the uncertain outcomes resulting from the alternative. Uncertain outcomes include actual nitrate concentrations in the aquifer, concentrations reported by the monitoring system, whether people abide by manager recommendations to use/not use aquifer water, and whether people get sick from drinking contaminated water

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

    Directory of Open Access Journals (Sweden)

    Xin Zhanguo


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

  14. A high throughput DNA extraction method with high yield and quality. (United States)

    Xin, Zhanguo; Chen, Junping


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

  15. CD 116: A vigorous wheat cultivar with high industrial quality


    Francisco de Assis Franco; Volmir Sergio Marchioro; Tatiane Dalla Nora; Ivan Schuster; Edson Feliciano de Oliveira; Elisa Serra Negra Vieira; Fábio Júnior Alcantara de Lima


    Cultivar CD 116 was developed by the Cooperativa Central de Pesquisa Agrícola (COODETEC) and issuitable for cultivation in the states of Paraná, São Paulo, Mato Grosso do Sul, Mato Grosso, Minas Gerais, Goiás, andDistrito Federal. CD 116 is tolerant to the major diseases, particularly blast, has a high industrial grain quality and meanyield of 3908 kg ha-1, exceeding the control cultivars by 6%.

  16. Evaluation of quality of TB control services by private health care providers in Plateau state, Nigeria; 2012. (United States)

    Ibrahim, Luka Mangveep; Oleribe, Obinna O; Nguku, Patrick; Tongwong, Gabriel Chukwak; Mato, Lakda Gonen; Longkyer, Musa Istifanus; Ogiri, Samuel; Nsubuga, Peter


    Tuberculosis (TB) is public health concern in Nigeria. The country uses the Directly Observed Treatment Short course (DOTS) strategy for its control. Plateau state started using the DOTS strategy in 2001 and had the Private health facilities (PHF) as an important stakeholder. We evaluated their contributions to case finding and quality of the services to identify gaps in monitoring and evaluation in the TB control services within the PHF to plan for intervention so as to meet the set target for TB control in the state. We used the logical framework approach to identify and analyze the problem. We drew up an objective tree and from the objective tree developed a logical framework matrix including evaluation plan. We also conducted desk review to extract data on case findings, case management and outcomes of the treatment. We interviewed TB focal persons and laboratory personnel using structured questionnaire. The data was analyzed using excel spread sheet. Of the 127 health facilities with TB patients on treatment 27 (21.3%) were PHF. The PHF reported 54.6% (1494) of TB cases in 2011. The sputum conversion rates, cured rate, treatment success rate, and default rates were 85%, 73%, 81.4% and 6.6% respectively. The discordant rates were 3.1% and 1.2% for the state and private health facilities respectively. Log frame approach is a useful tool for evaluation of TB control services and helps provide evidence for decision making to improve quality of the TB services in the public and private health facilities in the state.

  17. High quality fuel gas from biomass pyrolysis with calcium oxide. (United States)

    Zhao, Baofeng; Zhang, Xiaodong; Chen, Lei; Sun, Laizhi; Si, Hongyu; Chen, Guanyi


    The removal of CO2 and tar in fuel gas produced by biomass thermal conversion has aroused more attention due to their adverse effects on the subsequent fuel gas application. High quality fuel gas production from sawdust pyrolysis with CaO was studied in this paper. The results of pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) experiments indicate that the mass ratio of CaO to sawdust (Ca/S) remarkably affects the behavior of sawdust pyrolysis. On the basis of Py-GC/MS results, one system of a moving bed pyrolyzer coupled with a fluid bed combustor has been developed to produce high quality fuel gas. The lower heating value (LHV) of the fuel gas was above 16MJ/Nm(3) and the content of tar was under 50mg/Nm(3), which is suitable for gas turbine application to generate electricity and heat. Therefore, this technology may be a promising route to achieve high quality fuel gas for biomass utilization. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. High quality mask storage in an advanced Logic-Fab (United States)

    Jähnert, Carmen; Fritsche, Silvio


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

  19. Methods and systems for fabricating high quality superconducting tapes

    Energy Technology Data Exchange (ETDEWEB)

    Majkic, Goran; Selvamanickam, Venkat


    An MOCVD system fabricates high quality superconductor tapes with variable thicknesses. The MOCVD system can include a gas flow chamber between two parallel channels in a housing. A substrate tape is heated and then passed through the MOCVD housing such that the gas flow is perpendicular to the tape's surface. Precursors are injected into the gas flow for deposition on the substrate tape. In this way, superconductor tapes can be fabricated with variable thicknesses, uniform precursor deposition, and high critical current densities.

  20. High quality factor resonance at room temperature with nanostrings under high tensile stress (United States)

    Verbridge, Scott S.; Parpia, Jeevak M.; Reichenbach, Robert B.; Bellan, Leon M.; Craighead, H. G.


    Quality factors as high as 207 000 are demonstrated at room temperature for radio-frequency silicon nitride string resonators with cross sectional dimensions on the scale of 100 nm, made with a nonlithographic technique. A product of quality factor and surface to volume ratio greater than 6000 nm-1 is presented, the highest yet reported. Doubly clamped nanostring resonators are fabricated in high tensile-stress silicon nitride using a nonlithographic electrospinning process. We fabricate devices with an electron beam process, and demonstrate frequency and quality factor results identical to those obtained with the nonlithographic technique. We also compare high tensile-stress doubly clamped beams with doubly clamped and cantilever resonators made of a lower stress material, as well as cantilever beams made of the high stress material. In all cases, the doubly clamped high stress beams have the highest quality factors. We therefore attribute the high quality factors to high tensile stress. Potential dominant loss mechanisms are discussed, including surface and clamping losses, and thermoelastic dissipation. Some practical advantages offered by these nanostrings for mass sensing are discussed.

  1. Plant Growth under Natural Light Conditions Provides Highly Flexible Short-Term Acclimation Properties toward High Light Stress (United States)

    Schumann, Tobias; Paul, Suman; Melzer, Michael; Dörmann, Peter; Jahns, Peter


    Efficient acclimation to different growth light intensities is essential for plant fitness. So far, most studies on light acclimation have been conducted with plants grown under different constant light regimes, but more recent work indicated that acclimation to fluctuating light or field conditions may result in different physiological properties of plants. Thale cress (Arabidopsis thaliana) was grown under three different constant light intensities (LL: 25 μmol photons m−2 s−1; NL: 100 μmol photons m−2 s−1; HL: 500 μmol photons m−2 s−1) and under natural fluctuating light (NatL) conditions. We performed a thorough characterization of the morphological, physiological, and biochemical properties focusing on photo-protective mechanisms. Our analyses corroborated the known properties of LL, NL, and HL plants. NatL plants, however, were found to combine characteristics of both LL and HL grown plants, leading to efficient and unique light utilization capacities. Strikingly, the high energy dissipation capacity of NatL plants correlated with increased dynamics of thylakoid membrane reorganization upon short-term acclimation to excess light. We conclude that the thylakoid membrane organization and particularly the light-dependent and reversible unstacking of grana membranes likely represent key factors that provide the basis for the high acclimation capacity of NatL grown plants to rapidly changing light intensities. PMID:28515734

  2. Block periodization of high-intensity aerobic intervals provides superior training effects in trained cyclists. (United States)

    Rønnestad, B R; Hansen, J; Ellefsen, S


    The purpose of this study was to compare the effect of two different methods of organizing endurance training in trained cyclists. One group of cyclists performed block periodization, wherein the first week constituted five sessions of high-intensity aerobic training (HIT), followed by 3 weeks of one weekly HIT session and focus on low-intensity training (LIT) (BP; n = 10, VO2max  = 62 ± 2 mL/kg/min). Another group of cyclists performed a more traditional organization, with 4 weeks of two weekly HIT sessions interspersed with LIT (TRAD; n = 9, VO2max  = 63 ± 2 mL/kg/min). Similar volumes of both HIT and LIT was performed in the two groups. While BP increased VO2max , peak power output (Wmax) and power output at 2 mmol/L [la(-)] by 4.6 ± 3.7%, 2.1 ± 2.8%, and 10 ± 12%, respectively (P training compared with TRAD training (ES = 1.34, ES = 0.85, and ES = 0.71, respectively). The present study suggests that block periodization of training provides superior adaptations to traditional organization during a 4-week endurance training period, despite similar training volume and intensity. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. New Potentiometric Wireless Chloride Sensors Provide High Resolution Information on Chemical Transport Processes in Streams

    Directory of Open Access Journals (Sweden)

    Keith Smettem


    Full Text Available Quantifying the travel times, pathways, and dispersion of solutes moving through stream environments is critical for understanding the biogeochemical cycling processes that control ecosystem functioning. Validation of stream solute transport and exchange process models requires data obtained from in-stream measurement of chemical concentration changes through time. This can be expensive and time consuming, leading to a need for cheap distributed sensor arrays that respond instantly and record chemical transport at points of interest on timescales of seconds. To meet this need we apply new, low-cost (in the order of a euro per sensor potentiometric chloride sensors used in a distributed array to obtain data with high spatial and temporal resolution. The application here is to monitoring in-stream hydrodynamic transport and dispersive mixing of an injected chemical, in this case NaCl. We present data obtained from the distributed sensor array under baseflow conditions for stream reaches in Luxembourg and Western Australia. The reaches were selected to provide a range of increasingly complex in-channel flow patterns. Mid-channel sensor results are comparable to data obtained from more expensive electrical conductivity meters, but simultaneous acquisition of tracer data at several positions across the channel allows far greater spatial resolution of hydrodynamic mixing processes and identification of chemical ‘dead zones’ in the study reaches.

  4. Quality Assessment of Some High Consumption Foods in Zanjan City

    Directory of Open Access Journals (Sweden)

    Hassan Hassanzad Azar


    Full Text Available Background: Foods go through many changes from production to table and continuous control is necessary to maintain food safety and supply foods with good quality. The aim of this study was to evaluate the quality of some foods with high consumption in Zanjan city within 5 years from 2009 to 2013. Methods: In a case-control descriptive study with an annually- controlled program within 5 years from 2009 to 2014, some food samples including pasteurized milk, vegetable oils, flour, kebab, salt, confectionary products and a special cookie called nan-chay were collected and analyzed in food control laboratory of Zanjan university of medical sciences. Results: According to national standard of Iran, of Nan-chay, salt, vegetable oils, kebab, confectionary products, and pasteurized milk samples 68.4%, 46%, 24.3%, 10.4%, 9.3%, 5% were out of national standard limits and unacceptable, respectively. All flour samples had good standard quality. Mean± sd values of pH in Nan-chay samples were 7.5 and 1.19, respectively. Mean± sd values of the degree of purity in salt samples were 98.21 and 1.75, respectively. Conclusion: Results showed that among the 7 types of collected foods in Zanjan city, the most nonstandard cases were of Nan-chay samples and the best quality was seen in flour samples.

  5. Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider. (United States)

    Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna


    Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

  6. Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers

    Directory of Open Access Journals (Sweden)

    Mar Miserachs


    Full Text Available With improved survival outcomes after pediatric liver transplantation (LT, health-related quality of life (HRQoL is an important outcome metric. Understanding the elements contributing to HRQoL after LT in children would enable more targeted strategies towards optimizing best outcomes. This qualitative study aimed to explore health care providers (HCP perceptions about HRQoL after pediatric LT. Thirteen experienced HCP participated in two focus group discussions. Data analysis via a thematic analysis approach revealed 4 major themes: “LT as a facilitator of better HRQoL,” “coping and adapting to LT,” “living with a transplanted liver,” and “the family context.” HCP identified elements that both enhance (improved physical health, peer relationship, and activities of daily living and challenge (need for immunosuppression, transplant follow-up, and restrictions the multidimensional domains of HRQoL. HCP perceived LT to be a stressful life-changing event for children and their families. Patients and their parents’ ability to cope and adjust positively to LT was perceived as a key contributor to better HRQoL. HCP perspective highlights the importance of promoting psychosocial support and a family-centered care delivery model towards the overarching goal of optimizing durable outcomes.

  7. Quality metrics in high-dimensional data visualization: an overview and systematization. (United States)

    Bertini, Enrico; Tatu, Andrada; Keim, Daniel


    In this paper, we present a systematization of techniques that use quality metrics to help in the visual exploration of meaningful patterns in high-dimensional data. In a number of recent papers, different quality metrics are proposed to automate the demanding search through large spaces of alternative visualizations (e.g., alternative projections or ordering), allowing the user to concentrate on the most promising visualizations suggested by the quality metrics. Over the last decade, this approach has witnessed a remarkable development but few reflections exist on how these methods are related to each other and how the approach can be developed further. For this purpose, we provide an overview of approaches that use quality metrics in high-dimensional data visualization and propose a systematization based on a thorough literature review. We carefully analyze the papers and derive a set of factors for discriminating the quality metrics, visualization techniques, and the process itself. The process is described through a reworked version of the well-known information visualization pipeline. We demonstrate the usefulness of our model by applying it to several existing approaches that use quality metrics, and we provide reflections on implications of our model for future research. © 2010 IEEE

  8. Predictors of early acceptance of free spectacles provided to junior high school students in China. (United States)

    Keay, Lisa; Zeng, Yangfa; Munoz, Beatriz; He, Mingguang; Friedman, David S


    To examine factors influencing adherence to spectacle wear and perceived value within a prospective 1-month trial of ready-made and custom spectacles in school-aged children with uncorrected refractive error in urban China. A total of 428 students aged 12 to 15 years with at least 1 diopter of uncorrected refractive error were given free spectacles and evaluated 1 month later at an unannounced visit. Demographic factors, vision, optical effects, and perceptions were modeled as predictors of observed use and perceived value using logistic regression adjusted for spectacle allocation. Of 415 students, 388 (93.5%) planned to use their spectacles, 227 (54.7%) valued their spectacles highly, 204 (49.2%) had their spectacles on hand, and 13 (3.0%) were lost to follow-up. Female students were 1.72 times (95% confidence interval [CI], 1.10-2.68), students from lower income households were 1.78 times (1.32-2.39), and those not concerned over appearance were 2.04 times (1.25-3.36) more likely to have spectacles on hand. Students with a pupil size of 4 mm or greater were 2.55 times (95% CI, 1.61-4.03) and students with spectacle vision worse than 20/20 were 2.06 times (1.20-3.49) more likely to have spectacles on hand. Self-report of high perceived value was 2.23 times (95% CI, 1.30-3.80) more likely with 20/20 spectacle vision, 1.63 times (1.06-2.52) more likely with base-in prismatic effects of 0.5 prism diopters or more, 3.52 times (2.03-6.13) more likely when students would not tolerate blur to avoid wearing spectacles, and 2.16 times (1.24-3.76) more likely with disbelief that spectacles would make vision worse. Spectacle type had no effect. Although most students planned to use their spectacles, only half were observed using them. Day-to-day use might increase if students were less concerned over appearance. Optical factors and beliefs surrounding spectacles are also predictive of acceptance. These findings provide further understanding of spectacle acceptance in

  9. Biotransformation of Organic Waste into High Quality Fertilizer

    DEFF Research Database (Denmark)

    Bryndum, Sofie

    Agriculture faces several challenges of future provision of nutrients such as limited P reserves and increasing prices of synthetic fertilizers and recycling of nutrients from organic waste can be an important strategy for the long-term sustainability of the agricultural systems. Organically...... and S, is often low; and (3) the unbalanced composition of nutrients rarely matches crop demands. Therefore the objective of this project was to investigate the potential for (1) recycling nutrients from agro-industrial wastes and (2) compost biotransformation into high-quality organic fertilizers......, including three succeeding compost experiments, conducted in Denmark (Paper II). The composting studies investigated three management interventions to enhance the compost fertilizer quality and accelerate compost turnover: (1) the addition of nutrient rich material, (2) the compost turning frequency and (3...

  10. Efficient high-quality volume rendering of SPH data. (United States)

    Fraedrich, Roland; Auer, Stefan; Westermann, Rüdiger


    High quality volume rendering of SPH data requires a complex order-dependent resampling of particle quantities along the view rays. In this paper we present an efficient approach to perform this task using a novel view-space discretization of the simulation domain. Our method draws upon recent work on GPU-based particle voxelization for the efficient resampling of particles into uniform grids. We propose a new technique that leverages a perspective grid to adaptively discretize the view-volume, giving rise to a continuous level-of-detail sampling structure and reducing memory requirements compared to a uniform grid. In combination with a level-of-detail representation of the particle set, the perspective grid allows effectively reducing the amount of primitives to be processed at run-time. We demonstrate the quality and performance of our method for the rendering of fluid and gas dynamics SPH simulations consisting of many millions of particles.

  11. IEEE 802.15.4 Frame Aggregation Enhancement to Provide High Performance in Life-Critical Patient Monitoring Systems. (United States)

    Akbar, Muhammad Sajjad; Yu, Hongnian; Cang, Shuang


    In wireless body area sensor networks (WBASNs), Quality of Service (QoS) provision for patient monitoring systems in terms of time-critical deadlines, high throughput and energy efficiency is a challenging task. The periodic data from these systems generates a large number of small packets in a short time period which needs an efficient channel access mechanism. The IEEE 802.15.4 standard is recommended for low power devices and widely used for many wireless sensor networks applications. It provides a hybrid channel access mechanism at the Media Access Control (MAC) layer which plays a key role in overall successful transmission in WBASNs. There are many WBASN's MAC protocols that use this hybrid channel access mechanism in variety of sensor applications. However, these protocols are less efficient for patient monitoring systems where life critical data requires limited delay, high throughput and energy efficient communication simultaneously. To address these issues, this paper proposes a frame aggregation scheme by using the aggregated-MAC protocol data unit (A-MPDU) which works with the IEEE 802.15.4 MAC layer. To implement the scheme accurately, we develop a traffic patterns analysis mechanism to understand the requirements of the sensor nodes in patient monitoring systems, then model the channel access to find the performance gap on the basis of obtained requirements, finally propose the design based on the needs of patient monitoring systems. The mechanism is initially verified using numerical modelling and then simulation is conducted using NS2.29, Castalia 3.2 and OMNeT++. The proposed scheme provides the optimal performance considering the required QoS.

  12. High-resolution remote sensing of water quality in the San Francisco Bay-Delta Estuary (United States)

    Fichot, Cédric G.; Downing, Bryan D.; Bergamaschi, Brian; Windham-Myers, Lisamarie; Marvin-DiPasquale, Mark C.; Thompson, David R.; Gierach, Michelle M.


    The San Francisco Bay–Delta Estuary watershed is a major source of freshwater for California and a profoundly human-impacted environment. The water quality monitoring that is critical to the management of this important water resource and ecosystem relies primarily on a system of fixed water-quality monitoring stations, but the limited spatial coverage often hinders understanding. Here, we show how the latest technology in visible/near-infrared imaging spectroscopy can facilitate water quality monitoring in this highly dynamic and heterogeneous system by enabling simultaneous depictions of several water quality indicators at very high spatial resolution. The airborne portable remote imaging spectrometer (PRISM) was used to derive high-spatial-resolution (2.6 × 2.6 m) distributions of turbidity, and dissolved organic carbon (DOC) and chlorophyll-a concentrations in a wetland-influenced region of this estuary. A filter-passing methylmercury vs DOC relationship was also developed using in situ samples and enabled the high-spatial-resolution depiction of surface methylmercury concentrations in this area. The results illustrate how high-resolution imaging spectroscopy can inform management and policy development in important inland and estuarine water bodies by facilitating the detection of point- and nonpoint-source pollution, and by providing data to help assess the complex impacts of wetland restoration and climate change on water quality and ecosystem productivity.

  13. High-Resolution Remote Sensing of Water Quality in the San Francisco Bay-Delta Estuary. (United States)

    Fichot, Cédric G; Downing, Bryan D; Bergamaschi, Brian A; Windham-Myers, Lisamarie; Marvin-DiPasquale, Mark; Thompson, David R; Gierach, Michelle M


    The San Francisco Bay-Delta Estuary watershed is a major source of freshwater for California and a profoundly human-impacted environment. The water quality monitoring that is critical to the management of this important water resource and ecosystem relies primarily on a system of fixed water-quality monitoring stations, but the limited spatial coverage often hinders understanding. Here, we show how the latest technology in visible/near-infrared imaging spectroscopy can facilitate water quality monitoring in this highly dynamic and heterogeneous system by enabling simultaneous depictions of several water quality indicators at very high spatial resolution. The airborne portable remote imaging spectrometer (PRISM) was used to derive high-spatial-resolution (2.6 × 2.6 m) distributions of turbidity, and dissolved organic carbon (DOC) and chlorophyll-a concentrations in a wetland-influenced region of this estuary. A filter-passing methylmercury vs DOC relationship was also developed using in situ samples and enabled the high-spatial-resolution depiction of surface methylmercury concentrations in this area. The results illustrate how high-resolution imaging spectroscopy can inform management and policy development in important inland and estuarine water bodies by facilitating the detection of point- and nonpoint-source pollution, and by providing data to help assess the complex impacts of wetland restoration and climate change on water quality and ecosystem productivity.

  14. 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)


    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

  15. The quality of health care services provided in health care centers of Khorramabad using SERVQUAL model in 2010

    Directory of Open Access Journals (Sweden)

    mohammad javad tarrahi


    Conclusion: Expectations of the clients in all aspects of offering services are beyond than their perceptions, and needed to improve the quality of offering services in these centers in all the dimensions especially empathy dimension. It is recommended that the quality of the offering services be assessed periodically in these centers and intervene to improve the delivering of health services.

  16. A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance. (United States)

    Brighton, Lisa Jane; Koffman, Jonathan; Hawkins, Amy; McDonald, Christine; O'Brien, Suzanne; Robinson, Vicky; Khan, Shaheen A; George, Rob; Higginson, Irene J; Selman, Lucy Ellen


    End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarize the findings. From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were of low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n = 7), and most were taught using a mixture of didactics (n = 123), reflection and discussion (n = 105), and role play (n = 86). Evaluation designs were weak: skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  17. Fat Quality Influences the Obesogenic Effect of High Fat Diets (United States)

    Crescenzo, Raffaella; Bianco, Francesca; Mazzoli, Arianna; Giacco, Antonia; Cancelliere, Rosa; di Fabio, Giovanni; Zarrelli, Armando; Liverini, Giovanna; Iossa, Susanna


    High fat and/or carbohydrate intake are associated with an elevated risk for obesity and chronic diseases such as diabetes and cardiovascular diseases. The harmful effects of a high fat diet could be different, depending on dietary fat quality. In fact, high fat diets rich in unsaturated fatty acids are considered less deleterious for human health than those rich in saturated fat. In our previous studies, we have shown that rats fed a high fat diet developed obesity and exhibited a decrease in oxidative capacity and an increase in oxidative stress in liver mitochondria. To investigate whether polyunsaturated fats could attenuate the above deleterious effects of high fat diets, energy balance and body composition were assessed after two weeks in rats fed isocaloric amounts of a high-fat diet (58.2% by energy) rich either in lard or safflower/linseed oil. Hepatic functionality, plasma parameters, and oxidative status were also measured. The results show that feeding on safflower/linseed oil diet attenuates the obesogenic effect of high fat diets and ameliorates the blood lipid profile. Conversely, hepatic steatosis and mitochondrial oxidative stress appear to be negatively affected by a diet rich in unsaturated fatty acids. PMID:26580650

  18. Fat Quality Influences the Obesogenic Effect of High Fat Diets

    Directory of Open Access Journals (Sweden)

    Raffaella Crescenzo


    Full Text Available High fat and/or carbohydrate intake are associated with an elevated risk for obesity and chronic diseases such as diabetes and cardiovascular diseases. The harmful effects of a high fat diet could be different, depending on dietary fat quality. In fact, high fat diets rich in unsaturated fatty acids are considered less deleterious for human health than those rich in saturated fat. In our previous studies, we have shown that rats fed a high fat diet developed obesity and exhibited a decrease in oxidative capacity and an increase in oxidative stress in liver mitochondria. To investigate whether polyunsaturated fats could attenuate the above deleterious effects of high fat diets, energy balance and body composition were assessed after two weeks in rats fed isocaloric amounts of a high-fat diet (58.2% by energy rich either in lard or safflower/linseed oil. Hepatic functionality, plasma parameters, and oxidative status were also measured. The results show that feeding on safflower/linseed oil diet attenuates the obesogenic effect of high fat diets and ameliorates the blood lipid profile. Conversely, hepatic steatosis and mitochondrial oxidative stress appear to be negatively affected by a diet rich in unsaturated fatty acids.

  19. High Quality Acquisition of Surface Electromyography - Conditioning Circuit Design (United States)

    Shobaki, Mohammed M.; Malik, Noreha Abdul; Khan, Sheroz; Nurashikin, Anis; Haider, Samnan; Larbani, Sofiane; Arshad, Atika; Tasnim, Rumana


    The acquisition of Surface Electromyography (SEMG) signals is used for many applications including the diagnosis of neuromuscular diseases, and prosthesis control. The diagnostic quality of the SEMG signal is highly dependent on the conditioning circuit of the SEMG acquisition system. This paper presents the design of an SEMG conditioning circuit that can guarantee to collect high quality signal with high SNR such that it is immune to environmental noise. The conditioning circuit consists of four stages; consisting of an instrumentation amplifier that is used with a gain of around 250; 4th order band pass filter in the 20-500Hz frequency range as the two initial stages. The third stage is an amplifier with adjustable gain using a variable resistance; the gain could be changed from 1000 to 50000. In the final stage the signal is translated to meet the input requirements of data acquisition device or the ADC. Acquisition of accurate signals allows it to be analyzed for extracting the required characteristic features for medical and clinical applications. According to the experimental results, the value of SNR for collected signal is 52.4 dB which is higher than the commercial system, the power spectrum density (PSD) graph is also presented and it shows that the filter has eliminated the noise below 20 Hz.

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

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


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

  1. Performing High-Quality Science on CubeSats

    DEFF Research Database (Denmark)

    H. Zurbuchen, Thomas; von Steiger, Rudolf; Bartalev, Sergey


    January 2016 the International Space Science Institute in Berne, Switzerland,hosted a two-day Forum to focus on the rapid evolution of CubeSats as an enabling technology platform, with special emphasis on their promise to perform high-quality science.The Forum was initiated in coordination...... in this area of research. Our discussions focused on four themes characteristic of CubeSats and their evolution: 1) identification of appropriate science in avariety of research disciplines, 2) technology development, 3) international vs. national approaches, and 4) educational benefits. These discussions...

  2. Changes in sexual roles and quality of life for gay men after prostate cancer: challenges for sexual health providers. (United States)

    Hart, Tae L; Coon, David W; Kowalkowski, Marc A; Zhang, Karen; Hersom, Justin I; Goltz, Heather H; Wittmann, Daniela A; Latini, David M


    Gay men with prostate cancer (GMPCa) may have differential health-related quality of life (HRQOL) and sexual health outcomes than heterosexual men with prostate cancer (PCa), but existing information is based on clinical experience and small studies. Our goals were to: (i) describe HRQOL and examine changes in sexual functioning and bother; (ii) explore the psychosocial aspects of sexual health after PCa; and (iii) examine whether there were significant differences on HRQOL and sexual behavior between GMPCa and published norms. A convenience sample of GMPCa completed validated disease-specific and general measures of HRQOL, ejaculatory function and bother, fear of cancer recurrence, and satisfaction with prostate cancer care. Measures of self-efficacy for PCa management, illness intrusiveness, and disclosure of sexual orientation were also completed. Where possible, scores were compared against published norms. Main outcome measures were self-reported sexual functioning and bother on the Expanded Prostate Cancer Index. Compared with norms, GMPCa reported significantly worse functioning and more severe bother scores on urinary, bowel, hormonal symptom scales (Ps sexual functioning scores (P sexual bother scores were similar to that of published samples. GMPCa tended to be more "out" about their sexual orientation than other samples of gay men. GMPCa reported substantial changes in sexual functioning after PCa treatment. They also reported significantly worse disease-specific and general HRQOL, fear of recurrence, and were less satisfied with their medical care than other published PCa samples. Sexual health providers must have an awareness of the unique functional and HRQOL differences between gay and heterosexual men with PCa. © 2014 International Society for Sexual Medicine.

  3. Stress and sleep quality in high school brazilian adolescents. (United States)

    Mesquita, Gema; Reimão, Rubens


    The objective of the present study is to analyze the effect of stress on sleep quality in a group of adolescents. Two high schools in Alfenas, southern Minas Gerais State, Brazil, were chosen to participate in the study. The sample consisted of both genders (n=160) with 65.63% females. The age range of participants was 15 to18 years. The Pittsburgh Sleep Quality Index (PSQI) was applied for collection of data to quantify sleep quality. The Lipp Inventory of Stress Symptoms that objectively identifies symptoms of stress was applied. It was observed that 23.53% of stressed students and 45.33% of unstressed ones sleep well; 76.47% of stressed pupils and 54.67% of those unstressed do not sleep well. With regard to school performance, a mean of 0.65 was found for stressed students and 0.60 for those without stress, Mann-Whitney (p=0.0596). Stress contributed to raising the percentage of poor sleepers, as ell as increasing ean school performance.

  4. CCD Astrophotography High-Quality Imaging from the Suburbs

    CERN Document Server

    Stuart, Adam


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

  5. High-Quality Real-Time Video Inpaintingwith PixMix. (United States)

    Herling, Jan; Broll, Wolfgang


    While image inpainting has recently become widely available in image manipulation tools, existing approaches to video inpainting typically do not even achieve interactive frame rates yet as they are highly computationally expensive. Further, they either apply severe restrictions on the movement of the camera or do not provide a high-quality coherent video stream. In this paper we will present our approach to high-quality real-time capable image and video inpainting. Our PixMix approach even allows for the manipulation of live video streams, providing the basis for real Diminished Reality (DR) applications. We will show how our approach generates coherent video streams dealing with quite heterogeneous background environments and non-trivial camera movements, even applying constraints in real-time.

  6. Development of quality indicators for transition from pediatric to adult care in sickle cell disease: A modified Delphi survey of adult providers. (United States)

    Sobota, Amy E; Shah, Nishita; Mack, Jennifer W


    Transition from pediatric to adult care is a vulnerable time for young adults with sickle cell disease (SCD); however, improvements in transition are limited by a lack of quality indicators. The purpose of this study was to establish quality indicators for transition in SCD and to determine the optimal timing between the final pediatric visit and the first adult provider visit. We conducted a modified Delphi survey to reach a consensus on which quality indicators are most important for a successful transition. Our expert panel consisted of members of the Sickle Cell Adult Provider Network. In the first round, the participants ranked a list of quality indicators by importance. In the second round, the participants chose their "top 5" quality indicators in terms of importance and also ranked them on feasibility. The response rates for the two rounds were 68 and 96%, respectively. Nine quality indicators were chosen as "top 5" by a majority of respondents, including communication between pediatric and adult providers, timing of first adult visit, patient self-efficacy, quality of life, and trust with their adult provider. Based on the comments from round 1, respondents were also asked for the optimal timing between leaving pediatric care and entering adult care. Most recommended a first adult visit within 2 months of the final pediatric visit. By using these quality indicators chosen by the majority of respondents, we can better develop and evaluate transition programs for young adults with SCD and improve health outcomes for these vulnerable patients. © 2016 Wiley Periodicals, Inc.

  7. Delivering Service Quality in Alcohol Treatment: A Qualitative Comparison of Public and Private Treatment Centres by Service Users and Service Providers (United States)

    Resnick, Sheilagh M.; Griffiths, Mark D.


    In the UK, quality of care has now been placed at the centre of the National Health Service (NHS) modernisation programme. To date, there has been little research on the service quality delivery of alcohol treatment services from the perspective of both the service user and service provider. Therefore, this qualitative study explored the…

  8. The impact of a microfinance program on client perceptions of the quality of care provided by private sector midwives in Uganda. (United States)

    Agha, Sohail; Balal, Asma; Ogojo-Okello, Francis


    To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty. A quasi-experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow-up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow-up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T-tests, the analysis of variance, and multivariate logistic regression analysis were conducted. These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty. The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services.

  9. Training Physicians to Provide High-Value, Cost-Conscious Care A Systematic Review

    NARCIS (Netherlands)

    Stammen, L.A.; Stalmeijer, R.E.; Paternotte, E.; Pool, A.O.; Driessen, E.W.; Scheele, F.; Stassen, L.P.S.


    Importance Increasing health care expenditures are taxing the sustainability of the health care system. Physicians should be prepared to deliver high-value, cost-conscious care. Objective To understand the circumstances in which the delivery of high-value, cost-conscious care is learned, with a goal

  10. Practicing provider-initiated HIV testing in high prevalence settings: consent concerns and missed preventive opportunities


    Shayo Elizabeth H; Blystad Astrid; Njeru Mercy K; Nyamongo Isaac K; Fylkesnes Knut


    Abstract Background Counselling is considered a prerequisite for the proper handling of testing and for ensuring effective HIV preventive efforts. HIV testing services have recently been scaled up substantially with a particular focus on provider-initiated models. Increasing HIV test rates have been attributed to the rapid scale-up of the provider-initiated testing model, but there is limited documentation of experiences with this new service model. The aim of this study was to determine the ...

  11. High Quality Factor Fano-Resonant All-Dielectric Metamaterials

    CERN Document Server

    Yang, Yuanmu; Briggs, Dayrl P; Valentine, Jason


    Fano-resonant plasmonic metamaterials and nanostructures have become a major focus of the nanophotonics fields over the past several years due their ability to produce high quality factor (Q-factor) resonances. The origin of such resonances is the interference between a broad and narrow resonance, ultimately allowing suppression of radiative damping. However, Fano-resonant plasmonic structures still suffer non-radiative damping due to Ohmic loss, ultimately limiting the achievable Q-factors to values less than 10. Here, we report experimental demonstration of Fano-resonant silicon-based metamaterials that have a response that mimics the electromagnetically induced transparency (EIT) found in atomic systems. Due to extremely low absorption loss, a record-high Q-factor of 306 was experimentally observed. Furthermore, the unit cell of the metamaterial was designed with a feed-gap which results in strong local field enhancement in the surrounding medium resulting in strong light-matter interaction. This allows th...

  12. Percutaneous vertebroplasty with a high-quality rotational angiographic unit

    Energy Technology Data Exchange (ETDEWEB)

    Pedicelli, Alessandro [Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Policl. A.Gemelli, l.go Gemelli 1, 00168 Rome (Italy)], E-mail:; Rollo, Massimo [Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Policl. A.Gemelli, l.go Gemelli 1, 00168 Rome (Italy)], E-mail:; Piano, Mariangela [Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Policl. A.Gemelli, l.go Gemelli 1, 00168 Rome (Italy)], E-mail:; Re, Thomas J. [Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Policl. A.Gemelli, l.go Gemelli 1, 00168 Rome (Italy)], E-mail:; Cipriani, Maria C. [Department of Gerontology, Catholic University of Sacred Heart, Policl. A.Gemelli, l.go Gemelli 1, 00168 Rome (Italy)], E-mail:; Colosimo, Cesare [Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Policl. A.Gemelli, l.go Gemelli 1, 00168 Rome (Italy)], E-mail:; Bonomo, Lorenzo [Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Policl. A.Gemelli, l.go Gemelli 1, 00168 Rome (Italy)], E-mail:


    We evaluated the reliability of a rotational angiographic unit (RA) with flat-panel detector as a single technique to guide percutaneous vertebroplasty (PVP) and for post-procedure assessment by 2D and 3D reformatted images. Fifty-five consecutive patients (104 vertebral bodies) were treated under RA fluoroscopy. Rotational acquisitions with 2D and 3D reconstruction were obtained in all patients for immediate post-procedure assessment. In complex cases, this technique was also used to evaluate the needle position during the procedure. All patients underwent CT scan after the procedure. RA and CT findings were compared. In all cases, a safe trans-pedicular access and an accurate control of the bone-cement injection were successfully performed with high-quality fluoroscopy, even at the thoracic levels and in case of vertebra plana. 2D and 3D rotational reconstructions permitted CT-like images that clearly showed needle position and were similar to CT findings in depicting intrasomatic implant-distribution. RA detected 40 cement leakages compared to 42 demonstrated by CT and showed overall 95% sensitivity and 100% specificity compared to CT for final post-procedure assessment. Our preliminary results suggest that high-quality RA is reliable and safe as a single technique for PVP guidance, control and post-procedure assessment. It permits fast and cost-effective procedures avoiding multi-modality imaging.

  13. Health care in small prisons: incorporating high-quality standards. (United States)

    Rieder, Jean-Pierre; Casillas, Alejandra; Mary, Gérard; Secretan, Anne-Dominique; Gaspoz, Jean-Michel; Wolff, Hans


    In the past, health management in Geneva's six post-trial prisons had been variable and inconsistent. In 2008, the unit of penitentiary medicine of the Geneva University Hospitals was mandated to re-organize and provide health care at all six prison facilities. The specific aim of this paper is to outline the example as a practical solution to some of the common challenges in unifying the structure and process of health services across multiple small facilities, while meeting European prison health and local quality standards. Geneva's post-trial prisons are small and close to one another in geographical proximity - ideal conditions for the construction of a health mobile team (HMT). This multidisciplinary mobile team operated like a community ambulatory care model; it was progressively launched in all prison facilities in Geneva. The authors incorporated an implementation strategy where health providers partnered with prison and community stakeholders in the health delivery model's development and adaption process. The model's strategic initiatives are described along the following areas, in light of other international prison health activity and prior care models: access to a health care professional, equivalence of care, patient consent, confidentiality, humanitarian interventions, and professional competence and independence. From the perspective of the HMT members, the authors provide the "lessons learned" through this experience, especially to providers who are working on prison health services reform and coordination improvement. The paper particularly stresses the importance of partnering with community health stakeholders and prison staff, a key component to the approach.

  14. High Framingham risk score decreases quality of life in adults

    Directory of Open Access Journals (Sweden)

    Christian Yosaputra


    Full Text Available Cardiovascular disease (CVD risk factors, such as diabetes, hypertension, hypercholesterolemia, smoking, and obesity tend to occur together in the general population. Increasing prevalence of multiple CVD risk factors has been related to increased risk of death from coronary heart disease and stroke. Studies have suggested that people with several risk factors of CVD may have impaired health-related quality of life. The objective of this study was to assess the association of CVD risk factors with quality of life (QOL among adults aged 40 to 65 years. A cross-sectional study was conducted involving 220 subjects 40 - 65 years of age at a health center. The CVD risk factors were assessed using the Framingham risk score that is the standard instrument for assessment of the risk of a first cardiac event. The risk factors assessed were age, smoking, blood pressure, total cholesterol and high density lipoprotein cholesterol concentrations. QOL was assessed by means of the WHOQOL-BREF instrument that had been prevalidated. The results of the study showed that 28.2% of subjects were smokers, 56.4% had stage 1 hypertension, 42.8% high total cholesterol and 13.6% low HDL cholesterol. The high risk group amounted to 45.5% and 42.3% constitued an intermediate risk group. High CVD risk scores were significantly associated with a low QOL for all domains (physical, psychological, social and environment (p=0.000. Preventing or reducing the multiple CVD risk factors to improve QOL is necessary among adults.


    Directory of Open Access Journals (Sweden)

    А. М. Hashimov


    Full Text Available The article presents design engineering methods for the high-voltage pulse installations of technological purpose for disinfection of drinking water, sewage, and edible liquids by high field micro- and nanosecond pulsing exposure. Designing potentialities are considered of the principal elements of the high-voltage part and the discharge circuit of the installations towards assuring the best efficient on-load utilization of the source energy and safe operation of the high-voltage equipment. The study shows that for disinfection of drinking water and sewage it is expedient to apply microsecond pulse actions causing the electrohydraulic effect in aqueous media with associated complex of physical processes (ultraviolet emission, generation of ozone and atomic oxygen, mechanical compression waves, etc. having detrimental effect on life activity of the microorganisms. In case of disinfecting edible liquids it is recommended to use the nanosecond pulses capable of straight permeating the biological cell nucleus, inactivating it. Meanwhile, the nutritive and biological values of the foodstuffs are saved and their organoleptic properties are improved. It is noted that in elaboration process of high-frequency pulse installations special consideration should be given to issues of the operating personnel safety discipline and securing conditions for the entire installation uninterrupted performance. With this objective in view the necessary requirements should be fulfilled on shielding the high- and low-voltage installation parts against high-frequency electromagnetic emissions registered by special differential sensors. Simultaneously, the abatement measures should be applied on the high-voltage equipment operational noise level. The authors offer a technique for noise abatement to admissible levels (lower than 80 dB A by means of coating the inside surface with shielded enclosure of densely-packed abutting sheets of porous electro-acoustic insulating

  16. Different Polar Metabolites and Protein Profiles between High- and Low-Quality Japanese Ginjo Sake.

    Directory of Open Access Journals (Sweden)

    Kei Takahashi

    Full Text Available Japanese ginjo sake is a premium refined sake characterized by a pleasant fruity apple-like flavor and a sophisticated taste. Because of technical difficulties inherent in brewing ginjo sake, off-flavors sometimes occur. However, the metabolites responsible for off-flavors as well as those present or absent in higher quality ginjo sake remain uncertain. Here, the relationship between 202 polar chemical compounds in sake identified using capillary electrophoresis coupled with time-of-flight mass spectrometry and its organoleptic properties, such as quality and off-flavor, was examined. First, we found that some off-flavored sakes contained higher total amounts of metabolites than other sake samples. The results also identified that levels of 2-oxoglutaric acid and fumaric acid, metabolites in the tricarboxylic acid cycle, were highly but oppositely correlated with ginjo sake quality. Similarly, pyridoxine and pyridoxamine, co-enzymes for amino transferase, were also highly but oppositely correlated with ginjo sake quality. Additionally, pyruvic acid levels were associated with good quality as well. Compounds involved in the methionine salvage cycle, oxidative glutathione derivatives, and amino acid catabolites were correlated with low quality. Among off-flavors, an inharmonious bitter taste appeared attributable to polyamines. Furthermore, protein analysis displayed that a diversity of protein components and yeast protein (triosephosphate isomerase, TPI leakage was linked to the overall metabolite intensity in ginjo sake. This research provides insight into the relationship between sake components and organoleptic properties.

  17. Spatial correlation of high density EMG signals provides features robust to electrode number and shift in pattern recognition for myocontrol. (United States)

    Stango, Antonietta; Negro, Francesco; Farina, Dario


    Research on pattern recognition for myoelectric control has usually focused on a small number of electromyography (EMG) channels because of better clinical acceptability and low computational load with respect to multi-channel EMG. However, recently, high density (HD) EMG technology has substantially improved, also in practical usability, and can thus be applied in myocontrol. HD EMG provides several closely spaced recordings in multiple locations over the skin surface. This study considered the use of HD EMG for controlling upper limb prostheses, based on pattern recognition. In general, robustness and reliability of classical pattern recognition systems are influenced by electrode shift in dons and doff, and by the presence of malfunctioning channels. The aim of this study is to propose a new approach to attenuate these issues. The HD EMG grid of electrodes is an ensemble of sensors that records data spatially correlated. The experimental variogram, which is a measure of the degree of spatial correlation, was used as feature for classification, contrary to previous approaches that are based on temporal or frequency features. The classification based on the variogram was tested on seven able-bodied subjects and one subject with amputation, for the classification of nine and seven classes, respectively. The performance of the proposed approach was comparable with the classic methods based on time-domain and autoregressive features (average classification accuracy over all methods ∼ 95% for nine classes). However, the new spatial features demonstrated lower sensitivity to electrode shift ( ± 1 cm) with respect to the classic features . When even just one channel was noisy, the classification accuracy dropped by ∼ 10% for all methods. However, the new method could be applied without any retraining to a subset of high-quality channels whereas the classic methods require retraining when some channels are omitted. In conclusion, the new spatial feature space

  18. Access to high-volume surgeons and the opportunity cost of performing radical prostatectomy by low-volume providers. (United States)

    Barzi, Afsaneh; Klein, Eric A; Daneshmand, Siamak; Gill, Inderbir; Quinn, David I; Sadeghi, Sarmad


    Evidence suggests that redirecting surgeries to high-volume providers may be associated with better outcomes and significant societal savings. Whether such referrals are feasible remains unanswered. Medicare Provider Utilization and Payment Data, SEER 18, and US Incidence data were used to determine the geographic distribution and radical prostatectomy volume for providers. Access was defined as availability of a high-volume provider within driving distance of 100 miles. The opportunity cost was defined as the value of benefits achievable by performing the surgery by a high-volume provider that was forgone by not making a referral. The savings per referral were derived from a published Markov model for radical prostatectomy. A total of 14% of providers performed>27% of the radical prostatectomies with>30 cases per year and were designated high-volume providers. Providers with below-median volume (≤16 prostatectomies per year) performed>32% of radical prostatectomies. At least 47% of these were within a 100-mile driving distance (median = 22 miles), and therefore had access to a high-volume provider (>30 prostatectomies per year). This translated into a discounted savings of more than $24 million per year, representing the opportunity cost of not making a referral. The average volume for high- and low-volume providers was 55 and 13, respectively, resulting in an annual experience gap of 43 and a cumulative gap of 125 surgeries over 3 years. In 2014, the number of surgeons performing radical prostatectomy decreased by 5% while the number of high- and low-volume providers decreased by 25% and 11% showing a faster decline in the number of high-volume providers compared with low-volume surgeons. About half of prostatectomies performed by surgeons with below-median annual volume were within a 100-mile driving distance (median of 22 miles) of a high-volume surgeon. Such a referral may result in minimal additional costs and substantially improved outcomes. Copyright


    Directory of Open Access Journals (Sweden)

    Elizabeta Mitreva


    Full Text Available The question of quality of private and public high educational institutions in the Republic of Macedonia is being asked every academic year and results in numerous public debates which very often lead to stereotyping of individual institutions. This paper provides a comparative overview of the situation in the private and public high education system in the country through the analysis of subjective and objective indicators based on which a comparison is made between two types of high education institutions. The instruments used in the comparative analysis of subjective and objective indicators are statistical data, application of the SWOT method for comparative analysis between the units, as well as usage of various methods and techniques to improve the quality of high education. This comparative analysis raises questions and offers recommendations for the potential improvement of the quality of work of these institutions. The intent is to encourage continuous comparative evaluation and proposing practices for continuous development and growth of quality in the high education in the country.

  20. Time-lapse imaging provides further evidence that planar arrangement of blastomeres is highly abnormal. (United States)

    Ebner, Thomas; Höggerl, Alexandra; Oppelt, Peter; Radler, Elisabeth; Enzelsberger, Simon-Hermann; Mayer, Richard B; Petek, Erwin; Shebl, Omar


    Recently, guidelines on the annotation of dynamic human embryo monitoring recommended screening for the presence of planar blastomere arrangement at the 4-cell stage. This observational study was set up in order to analyze whether developmental kinetics of planar human embryos are different from tetrahedral ones. Therefore, embryos of 115 consecutive ICSI patients (showing 32 planar and 554 tetrahedral embryos) were cultured in a new time-lapse system (Miri TL) and their embryos were annotated for morphokinetic development and screened for irregular cleavages and morphological dysmorphisms. Significantly less planar embryos reached blastocyst stage and showed worse quality as compared to regular tetrahedral embryos. The rate of bi- and/or multinucleation was also significantly higher in the affected group. Irregular cleavages, particularly embryo rolling, were more often seen in planar embryos. Morphokinetics between planar and tetrahedral were distinguishable up to 4-cell stage (t2-t4), thereafter the observed delay in planar embryos (t8) was more likely the result of a higher rate of arrested embryos in the planar group. Planar embryos are associated with both a significant increase in irregular cleavage as well as a delay in preimplantation development. This indicates that planar embryos are rather abnormal and should only be considered for transfer if no other embryos are available.

  1. Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare Beneficiaries. (United States)

    Perloff, Jennifer; Clarke, Sean; DesRoches, Catherine M; O'Reilly-Jacob, Monica; Buerhaus, Peter


    State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. State regulations restricting NP SoP do not improve the quality of care.

  2. High quality yarns from high speed roller ginning of upland cotton (United States)

    The highest quality yarns from upland cotton are typically produced by using combing in the textile mill. Combing is a resource-intensive process in which short fibers are removed from cotton before spinning. The improvement in fiber length and length uniformity of upland cotton when high speed ro...

  3. High-resolution phylogeny providing insights towards the epidemiology, zoonotic aspects and taxonomy of sapoviruses

    NARCIS (Netherlands)

    Barry, A.F.; Durães-Carvalho, R.; Oliveira-Filho, Edmilson F.; Alfieri, A.; Poel, Van der W.H.M.


    The evolution, epidemiology and zoonotic aspects of Sapoviruses (SaV) are still not well explored. In this study, we applied high-resolution phylogeny to investigate the epidemiological and zoonotic origins as well as taxonomic classification of animal and human SaV. Bayesian framework analyses

  4. New Policies Allow High School Child Development Programs to Provide CDA Licensure (United States)

    Langlais, Amanda G.


    Recent changes made by the Council for Professional Recognition to the Child Development Associate (CDA) credentialing program create an opportunity to redesign high school child development programs. On April 1, 2011, the Council for Professional Recognition lifted the age restriction in the CDA credentialing requirements, now allowing students…

  5. Academic coordination at university: Strategies for high quality education

    Directory of Open Access Journals (Sweden)

    Maria del Mar Durán Bellonch


    Full Text Available Most lecturers and professors involved in teaching School Management and Education Management courses have been engaged in developing some innovative actions to improve the training quality that we offer to students in the Pedagogy degree at the Autonomous University of Barcelona. These actions are aimed at increasing co-ordination among the teaching staff when designing and implementing the course curricula. Co-ordination meetings, exchanges of teaching experiences, discussions about what, how and when to teach the different contents, in which courses and at what level, methodological issues pointed out through technical description cards or the elaboration of study cases to be solved have become the basis of relevant actions during the last academic years. This paper explains each one of them, and provides useful information about the theoretical background, the process carried out, some of the results obtained, the output and the tools created.

  6. Publishing high-quality climate data on the semantic web (United States)

    Woolf, Andrew; Haller, Armin; Lefort, Laurent; Taylor, Kerry


    The effort over more than a decade to establish the semantic web [Berners-Lee et. al., 2001] has received a major boost in recent years through the Open Government movement. Governments around the world are seeking technical solutions to enable more open and transparent access to Public Sector Information (PSI) they hold. Existing technical protocols and data standards tend to be domain specific, and so limit the ability to publish and integrate data across domains (health, environment, statistics, education, etc.). The web provides a domain-neutral platform for information publishing, and has proven itself beyond expectations for publishing and linking human-readable electronic documents. Extending the web pattern to data (often called Web 3.0) offers enormous potential. The semantic web applies the basic web principles to data [Berners-Lee, 2006]: using URIs as identifiers (for data objects and real-world 'things', instead of documents) making the URIs actionable by providing useful information via HTTP using a common exchange standard (serialised RDF for data instead of HTML for documents) establishing typed links between information objects to enable linking and integration Leading examples of 'linked data' for publishing PSI may be found in both the UK ( and US ( The Bureau of Meteorology (BoM) is Australia's national meteorological agency, and has a new mandate to establish a national environmental information infrastructure (under the National Plan for Environmental Information, NPEI [BoM, 2012a]). While the initial approach is based on the existing best practice Spatial Data Infrastructure (SDI) architecture, linked-data is being explored as a technological alternative that shows great promise for the future. We report here the first trial of government linked-data in Australia under In this initial pilot study, we have taken BoM's new high-quality reference surface

  7. High-Speed AFM Images of Thermal Motion Provide Stiffness Map of Interfacial Membrane Protein Moieties


    Preiner, Johannes; Horner, Andreas; Karner, Andreas; Ollinger, Nicole; Siligan, Christine; Pohl, Peter; Hinterdorfer, Peter


    The flexibilities of extracellular loops determine ligand binding and activation of membrane receptors. Arising from fluctuations in inter- and intraproteinaceous interactions, flexibility manifests in thermal motion. Here we demonstrate that quantitative flexibility values can be extracted from directly imaging the thermal motion of membrane protein moieties using high-speed atomic force microscopy (HS-AFM). Stiffness maps of the main periplasmic loops of single reconstituted water channels ...

  8. Design of a miniaturized high quality power switching converter for space application (United States)

    Clemans, D. W.; Thibodeaux, R. J.

    Power Distribution System (PDS) requirements for space applications are becoming more demanding. Desired PDS architectures consists of a high voltage (270) dc distribution bus for low power loss with local switching regulators to provide high quality power at the load interface. There are difficult performance requirements that these local switching regulators must meet in terms of size, weight, efficiency, transient response, and wide input voltage range. The design of a hybridized switching regulator is realized with a series resonant half-bridge topology employing a high switching frequency. This paper describes the design, analysis, and fabrication of a breadboard power converter for a local rlegulator scheme in a PDS for space applications.

  9. Determination of saffron quality by high-performance liquid chromatography. (United States)

    Valle García-Rodríguez, M; Serrano-Díaz, Jéssica; Tarantilis, Petros A; López-Córcoles, Horacio; Carmona, Manuel; Alonso, Gonzalo L


    The aim of this work was to propose a high-performance liquid chromatography with diode array detection (HPLC-DAD) method for determining the three main compounds responsible for determining the quality of saffron (crocetin esters, picrocrocin, and safranal) by preparing an aqueous extract according to the ISO 3632 standard to solve the difficulty that this standard has for aroma and taste determination by ultraviolet-visible spectroscopy. Toward this aim, laboratory-isolated picrocrocin, a safranal standard with a purity of ≥ 88%, trans-crocetin di(β-D-gentiobiosyl) ester (trans-4-GG) and trans-crocetin (β-D-glucosyl)-(β-D-gentiobiosyl) ester (trans-3-Gg) standards, both with a purity of ≥ 99%, and 50 different saffron spice samples from Italy, Iran, Greece, and Spain were used in the intralaboratory validation of the HPLC method. The analytical method proposed was adequate in terms of linearity, selectivity, sensitivity, and accuracy for determining the three foremost parameters that define the quality of saffron using only a saffron solution prepared according to the ISO 3632 standard.

  10. Improving eggshell quality at high temperatures with dietary sodium bicarbonate. (United States)

    Balnave, D; Muheereza, S K


    Two experiments were conducted that confirmed the hypothesis that a dietary bicarbonate supplement will improve eggshell quality in hens at high temperatures as long as feed is consumed during the period of eggshell formation. End-of-lay hens were maintained on continuous light at temperatures of 30 and 35 C. Individual egg weights and shell quality measures for each hen were calculated as a proportion of the initial values determined during an acclimatization period at 25 C. Improvements in shell breaking strength in both experiments were observed as a result of supplementing control diets with 1% sodium bicarbonate (NaHCO3). This response to NaHCO3 was not a reflection of a reduced rate of lay or egg mass output, as these were similar or inferior on the control diets. Similar feed intakes on the control and NaHCO3 diets indicated that the response was not related to differences in calcium intakes. Supplements of zinc methionine and ascorbic acid proved to be inferior to NaHCO3. Improvements in egg weight were associated with the introduction of continuous lighting.

  11. EMODNet Bathymetry - building and providing a high resolution digital bathymetry for European seas (United States)

    Schaap, D.


    Access to marine data is a key issue for the EU Marine Strategy Framework Directive and the EU Marine Knowledge 2020 agenda and includes the European Marine Observation and Data Network (EMODnet) initiative. The EMODnet Bathymetry project develops and publishes Digital Terrain Models (DTM) for the European seas. These are produced from survey and aggregated data sets that are indexed with metadata by adopting from SeaDataNet the Common Data Index (CDI) data discovery and access service and the Sextant data products catalogue service. SeaDataNet is a network of major oceanographic data centres around the European seas that manage, operate and further develop a pan-European infrastructure for marine and ocean data management. SeaDataNet is also setting and governing marine data standards, and exploring and establishing interoperability solutions to connect to other e-infrastructures on the basis of standards such as ISO and OGC. The SeaDataNet portal provides users a number of interrelated meta directories, an extensive range of controlled vocabularies, and the various SeaDataNet standards and tools. SeaDataNet at present gives overview and access to more than 1.8 million data sets for physical oceanography, chemistry, geology, geophysics, bathymetry and biology from more than 100 connected data centres from 34 countries riparian to European seas. The latest EMODnet Bathymetry DTM has a resolution of 1/8 arcminute * 1/8 arcminute and covers all European sea regions. Use is made of available and gathered surveys and already more than 13.000 surveys have been indexed by 27 European data providers from 15 countries. Also use is made of composite DTMs as generated and maintained by several data providers for their areas of interest. Already 44 composite DTMs are included in the Sextant data products catalogue. For areas without coverage use is made of the latest global DTM of GEBCO who is partner in the EMODnet Bathymetry project. In return GEBCO integrates the EMODnet

  12. Cloud tracking of the Venus atmosphere with Akatsuki: High-quality wind snapshots, jets, and instabilities (United States)

    Horinouchi, T.; Murakami, S.; Satoh, T.; Watanabe, S.; Kouyama, T.; Ogohara, K.; Imamura, T.; Takagi, M.; Kashimura, H.; Peralta, J.; Limaye, S. S.; Sato, T. M.; Nakamura, M.; Yamada, M.; Yamazaki, A.; Young, E. F.


    We have conducted cloud tracking using image data from Akatsuki, a Venus orbiting satellite, at multiple wavelengths. Our method provides cloud-motion vectors with unprecedented high quality. Obtained cloud top winds exhibit rich spatial and temporal variability. In the lower cloud layer, it is observed that a jet stream was formed in the equatorial region in 2016, which persisted at least over a few months. Occasionally, batropically unstable vortices are found to develop to erode the shear associated with the jet.

  13. 75 FR 44971 - Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children (United States)


    ... conditions. + Chronic health care. + Health services to ameliorate the effects of physical and mental... these factors affecting the quality of care given to children under titles XIX and XXI, the Secretary is... Doc No: 2010-18140] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services...

  14. Computerized Provider Order Entry and Health Care Quality on Hospital Level among Pediatric Patients during 2006-2009 (United States)

    Wang, Liya


    This study examined the association between Computerized Physician Order Entry (CPOE) application and healthcare quality in pediatric patients at hospital level. This was a retrospective study among 1,428 hospitals with pediatric setting in Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) and Health Information and…

  15. Health Care of Latino Children with Autism and Other Developmental Disabilities: Quality of Provider Interaction Mediates Utilization (United States)

    Parish, Susan; Magana, Sandra; Rose, Roderick; Timberlake, Maria; Swaine, Jamie G.


    This study examines access to, utilization of, and quality of health care for Latino children with autism and other developmental disabilities. We analyze data from the National Survey of Children with Special Health Care Needs (N = 4,414 children with autism and other developmental disabilities). Compared with White children, Latino children with…

  16. (Collection of high quality acoustical records for honeybees)

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, H.T.; Buchanan, M.E.


    High quality acoustical data records were collected for both European and Africanized honeybees under various field conditions. This data base was needed for more rigorous evaluation of a honeybee identification technique previously developed by the travelers from preliminary data sets. Laboratory-grade recording equipment was used to record sounds made by honeybees in and near their nests and during foraging flights. Recordings were obtained from European and Africanized honeybees in the same general environment. Preliminary analyses of the acoustical data base clearly support the general identification algorithm: Africanized honeybee noise has significantly higher frequency content than does European honeybee noise. As this algorithm is refined, it may result in the development of a simple field-portable device for identifying subspecies of honeybees. Further, the honeybee's acoustical signals appear to be correlated with specific colony conditions. Understanding these variations may have enormous benefit for entomologists and for the beekeeping industry.

  17. High Quality Rapeseed Products as Feed for Sensitive Monogastrics

    DEFF Research Database (Denmark)

    Frandsen, Heidi Blok

    . Glucosinolates can be transformed enzymatic by the enzyme myrosinase (EC., or non-enzymatic by heat treatment or under the acidic and reducing conditions in the stomach of monogastrics. The type of transformation product depends on the parent glucosinolate and of the chemical conditions, and in some...... for cheaper protein rapeseed meal has been considered as an alternative to soya-protein. Rapeseed (Brassica napus L. spp. oleifera) has a well-balanced amino acid profile for monogastrics, but it contains several compounds which are anti-nutritional and might lower the protein quality and limit the amount...... cake was included, while losses up to 88% were observed when cold-pressed rapeseed caked was used. N-balance trials with rats clearly demonstrated effects on the biologic value caused by high glucosinolate concentrations, active myrosinase and long temperature treatments. The second study (manuscript...

  18. Power quality in high-tech campus: a case study

    Energy Technology Data Exchange (ETDEWEB)

    Moreno-Munoz, A.; Redel, M.; Gonzalez, M. [Universidad de Cordoba (Spain). Departamento de Electrotecnia y Electronica


    This paper presents preliminary results from a power-quality audit conducted at a high-tech campus over the last year. Voltage and current were measured at various R and D buildings; it was found that the main problems for the equipment installed were voltage sags and surges. The paper examines the causes and effects of power disturbances that affect computer or any other microprocessor-based equipment and analyses the auto-protection capabilities of modern power supplies. The convenience of 'enhanced power supply' or 'low-cost customer-side' protection solutions is also discussed. Finally, it addresses the role of the standards on the protection of electronic equipment and the implications for the final customer. (author)

  19. The Effect of Cognitive Appraisal on Quality of Life of Providers of Home Care for Patients With Stroke. (United States)

    Pai, Hsiang-Chu; Tsai, Yi-Chen


    Stroke is a major cause of long-term disability. Most stroke survivors return to their own home and need to be cared for by family members, most of whom are informal caregivers. The aim of this study was to identify whether cognitive appraisal influences health-related quality of life. A cross-sectional, descriptive, correlational design was used. Participants included 77 primary support persons, mean age = 59.47 years, who were younger than stroke survivors (mean age = 78.13 years). Data were collected between March-November 2012 and obtained through face-to-face interviews, using the Short-Form-36 Health Survey, Caregiver Burden Inventory, and five cognitive appraisal questions. In addition, the Barthel Index, Modified Rankin Scale, and Glasgow Coma Scale were used to assess patient disease severity. Hierarchical multiple regression analysis was used to identify predictors of health-related quality of life. The results indicated that 61% of participants rated their health as poor or fair. Patient severity, gender of primary support person, age, employment, burden, and cognitive appraisal impact accounted for 45.8% of the variance in primary support persons' physical component summary of health-related quality of life, with age, burden, and appraisal impact being the strongest of six predictors. In addition, burden and appraisal impact were the strongest of six predictors, explaining 18.1% of the variance in primary support persons' mental component summary of health-related quality of life. The results of the current study further highlight the importance of cognitive appraisal on the stroke survivor's primary support person's health-related quality of life.

  20. Neuraminidase activity provides a practical read-out for a high throughput influenza antiviral screening assay

    Directory of Open Access Journals (Sweden)

    Wu Meng


    Full Text Available Abstract Background The emergence of influenza strains that are resistant to commonly used antivirals has highlighted the need to develop new compounds that target viral gene products or host mechanisms that are essential for effective virus replication. Existing assays to identify potential antiviral compounds often use high throughput screening assays that target specific viral replication steps. To broaden the search for antivirals, cell-based replication assays can be performed, but these are often labor intensive and have limited throughput. Results We have adapted a traditional virus neutralization assay to develop a practical, cell-based, high throughput screening assay. This assay uses viral neuraminidase (NA as a read-out to quantify influenza replication, thereby offering an assay that is both rapid and sensitive. In addition to identification of inhibitors that target either viral or host factors, the assay allows simultaneous evaluation of drug toxicity. Antiviral activity was demonstrated for a number of known influenza inhibitors including amantadine that targets the M2 ion channel, zanamivir that targets NA, ribavirin that targets IMP dehydrogenase, and bis-indolyl maleimide that targets protein kinase A/C. Amantadine-resistant strains were identified by comparing IC50 with that of the wild-type virus. Conclusion Antivirals with specificity for a broad range of targets are easily identified in an accelerated viral inhibition assay that uses NA as a read-out of replication. This assay is suitable for high throughput screening to identify potential antivirals or can be used to identify drug-resistant influenza strains.

  1. High sensitivity troponin T provides useful prognostic information in non-acute chest pain. (United States)

    George, J; Jack, D; Mackle, G; Callaghan, T S; Wei, L; Lang, C C; Dow, E; Struthers, A D


    To evaluate the prognostic value of high-sensitivity troponin T (hs-cTnT) in patients who present to General Practitioners (GPs) with non-acute chest pain. A total of 625 patients who were referred by their GPs to a regional Rapid Access Chest Pain Clinic in Tayside, Scotland were consented and recruited. Diamond-Forrester pretest probability of coronary artery disease (CAD) was used to select patients with intermediate and high-pretest probability. Hs-cTnT and B-type Natriuretic Peptide (BNP) were measured and final diagnosis recorded. Twelve-month follow-up for cardiac events and hospital admission data was collected. Sensitivity, specificity, positive predictive value and negative predictive value (NPV), for both prognosis and diagnosis, were produced using various pre-specified cut-off values for hs-cTnT and BNP. A total of 579 patients were included in the final analysis. Of these, 477 had intermediate/high-pretest probability of CAD. A total of 431 (90.4%) of patients had a hs-cTnT ≤14 ng/l. In this study, hs-cTnT of 14 ng/l was the best cut-off for ruling out if a patient would have an admission for cardiac chest pain in the following 12 months (specificity 90%, NPV 91.4%). It performed well as a predictor of a subsequent negative diagnosis of cardiac chest pain with a specificity of 92.4% and NPV of 83.5%. Hs-cTnT, at the same level currently used in clinical practice as a diagnostic cut-off for myocardial infarction and acute coronary syndromes, is also a clinically-meaningful indicator for further 12-month cardiac chest pain hospital admissions in patients with non-acute chest pain referred to chest pain clinics by GPs.

  2. Improving the quality of paediatric malaria diagnosis and treatment by rural providers in Myanmar: an evaluation of a training and support intervention. (United States)

    Aung, Tin; Longfield, Kim; Aye, Nyo Me; San, Aung Kyaw; Sutton, Thea S; Montagu, Dominic


    This study evaluates the effectiveness of a training programme for improving the diagnostic and treatment quality of the most complex service offered by Sun Primary Health (SPH) providers, paediatric malaria. The study further assesses whether any quality improvements were sustained over the following 12 months. The study took place in 13 townships in central Myanmar between January 2011 and October 2012. A total of 251 community health workers were recruited and trained in the provision of paediatric and adult malaria diagnosis and treatment; 197 were surveyed in all three rounds: baseline, 6 and 12 months. Townships were selected based on a lack of alterative sources of medical care, averaging 20 km from government or private professional health care treatment facilities. Seventy percent of recruits were assistant nurse midwives or had other basic health training; the rest had no health training experience. Recruits were evaluated on their ability to properly diagnosis and treat a simulated 5-year-old patient using a previously validated method known as Observed Simulated Patient. A trained observer scored SPH providers on a scale of 1-100, based on WHO and Myanmar MOH established best practices. During a pilot test, 20 established private physicians operating in malaria-endemic areas of Myanmar scored an average of 70/100. Average quality scores of newly recruited SPH providers prior to training (baseline) were 12/100. Six months after training, average quality scores were 48/100. This increase was statistically significant (p training, providers were retested and average quality scores were 45/100 (R3-R1, p training programme was able to improve the quality of paediatric malaria care significantly, and to maintain that improvement over time. Quality of care remains lower than that of trained physicians; however, SPH providers operate in rural areas where no trained physicians operate. More research is needed to establish acceptable and achievable levels of

  3. Assessment of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study. (United States)

    McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J; Salami, Habeeb; Jega, Farouk


    Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (peducation. These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

  4. Attitudes of high school students regarding intimate relationships and gender norms in New Providence, The Bahamas

    Directory of Open Access Journals (Sweden)

    Nicolls, Donna


    Full Text Available This paper reports the attitudes and actions on relationships with the opposite sex of 1,002 Grade 10 and Grade 12 students in New Providence. Girls were more likely than boys to use aggressive behaviours in teen relationships. Some of the behaviours noted in teen relationships informed expectations of marital relationships, such as restricted access to friends of the opposite sex. The students endorsed a number of sex-related stereotypes, such as a man being the head of the household. Both male and female students indicated that it was acceptable for men to control their wives. Participation in aggressive and controlling behaviours by teens points to the need to educate students about how to develop more respectful relationships.

  5. A Highly Flexible, Automated System Providing Reliable Sample Preparation in Element- and Structure-Specific Measurements. (United States)

    Vorberg, Ellen; Fleischer, Heidi; Junginger, Steffen; Liu, Hui; Stoll, Norbert; Thurow, Kerstin


    Life science areas require specific sample pretreatment to increase the concentration of the analytes and/or to convert the analytes into an appropriate form for the detection and separation systems. Various workstations are commercially available, allowing for automated biological sample pretreatment. Nevertheless, due to the required temperature, pressure, and volume conditions in typical element and structure-specific measurements, automated platforms are not suitable for analytical processes. Thus, the purpose of the presented investigation was the design, realization, and evaluation of an automated system ensuring high-precision sample preparation for a variety of analytical measurements. The developed system has to enable system adaption and high performance flexibility. Furthermore, the system has to be capable of dealing with the wide range of required vessels simultaneously, allowing for less cost and time-consuming process steps. However, the system's functionality has been confirmed in various validation sequences. Using element-specific measurements, the automated system was up to 25% more precise compared to the manual procedure and as precise as the manual procedure using structure-specific measurements. © 2015 Society for Laboratory Automation and Screening.

  6. Bio-Inspired Supramolecular Chemistry Provides Highly Concentrated Dispersions of Carbon Nanotubes in Polythiophene

    Directory of Open Access Journals (Sweden)

    Yen-Ting Lin


    Full Text Available In this paper we report the first observation, through X-ray diffraction, of noncovalent uracil–uracil (U–U dimeric π-stacking interactions in carbon nanotube (CNT–based supramolecular assemblies. The directionally oriented morphology determined using atomic force microscopy revealed highly organized behavior through π-stacking of U moieties in a U-functionalized CNT derivative (CNT–U. We developed a dispersion system to investigate the bio-inspired interactions between an adenine (A-terminated poly(3-adeninehexyl thiophene (PAT and CNT–U. These hybrid CNT–U/PAT materials interacted through π-stacking and multiple hydrogen bonding between the U moieties of CNT–U and the A moieties of PAT. Most importantly, the U···A multiple hydrogen bonding interactions between CNT–U and PAT enhanced the dispersion of CNT–U in a high-polarity solvent (DMSO. The morphology of these hybrids, determined using transmission electron microscopy, featured grape-like PAT bundles wrapped around the CNT–U surface; this tight connection was responsible for the enhanced dispersion of CNT–U in DMSO.

  7. High-quality stable electron beams from laser wakefield acceleration in high density plasma

    Directory of Open Access Journals (Sweden)

    B. S. Rao


    Full Text Available High-quality, stable electron beams are produced from self-injected laser wakefield acceleration using the interaction of moderate 3 TW, 45 fs duration Ti:sapphire laser pulses with high density (>5×10^{19}   cm^{−3} helium gas jet plasma. The electron beam has virtually background-free quasimonoenergetic distribution with energy 35.6_{−2.5}^{+3.9}  MeV, charge 3.8_{−1.2}^{+2.8}  pC, divergence and pointing variation ∼10  mrad. The stable and high quality of the electron beam opens an easy way for applications of the laser wakefield accelerator in the future, particularly due to the widespread availability of sub-10 TW class lasers with a number of laser plasma laboratories around the world.

  8. Continuous Renal Replacement Therapy Update: An Emphasis on Safe and High-Quality Care. (United States)

    Schell-Chaple, Hildy


    Continuous renal replacement therapy (CRRT) was introduced more than 40 years ago as a renal support option for critically ill patients who had contraindications to intermittent hemodialysis and peritoneal dialysis. Despite being the most common renal support therapy used in intensive care units today, the tremendous variability in CRRT management challenges the interpretation of findings from CRRT outcome studies. The lack of standardization in practice and training of clinicians along with the high risk of CRRT-related adverse events has been the impetus for the recent expert consensus work on identifying quality indicators for CRRT programs. This article summarizes the potential complications that establish CRRT as a high-risk therapy and also the recently published best-practice recommendations for providing high-quality CRRT. ©2017 American Association of Critical-Care Nurses.

  9. High quality atomically thin PtSe2 films grown by molecular beam epitaxy (United States)

    Yan, Mingzhe; Wang, Eryin; Zhou, Xue; Zhang, Guangqi; Zhang, Hongyun; Zhang, Kenan; Yao, Wei; Lu, Nianpeng; Yang, Shuzhen; Wu, Shilong; Yoshikawa, Tomoki; Miyamoto, Koji; Okuda, Taichi; Wu, Yang; Yu, Pu; Duan, Wenhui; Zhou, Shuyun


    Atomically thin PtSe2 films have attracted extensive research interests for potential applications in high-speed electronics, spintronics and photodetectors. Obtaining high quality thin films with large size and controlled thickness is critical. Here we report the first successful epitaxial growth of high quality PtSe2 films by molecular beam epitaxy. Atomically thin films from 1 ML to 22 ML have been grown and characterized by low-energy electron diffraction, Raman spectroscopy and x-ray photoemission spectroscopy. Moreover, a systematic thickness dependent study of the electronic structure is revealed by angle-resolved photoemission spectroscopy (ARPES), and helical spin texture is revealed by spin-ARPES. Our work provides new opportunities for growing large size single crystalline films to investigate the physical properties and potential applications of PtSe2.

  10. Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care. (United States)

    Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E


    Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost

  11. High-quality JPEG compression history detection for fake uncompressed images (United States)

    Zhang, Rong; Wang, Rang-Ding; Guo, Li-Jun; Jiang, Bao-Chuan


    Authenticity is one of the most important evaluation factors of images for photography competitions or journalism. Unusual compression history of an image often implies the illicit intent of its author. Our work aims at distinguishing real uncompressed images from fake uncompressed images that are saved in uncompressed formats but have been previously compressed. To detect the potential image JPEG compression, we analyze the JPEG compression artifacts based on the tetrolet covering, which corresponds to the local image geometrical structure. Since the compression can alter the structure information, the tetrolet covering indexes may be changed if a compression is performed on the test image. Such changes can provide valuable clues about the image compression history. To be specific, the test image is first compressed with different quality factors to generate a set of temporary images. Then, the test image is compared with each temporary image block-by-block to investigate whether the tetrolet covering index of each 4×4 block is different between them. The percentages of the changed tetrolet covering indexes corresponding to the quality factors (from low to high) are computed and used to form the p-curve, the local minimum of which may indicate the potential compression. Our experimental results demonstrate the advantage of our method to detect JPEG compressions of high quality, even the highest quality factors such as 98, 99, or 100 of the standard JPEG compression, from uncompressed-format images. At the same time, our detection algorithm can accurately identify the corresponding compression quality factor.

  12. msmsEval: tandem mass spectral quality assignment for high-throughput proteomics

    Directory of Open Access Journals (Sweden)

    Cartwright Hugh M


    Full Text Available Abstract Background In proteomics experiments, database-search programs are the method of choice for protein identification from tandem mass spectra. As amino acid sequence databases grow however, computing resources required for these programs have become prohibitive, particularly in searches for modified proteins. Recently, methods to limit the number of spectra to be searched based on spectral quality have been proposed by different research groups, but rankings of spectral quality have thus far been based on arbitrary cut-off values. In this work, we develop a more readily interpretable spectral quality statistic by providing probability values for the likelihood that spectra will be identifiable. Results We describe an application, msmsEval, that builds on previous work by statistically modeling the spectral quality discriminant function using a Gaussian mixture model. This allows a researcher to filter spectra based on the probability that a spectrum will ultimately be identified by database searching. We show that spectra that are predicted by msmsEval to be of high quality, yet remain unidentified in standard database searches, are candidates for more intensive search strategies. Using a well studied public dataset we also show that a high proportion (83.9% of the spectra predicted by msmsEval to be of high quality but that elude standard search strategies, are in fact interpretable. Conclusion msmsEval will be useful for high-throughput proteomics projects and is freely available for download from Supports Windows, Mac OS X and Linux/Unix operating systems.

  13. Fully automated high-quality NMR structure determination of small (2)H-enriched proteins. (United States)

    Tang, Yuefeng; Schneider, William M; Shen, Yang; Raman, Srivatsan; Inouye, Masayori; Baker, David; Roth, Monica J; Montelione, Gaetano T


    Determination of high-quality small protein structures by nuclear magnetic resonance (NMR) methods generally requires acquisition and analysis of an extensive set of structural constraints. The process generally demands extensive backbone and sidechain resonance assignments, and weeks or even months of data collection and interpretation. Here we demonstrate rapid and high-quality protein NMR structure generation using CS-Rosetta with a perdeuterated protein sample made at a significantly reduced cost using new bacterial culture condensation methods. Our strategy provides the basis for a high-throughput approach for routine, rapid, high-quality structure determination of small proteins. As an example, we demonstrate the determination of a high-quality 3D structure of a small 8 kDa protein, E. coli cold shock protein A (CspA), using structure is highly converged and in excellent agreement with the published crystal structure, with a backbone RMSD value of 0.5 Å, an all atom RMSD value of 1.2 Å to the crystal structure for well-defined regions, and RMSD value of 1.1 Å to crystal structure for core, non-solvent exposed sidechain atoms. Cross validation of the structure with (15)N- and (13)C-edited NOESY data obtained with a perdeuterated (15)N, (13)C-enriched (13)CH(3) methyl protonated CspA sample confirms that essentially all of these independently-interpreted NOE-based constraints are already satisfied in each of the 10 CS-Rosetta structures. By these criteria, the CS-Rosetta structure generated by fully automated analysis of data for a perdeuterated sample provides an accurate structure of CspA. This represents a general approach for rapid, automated structure determination of small proteins by NMR.

  14. Why India should become a global leader in high-quality, affordable TB diagnostics. (United States)

    Small, Peter


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

  15. [Providing quality pharmaceutical services in Brazil: items pending the unified health on the Unified Health System's agenda]. (United States)

    Vieira, Fabiola Sulpino


    To identify items on the agenda of Brazil's Unified Health System that are related to the quality of pharmaceutical services and have not yet been implemented. Data were collected from the inspection reports issued by the federal government's controllership office. Inspection reports completed from August 2004-July 2006, available on the Internet, were reviewed. The issues identified were classified into 15 categories. Of the 660 inspections that were carried out, 659 were analyzed (one was unavailable). In 62 cities pharmaceutical assistance services had not been audited, therefore, a the final sample of 597 cities was analyzed (10.7% of Brazil's municipalities). Of these, 90.3% had issues associated with the management of resources or services. In 71% of the municipalities, the reports indicated lack of or deficient inventory control, and in 39%, inadequate storage conditions. A shortage of drugs was observed in 24% of the municipalities. The goals of Brazil's national drug and pharmaceutical assistance policies are far from being met. Quality pharmaceutical services must again be included on the agenda at all three government levels since it is impossible to have effective health care without quality pharmaceutical services.

  16. Extracting DNA from 'jaws': High yield and quality from archived tiger shark (Galeocerdo cuvier) skeletal material

    DEFF Research Database (Denmark)

    Eg Nielsen, Einar; Morgan, J. A T; Maher, S. L.


    archived skeletal material from sharks as a source of DNA for temporal genomic studies. Six different methods for DNA extraction, encompassing two different commercial kits and three different protocols, were applied to material, so-called bio-swarf, from contemporary and archived jaws and vertebrae...... of tiger sharks (Galeocerdo cuvier). Protocols were compared for DNA yield and quality using a qPCR approach. For jaw swarf, all methods provided relatively high DNA yield and quality, while large differences in yield between protocols were observed for vertebrae. Similar results were obtained from samples...... of white shark (Carcharodon carcharias). Application of the optimized methods to 38 museum and private angler trophy specimens dating back to 1912 yielded sufficient DNA for downstream genomic analysis for 68% of the samples. No clear relationships between age of samples, DNA quality and quantity were...

  17. The use of microbead-based spoligotyping for Mycobacterium tuberculosis complex to evaluate the quality of the conventional method: providing guidelines for Quality Assurance when working on membranes.

    NARCIS (Netherlands)

    Abadia, E.; Zhang, Jian; Ritacco, V.; Kremer, K.; Ruimy, R.; Rigouts, L.; Gomes, H.M.; Elias, A.R.; Fauville-Dufaux, M.; Stoffels, K.; Rasolofo-Razanamparany, V.; rcia de Viedma, D. Ga; Herranz, M.; Al-Hajoj, S.; Rastogi, N.; Garzelli, C.; Tortoli, E.; Suffys, P.N.; Soolingen, D. van; Refregier, G.; Sola, C.


    BACKGROUND: The classical spoligotyping technique, relying on membrane reverse line-blot hybridization of the spacers of the Mycobacterium tuberculosis CRISPR locus, is used world-wide (598 references in Pubmed on April 8th, 2011). However, until now no inter-laboratory quality control study had

  18. A Patient-Centered, Provider-Facilitated Approach to the Refinement of Nonlinear Frequency Compression Parameters Based on Subjective Preference Ratings of Amplified Sound Quality. (United States)

    Johnson, Earl E; Light, Keri C


    To evaluate sound quality preferences of participants wearing hearing aids with different strengths of nonlinear frequency compression (NFC) processing versus no NFC processing. Two analysis methods, one without and one with a qualifier as to the magnitude of preferences, were compared for their percent agreement to differentiate a small difference in perceived sound quality as a result of applied NFC processing. A single-blind design was used with participants unaware of the presence or strength of NFC processing (independent variable). The National Acoustic Laboratories-Nonlinear 2 (NAL-NL2) prescription of amplification was chosen because audibility is intentionally not prescribed in the presence of larger sensorineural hearing loss thresholds. A lack of prescribed audibility, when present, was deemed an objective qualifier for NFC. NFC is known to improve the input bandwidth available to listeners when high-frequency audibility is not otherwise available and increasing strengths of NFC were examined. Experimental condition 3 (EC3) was stronger than the manufacturer default (EC2). More aggressive strengths (e.g., EC4 and EC5), however, were expected to include excessive distortion and even reduce the output bandwidth that had been prescribed as audible by NAL-NL2 (EC1). A total of 14 male Veterans with severe high-frequency sensorineural hearing loss. Participant sound quality preference ratings (dependent variable) without a qualifier as to the magnitude of preference were analyzed based on binomial probability theory, as is traditional with paired comparison data. The ratings with a qualifier as to the magnitude of preference were analyzed based on the nonparametric statistic of the Wilcoxon signed rank test. The binomial probability analysis method identified a sound quality preference as well as the nonparametric probability test method. As the strength of NFC increased, more participants preferred the EC with less NFC. Fourteen of 14 participants showed

  19. High-density surface electromyography provides reliable estimates of motor unit behavior. (United States)

    Martinez-Valdes, E; Laine, C M; Falla, D; Mayer, F; Farina, D


    To assess the intra- and inter-session reliability of estimates of motor unit behavior and muscle fiber properties derived from high-density surface electromyography (HDEMG). Ten healthy subjects performed submaximal isometric knee extensions during three recording sessions (separate days) at 10%, 30%, 50% and 70% of their maximum voluntary effort. The discharge timings of motor units of the vastus lateralis and medialis muscles were automatically identified from HDEMG by a decomposition algorithm. We characterized the number of detected motor units, their discharge rates, the coefficient of variation of their inter-spike intervals (CoVisi), the action potential conduction velocity and peak-to-peak amplitude. Reliability was assessed for each motor unit characteristics by intra-class correlation coefficient (ICC). Additionally, a pulse-to-noise ratio (PNR) was calculated, to verify the accuracy of the decomposition. Good to excellent reliability within and between sessions was found for all motor unit characteristics at all force levels (ICCs>0.8), with the exception of CoVisi that presented poor reliability (ICC95%). Motor unit features can be assessed non-invasively and reliably within and across sessions over a wide range of force levels. These results suggest that it is possible to characterize motor units in longitudinal intervention studies. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  20. A review of atomic layer deposition providing high performance lithium sulfur batteries (United States)

    Yan, Bo; Li, Xifei; Bai, Zhimin; Song, Xiaosheng; Xiong, Dongbin; Zhao, Mengli; Li, Dejun; Lu, Shigang


    With the significant obstacles that have been conquered in lithium-sulfur (Li-S) batteries, it is urgent to impel accelerating development of room-temperature Li-S batteries with high energy density and long-term stability. In view of the unique solid-liquid-solid conversion processes of Li-S batteries, however, designing effective strategies to address the insulativity and volume effect of cathode, shuttle of soluble polysulfides, and/or safety hazard of Li metal anode has been challenging. An atomic layer deposition (ALD) is a representative thin film technology with exceptional capabilities in developing atomic-precisely conformal films. It has been demonstrated to be a promise strategy of solving emerging issues in advanced electrical energy storage (EES) devices via the surface modification and/or the fabrication of complex nanostructured materials. In this review, the recent developments and significances on how ALD improves the performance of Li-S batteries were discussed in detail. Significant attention mainly focused on the various strategies with the use of ALD to refine the electrochemical interfaces and cell configurations. Furthermore, the novel opportunities and perspective associated with ALD for future research directions were summarized. This review may boost the development and application of advanced Li-S batteries using ALD.

  1. A Vesicle-to-Worm Transition Provides a New High-Temperature Oil Thickening Mechanism. (United States)

    Derry, Matthew J; Mykhaylyk, Oleksandr O; Armes, Steven P


    Diblock copolymer vesicles are prepared via RAFT dispersion polymerization directly in mineral oil. Such vesicles undergo a vesicle-to-worm transition on heating to 150 °C, as judged by TEM and SAXS. Variable-temperature 1 H NMR spectroscopy indicates that this transition is the result of surface plasticization of the membrane-forming block by hot solvent, effectively increasing the volume fraction of the stabilizer block and so reducing the packing parameter for the copolymer chains. The rheological behavior of a 10 % w/w copolymer dispersion in mineral oil is strongly temperature-dependent: the storage modulus increases by five orders of magnitude on heating above the critical gelation temperature of 135 °C, as the non-interacting vesicles are converted into weakly interacting worms. SAXS studies indicate that, on average, three worms are formed per vesicle. Such vesicle-to-worm transitions offer an interesting new mechanism for the high-temperature thickening of oils. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. The IceCube MasterClass: providing high school students an authentic research experience (United States)

    Bravo Gallart, Silvia; Bechtol, Ellen; Schultz, David; Madsen, Megan; Demerit, Jean; IceCube Collaboration


    In May 2014, the first one-day long IceCube Masterclass for high school students was offered. The program was inspired by the masterclasses started in 2005 by the International Particle Physics Outreach Group and supported in the U.S. by QuarkNet. Participation in the IceCube masterclasses has grown each year, with a total of over 500 students in three U.S states and three European countries after three editions. In a masterclass, students join an IceCube research team to learn about astrophysics and replicate the results of a published paper, such as the discovery of astrophysical neutrinos or a measurement of the cosmic ray flux. We will discuss both the scientific and educational goals of the program as well as the organizational challenges. Data from the program evaluation will be used to support the need of educational activities based on actual research as a powerful approach for motivating more students to pursue STEM college programs, making science and scientists more approachable to teenagers, and helping students envision a career in science.

  3. High quality protein microarray using in situ protein purification

    Directory of Open Access Journals (Sweden)

    Fleischmann Robert D


    Full Text Available Abstract Background In the postgenomic era, high throughput protein expression and protein microarray technologies have progressed markedly permitting screening of therapeutic reagents and discovery of novel protein functions. Hexa-histidine is one of the most commonly used fusion tags for protein expression due to its small size and convenient purification via immobilized metal ion affinity chromatography (IMAC. This purification process has been adapted to the protein microarray format, but the quality of in situ His-tagged protein purification on slides has not been systematically evaluated. We established methods to determine the level of purification of such proteins on metal chelate-modified slide surfaces. Optimized in situ purification of His-tagged recombinant proteins has the potential to become the new gold standard for cost-effective generation of high-quality and high-density protein microarrays. Results Two slide surfaces were examined, chelated Cu2+ slides suspended on a polyethylene glycol (PEG coating and chelated Ni2+ slides immobilized on a support without PEG coating. Using PEG-coated chelated Cu2+ slides, consistently higher purities of recombinant proteins were measured. An optimized wash buffer (PBST composed of 10 mM phosphate buffer, 2.7 mM KCl, 140 mM NaCl and 0.05% Tween 20, pH 7.4, further improved protein purity levels. Using Escherichia coli cell lysates expressing 90 recombinant Streptococcus pneumoniae proteins, 73 proteins were successfully immobilized, and 66 proteins were in situ purified with greater than 90% purity. We identified several antigens among the in situ-purified proteins via assays with anti-S. pneumoniae rabbit antibodies and a human patient antiserum, as a demonstration project of large scale microarray-based immunoproteomics profiling. The methodology is compatible with higher throughput formats of in vivo protein expression, eliminates the need for resin-based purification and circumvents

  4. The structure of high-quality aluminium cast iron

    Directory of Open Access Journals (Sweden)

    D. Kopyciński


    Full Text Available In this study presents the analyse of aluminium iron cast structure (as-cast condition which are used in high temperature. While producing the casts of aluminium iron major influence has been preserve the structure of technological process parameters. The addition to Fe-C-Al alloy V, Ti, Cr leads to the improvement of functional and mechanical cast qualities. In this study, a method was investigated to eliminate the presence of undesirable Al4C3 phases in a aluminium cast iron structure and thus improve the production process. V and Ti additions in aluminium cast iron allows to development of FeAl - VC or TiC alloys. In particular, V or Ti contents above 5 wt.% were found to totally eliminate the presence of Al4C3. In addition, preliminary work indicates that the alloy with the FeAl - VC or TiC structure reveals high oxidation resistance. The introduction of 5 wt.% chromium to aluminium cast iron strengthened Al4C3 precipitate. Thus, the resultant alloy can be considered an intermetallic FeAl matrix strengthened by VC and TiC or modified Al4C3 reinforcements.

  5. Assessment of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study.

    Directory of Open Access Journals (Sweden)

    Marion McNabb

    Full Text Available Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre.Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care.Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001, out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education.These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

  6. Stress and sleep quality in high school brazilian adolescents

    Directory of Open Access Journals (Sweden)

    Gema Mesquita


    Full Text Available OBJECTIVE: The objective of the present study is to analyze the effect of stress on sleep quality in a group of adolescents. METHOD: Two high schools in Alfenas, southern Minas Gerais State, Brazil, were chosen to participate in the study. The sample consisted of both genders (n=160 with 65.63% females. The age range of participants was 15 to18 years. The Pittsburgh Sleep Quality Index (PSQI was applied for collection of data to quantify sleep quality. The Lipp Inventory of Stress Symptoms that objectively identifies symptoms of stress was applied. RESULTS: It was observed that 23.53% of stressed students and 45.33% of unstressed ones sleep well; 76.47% of stressed pupils and 54.67% of those unstressed do not sleep well. With regard to school performance, a mean of 0.65 was found for stressed students and 0.60 for those without stress, Mann-Whitney (p=0.0596. CONCLUSION: Stress contributed to raising the percentage of poor sleepers, as ell as increasing ean school performance.OBJETIVO: O objetivo do presente estudo foi analisar a influência do stress sobre a qualidade do sono em um grupo de adolescentes. MÉTODO: Foram escolhidas duas instituições educacionais do ensino médio, na cidade de Alfenas, sul de Minas Gerais, Brasil. A amostra foi composta por ambos os sexos (n=160, com 65,63% do sexo feminino. A faixa etária dos participantes foi de 15 a 18 anos. Para a coleta de dados aplicou-se: Índice de Qualidade de Sono de Pittsburgh (IQSP utilizado para quantificar a qualidade do sono; o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL que identifica de modo objetivo a sintomatologia de stress foi aplicado. RESULTADOS: Observou-se que 23,53% dos estressados dormem bem e 45,33% dos não estressados dormem bem; 76,47% dos estressados não dormem bem e 54,67% dos não estressados não dormem bem. Quanto ao rendimento escolar têm-se as médias 0,65 para os alunos estressados e 0,60 para aqueles que não sofrem de stress, Mann

  7. High-quality endoscope reprocessing decreases endoscope contamination. (United States)

    Decristoforo, Petra; Kaltseis, Josef; Fritz, Andreas; Edlinger, Michael; Posch, Wilfried; Wilflingseder, Doris; Lass-Flörl, Cornelia; Orth-Höller, Dorothea


    Several outbreaks of severe infections due to contamination of gastrointestinal (GI) endoscopes, mainly duodenoscopes have been described previously. The rate of microbial endoscope contamination is varying dramatically in literature. Thus, the aim of this multicentre prospective study was to evaluate the hygiene quality of endoscopes and automated endoscope reprocessors (AERs) in Tyrol/Austria. In 2015 and 2016, a total of 463 GI endoscopes and 105 AERs from 29 endoscopy centres were analysed by a routine (R) and a combined routine and advanced (CRA) sampling procedure and investigated for microbial contamination by culture- and molecular-based analyses. The contamination rate of GI endoscopes was 1.3-4.6% according to national guideline, suggesting that 1.3-4.6 patients out of 100 could have had contacts with hygiene relevant microorganisms through an endoscopic intervention. Comparison of R and CRA sampling showed 1.8% of R versus 4.6% of CRA failing the acceptance criteria in phase I and 1.3% of R versus 3.0% of CRA samples in phase II. The most commonly identified indicator organism was Pseudomonas spp., mainly P. oleovorans. None of the tested viruses were detected in 40 samples. While AERs in phase I failed (n=9, 17.6%) mainly due to technical faults, phase II revealed lapses (n=6, 11.5%) only on account to microbial contamination of the last rinsing water, mainly with Pseudomonas spp. In the present study the contamination rate of endoscopes was low compared to results from other European countries, possibly due to high quality of endoscope reprocessing, drying and storage. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  8. Design principles for high quality electron beams via colliding pulses in laser plasma accelerators

    Directory of Open Access Journals (Sweden)

    E. Cormier-Michel


    Full Text Available Laser plasma based accelerators have the potential to reduce dramatically the size and cost of future particle colliders and light sources. Production of high quality beams along with reproducibility, tunability, and efficiency are required for many applications. We present design principles for two-pulse colliding laser pulse injection mechanisms, which can meet these requirements. Simulations are used to determine the best conditions for the production of high quality beams: high charge, low energy spread, and low emittance. Simulations also allow access to the internal dynamics of the interaction, providing insight regarding further improvement of the beam quality. We find that a 20 pC beam can be accelerated to 300 MeV in 4 mm with only a few percent energy spread and transverse normalized emittance close to 1 mm mrad, using a 10 TW laser. We demonstrate that this design scales according to linear theory. Control of the laser pulse mode content and subsequent evolution in the plasma channel are shown to be critical for achieving the highest beam quality.

  9. Quality and safety of hospital discharge: a study on experiences and perceptions of patients, relatives and care providers

    NARCIS (Netherlands)

    Hesselink, G.J.; Schoonhoven, L.; Plas, M. van der; Wollersheim, H.C.H.; Vernooij-Dassen, M.J.F.J.


    OBJECTIVE: To identify barriers experienced and perceived at discharge by physicians, nurses, patients and relatives. DESIGN: We developed questionnaires based on focus group interviews with hospital and community care providers, and individual interviews with patients and relatives. A survey was

  10. Low-quality birds do not display high-quality signals: The cysteine-pheomelanin mechanism of honesty (United States)

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


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

  11. Low-quality birds do not display high-quality signals: The cysteine-pheomelanin mechanism of honesty. (United States)

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


    The mechanisms that make that the costs of producing high-quality signals are unaffordable to low-quality signalers are a current issue in animal communication. The size of the melanin-based bib of male house sparrows Passer domesticus honestly signals quality. We induced the development of new bibs while treating males with buthionine-sulfoximine (BSO), a substance that depletes the levels of the antioxidant glutathione (GSH) and the amino acid cysteine, two elements that switch melanogenesis from eumelanin to pheomelanin. Final bib size is negatively related to pheomelanin levels in the bib feathers. BSO reduced cysteine and GSH levels in all birds, but improved phenotypes (bibs larger than controls) were only expressed by high-quality birds (BSO birds with largest bibs initially). Negative associations between final bib size and cysteine levels in erythrocytes, and between pheomelanin and cysteine levels, were observed in high-quality birds only. These findings suggest that a mechanism uncoupling pheomelanin and cysteine levels may have evolved in low-quality birds to avoid producing bibs of size not corresponding to their quality and greater relative costs. Indeed, greater oxidative stress in cells was not observed in low-quality birds. This may represent the first mechanism maintaining signal honesty without producing greater relative costs on low-quality signalers. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.

  12. 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: [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: [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)


    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.

  13. 2D XD-GRASP provides better image quality than conventional 2D cardiac cine MRI for patients who cannot suspend respiration (United States)

    Piekarski, Eve; Chitiboi, Teodora; Ramb, Rebecca; Latson, Larry A; Bhatla, Puneet; Feng, Li; Axel, Leon


    Object Residual respiratory motion degrades image quality in conventional cardiac cine MRI (CCMR). We evaluated whether a free-breathing (FB) radial imaging CCMR sequence with compressed sensing reconstruction (eXtra-Dimension (e.g. cardiac and respiratory phases) Golden-angle RAdial Sparse Parallel, or XD-GRASP) could provide better image quality than a conventional Cartesian breath-held (BH) sequence, in an unselected population of patients undergoing clinical CCMR. Material and Methods 101 patients who underwent BH and FB imaging in a mid-ventricular short-axis plane at a matching location were included. Visual and quantitative image analysis was performed by two blinded experienced readers, using a 5-point qualitative scale to score overall image quality and visual signal-to-noise ratio (SNR) grade, with measures of noise and sharpness. End-diastole (ED) and end-systole (ES) left-ventricular areas were also measured and compared for both BH and FB images. Results Image quality was generally better with the BH cines (overall quality grade BH vs FB: 4 vs 2.9, pcine in general, it provided improved image quality in the subgroup of patients presenting respiratory motion-induced artifacts on breath-held images. PMID:29067539

  14. The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention. (United States)

    Reiter, Kristin L; Lemos, Kristin Andrews; Williams, Charlotte E; Esposito, Dominick; Greene, Sandra B


    To measure the return on investment (ROI) for a pediatric asthma pay-for-reporting intervention initiated by a Medicaid managed care plan in New York State. Practice-level, randomized prospective evaluation. Twenty-five primary care practices providing care to children enrolled in the Monroe Plan for Medical Care (the Monroe Plan). Practices were randomized to either treatment (13 practices, 11 participated) or control (12 practices). For each of its eligible members assigned to a treatment group practice, the Monroe plan paid a low monthly incentive fee to the practice. To receive the incentive, treatment group practices were required to conduct, and report to the Monroe Plan, the results of chart audits on eligible members. Chart audits were conducted by practices every 6 months. After each chart audit, the Monroe Plan provided performance feedback to each practice comparing its adherence to asthma care guidelines with averages from all other treatment group practices. Control practices continued with usual care. Intervention implementation and operating costs and per member, per month claims costs. ROI was measured by net present value (discounted cash flow analysis). The ROI to the Monroe Plan was negative, primarily due to high intervention costs and lack of reductions in spending on emergency department and hospital utilization for children in treatment relative to control practices. A pay-for-reporting, chart audit intervention is unlikely to achieve the meaningful reductions in utilization of high-cost services that would be necessary to produce a financial ROI in 2.5 years. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  15. Perceptions of final-year nursing students on the facilities, resources and quality of education provided by schools in Turkey. (United States)

    Güner, Perihan


    The purpose of this study is to determine the perceptions of final-year nursing students regarding the adequacy of education, resources and internships in preparation for graduation. The study design was a descriptive cross-sectional study of nursing students (n: 1804) in their final year of education and questionnaires were used to collect data. Information related to student-to-instructor ratios and internships was obtained from each institution. Most students reported receiving instruction or supervision by lecturers and clinicians who did not specialise in the field. Overall, students did not find the facilities, educational or technological resources and the quality of education offered by their respective schools adequate. The proportion of students who found the level of theoretical education, clinical practice and instructor support adequate was higher in state university colleges of nursing/faculties of health sciences than in state university schools of health sciences.

  16. Quality Factor for the Hadronic Calorimeter in High Luminosity Conditions

    CERN Document Server

    Seixas, Jose; The ATLAS collaboration; Manhaes de Andrade Filho, Luciano; Sotto-Maior-Peralva, Bernardo


    The Tile Calorimeter (TileCal) is the central section of the hadronic calorimeter of ATLAS experiment and has about 10,000 eletronic channels. An Optimal Filter (OF) has been used to estimate the energy sampled by the calorimeter and applies a Quality Factor (QF) for signal acceptance. An approach using Matched Filter (MF) has also been pursued. In order to cope with the luminosity rising foreseen for LHC operation upgrade, different algorithms have been developed. Currently, the OF measure for signal acceptance is implemented through a chi-square test. At a low luminosity scenario, such QF measure has been used as a way to describe how the acquired signal is compatible to the pulse shape pattern. However, at high-luminosity conditions, due to pile up, this QF acceptance is no longer possible when OF is employed, and the QF becomes a measure to indicate whether the reconstructed signal suffers or not from pile up. Methods are being developed in order to recover the superposed information, and the QF may be us...

  17. Evaluation of input and process components of quality of child health services provided at 24 × 7 primary health centers of a district in Central Gujarat. (United States)

    Chavda, Paragkumar; Misra, Shobha


    With the critical Indian challenge on child survival and health, time is ripe to initiate focus on quality of services apart from measuring coverage, to bring about improvements. To assess the quality of child health services provided at 24 × 7 Primary Health Centers of Vadodara District in Gujarat in terms of Input and Process Indicators. The study was carried out in 12 randomly chosen 24 × 7 Primary Health Centers (PHCs) of Vadodara district using a modified quality assessment checklist of the Program on District Quality Assurance for Reproductive and Child Health (RCH) services with use of scores from May 2010 to June 2011. Inputs assessment was done by facility survey. Process assessment for the four child health service components used actual observation of service, review of records and interview of service providers and clients. The mean obtained score for facilities in Input section was 65%. Highest score was obtained for Drugs and Consumables (86%) followed by Equipments and Supplies (74%). The score obtained for Infrastructure facility was 65%, Personnel and training was 56% and Essential protocols and guidelines scored 43%. The mean obtained score in the process section was 55%. Highest scores were obtained for immunization at 76%. This was followed by newborn care (52%), growth monitoring (52%). management of sick child (41%). Quality improvement efforts should focus not only on resource-intensive structural improvements, but also on cost-effective measures at improving service delivery process, especially adherence to service guidelines by providers.

  18. Two-dimensional XD-GRASP provides better image quality than conventional 2D cardiac cine MRI for patients who cannot suspend respiration. (United States)

    Piekarski, Eve; Chitiboi, Teodora; Ramb, Rebecca; Latson, Larry A; Bhatla, Puneet; Feng, Li; Axel, Leon


    Residual respiratory motion degrades image quality in conventional cardiac cine MRI (CCMRI). We evaluated whether a free-breathing (FB) radial imaging CCMRI sequence with compressed sensing reconstruction [extradimensional (e.g. cardiac and respiratory phases) golden-angle radial sparse parallel, or XD-GRASP] could provide better image quality than a conventional Cartesian breath-held (BH) sequence in an unselected population of patients undergoing clinical CCMRI. One hundred one patients who underwent BH and FB imaging in a midventricular short-axis plane at a matching location were included. Visual and quantitative image analysis was performed by two blinded experienced readers, using a five-point qualitative scale to score overall image quality and visual signal-to-noise ratio (SNR) grade, with measures of noise and sharpness. End-diastolic and end-systolic left ventricular areas were also measured and compared for both BH and FB images. Image quality was generally better with the BH cines (overall quality grade for BH vs FB images 4 vs 2.9, p images regarding end-diastolic or end-systolic areas (p = 0.35 and p = 0.12). Eighteen of the 101 patients had poor BH image quality (grade 1 or 2). In this subgroup, the quality of the FB images was better (p = 0.0032), as was the SNR grade (p = 0.003), but there were no significant differences regarding noise and sharpness (p = 0.45 and p = 0.47). Although FB XD-GRASP CCMRI was visually inferior to conventional BH CCMRI in general, it provided improved image quality in the subgroup of patients with respiratory-motion-induced artifacts on BH images.

  19. Quality Assurance Roadmap for High Performance Residential Buildings

    Energy Technology Data Exchange (ETDEWEB)



    This report outlines the approach to quality assurance in the construction process for new residential construction, including seven process steps from the assessment of current construction practice, through design and documentation changes, to training and quality control for on-site personnel.

  20. Diversity in diabetes care programmes and views on high quality diabetes care: are we in need of a standardized framework?

    Directory of Open Access Journals (Sweden)

    Liesbeth A.D. Borgermans


    Full Text Available Methods: A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes quality indicators with special reference to those aspects that hinder the conceptualization of high quality diabetes care. Based on these findings the relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care was further explored. Results: Twenty-one systematic reviews met the inclusion criteria representing a total of 185 diabetes care programmes. Six elements were identified to produce a picture of diversity in diabetes care programmes and hinder their standardization: 1 the variety and relative absence of conceptual backgrounds in diabetes care programmes, 2 confusion over what is considered a constituent of a diabetes care program and components of the implementation strategy, 3 large variety in type of diabetes care programmes, settings and related goals, 4 a large number and variety in interventions and quality indicators used, 5 no conclusive evidence on effectiveness, 6 no systematic results on costs. Conclusions: There is large diversity in diabetes care programmes and related quality indicators. From this review and our analysis on the mutual relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care, we conclude that no single conceptual framework used to date provides a comprehensive overview of attributes of high quality diabetes care linked to quality indicators at the structure, process and outcome level. There is a need for a

  1. A guide to calculating habitat-quality metrics to inform conservation of highly mobile species (United States)

    Bieri, Joanna A.; Sample, Christine; Thogmartin, Wayne E.; Diffendorfer, James E.; Earl, Julia E.; Erickson, Richard A.; Federico, Paula; Flockhart, D. T. Tyler; Nicol, Sam; Semmens, Darius J.; Skraber, T.; Wiederholt, Ruscena; Mattsson, Brady J.


    Many metrics exist for quantifying the relative value of habitats and pathways used by highly mobile species. Properly selecting and applying such metrics requires substantial background in mathematics and understanding the relevant management arena. To address this multidimensional challenge, we demonstrate and compare three measurements of habitat quality: graph-, occupancy-, and demographic-based metrics. Each metric provides insights into system dynamics, at the expense of increasing amounts and complexity of data and models. Our descriptions and comparisons of diverse habitat-quality metrics provide means for practitioners to overcome the modeling challenges associated with management or conservation of such highly mobile species. Whereas previous guidance for applying habitat-quality metrics has been scattered in diversified tracks of literature, we have brought this information together into an approachable format including accessible descriptions and a modeling case study for a typical example that conservation professionals can adapt for their own decision contexts and focal populations.Considerations for Resource ManagersManagement objectives, proposed actions, data availability and quality, and model assumptions are all relevant considerations when applying and interpreting habitat-quality metrics.Graph-based metrics answer questions related to habitat centrality and connectivity, are suitable for populations with any movement pattern, quantify basic spatial and temporal patterns of occupancy and movement, and require the least data.Occupancy-based metrics answer questions about likelihood of persistence or colonization, are suitable for populations that undergo localized extinctions, quantify spatial and temporal patterns of occupancy and movement, and require a moderate amount of data.Demographic-based metrics answer questions about relative or absolute population size, are suitable for populations with any movement pattern, quantify demographic

  2. Chemical vapor deposition of high quality graphene films from carbon dioxide atmospheres. (United States)

    Strudwick, Andrew James; Weber, Nils Eike; Schwab, Matthias Georg; Kettner, Michel; Weitz, R Thomas; Wünsch, Josef R; Müllen, Klaus; Sachdev, Hermann


    The realization of graphene-based, next-generation electronic applications essentially depends on a reproducible, large-scale production of graphene films via chemical vapor deposition (CVD). We demonstrate how key challenges such as uniformity and homogeneity of the copper metal substrate as well as the growth chemistry can be improved by the use of carbon dioxide and carbon dioxide enriched gas atmospheres. Our approach enables graphene film production protocols free of elemental hydrogen and provides graphene layers of superior quality compared to samples produced by conventional hydrogen/methane based CVD processes. The substrates and resulting graphene films were characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX) and Raman microscopy, sheet resistance and transport measurements. The superior quality of the as-grown graphene films on copper is indicated by Raman maps revealing average G band widths as low as 18 ± 8 cm(-1) at 514.5 nm excitation. In addition, high charge carrier mobilities of up to 1975 cm(2)/(V s) were observed for electrons in transferred films obtained from a carbon dioxide based growth protocol. The enhanced graphene film quality can be explained by the mild oxidation properties of carbon dioxide, which at high temperatures enables an uniform conditioning of the substrates by an efficient removal of pre-existing and emerging carbon impurities and a continuous suppression and in situ etching of carbon of lesser quality being co-deposited during the CVD growth.

  3. 75 FR 41693 - Export Inspection and Weighing Waiver for High Quality Specialty Grains Transported in Containers (United States)


    ... and Weighing Waiver for High Quality Specialty Grains Transported in Containers AGENCY: Grain... quality grain exported in containers ] from the mandatory inspection and weighing requirements of the... for high quality specialty grains exported in containers that was established by a final rule on...

  4. Using a quality improvement model to enhance providers' performance in maternal and newborn health care : a post-only intervention and comparison design

    NARCIS (Netherlands)

    Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle


    Background: The Standards Based Management and Recognition (SBM-R (R)) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine

  5. New developments in high quality grey cast irons

    Directory of Open Access Journals (Sweden)

    Iulian Riposan


    Full Text Available The paper reviews original data obtained by the present authors, revealed in recent separate publications, describing specific procedures for high quality grey irons, and reflecting the forecast needs of the worldwide iron foundry industry. High power, medium frequency coreless induction furnaces are commonly used in electric melting grey iron foundries. This has resulted in low sulphur (1,500 °C, contributing to unfavourable conditions for graphite nucleation. Thin wall castings are increasingly produced by these electric melt shops with a risk of greater eutectic undercooling during solidification. The paper focused on two groups of grey cast irons and their specific problems: carbides and graphite morphology control in lower carbon equivalent high strength irons (CE=3.4%-3.8%, and austenite dendrite promotion in eutectic and slightly hypereutectic irons (CE=4.1%-4.5%, in order to increase their strength characteristics. There are 3 stages and 3 steps involving graphite formation, iron chemistry and iron processing that appear to be important. The concept in the present paper sustains a threestage model for nucleating flake graphite [(Mn,XS type nuclei]. There are three important groups of elements (deoxidizer, Mn/S, and inoculant and three technological stages in electric melting of iron (superheat, pre-conditioning of base iron, final inoculation. Attention is drawn to a control factor (%Mn x (%S ensuring it equals to 0.03 – 0.06, accompanied by 0.005wt.%–0.010wt.% Al and/or Zr content in inoculated irons. It was found that iron powder addition promotes austenite dendrite formation in eutectic and slightly eutectic, acting as reinforcement for the eutectic cells. But, there is an accompanying possible negative influence on the characteristics of the (Mn,XS type graphite nuclei (change the morphology of nuclei from polygonal compact to irregular polygonal, and therefore promote chill tendency in treated irons. A double addition (iron

  6. A reduced factor structure for the PROQOL-HIV questionnaire provided reliable indicators of health-related quality of life. (United States)

    Lalanne, Christophe; Chassany, Olivier; Carrieri, Patrizia; Marcellin, Fabienne; Armstrong, Andrew R; Lert, France; Spire, Bruno; Dray-Spira, Rosemary; Duracinsky, Martin


    To identify a simplified factor structure for the PROQOL-human immunodeficiency virus (HIV) questionnaire to improve the measurement of the health-related quality of life (HRQL) of HIV-positive patients in clinical care and research settings. HRQL data were collected using the eight-dimension PROQOL-HIV questionnaire from 2,537 patients (VESPA2 study). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) validated a simpler four-factor structure and assessed measurement invariance (MI). Multigroup analysis assessed the effect of sex, age, and antiretroviral therapy (ART) on the resulting factor scores. Correlations with symptom and Short Form (SF)-12 self-reports assessed convergent validity. Item analysis, EFA, and CFAs confirmed the validity [comparative fit index (CFI), 0.948; root mean square error of approximation, 0.064] and reliability (α's ≥ 0.8) of four dimensions: physical health and symptoms, health concerns and mental distress, social and intimate relationships, and treatment-related impact. Strong MI was demonstrated across sex and age (decrease in CFI indicator model indicated that HRQL correlated as expected with sex, age, and the ART status. Correlations of HRQL, symptom reports, and SF-12 scores evidenced convergent validity criterion. The simplified factor structure and scoring scheme for PROQOL-HIV will allow clinicians to monitor with greater reliability the HRQL of patients in clinical care and research settings. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. A Portable Low-Cost High Density Sensor Network for Air Quality at London Heathrow Airport (United States)

    Popoola, Olalekan; Mead, Iq; Bright, Vivien; Baron, Ronan; Saffell, John; Stewart, Gregor; Kaye, Paul; Jones, Roderic


    Outdoor air quality and its impact on human health and the environment have been well studied and it has been projected that poor air quality will surpass poor sanitation as the major course of environmental premature mortality by 2050 (IGAC / IGBP, release statement, 2012). Transport-related pollution has been regulated at various levels by enactment of legislations at local, national, regional and global stages. As part of the mitigation measures, routine measurements of atmospheric pollutants such as carbon monoxide (CO), nitric oxide (NO) and nitrogen dioxide (NO2) have to be established in areas where air quality problems are identified. In addition, emission inventories are also generated for different atmospheric environments including urban areas and airport environments required for air quality models. Whilst recognising that most of the existing sparse monitoring networks provide high temporal measurements, spatial data of these highly variable pollutants are not captured, making it difficult to adequately characterise the highly heterogeneous air quality. Spatial information is often obtained from model data which can only be constrained using measurements from the sparse monitoring networks. The work presented here shows the application of low-cost sensor networks aimed at addressing this missing spatial information. We have shown in previous studies the application of low-cost electrochemical sensor network instruments in monitoring road transport pollutants including CO, NO and NO2 in an urban environment (Mead et. al. 2012, accepted Atmospheric Environment). Modified versions of these instruments which include additional species such as O3, SO2, VOCs and CO2 are currently deployed at London Heathrow Airport (LHR) as part of the Sensor Network for Air Quality (SNAQ) project. Meteorology data such as temperature, relative humidity, wind speed and direction are also measured as well as size-speciated particulates (0.38 to 17.4 µm). A network of 50

  8. Aerodynamic and engineering design of a 1.5 s high quality microgravity drop tower facility (United States)

    Belser, Valentin; Breuninger, Jakob; Reilly, Matthew; Laufer, René; Dropmann, Michael; Herdrich, Georg; Hyde, Truell; Röser, Hans-Peter; Fasoulas, Stefanos


    Microgravity experiments are essential for research in space science, biology, fluid mechanics, combustion, and material sciences. One way to conduct microgravity experiments on Earth is by using drop tower facilities. These facilities combine a high quality of microgravity, adequate payload masses and have the advantage of virtually unlimited repeatability under same experimental conditions, at a low cost. In a collaboration between the Institute of Space Systems (IRS) at the University of Stuttgart and Baylor University (BU) in Waco, Texas, a new drop tower is currently under development at the Center for Astrophysics, Space Physics and Engineering Research (CASPER). The design parameters of the drop tower ask for at least 1.5 s in free fall duration while providing a quality of at least 10-5 g. Previously, this quality has only been achieved in vacuum drop tower facilities where the capsule experiences virtually zero aerodynamic drag during its free fall. Since this design comes at high costs, a different drop tower design concept, which does not require an evacuated drop shaft, was chosen. It features a dual-capsule system in which the experiment capsule is shielded from aerodynamic forces by surrounding it with a drag shield during the drop. As no other dual-capsule drop tower has been able to achieve a quality as good as or better than 10-5 g previous work optimized the design with an aerodynamic perspective by using computational fluid dynamics (CFD) simulations to determine the ideal shape and size of the outer capsule and to specify the aerodynamically crucial dimensions for the overall system. Experiments later demonstrated that the required quality of microgravity can be met with the proposed design. The main focus of this paper is the mechanical realization of the capsule as well as the development and layout of the surrounding components, such as the release mechanism, the deceleration device and the drop shaft. Because the drop tower facility is a

  9. High-Density, High-Resolution, Low-Cost Air Quality Sensor Networks for Urban Air Monitoring (United States)

    Mead, M. I.; Popoola, O. A.; Stewart, G.; Bright, V.; Kaye, P.; Saffell, J.


    humidity, wind speed and direction. The network incorporates existing GPRS infrastructures for real time sending of data with low overheads in terms of cost, effort and installation. In this paper we present data from the SNAQ Heathrow project as well as previous deployments showing measurement capability at the ppb level for NO, NO2 and CO. We show that variability can be observed and measured quantitatively using these sensor networks over widely differing time scales from individual emission events, diurnal variability associated with traffic and meteorological conditions, through to longer term synoptic weather conditions and seasonal behaviour. This work demonstrates a widely applicable generic capability to urban areas, airports as well as other complex emissions environments making this sensor system methodology valuable for scientific, policy and regulatory issues. We conclude that the low-cost high-density network philosophy has the potential to provide a more complete assessment of the high-granularity air quality structure generally observed in the environment. Further, when appropriately deployed, has the potential to offer a new paradigm in air quality quantification and monitoring.

  10. A Quality Improvement Project to Improve Education Provided by Nurses to ED Patients Prescribed Opioid Analgesics at Discharge. (United States)

    Waszak, Daria L; Mitchell, Ann M; Ren, Dianxu; Fennimore, Laura A


    The opioid crisis continues to take an unprecedented number of lives and is the top cause of injury death in the United States. The emergency department is a setting where patients with pain seek care and may be prescribed an opioid, yet many patients do not receive evidence-based education about taking their opioid safely. Like many communities across the country, Allegheny County, Pennsylvania, has experienced an increased rate of opioid overdoses; from 2015-2016, the number of opioid-related overdose deaths in the county increased by 44%. This quality improvement project is the implementation of a nurse-delivered, evidence-based education initiative for patients prescribed an opioid in an emergency department. Nurses were briefly trained on opioid safety and patient education, then over 12 weeks, delivered the dual-modal (verbal and written) education with a patient teach-back to verify comprehension. Nurses who completed the project training on opioid safety and patient education had a statistically significant improvement in their knowledge. Patient satisfaction surveys showed 100% of patients reported clear understanding of how to take their pain medication, and out of the patients receiving the opioid pain education for the first time, 88.2% learned something new about how to safely take, store, or dispose of their pain medication. Improving the delivery of opioid prescription education at emergency department discharge will enhance patient knowledge and promote safety, which may help mitigate the opioid crisis by reducing the rate of opioid use disorder and accidental overdoses. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Measuring quality of omnidirectional high dynamic range content (United States)

    Perrin, Anne-Flore; Bist, Cambodge; Cozot, Rémi; Ebrahimi, Touradj


    Although HDR content processing, coding and quality assessment have been largely addressed in the last few years, little to no work has been concentrating on how to assess quality in HDR for 360° or omnidirectional content. This paper is an attempt to answer to various questions in this direction. As a minimum, a new data set for 360° HDR content is proposed and a new methodology is designed to assess subjective quality of HDR 360° content when it is displayed on SDR HMD after applying various tone mapping operators. The results are then analyzed and conclusions are drawn.

  12. The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? (United States)

    Barron, David N; West, Elizabeth


    There has been a radical transformation in the provision of adult residential and nursing home care in England over the past four decades. Up to the 1980s, over 80% of adult residential care was provided by the public sector, but today public sector facilities account for only 8% of the available places, with the rest being provided by a mixture of for-profit firms (74%) and non-profit charities (18%). The public sector's role is often now that of purchaser (paying the fees of people unable to afford them) and regulator. While the idea that private companies may play a bigger role in the future provision of health care is highly contentious in the UK, the transformation of the residential and nursing home care has attracted little comment. Concerns about the quality of care do emerge from time to time, often stimulated by high profile media investigations, scandals or criminal prosecutions, but there is little or no evidence about whether or not the transformation of the sector from largely public to private provision has had a beneficial effect on those who need the service. This study asks whether there are differences in the quality of care provided by public, non-profit or for-profit facilities in England. We use data on care quality for over 15,000 homes that are provided by the industry regulator in England: the Care Quality Commission (CQC). These data are the results of inspections carried out between April 2011 and October 2015. Controlling for a range of facility characteristics such as age and size, proportional odds logistic regression showed that for-profit facilities have lower CQC quality ratings than public and non-profit providers over a range of measures, including safety, effectiveness, respect, meeting needs and leadership. We discuss the implications of these results for the ongoing debates about the role of for-profit providers of health and social care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Comparison of good- and bad-quality cork: application of high-throughput sequencing of phellogenic tissue. (United States)

    Teixeira, Rita Teresa; Fortes, Ana Margarida; Pinheiro, Carla; Pereira, Helena


    Cork is one of the most valuable non-wood forest products and plays an important role in Mediterranean economies. The production of high-quality cork is dependent on both genome and environment, posing constraints on the industry because an ever-growing amount of bad-quality cork (BQC) development has been observed. In order to identify genes responsible for production of cork of superior quality we performed a comparative analysis using the 454 pyrosequencing approach on phellogenic tissue of good- and bad-quality samples. The transcriptional profiling showed a high number of genes differentially expressed (8.48%) from which 78.8% displayed annotation. Genes more highly represented in BQC are involved in DNA synthesis, RNA processing, proteolysis, and transcription factors related to the abiotic stress response. Putative stomatal/lenticular-associated genes which may be responsible for the disadvantageous higher number of lenticular channels in BQC are also more highly represented. BQC also showed an elevated content of free phenolics. On the other hand, good-quality cork (GQC) can be distinguished by highly expressed genes encoding heat-shock proteins. Together the results provide valuable new information about the molecular events leading to cork formation and provide putative biomarkers associated with cork quality that can be useful in breeding programmes. © The Author 2014. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email:

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

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


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

  15. Improving the quality of pork and pork products for the consumer : development of innovative, integrated, and sustainable food production chains of high quality pork products matching consumer demands

    NARCIS (Netherlands)

    Heimann, B.; Christensen, M.; Rosendal Rasmussen, S.; Bonneau, M.; Grunert, K.G.; Arnau, J.; Trienekens, J.H.; Oksbjerg, N.; Greef, de K.H.; Petersen, B.


    Improving the quality of pork and pork products for the consumer: development of innovative, integrated, and sustainable food production chains of high quality pork products matching consumer demands.

  16. Long-run benefits from universal high-quality preschooling

    DEFF Research Database (Denmark)

    Bauchmüller, Robert; Gørtz, Mette; Rasmussen, Astrid Würtz


    a formal preschool institution in 1998 are used in the analyses. OLS analyses show that three out of five quality indicators, a higher staff-per-child ratio, a higher share of male staff, and a higher share of staff with formal preschool teacher training are associated with significant improvements...... in children's test results in Danish. Boys benefit more from preschool quality than girls. Ethnic minority children benefit from higher staff stability....


    The coastal waters of American Samoa’s 5 high islands (Tutuila, Aunu’u, Ofu, Olosega,and Ta’u) were surveyed in 2004 using a probabilistic design. Water quality data were collected from the near-shore coastal habitat, defined as all near-shore coastal waters including embayments,...


    Directory of Open Access Journals (Sweden)

    Potapov Yuriy Borisovich


    Full Text Available One of the main requirements to the operational integrity of reinforced concrete flexural elements is nonexeedance of the deflection limits at the assumed load. It is possible to provide the given requirement using different methods, one of which is the production of a sandwich construction of the concretes with different strength. The article presents the results of theoretical and experimental investigations of the deflection of reinforced concrete beams with the top layer made of high-quality concrete, with different percentage and strength of longitudinal tensile reinforcement without prestressing. The study of different methods of calculating the curvature of reinforced concrete beams is carried out and the recommendations on calculating the deflections of such elements are made. The use of high quality concrete in the compression area of flexural elements allows reducing the deflections. The theoretical deflections of beams produced of the B60 class concrete are 15…20 % more than the deflections of the proposed composite sections in case of equal bearing capacity. The authors proposed a formula to calculate the bending of reinforced concrete flexural members with the top layer made of high-quality concrete in the compressed area.

  19. High Yield Chemical Vapor Deposition Growth of High Quality Large-Area AB Stacked Bilayer Graphene (United States)

    Liu, Lixin; Zhou, Hailong; Cheng, Rui; Yu, Woo Jong; Liu, Yuan; Chen, Yu; Shaw, Jonathan; Zhong, Xing; Huang, Yu; Duan, Xiangfeng


    Bernal stacked (AB stacked) bilayer graphene is of significant interest for functional electronic and photonic devices due to the feasibility to continuously tune its band gap with a vertical electrical field. Mechanical exfoliation can be used to produce AB stacked bilayer graphene flakes but typically with the sizes limited to a few micrometers. Chemical vapor deposition (CVD) has been recently explored for the synthesis of bilayer graphene but usually with limited coverage and a mixture of AB and randomly stacked structures. Herein we report a rational approach to produce large-area high quality AB stacked bilayer graphene. We show that the self-limiting effect of graphene growth on Cu foil can be broken by using a high H2/CH4 ratio in a low pressure CVD process to enable the continued growth of bilayer graphene. A high temperature and low pressure nucleation step is found to be critical for the formation of bilayer graphene nuclei with high AB stacking ratio. A rational design of a two-step CVD process is developed for the growth of bilayer graphene with high AB stacking ratio (up to 90 %) and high coverage (up to 99 %). The electrical transport studies demonstrated that devices made of the as-grown bilayer graphene exhibit typical characteristics of AB stacked bilayer graphene with the highest carrier mobility exceeding 4,000 cm2/V·s at room temperature, comparable to that of the exfoliated bilayer graphene. PMID:22906199

  20. Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions

    Directory of Open Access Journals (Sweden)

    Smarth Carole


    Full Text Available Abstract Background Despite awareness of inequities in health care quality, little is known about strategies that could improve the quality of healthcare for ethnic minority populations. We conducted a systematic literature review and analysis to synthesize the findings of controlled studies evaluating interventions targeted at health care providers to improve health care quality or reduce disparities in care for racial/ethnic minorities. Methods We performed electronic and hand searches from 1980 through June 2003 to identify randomized controlled trials or concurrent controlled trials. Reviewers abstracted data from studies to determine study characteristics, results, and quality. We graded the strength of the evidence as excellent, good, fair or poor using predetermined criteria. The main outcome measures were evidence of effectiveness and cost of strategies to improve health care quality or reduce disparities in care for racial/ethnic minorities. Results Twenty-seven studies met criteria for review. Almost all (n = 26 took place in the primary care setting, and most (n = 19 focused on improving provision of preventive services. Only two studies were designed specifically to meet the needs of racial/ethnic minority patients. All 10 studies that used a provider reminder system for provision of standardized services (mostly preventive reported favorable outcomes. The following quality improvement strategies demonstrated favorable results but were used in a small number of studies: bypassing the physician to offer preventive services directly to patients (2 of 2 studies favorable, provider education alone (2 of 2 studies favorable, use of a structured questionnaire to assess adolescent health behaviors (1 of 1 study favorable, and use of remote simultaneous translation (1 of 1 study favorable. Interventions employing more than one main strategy were used in 9 studies with inconsistent results. There were limited data on the costs of these

  1. A Low Cost High Density Sensor Network for Air Quality at London Heathrow Airport (United States)

    Bright, V.; Mead, M. I.; Popoola, O. A.; Baron, R. P.; Saffell, J.; Stewart, G.; Kaye, P.; Jones, R.


    Atmospheric composition within urban areas has a direct effect on the air quality of an environment in which a large majority of people live and work. Atmospheric pollutants including ozone (O3), nitrogen dioxide (NO2), volatile organic compounds (VOCs) and particulate matter (PM) can have a significant effect on human health. As such it is important to determine the potential exposure of individuals to these atmospheric constituents and investigate the processes that lead to the degradation of air quality within the urban environment. Whilst modelled pollutant levels on the local scale often suggest high degrees of spatial and temporal variability, the relatively sparse fixed site automated urban networks only provide low spatial resolution data that do not appear adequate in detecting such small scale variability. In this paper we demonstrate that measurements can now be made using networks of low-cost sensors that utilise a variety of techniques, including electrochemical and optical, to measure concentrations of atmospheric species. Once equipped with GPS and GPRS to determine position and transmit data respectively, these networks have the potential to provide valuable insights into pollutant variability inherent on the local or micro-scale. The methodology has been demonstrated successfully in field campaigns carried out in cities including London and Valencia, and is now being deployed as part of the Sensor Networks for Air Quality currently deployed at London Heathrow airport (SNAQ-Heathrow) which is outlined in the partner paper presented by Mead et al. (this conference). The SNAQ-Heathrow network of 50 sensor nodes will provide an unprecedented data set that includes measurements of O3, NO, NO2, CO, CO2, SO2, total VOCs, size-speciated PM as well as meteorological variables that include temperature, relative humidity, wind speed and direction. This network will provide high temporal (20 second intervals) and spatial (50 sites within the airport area

  2. Whispering gallery mode lasing in high quality GaAs/AlAs pillar microcavities (United States)

    Jaffrennou, P.; Claudon, J.; Bazin, M.; Malik, N. S.; Reitzenstein, S.; Worschech, L.; Kamp, M.; Forchel, A.; Gérard, J.-M.


    We report whispering gallery mode (WGM) lasing from high quality GaAs/AlAs micropillars with embedded InAs quantum dots, under continuous optical pumping. For temperatures ranging from 5 to 100 K, simultaneous lasing from TE1,1,m WGMs is observed for pillar diameters in the 3-4 μm range. Spectral linewidths and energy shifts of the lasing modes are analyzed as a function of the pump power. Thanks to the efficient heat sinking provided by the micropillar geometry, a clear line narrowing is observed above threshold. Moreover, the lasing mode energy remains stable for pump power as large as six times the lasing threshold.

  3. Joining Forces: Collaborating Internationally to Deliver High-Quality, Online Postgraduate Education in Pain Management

    Directory of Open Access Journals (Sweden)

    Elizabeth Devonshire


    Full Text Available The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high-quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives.

  4. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC (United States)

    Sciarra, Adilia Maria Pires; Croti, Ulisses Alexandre; Batigalia, Fernando


    Introduction Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases. PMID:24896168

  5. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program--IQIC. (United States)

    Sciarra, Adilia Maria Pires; Croti, Ulisses Alexandre; Batigalia, Fernando


    Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

  6. A Vote for School Lunches: School Lunches Provide Superior Nutrient Quality than Lunches Obtained from Other Sources in a Nationally Representative Sample of US Children

    Directory of Open Access Journals (Sweden)

    Jacqueline A. Vernarelli


    Full Text Available Childhood obesity is an ongoing public health program. As such, a major public health research objective is to identify potential targets for intervention; one such area is school lunches (SL. The National School Lunch Program (NSLP serves over 31 million children each day; the National Health and Nutrition Examination Survey (NHANES is uniquely positioned to allow researchers to assess diet quality in federal nutrition assistance programs. The objective of the study was to investigate whether lunches provided by schools provide different nutritional value than lunches obtained elsewhere. In a nationally representative sample of 2190 children, consumption of a school-provided lunch (SL was associated with greater nutritional quality compared to lunches obtained elsewhere across both age and income categories. Children who were eligible for no-cost school lunch, but did not participate in the NSLP consumed approximately 60% more energy, 58% more total fat, 60% more saturated fat, 50% more solid fat, 61% more sodium, double the amount of added sugars and less than half the amount of fruit than NSLP participants (all p < 0.001. The results of this study suggest that though widely criticized, school lunches provide superior nutrient quality than lunches obtained from other sources, particularly for low-income children.

  7. Identifying high quality medical education websites in Otolaryngology: a guide for medical students and residents. (United States)

    Yang, Nathan; Hosseini, Sarah; Mascarella, Marco A; Young, Meredith; Posel, Nancy; Fung, Kevin; Nguyen, Lily H P


    Learners often utilize online resources to supplement formalized curricula, and to appropriately support learning, these resources should be of high quality. Thus, the objectives of this study are to develop and provide validity evidence supporting an assessment tool designed to assess the quality of educational websites in Otolaryngology- Head & Neck Surgery (ORL-HNS), and identify those that could support effective web-based learning. METHODS: After a literature review, the Modified Education in Otolaryngology Website (MEOW) assessment tool was designed by a panel of experts based on a previously validated website assessment tool. A search strategy using a Google-based search engine was used subsequently to identify websites. Those that were free of charge and in English were included. Websites were coded for whether their content targeted medical students or residents. Using the MEOW assessment tool, two independent raters scored the websites. Inter-rater and intra-rater reliability were evaluated, and scores were compared to recommendations from a content expert. The MEOW assessment tool included a total of 20 items divided in 8 categories related to authorship, frequency of revision, content accuracy, interactivity, visual presentation, navigability, speed and recommended hyperlinks. A total of 43 out of 334 websites identified by the search met inclusion criteria. The scores generated by our tool appeared to differentiate higher quality websites from lower quality ones: websites that the expert "would recommend" scored 38.4 (out of 56; CI [34.4-42.4]) and "would not recommend" 27.0 (CI [23.2-30.9]). Inter-rater and intra-rater intraclass correlation coefficient were greater than 0.7. Using the MEOW assessment tool, high quality ORL-HNS educational websites were identified.

  8. Establishing High-Quality Prostate Brachytherapy Using a Phantom Simulator Training Program

    Energy Technology Data Exchange (ETDEWEB)

    Thaker, Nikhil G. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kudchadker, Rajat J. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swanson, David A. [Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Albert, Jeffrey M. [Department of Radiation Oncology, Banner Health, Loveland/Greeley, Colorado (United States); Mahmood, Usama; Pugh, Thomas J.; Boehling, Nicholas S. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Bruno, Teresa L. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Prestidge, Bradley R. [Department of Radiation Oncology, Bon Secours Health System, Norfolk, Virginia (United States); Crook, Juanita M. [Department of Radiation Oncology, Cancer Center for the Southern Interior, Kelowna, British Columbia (Canada); Cox, Brett W.; Potters, Louis [Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, Illinois (United States); Keyes, Mira [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Center, Vancouver, British Columbia (Canada); Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Frank, Steven J., E-mail: [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)


    Purpose: To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education. Methods and Materials: Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ({sup 125}I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parameters were compared and correlated using regression analysis. Results: Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process. Conclusions: Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB.

  9. Metabolic profiling assisted quality assessment of Rhodiola rosea extracts by high-performance liquid chromatography. (United States)

    Wang, Zhanguo; Hu, Huiling; Chen, Fang; Zou, Liang; Yang, Mingfu; Wang, Anqi; Foulsham, James E; Lan, Ke


    In this work, fast and sensitive high-performance liquid chromatography (HPLC) coupled with multivariate analysis was utilized to assist the quality assessment of Rhodiola rosea extracts (RREs). 131 peaks were separated and detected in RREs on a fused-core C18 column. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) of the chromatographic data demonstrated that 10 batches of RREs could be well-differentiated and categorized into three groups which were closely related to the origins of RREs. Partial least square-discriminant analysis (PLS-DA) showed that the quality differentiation might be explained by at least 6 components, in which rosavin was characterized by an external reference, rosiridine was identified by liquid chromatography-mass spectrometry (LC-MS), and the mass spectra of the others were provided. The observation that the level of rosavin was more relevant to the multivariate chromatographic data than the ones of salidroside and tyrosol, the other two components commonly used to standardize RREs, was confirmed by the PLS prediction models. Results of the present study not only indicated that rosavin was a rational marker to represent the quality of RREs, but also demonstrated the power of HPLC-based metabolic profiling in the quality assessment of herbal extracts. © Georg Thieme Verlag KG Stuttgart · New York.

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

    DEFF Research Database (Denmark)

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


    a multi-disciplinary team, with food safety and quality experts, engineers, agronomists and economists from17 research institutes and private companies in Europe, Israel and China working together. The project assesses potential risks to farmers. Coupled with farm management and economic models, a new......: the safety and quality of food products, and the increasing competition for clean freshwater. SAFIR is funded for the period 2005-2009 under the Food Quality and Safety thematic area of the EU 6th Framework Research Programme. The challenge for the next years will be to produce safe and high quality foods...... while at the same time reducing the use of natural resources and the impact on aquatic ecosystems that are frequently already polluted. These problems are linked, since most of our vegetables are produced using irrigation water from the same ecosystems. To ensure food safety and quality, the innovative...

  11. New lighting for the design of high quality biomedical devices (United States)

    Jaffe, Claudia B.; Jaffe, Steven M.; Conner, Arlie R.


    Among the trends redefining 21st century biomedical diagnostics and therapeutics are the advent of low-cost portable analyzers. Because light is a powerful tool in many of today's most widely used life science instruments, high intensity, low cost light engines are essential to the design and proliferation of the newest bioanalytical instruments, medical devices and miniaturized analyzers. The development of new light technology represents a critical technical hurdle in the realization of point-of-care analysis. Lumencor has developed an inexpensive lighting solution, uniquely well suited to the production of safe, effective and commercially viable life science tools and biomedical devices. Lumencor's proprietary, solid-state light engine provides powerful, pure, stable, inexpensive light across the UV-Vis- NIR. Light engines are designed to directly replace the entire configuration of light management components with a single, simple unit. Power, spectral breadth and purity, stability and reliability data will demonstrate the advantages of these light engines for today's bioanalytical needs. Performance and cost analyses will be compared to traditional optical subsystems based on lamps, lasers and LEDs with respect to their suitability as sources for biomedical applications, implementation for development/evaluation of novel measurement tools and overall superior reliability. Next generation products based on such sources will be described to fulfill the demand for portable, hand-held analyzers and affordable devices with highly integrated light sources. A four color violet/cyan/green/red product will be demonstrated. A variety of multicolor prototypes, their spectral outputs and facile modulation will be discussed and their performance capabilities disclosed.

  12. Consumers' expected quality and intention to purchase high quality pork meat. (United States)

    Papanagiotou, P; Tzimitra-Kalogianni, I; Melfou, K


    Expected quality is believed to be one of the most important factors that influence consumers' intention to purchase food. The present study seeks to explore the concept of pork meat expected quality and compare it with self-stated consumer intention to purchase pork meat. The aim is attempted by means of a field research conducted in Greece, following a conjoint analytic procedure. Results show that quality expectations comply with intention to buy pork, in many aspects. However, several differences have been identified. More specifically, country of origin and marbling appear to be more important for respondents' purchase decisions than they are for their quality evaluations, while the opposite appears to be true for price. Finally, socio-demographic factors such as gender, level of education, place of purchase and consumption habits seem to influence perceptions. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Safe and high quality food production using low quality waters and improved irrigation systems and management

    DEFF Research Database (Denmark)

    Plauborg, Finn; Andersen, Mathias Neumann; Liu, Fulai


    The present paper presents the SAFIR project (, which addresses two fundamental problems that over the past decade increasingly have become concerns of the general public: the one problem being the jeopardizing of safety and quality of our food products, while the other being...... the increasing competition for clean freshwater. The SAFIR project has a multi-disciplinary approach, which integrates the European as well as the global dimension of the EU-policy on food quality and safety. The main driving force behind the project idea is new research results that demonstrated that scheduled...... uneven irrigation patterns can increase the water use efficiency as well as the quality of vegetable crops. Furthermore, recent innovations in the water treatment and irrigation industry have shown potential for the use of low quality water resources, such as reclaimed water or surface water in peri...

  14. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research (United States)

    Robertshaw, Luke; Dhesi, Surindar


    Objectives To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. Design Systematic review and qualitative thematic synthesis. Methods Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. Results Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. Conclusions A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group. PMID:28780549

  15. Validation of a new method for testing provider clinical quality in rural settings in low- and middle-income countries: the observed simulated patient.

    Directory of Open Access Journals (Sweden)

    Tin Aung

    Full Text Available BACKGROUND: Assessing the quality of care provided by individual health practitioners is critical to identifying possible risks to the health of the public. However, existing assessment methods can be inaccurate, expensive, or infeasible in many developing country settings, particularly in rural areas and especially for children. Following an assessment of the strengths and weaknesses of the existing methods for provider assessment, we developed a synthesis method combining components of direct observation, clinical vignettes, and medical mannequins which we have termed "Observed Simulated Patient" or OSP. An OSP assessment involves a trained actor playing the role of a 'mother', a life-size doll representing a 5-year old boy, and a trained observer. The provider being assessed was informed in advance of the role-playing, and told to conduct the diagnosis and treatment as he normally would while verbally describing the examinations. METHODOLOGY/PRINCIPAL FINDINGS: We tested the validity of OSP by conducting parallel scoring of medical providers in Myanmar, assessing the quality of their diagnosis and treatment of pediatric malaria, first by direct observation of true patients and second by OSP. Data were collected from 20 private independent medical practitioners in Mon and Kayin States, Myanmar between December 26, 2010 and January 12, 2011. All areas of assessment showed agreement between OSP and direct observation above 90% except for history taking related to past experience with malaria medicines. In this area, providers did not ask questions of the OSP to the same degree that they questioned real patients (agreement 82.8%. CONCLUSIONS/SIGNIFICANCE: The OSP methodology may provide a valuable option for quality assessment of providers in places, or for health conditions, where other assessment tools are unworkable.

  16. Validation of a new method for testing provider clinical quality in rural settings in low- and middle-income countries: the observed simulated patient. (United States)

    Aung, Tin; Montagu, Dominic; Schlein, Karen; Khine, Thin Myat; McFarland, Willi


    Assessing the quality of care provided by individual health practitioners is critical to identifying possible risks to the health of the public. However, existing assessment methods can be inaccurate, expensive, or infeasible in many developing country settings, particularly in rural areas and especially for children. Following an assessment of the strengths and weaknesses of the existing methods for provider assessment, we developed a synthesis method combining components of direct observation, clinical vignettes, and medical mannequins which we have termed "Observed Simulated Patient" or OSP. An OSP assessment involves a trained actor playing the role of a 'mother', a life-size doll representing a 5-year old boy, and a trained observer. The provider being assessed was informed in advance of the role-playing, and told to conduct the diagnosis and treatment as he normally would while verbally describing the examinations. We tested the validity of OSP by conducting parallel scoring of medical providers in Myanmar, assessing the quality of their diagnosis and treatment of pediatric malaria, first by direct observation of true patients and second by OSP. Data were collected from 20 private independent medical practitioners in Mon and Kayin States, Myanmar between December 26, 2010 and January 12, 2011. All areas of assessment showed agreement between OSP and direct observation above 90% except for history taking related to past experience with malaria medicines. In this area, providers did not ask questions of the OSP to the same degree that they questioned real patients (agreement 82.8%). The OSP methodology may provide a valuable option for quality assessment of providers in places, or for health conditions, where other assessment tools are unworkable.

  17. From Research to Practice: Which Research Strategy Contributes More to Clinical Excellence? Comparing High-Volume versus High-Quality Biomedical Research.

    Directory of Open Access Journals (Sweden)

    Anat Tchetchik

    Full Text Available The question when and to what extent academic research can benefit society is of great interest to policy-makers and the academic community. Physicians in university hospitals represent a highly relevant test-group for studying the link between research and practice because they engage in biomedical academic research while also providing medical care of measurable quality. Physicians' research contribution to medical practice can be driven by either high-volume or high-quality research productivity, as often pursuing one productivity strategy excludes the other. To empirically examine the differential contribution to medical practice of the two strategies, we collected secondary data on departments across three specializations (Cardiology, Oncology and Orthopedics in 50 U.S.-based university hospitals served by 4,330 physicians. Data on volume and quality of biomedical research at each department was correlated with publicly available ratings of departments' quality of care, demonstrating that high-quality research has significantly greater contribution to quality of care than high-volume research.

  18. From Research to Practice: Which Research Strategy Contributes More to Clinical Excellence? Comparing High-Volume versus High-Quality Biomedical Research. (United States)

    Tchetchik, Anat; Grinstein, Amir; Manes, Eran; Shapira, Daniel; Durst, Ronen


    The question when and to what extent academic research can benefit society is of great interest to policy-makers and the academic community. Physicians in university hospitals represent a highly relevant test-group for studying the link between research and practice because they engage in biomedical academic research while also providing medical care of measurable quality. Physicians' research contribution to medical practice can be driven by either high-volume or high-quality research productivity, as often pursuing one productivity strategy excludes the other. To empirically examine the differential contribution to medical practice of the two strategies, we collected secondary data on departments across three specializations (Cardiology, Oncology and Orthopedics) in 50 U.S.-based university hospitals served by 4,330 physicians. Data on volume and quality of biomedical research at each department was correlated with publicly available ratings of departments' quality of care, demonstrating that high-quality research has significantly greater contribution to quality of care than high-volume research.

  19. The GRACE Checklist: A Validated Assessment Tool for High Quality Observational Studies of Comparative Effectiveness. (United States)

    Dreyer, Nancy A; Bryant, Allison; Velentgas, Priscilla


    a predictor of quality in all 4 trees. When a composite outcome of the 3 quality measures was used, the GRACE Checklist showed high sensitivity and specificity (71.43% and 80.95%, respectively). The GRACE Checklist stands out from other consensus-driven and expert guidance documents because of its extensive validation efforts. This most recent work shows that the checklist has strong sensitivity and specificity, increasing its utility as a screening tool to identify high-quality observational comparative effectiveness research worthy of in-depth review and applicability for decision support. No outside funding supported this research. All authors are full-time employees of Quintiles, which provides research and consulting services to the biopharmaceutical industry. The authors have no other disclosures to report. Two of the 3 CART trees were presented at the International Society of Pharmacepidemiology in 2015 ("Article Citations per Year" and "Journal Impact Factor"). The original validation study was published in the March 2014 issue of the Journal of Managed Care & Specialty Pharmacy. The checklist questions and scoring were included using a table that was originally published by this journal in 2014. Study concept and design were primarily contributed by Dreyer and Velentgas, along with Bryant. Bryant took the lead in data collection and analysis, along with Dreyer and Velentgas, and data interpretation was performed by Dreyer, Velentgas, and Bryant. The manuscript was written and revised primarily by Dreyer, along with Bryant and Velentgas.

  20. Bacteriophage-insensitive mutants for high quality Crescenza manufacture

    Directory of Open Access Journals (Sweden)

    Donatella eChirico


    Full Text Available Streptococcus thermophilus is a thermophilic lactic acid bacterium used as starter culture for the manufacture of fermented dairy products. For the production of Crescenza and other soft cheeses, Sacco has developed and provides dairies with 3 different defined blends of S. thermophilus strains. Each blend contains 2 different S. thermophilus strains. The strains were selected based on their unique technological properties as well as different phage profiles. Analysis of 133 whey samples collected in 2009-2010 from Italian dairies showed a high prevalence (about 50% of bacteriophage attacks on the blend ST020. More specifically, the strain S. thermophilus ST1A was found to be the preferred target of the bacteriophages. A bacteriophage insensitive mutant (BIM5 of the phage-sensitive strain ST1A was successfully developed and used to substitute strain ST1A in the Crescenza starter culture ST020. The strain BIM5 showed identical technological and industrial traits as those of the phage-sensitive strain ST1A. The improved resistance of the modified Crescenza starter culture ST020R was confirmed at Italian dairies, and its effectiveness monitored on 122 whey samples collected in 2011-2012. Compared to the previous values (2009-2010, the use of the phage-hardened blend ST020R allowed reducing of frequency of phage attacks from about 50 to less than 5% of the whey samples investigated.

  1. Bacteriophage-insensitive mutants for high quality Crescenza manufacture. (United States)

    Chirico, Donatella; Gorla, Arianna; Verga, Viola; Pedersen, Per D; Polgatti, Eliseo; Cava, Antonio; Dal Bello, Fabio


    Streptococcus thermophilus is a thermophilic lactic acid bacterium used as starter culture for the manufacture of fermented dairy products. For the production of Crescenza and other soft cheeses, Sacco has developed and provides dairies with three different defined blends of S. thermophilus strains. Each blend contains two different S. thermophilus strains. The strains were selected based on their unique technological properties as well as different phage profiles. Analysis of 133 whey samples collected in 2009-2010 from Italian dairies showed a high prevalence (about 50%) of bacteriophage attacks on the blend ST020. More specifically, the strain S. thermophilus ST1A was found to be the preferred target of the bacteriophages. A bacteriophage insensitive mutant (BIM5) of the phage-sensitive strain ST1A was successfully developed and used to substitute strain ST1A in the Crescenza starter culture ST020. The strain BIM5 showed identical technological and industrial traits as those of the phage-sensitive strain ST1A. The improved resistance of the modified Crescenza starter culture ST020R was confirmed at Italian dairies, and its effectiveness monitored on 122 whey samples collected in 2011-2012. Compared to the previous values (2009-2010), the use of the phage-hardened blend ST020R allowed reducing of frequency of phage attacks from about 50 to less than 5% of the whey samples investigated.

  2. Solvent engineering for high-quality perovskite solar cell with an efficiency approaching 20% (United States)

    Wu, Tongyue; Wu, Jihuai; Tu, Yongguang; He, Xin; Lan, Zhang; Huang, Miaoliang; Lin, Jianming


    The perovskite layer is the most crucial factor for the high performance perovskite solar cells. Based on solvent engineering, we develop a ternary-mixed-solvent method for the growth of high-quality [Cs0.05(MA0.17FA0.83)0.95Pb(I0.83Br0.17)3] cation-anion-mixed perovskite films by introducing N-methyl-2-pyrrolidone (NMP) into the precursor mixed solution. By controlling rapid nucleation and retarding crystal growth via intermediate phase PbI2-NMP (Lewis acid-base adduct), a dense, large grain, pinhole-free and long charge carrier lifetime perovskite film is obtained. By optimizing the precursor solvent composition, the perovskite solar cell achieves an impressive power conversion efficiency of 19.61% under one-sun illumination. The research presented here provides a facile, low-cost and highly efficient way for the preparation of perovskite solar cells.

  3. Using a quality improvement model to enhance providers' performance in maternal and newborn health care: a post-only intervention and comparison design. (United States)

    Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle


    The Standards Based Management and Recognition (SBM-R(©)) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services. A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups. There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn

  4. Quality assessment and potential utilization of high amylolytic ...

    African Journals Online (AJOL)



    Dec 3, 2008 ... This study was carried out to compare the qualities of two acclaimed Nigerian amylolytic maize cultivars; SPMAT and TZEE*TZEE-W*DEMARSCUS*TZEE-W with barley, red and white sorghum. Results obtained (P ≤ 0.05) showed marked differences in the properties of the two maize cultivars compared to ...

  5. Twin pregnancy possibly associated with high semen quality

    DEFF Research Database (Denmark)

    Asklund, Camilla; Jensen, Tina Kold; Jørgensen, Niels


    BACKGROUND: Recent studies found an association between a long waiting time to pregnancy (TTP) and reduced probability of twinning and a reduced dizygotic (DZ) twinning rate in subfertile men. However, it remains unsolved whether semen quality is associated with twin offspring. We therefore studied...

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

    African Journals Online (AJOL)

    ... assisting smallholders to produce value-added products competitively, working with a range of partners at different stages in the value chain to take pilot studies to scale, ensuring and maintaining quality, selecting appropriate technologies for different circumstances, anticipating negative effects of the market environment ...

  7. Innovation in Business Education: Developing a High Quality Online MBA (United States)

    Roe, C. William; Toma, Alfred G.; Yallapragada, RamMohan R.


    Online degree programs were probably pioneered by for-profit universities such as University of Phoenix. Many online degree programs were initially considered low quality academic programs compared to traditional programs. Therefore, many public and private universities were slow to adopt the online programs. However, gradually more and more…

  8. Creating High-Quality Paths for Motion Planning

    NARCIS (Netherlands)

    Geraerts, R.J.; Overmars, M.H.


    Many algorithms have been proposed that create a path for a robot in an environment with obstacles. Most methods are aimed at finding a solution. However, for many applications, the path must be of a good quality as well. That is, a path should be short and should keep some amount of minimum

  9. High-quality slab-based intermixing method for fusion rendering of multiple medical objects. (United States)

    Kim, Dong-Joon; Kim, Bohyoung; Lee, Jeongjin; Shin, Juneseuk; Kim, Kyoung Won; Shin, Yeong-Gil


    The visualization of multiple 3D objects has been increasingly required for recent applications in medical fields. Due to the heterogeneity in data representation or data configuration, it is difficult to efficiently render multiple medical objects in high quality. In this paper, we present a novel intermixing scheme for fusion rendering of multiple medical objects while preserving the real-time performance. First, we present an in-slab visibility interpolation method for the representation of subdivided slabs. Second, we introduce virtual zSlab, which extends an infinitely thin boundary (such as polygonal objects) into a slab with a finite thickness. Finally, based on virtual zSlab and in-slab visibility interpolation, we propose a slab-based visibility intermixing method with the newly proposed rendering pipeline. Experimental results demonstrate that the proposed method delivers more effective multiple-object renderings in terms of rendering quality, compared to conventional approaches. And proposed intermixing scheme provides high-quality intermixing results for the visualization of intersecting and overlapping surfaces by resolving aliasing and z-fighting problems. Moreover, two case studies are presented that apply the proposed method to the real clinical applications. These case studies manifest that the proposed method has the outstanding advantages of the rendering independency and reusability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Quality assurance plan for the High Level Controller for the CBMS Block II

    Energy Technology Data Exchange (ETDEWEB)

    Reid, R.W.; Robbins, I.F.; Stewart, K.A.; Terry, C.L.; Whitaker, R.A.; Wolf, D.A.; Zager, J.C.


    This document establishes the software Quality Assurance Plan (QAP) for the High Level Controller for the Chemical and Biological Mass Spectrometer Block II (HLC/CBMS-II) project activities under the Computing, Robotics, and Education (CRE) Directorate management. It defines the requirements and assigns responsibilities for ensuring, with a high degree of confidence, that project objectives will be achieved as planned. The CBMS Program was awarded to ORNL by the US Army Chemical and Biological Defense command, Aberdeen Proving Ground, Maryland, to design the next version (Block II) mass spectrometer for the detection and identification of chemical and biological warfare agents, to fabricate four engineering prototypes, and to construct eight preproduction units. Section 1 of this document provides an introduction to the HLC/CBMS-II project QAP. Sections 2 and 3 describe the specific aspects of quality assurance as applicable to the project. Section 4 reviews the project approach to risk management. The Risk Management Matrix given in Appendix A is a tool to assess, prioritize, and prevent problems before they occur; therefore, the matrix will be reviewed and revised on a periodic basis. Appendix B shows the quality assurance criteria of the DOE Order 5700.6C and their applicability to this project.

  11. Argumentation Quality of Socio-scientific Issue between High School Students and Postgraduate Students about Cancer (United States)

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


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

  12. Project quality assurance plan for research and development services provided by Oak Ridge National Laboratory in support of the Hanford Grout Disposal Program

    Energy Technology Data Exchange (ETDEWEB)

    Spence, R.D.; Gilliam, T.M.


    This Project Quality Assurance Plan (PQAP) is being published to provide the sponsor with referenceable documentation for work conducted in support of the Hanford WHC Grout Disposal Program. This plan, which meets NQA-1 requirements, is being applied to work performed at Oak Ridge National Laboratory (ORNL) during FY 1991 in support of this program. It should also be noted that with minor revisions, this plan should be applicable to other projects involving research and development that must comply with NQA-1 requirements.

  13. The Politics of Quality Teacher Discourses: Implications for Pre-Service Teachers in High Poverty Schools (United States)

    Scholes, Laura; Lampert, Jo; Burnett, Bruce; Comber, Barbara M.; Hoff, Lutz; Ferguson, Angela


    Improving the quality of education for young people growing up in high poverty and culturally diverse communities is an escalating problem in affluent nations with increasing gaps between the wealthy and the poor. Improving the quality of teachers and improving the quality of teaching are amongst the prominent solutions offered to redress the…

  14. Building High-Performing and Improving Education Systems: Quality Assurance and Accountability. Review (United States)

    Slater, Liz


    Monitoring, evaluation, and quality assurance in their various forms are seen as being one of the foundation stones of high-quality education systems. De Grauwe, writing about "school supervision" in four African countries in 2001, linked the decline in the quality of basic education to the cut in resources for supervision and support.…

  15. Modeling the Subjective Quality of Highly Contrasted Videos Displayed on LCD With Local Backlight Dimming

    DEFF Research Database (Denmark)

    Mantel, Claire; Bech, Søren; Korhonen, Jari


    signal can then be used as input to objective quality metrics. The focus of this paper is on determining which characteristics of locally backlit displays influence quality assessment. A subjective experiment assessing the quality of highly contrasted videos displayed with various local backlight...

  16. The Cost of Inequality: The Importance of Investing in High Quality Early Childhood Education Programs (United States)

    Keith, Rebecca S.


    The focus of this dissertation was to explore the importance of high quality early education in later secondary education development, quantifying quality in early childhood education programs, and examining how teacher education contributes to quality of early childhood education programs. For phase I, early childhood education positively…

  17. Ultra Efficient CHHP Using a High Temperature Fuel Cell to Provide On-Site Process Reducing Gas, Clean Power, and Heat

    Energy Technology Data Exchange (ETDEWEB)

    Jahnke, Fred C. [Fuelcell Energy, Inc., Danbury, CT (United States)


    FuelCell Energy and ACuPowder investigated and demonstrated the use of waste anode exhaust gas from a high temperature fuel cell for replacing the reducing gas in a metal processing furnace. Currently companies purchase high pressure or liquefied gases for the reducing gas which requires substantial energy in production, compression/liquefaction, and transportation, all of which is eliminated by on-site use of anode exhaust gas as reducing gas. We performed research on the impact of the gas composition on product quality and then demonstrated at FuelCell Energy’s manufacturing facility in Torrington, Connecticut. This demonstration project continues to operate even though the research program is completed as it provides substantial benefits to the manufacturing facility by supplying power, heat, and hydrogen.

  18. Most clinical laboratory testing in Kampala occurs in high-volume, high-quality laboratories or low-volume, low-quality laboratories. A tale of two cities. (United States)

    Amukele, Timothy K; Schroeder, Lee F; Jackson, J Brooks; Elbireer, Ali


    To describe key characteristics (laboratory quality, test volumes, and complexity) of clinical laboratories in Kampala, Uganda (population ~1.7 million). Cross-sectional survey using a standard questionnaire to document laboratory type and quality, as well as test menus and volumes. Quality was based on the World Health Organization-Africa Region checklist. Of the 954 laboratories identified (a density of one laboratory per 1,781 persons), 779 (82%) performed only simple kit tests or light microscope examinations. The 95% (907/954) of laboratories for whom volumes were obtained performed an average aggregate of 13,189 tests daily, for a test utilization rate of around 2 tests per individual per year. Laboratories could be segregated into eight groups based on quality, test volume, and complexity. However, 90% of the testing was performed by just two groups: (1) low-volume (≤100 tests daily), low-quality laboratories performing simple tests or (2) high-volume (>100 tests daily), high-quality laboratories. Each of these two groups did 45% of the daily testing volume (90% combined). Clinical laboratory density in Kampala (1/1,781 persons) is high, approaching that in the United States (1/1,347 persons). Low-volume/low-quality and high-volume/high-quality laboratories do 90% of the daily aggregate testing. Quality improvement (QI) schemes for Africa must be appropriate to low-volume laboratories as well as to the large laboratories that have been the focus of previous QI efforts. Copyright© by the American Society for Clinical Pathology.

  19. High fidelity system modeling for high quality image reconstruction in clinical CT.

    Directory of Open Access Journals (Sweden)

    Synho Do

    Full Text Available Today, while many researchers focus on the improvement of the regularization term in IR algorithms, they pay less concern to the improvement of the fidelity term. In this paper, we hypothesize that improving the fidelity term will further improve IR image quality in low-dose scanning, which typically causes more noise. The purpose of this paper is to systematically test and examine the role of high-fidelity system models using raw data in the performance of iterative image reconstruction approach minimizing energy functional. We first isolated the fidelity term and analyzed the importance of using focal spot area modeling, flying focal spot location modeling, and active detector area modeling as opposed to just flying focal spot motion. We then compared images using different permutations of all three factors. Next, we tested the ability of the fidelity terms to retain signals upon application of the regularization term with all three factors. We then compared the differences between images generated by the proposed method and Filtered-Back-Projection. Lastly, we compared images of low-dose in vivo data using Filtered-Back-Projection, Iterative Reconstruction in Image Space, and the proposed method using raw data. The initial comparison of difference maps of images constructed showed that the focal spot area model and the active detector area model also have significant impacts on the quality of images produced. Upon application of the regularization term, images generated using all three factors were able to substantially decrease model mismatch error, artifacts, and noise. When the images generated by the proposed method were tested, conspicuity greatly increased, noise standard deviation decreased by 90% in homogeneous regions, and resolution also greatly improved. In conclusion, the improvement of the fidelity term to model clinical scanners is essential to generating higher quality images in low-dose imaging.

  20. A Modified SDS-Based DNA Extraction Method for High Quality Environmental DNA from Seafloor Environments. (United States)

    Natarajan, Vengadesh Perumal; Zhang, Xinxu; Morono, Yuki; Inagaki, Fumio; Wang, Fengping


    Recovering high quality genomic DNA from environmental samples is a crucial primary step to understand the genetic, metabolic, and evolutionary characteristics of microbial communities through molecular ecological approaches. However, it is often challenging because of the difficulty of effective cell lysis without fragmenting the genomic DNA. This work aims to improve the previous SDS-based DNA extraction methods for high-biomass seafloor samples, such as pelagic sediments and metal sulfide chimney, to obtain high quality and high molecular weight of the genomic DNA applicable for the subsequent molecular ecological analyses. In this regard, we standardized a modified SDS-based DNA extraction method (M-SDS), and its performance was then compared to those extracted by a recently developed hot-alkaline DNA extraction method (HA) and a commercial DNA extraction kit. Consequently, the M-SDS method resulted in higher DNA yield and cell lysis efficiency, lower DNA shearing, and higher diversity scores than other two methods, providing a comprehensive DNA assemblage of the microbial community on the seafloor depositional environment.

  1. High quality draft sequences for prokaryotic genomes using a mix of new sequencing technologies

    Directory of Open Access Journals (Sweden)

    Samson Gaelle


    Full Text Available Abstract Background Massively parallel DNA sequencing instruments are enabling the decoding of whole genomes at significantly lower cost and higher throughput than classical Sanger technology. Each of these technologies have been estimated to yield assemblies with more problematic features than the standard method. These problems are of a different nature depending on the techniques used. So, an appropriate mix of technologies may help resolve most difficulties, and eventually provide assemblies of high quality without requiring any Sanger-based input. Results We compared assemblies obtained using Sanger data with those from different inputs from New Sequencing Technologies. The assemblies were systematically compared with a reference finished sequence. We found that the 454 GSFLX can efficiently produce high continuity when used at high coverage. The potential to enhance continuity by scaffolding was tested using 454 sequences from circularized genomic fragments. Finally, we explore the use of Solexa-Illumina short reads to polish the genome draft by implementing a technique to correct 454 consensus errors. Conclusion High quality drafts can be produced for small genomes without any Sanger data input. We found that 454 GSFLX and Solexa/Illumina show great complementarity in producing large contigs and supercontigs with a low error rate.

  2. High quality draft sequences for prokaryotic genomes using a mix of new sequencing technologies. (United States)

    Aury, Jean-Marc; Cruaud, Corinne; Barbe, Valérie; Rogier, Odile; Mangenot, Sophie; Samson, Gaelle; Poulain, Julie; Anthouard, Véronique; Scarpelli, Claude; Artiguenave, François; Wincker, Patrick


    Massively parallel DNA sequencing instruments are enabling the decoding of whole genomes at significantly lower cost and higher throughput than classical Sanger technology. Each of these technologies have been estimated to yield assemblies with more problematic features than the standard method. These problems are of a different nature depending on the techniques used. So, an appropriate mix of technologies may help resolve most difficulties, and eventually provide assemblies of high quality without requiring any Sanger-based input. We compared assemblies obtained using Sanger data with those from different inputs from New Sequencing Technologies. The assemblies were systematically compared with a reference finished sequence. We found that the 454 GSFLX can efficiently produce high continuity when used at high coverage. The potential to enhance continuity by scaffolding was tested using 454 sequences from circularized genomic fragments. Finally, we explore the use of Solexa-Illumina short reads to polish the genome draft by implementing a technique to correct 454 consensus errors. High quality drafts can be produced for small genomes without any Sanger data input. We found that 454 GSFLX and Solexa/Illumina show great complementarity in producing large contigs and supercontigs with a low error rate.

  3. Manufacturing High-Quality Carbon Nanotubes at Lower Cost (United States)

    Benavides, Jeanette M.; Lidecker, Henning


    A modified electric-arc welding process has been developed for manufacturing high-quality batches of carbon nanotubes at relatively low cost. Unlike in some other processes for making carbon nanotubes, metal catalysts are not used and, consequently, it is not necessary to perform extensive cleaning and purification. Also, unlike some other processes, this process is carried out at atmospheric pressure under a hood instead of in a closed, pressurized chamber; as a result, the present process can be implemented more easily. Although the present welding-based process includes an electric arc, it differs from a prior electric-arc nanotube-production process. The welding equipment used in this process includes an AC/DC welding power source with an integral helium-gas delivery system and circulating water for cooling an assembly that holds one of the welding electrodes (in this case, the anode). The cathode is a hollow carbon (optionally, graphite) rod having an outside diameter of 2 in. (approximately equal to 5.1 cm) and an inside diameter of 5/8 in. (approximately equal to 1.6 cm). The cathode is partly immersed in a water bath, such that it protrudes about 2 in. (about 5.1 cm) above the surface of the water. The bottom end of the cathode is held underwater by a clamp, to which is connected the grounding cable of the welding power source. The anode is a carbon rod 1/8 in. (approximately equal to 0.3 cm) in diameter. The assembly that holds the anode includes a thumbknob- driven mechanism for controlling the height of the anode. A small hood is placed over the anode to direct a flow of helium downward from the anode to the cathode during the welding process. A bell-shaped exhaust hood collects the helium and other gases from the process. During the process, as the anode is consumed, the height of the anode is adjusted to maintain an anode-to-cathode gap of 1 mm. The arc-welding process is continued until the upper end of the anode has been lowered to a specified height

  4. High-quality thorium TRISO fuel performance in HTGRs

    Energy Technology Data Exchange (ETDEWEB)

    Verfondern, Karl [Forschungszentrum Juelich GmbH (Germany); Allelein, Hans-Josef [Forschungszentrum Juelich GmbH (Germany); Technische Hochschule Aachen (Germany); Nabielek, Heinz; Kania, Michael J.


    Thorium as a nuclear fuel has received renewed interest, because of its widespread availability and the good irradiation performance of Th and mixed (Th,U) oxide compounds as fuels in nuclear power systems. Early HTGR development employed thorium together with high-enriched uranium (HEU). After 1980, HTGR fuel systems switched to low-enriched uranium (LEU). After completing fuel development for the AVR and the THTR with BISO coated particles, the German program expanded its efforts utilizing thorium and HEU TRISO coated particles in advanced HTGR concepts for process heat applications (PNP) and direct-cycle electricity production (HHT). The combination of a low-temperature isotropic (LTI) inner and outer pyrocarbon layers surrounding a strong, stable SiC layer greatly improved manufacturing conditions and the subsequent contamination and defective particle fractions in production fuel elements. In addition, this combination provided improved mechanical strength and a higher degree of solid fission product retention, not known previously with high-temperature isotropic (HTI) BISO coatings. The improved performance of the HEU (Th, U)O{sub 2} TRISO fuel system was successfully demonstrated in three primary areas of development: manufacturing, irradiation testing under normal operating conditions, and accident simulation testing. In terms of demonstrating performance for advanced HTGR applications, the experimental failure statistic from manufacture and irradiation testing are significantly below the coated particle requirements specified for PNP and HHT designs at the time. Covering a range to 1300 C in normal operations and 1600 C in accidents, with burnups to 13% FIMA and fast fluences to 8 x 10{sup 25} n/m{sup 2} (E> 16 fJ), the performance results exceed the design limits on manufacturing and operational requirements for the German HTR-Modul concept, which are 6.5 x 10{sup -5} for manufacturing, 2 x 10{sup -4} for normal operating conditions, and 5 x 10{sup -4

  5. Potential roles of research in enhancing the performance of management in securing high quality visitor experiences in wilderness (United States)

    Stephen F. McCool


    Does research help managers provide opportunities for visitors to have high quality experiences in wilderness? Difficulties in applying visitor experience research result from several factors: the nature of wilderness itself, the character of the wilderness visitor experience challenge as a research and management topic, and the paradigm of research applications...

  6. 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.


    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

  7. Prodigious Effects of Concentration Intensification on Nanoparticle Synthesis: A High-Quality, Scalable Approach

    KAUST Repository

    Williamson, Curtis B.


    © 2015 American Chemical Society. Realizing the promise of nanoparticle-based technologies demands more efficient, robust synthesis methods (i.e., process intensification) that consistently produce large quantities of high-quality nanoparticles (NPs). We explored NP synthesis via the heat-up method in a regime of previously unexplored high concentrations near the solubility limit of the precursors. We discovered that in this highly concentrated and viscous regime the NP synthesis parameters are less sensitive to experimental variability and thereby provide a robust, scalable, and size-focusing NP synthesis. Specifically, we synthesize high-quality metal sulfide NPs (<7% relative standard deviation for Cu2-xS and CdS), and demonstrate a 10-1000-fold increase in Cu2-xS NP production (>200 g) relative to the current field of large-scale (0.1-5 g yields) and laboratory-scale (<0.1 g) efforts. Compared to conventional synthesis methods (hot injection with dilute precursor concentration) characterized by rapid growth and low yield, our highly concentrated NP system supplies remarkably controlled growth rates and a 10-fold increase in NP volumetric production capacity (86 g/L). The controlled growth, high yield, and robust nature of highly concentrated solutions can facilitate large-scale nanomanufacturing of NPs by relaxing the synthesis requirements to achieve monodisperse products. Mechanistically, our investigation of the thermal and rheological properties and growth rates reveals that this high concentration regime has reduced mass diffusion (a 5-fold increase in solution viscosity), is stable to thermal perturbations (64% increase in heat capacity), and is resistant to Ostwald ripening.

  8. Society of Behavioral Medicine supports implementation of high quality lung cancer screening in high-risk populations. (United States)

    Watson, Karriem S; Blok, Amanda C; Buscemi, Joanna; Molina, Yamile; Fitzgibbon, Marian; Simon, Melissa A; Williams, Lance; Matthews, Kameron; Studts, Jamie L; Lillie, Sarah E; Ostroff, Jamie S; Carter-Harris, Lisa; Winn, Robert A


    The Society of Behavioral Medicine (SBM) supports the United States Preventive Services Task Force (USPSTF) recommendation of low-dose computed tomography (LDCT) screening of the chest for eligible populations to reduce lung cancer mortality. Consistent with efforts to translate research findings into real-world settings, SBM encourages health-care providers and health-care systems to (1) integrate evidence-based tobacco treatment as an essential component of LDCT-based lung cancer screening, (2) examine the structural barriers that may impact screening uptake, and (3) incorporate shared decision-making as a clinical platform to facilitate consultations and engagement with individuals at high risk for lung cancer about the potential benefits and harms associated with participation in a lung cancer screening program. We advise policy makers and legislators to support screening in high-risk populations by continuing to (1) expand access to high quality LDCT-based screening among underserved high-risk populations, (2) enhance cost-effectiveness by integrating evidence-based tobacco treatments into screening in high-risk populations, and (3) increase funding for research that explores implementation science and increased public awareness and access of diverse populations to participate in clinical and translational research.

  9. Social media: opportunities for quality improvement and lessons for providers-a networked model for patient-centered care through digital engagement. (United States)

    Bornkessel, Alexandra; Furberg, Robert; Lefebvre, R Craig


    Social media brings a new dimension to health care for patients, providers, and their support networks. Increasing evidence demonstrates that patients who are more actively involved in their healthcare experience have better health outcomes and incur lower costs. In the field of cardiology, social media are proposed as innovative tools for the education and update of clinicians, physicians, nurses, and medical students. This article reviews the use of social media by healthcare providers and patients and proposes a model of "networked care" that integrates the use of digital social networks and platforms by both patients and providers and offers recommendations for providers to optimize their use and understanding of social media for quality improvement.

  10. What makes a high quality clinical research paper? (United States)

    Groves, T


    The quality of a research paper depends primarily on the quality of the research study it reports. However, there is also much that authors can do to maximise the clarity and usefulness of their papers. Journals' instructions for authors often focus on the format, style, and length of articles but do not always emphasise the need to clearly explain the work's science and ethics: so this review reminds researchers that transparency is important too. The research question should be stated clearly, along with an explanation of where it came from and why it is important. The study methods must be reported fully and, where appropriate, in line with an evidence based reporting guideline such as the CONSORT statement for randomised controlled trials. If the study was a trial the paper should state where and when the study was registered and state its registration identifier. Finally, any relevant conflicts of interest should be declared.

  11. High quality factor photonic resonators for nitride quantum dots

    Energy Technology Data Exchange (ETDEWEB)

    Guillet, T. [Universite Montpellier 2, Laboratoire Charles Coulomb UMR 5221, 34095 Montpellier (France); Mexis, M.; Rennesson, S.; Brimont, C.; Bretagnon, T.; Gil, B. [Universite Montpellier 2, Laboratoire Charles Coulomb UMR 5221, 34095 Montpellier (France); CNRS, Laboratoire Charles Coulomb UMR 5221, 34095 Montpellier (France); Sergent, S. [CRHEA-CNRS, Valbonne 06560 (France); Universite de Nice Sophia Antipolis, Parc Valrose, Nice 06102 Cedex 2 (France); Neel, D.; David, S.; Checoury, X.; Boucaud, P. [Institut d' Electronique Fondamentale, CNRS - Universite Paris Sud 11, 91405 Orsay (France); Sam-Giao, D.; Gayral, B. [CEA-INAC, 17 rue des Martyrs, 38054 Grenoble (France); Semond, F.; Leroux, M. [CRHEA-CNRS, Valbonne 06560 (France)


    We report the realization and the optical study of nitride photonic resonators dedicated to the blue and UV spectral range. Microdisks and photonic crystal (PC) cavities are investigated containing GaN/AlN quantum dots (QDs) embedded in an AlN waveguide. The PC cavities are fabricated through the conformal growth of nitrides on a patterned Si substrate, and present delocalized and confined cavity modes in their microphotoluminescence spectra, that are compared to simulations. A large quality factor of 1800 is reached for a modified L3 cavity. In the case of microdisks, which are fabricated through a classical top-down approach, the series of whispering gallery modes (WGMs) with large quality factors (up to 7300) are observed and analysed. Scanning electron micrograph and microphotoluminescence spectrum of a 2 {mu}m AlN microdisk embedding GaN QDs; the WGMs appear as sharp peaks, with quality factors up to 5000. (Copyright copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  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. (United States)

    Cragun, Joshua N; April, Michael D; Thaxton, Robert E


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

    CERN Document Server

    Bergmann, Sebastian


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

  14. What is the quality of information on social oocyte cryopreservation provided by websites of Society for Assisted Reproductive Technology member fertility clinics? (United States)

    Avraham, Sarit; Machtinger, Ronit; Cahan, Tal; Sokolov, Amit; Racowsky, Catherine; Seidman, Daniel S


    To evaluate adequacy and adherence to American Society for Reproductive Medicine (ASRM) guidelines of internet information provided by Society for Assisted Reproductive Technology (SART)-affiliated clinics regarding social oocyte cryopreservation (SOC). Systematic evaluation of websites of all SART member fertility clinics. The internet. None. All websites offering SOC services were scored using a 0-13 scale, based on 10 questions designed to assess website quality and adherence to the ASRM/SART guidelines. The websites were analyzed independently by two authors. Whenever disagreement occurred, a third investigator determined the score. Scores defined website quality as excellent, ≥9; moderate, 5-8; or poor, ≤4 points. Of the 387 clinics registered as SART members, 200 offered oocyte cryopreservation services for either medical or social reasons; 147 of these advertised SOC. The average website scores of those clinics offering SOC was 3.4 ± 2.1 (range, 2-11) points. There was no significant difference in scores between private versus academic clinics or clinics performing more or less than 500 cycles per year. The majority of the websites do not follow the SART/ASRM guidelines for SOC, indicating that there is a need to improve the type and quality of information provided on SOC by SART member websites. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Health-Related Quality of Life in Children with High-Functioning Autism (United States)

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


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

  16. Evaluation of problematic use of mobile phones and quality of sleep among high school students


    Fatih Öz; Didem Arslantaş; Necati Buğrul; Tuğçe Koyuncu; Alaettin Ünsal


    It was aimed to evaluate the problematic use of mobile phones and quality of sleep among high school students. This is a cross-sectional study carried out on 1,131 high school students studying at Sivrihisar, a district of Eskisehir, in December 2012. The questionnaire form include the sociodemographic characteristics, problematic use of mobile phones and quality of sleep. Bianchi-Phillips problematic use of mobile phones (PUMP) scale and Pittsburgh Sleep Quality Index (PSQI) was used. Median...

  17. Rehosting of Bacterial Chaperones for High-Quality Protein Production▿ (United States)

    Martínez-Alonso, Mónica; Toledo-Rubio, Verónica; Noad, Rob; Unzueta, Ugutz; Ferrer-Miralles, Neus; Roy, Polly; Villaverde, Antonio


    Coproduction of DnaK/DnaJ in Escherichia coli enhances solubility but promotes proteolytic degradation of their substrates, minimizing the yield of unstable polypeptides. Higher eukaryotes have orthologs of DnaK/DnaJ but lack the linked bacterial proteolytic system. By coexpression of DnaK and DnaJ in insect cells with inherently misfolding-prone recombinant proteins, we demonstrate simultaneous improvement of soluble protein yield and quality and proteolytic stability. Thus, undesired side effects of bacterial folding modulators can be avoided by appropriate rehosting in heterologous cell expression systems. PMID:19820142

  18. The costs and cost-efficiency of providing food through schools in areas of high food insecurity. (United States)

    Gelli, Aulo; Al-Shaiba, Najeeb; Espejo, Francisco


    The provision of food in and through schools has been used to support the education, health, and nutrition of school-aged children. The monitoring of financial inputs into school health and nutrition programs is critical for a number of reasons, including accountability, transparency, and equity. Furthermore, there is a gap in the evidence on the costs, cost-efficiency, and cost-effectiveness of providing food through schools, particularly in areas of high food insecurity. To estimate the programmatic costs and cost-efficiency associated with providing food through schools in food-insecure, developing-country contexts, by analyzing global project data from the World Food Programme (WFP). Project data, including expenditures and number of schoolchildren covered, were collected through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms. The average yearly expenditure per child, standardized over a 200-day on-site feeding period and an average ration, excluding school-level costs, was US$21.59. The costs varied substantially according to choice of food modality, with fortified biscuits providing the least costly option of about US$11 per year and take-home rations providing the most expensive option at approximately US$52 per year. Comparisons across the different food modalities suggested that fortified biscuits provide the most cost-efficient option in terms of micronutrient delivery (particularly vitamin A and iodine), whereas on-site meals appear to be more efficient in terms of calories delivered. Transportation and logistics costs were the main drivers for the high costs. The choice of program objectives will to a large degree dictate the food modality

  19. A reliable way of mechanical exfoliation of large scale two dimensional materials with high quality (United States)

    Yuan, Lin; Ge, Jun; Peng, Xianglin; Zhang, Qian; Wu, Zefei; Jian, Yu; Xiong, Xiaolu; Yin, Hongxing; Han, Junfeng


    In this work, we have developed a modified way of mechanical exfoliation for making two-dimensional materials by introducing a home-designed exfoliation machine. Optical microscopy was employed to identify the thin-layer (mono- and few-layer) flakes primarily. To testify the high efficiency of our modified exfoliation method, we did a simple statistical work on the exfoliation of graphene and WSe2. Further, we used the Raman spectroscopy and the Atomic Force Microscopy (AFM) to characterize the samples. The results indicated the high quality of the as-fabricated samples. Finally, we developed an exfoliation technique for working with easily oxidizing samples. Our modified exfoliation method would be intriguing and innovative for fabricating two dimensional materials, providing a facile way for making electronic and optoelectronic devices.

  20. A reliable way of mechanical exfoliation of large scale two dimensional materials with high quality

    Directory of Open Access Journals (Sweden)

    Lin Yuan


    Full Text Available In this work, we have developed a modified way of mechanical exfoliation for making two-dimensional materials by introducing a home-designed exfoliation machine. Optical microscopy was employed to identify the thin-layer (mono- and few-layer flakes primarily. To testify the high efficiency of our modified exfoliation method, we did a simple statistical work on the exfoliation of graphene and WSe2. Further, we used the Raman spectroscopy and the Atomic Force Microscopy (AFM to characterize the samples. The results indicated the high quality of the as-fabricated samples. Finally, we developed an exfoliation technique for working with easily oxidizing samples. Our modified exfoliation method would be intriguing and innovative for fabricating two dimensional materials, providing a facile way for making electronic and optoelectronic devices.

  1. The perceptions of teachers and principals toward providing additional compensation to teachers in high-need subject areas (United States)

    Longing, Jeffrey Lucian

    The purpose of this study was to determine possible differences in the perceptions of teachers teaching in high-need areas (i.e., math, science, special education, etc.) and teachers not teaching in high-need areas, (i.e., business education, physical education, etc.) as defined by the states of Arkansas and Louisiana, regarding higher compensation for high-need teachers. In addition, possible perception differences among principals and teachers were determined. The independent variables consisted of gender, position held, years of certified experience, and certification areas. The dependent variable was the perceptions of the participants on providing higher compensation for high-need teachers in order to attract and retain them. The data for all variables were collected using the Teacher Compensation Survey. The sample for this study was limited to teachers, grades 9 through 12, and principals of public high schools in south Arkansas and north Louisiana. Forty-four school districts in south Arkansas (Arkansas Department of Education, 2008a) and north Louisiana (Louisiana Department of Education, 2008a) met the criteria for this study. Twenty-two superintendents gave permission for their districts to participate in the research. A sample of 849 teachers and 38 principals were identified in these districts. Surveys were returned from 350 teachers, creating a 41% response rate. When the 31 principals that returned surveys were added to the total population, the response rate increased to 43% with 381 of the 887 surveyed responding. However, 42 of the teachers and two of the principals skipped some of the questions on the survey and were not included in the study. The researcher used a One-Way ANOVA and independent t-tests to determine the presence of statistical differences at the .05 level. The data showed that most math and science teachers agreed that high-need teachers should be compensated at a higher rate than teachers not teaching in high-need areas. The data

  2. Abstinence and teenagers: prevention counseling practices of health care providers serving high-risk patients in the United States. (United States)

    Harper, Cynthia C; Henderson, Jillian T; Schalet, Amy; Becker, Davida; Stratton, Laura; Raine, Tina R


    Abstinence-only education has had little demonstrable impact on teenagers' sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers' reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention. In 2005, a qualitative study with 31 clinicians serving low-income, at-risk patients was conducted. A semistructured interview guide was used to ask clinicians about adolescent pregnancy, HIV and STD prevention counseling, and when they include abstinence. Thematic content analysis was used to examine the content of the counseling and the techniques used in different situations. Providers reported offering comprehensive counseling, presenting abstinence as a choice for teenagers, along with information about contraceptives and condoms. Several providers mentioned that with young, sexually inexperienced teenagers, they discuss delaying sexual activity and suggest other ways to be affectionate, while giving information on condoms. Providers explained how they assess whether teenagers feel ready to be sexually active and try to impart skills for healthy relationships. Some described abstinence as giving teenagers a way to opt out of unwanted sexual activity. Many support abstinence if that is the patient's desire, but routinely dispense condoms and contraceptives. Overall, providers did not give abstinence counseling as a rigid categorical concept in their preventive practices, but as a health tool to give agency to teenagers within a harm reduction framework. Their approach may be informative for adolescent policies and programs in the future.

  3. Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? (United States)

    DeVoe, Jennifer; Fryer Jr, George E; Hargraves, J Lee; Phillips, Robert L; Green, Larry A


    A usual source of care is associated with better health outcomes. Dissatisfaction among family physicians and general practitioners (FP/GPs) may compromise the accessibility of a usual source of care and the quality of services. We examined the association between FP/GP dissatisfaction and an inability to deliver high-quality care. We performed a secondary data analysis of the Community Tracking Study (CTS) Physician Survey (1996-1997). The study included a nationally representative sample of more than 12,000 nonfederal physicians practicing direct patient care in the United States. We measured associations of career dissatisfaction with physicians&rsquo perceptions of their ability to provide high-quality care as defined by 6 survey items. Multivariate analyses controlled for the effects of personal, professional, and practice characteristics. Among FP/GPs in 1996-1997, more than 17% were dissatisfied. Age was the most significant personal factor associated with dissatisfaction; 25.1% of those aged 55 to 64 years reported dissatisfaction compared with only 10.1% of those younger than 35 years. Other personal or professional characteristics significantly associated with FP/GP dissatisfaction included osteopathic training, graduation from a foreign medical school, full practice ownership, and an income of less than $100,000. Physicians dissatisfied with their careers were much more likely to report difficulties in caring for patients, strongly disagreeing (vs strongly agreeing, odds ratio [OR] 1.0) that they had enough clinical freedom (OR 7.89; 95% confidence interval [CI], 4.86-12.83); continuous patient relationships (OR 7.11; 95% CI, 4.90-10.33); no financial penalties for clinical decisions (OR 4.44; 95% CI, 3.13-6.31); adequate time with patients (OR 4.42; 95% CI, 2.84-6.87); ability to provide quality care (OR 4.26; 95% CI, 2.88-6.31); and sufficient communication with specialists (OR 3.57; CI, 2.20-5.80). An inability to care for patients is significantly

  4. Joint interpretation of seismic tomography and new magnetotelluric results provide evidence for support of high topography in the Southern Rocky Mountains and High Plains of eastern Colorado, USA (United States)

    Feucht, D. W.; Sheehan, A. F.; Bedrosian, P.


    A recent magnetotelluric (MT) survey in central Colorado, USA, when interpreted alongside existing seismic tomography, reveals potential mechanisms of support for high topography both regionally and locally. Broadband and long period magnetotelluric data were collected at twenty-three sites along a 330 km E-W profile across the Southern Rocky Mountains and High Plains of central North America as part of the Deep RIFT Electrical Resistivity (DRIFTER) experiment. Remote-reference data processing yielded high quality MT data over a period range of 100 Hz to 10,000 seconds. A prominent feature of the regional geo-electric structure is the Denver Basin, which contains a thick package of highly conductive shales and porous sandstone aquifers. One-dimensional forward modeling was performed on stations within the Denver Basin to estimate depth to the base of this shallow conductor. Those estimates were then used to place a horizontal penalty cut in the model mesh of a regularized two-dimensional inversion. Two-dimensional modeling of the resistivity structure reveals two major anomalous regions in the lithosphere: 1) a high conductivity region in the crust under the tallest peaks of the Rocky Mountains and 2) a lateral step increase in lithospheric resistivity beneath the plains. The Rocky Mountain crustal anomaly coincides with low seismic wave speeds and enhanced heat flow and is thus interpreted as evidence of partial melt and/or high temperature fluids emplaced in the crust by tectonic activity along the Rio Grande Rift. The lateral variation in the mantle lithosphere, while co-located with a pronounced step increase in seismic velocity, appears to be a gradational boundary in resistivity across eastern Colorado and could indicate a small degree of compositional modification at the edge of the North American craton. These inferred conductivity mechanisms, namely crustal melt and modification of mantle lithosphere, likely contribute to high topography locally in the

  5. Monitoring urban air quality using a high-density network of low-cost sensor nodes in Oslo, Norway. (United States)

    Castell, Nuria; Schneider, Philipp; Vogt, Matthias; Dauge, Franck R.; Lahoz, William; Bartonova, Alena


    Urban air quality represents a major public health burden and is a long-standing concern to citizens. Air pollution is associated with a range of diseases, symptoms and conditions that impair health and quality of life. In Oslo, traffic, especially exhaust from heavy-duty and private diesel vehicles and dust resuspension from studded tyres, together with wood burning in winter, are the main sources of pollution. Norway, as part of the European Economic Area, is obliged to comply with the European air quality regulations and ensure clean air. Despite this, Oslo has exceeded both the NO2 and PM10 thresholds for health protection defined in the Directive 2008/50/EC. The air quality in the Oslo area is continuously monitored in 12 compliance monitoring stations. These stations provide reliable and accurate data but their density is too low to provide a detailed spatial distribution of air quality. The emergence of low-cost nodes enables observations at high spatial resolution, providing the opportunity to enhance existing monitoring systems. However, the data generated by these nodes is significantly less accurate and precise than the data provided by reference equipment. We have conducted an evaluation of low-cost nodes to monitor NO2 and PM10, comparing the data collected with low-cost nodes against CEN (European Standardization Organization) reference analysers. During January and March 2016, a network of 24 nodes was deployed in Oslo. During January, high NO2 levels were observed for several days in a row coinciding with the formation of a thermal inversion. During March, we observed an episode with high PM10 levels due to road dust resuspension. Our results show that there is a major technical challenge associated with current commercial low-cost sensors, regarding the sensor robustness and measurement repeatability. Despite this, low-cost sensor nodes are able to reproduce the NO2 and PM10 variability. The data from the sensors was employed to generate detailed

  6. Reconstruction of perfect ZnO nanowires facets with high optical quality (United States)

    Zehani, E.; Hassani, S.; Lusson, A.; Vigneron, J.; Etcheberry, A.; Galtier, P.; Sallet, V.


    ZnO nanowires were grown on sapphire substrates using metalorganic chemical vapor deposition. The samples were subsequently annealed under zinc pressure in a vacuum-sealed ampoule, at temperature ranging from 500 to 800 °C. The originality and the main motivation to provide a zinc-rich atmosphere were to prevent the out-diffusion of zinc from the nanowires. In doing so, the perfect structural properties and the morphology of the nanowires are kept. Interestingly, photoluminescence experiments performed on nanowires annealed in a narrow window of temperature [580-620 °C] show a spectacular improvement of the optical quality, as transitions commonly observable in high quality bulk samples are found. In addition, the intensity of the so-called "surface excitons" (SX) is strongly decreased. To accurately investigate the chemical modifications of the surface, XPS experiments were carried out and show that zinc hydroxide species and/or Zn(OH)2 sublayer were partially removed from the surface. These results suggest that the annealing process in zinc vapor helps to properly reconstruct the surface of ZnO nanowires, and improves the optical quality of their core. Such a thermal treatment at moderate temperature should be beneficial to nanodevices involving surface reaction, e.g. gas sensors.

  7. Computational generation of high-quality digital halftones (grey/colour patterns

    Directory of Open Access Journals (Sweden)

    Alfonsas Misevičius


    Full Text Available The purpose of this paper is to describe the computational algorithmic generation of the high-quality digital halftones (grey/colour patterns. At the beginning, the formal model for generation of the digital halftones, the so-called grey pattern problem (GPP is introduced. Then, the heuristic algorithm for the solution, in particular, of the grey pattern problem is discussed. Although the algorithm employed does not guarantee the optimality of the solutions found, still superior-quality, near-optimal (and in some cases probably optimal solutions can be achieved within reasonable computation time. Further, we provide the results of the extensive computational experiments with the newly proposed, extra-large size instance (data set of the GPP — which is the main contribution of this work. As a confirmation of the quality of the solutions produced, we also give the visual representations of several fine-looking halftone patterns and the reader can judge about the perfection of the images obtained.

  8. Oenological and Quality Characteristic on Young White Wines (Sauvignon Blanc: Effects of High Hydrostatic Pressure Processing

    Directory of Open Access Journals (Sweden)

    Vilbett Briones-Labarca


    Full Text Available High hydrostatic pressure (HHP has shown to have an effect of enhancing some properties without detrimental effects on important quality characteristics, such as colour, pH, and turbidity. This suggests that this technique can be used as an alternative to the existing methods used in wine industry processing. The aim of this study was to investigate the effects of HHP on aroma compounds and also sensory and quality properties of young white wine. HHP treatment did not influence physicochemical parameters, total phenols, and flavonoid contents of white wine; however, the results from analysis of wine indicate that there was a great variation in the concentration of free and total sulphur dioxide (SO2 values and antioxidant capacity of white wine after HHP application. The sensory attributes, such as taste, odour, and overall quality, were not affected by HHP processing at 300 MPa. The chromatic characteristics changed slightly after applying HHP, but these changes could not be visually perceived because they were less than 5%. The use of this technique has the potential to decrease the amount of SO2 added to raw grapes thus maintaining the same properties found in untreated wine. This study provided valuable insights into the biochemical and sensory composition of commercial white wine and how this might change during HHP processing.

  9. A Portable Low-Cost High Density Sensor Network for Air Quality at London Heathrow Airport (United States)

    Popoola, O. A.; Mead, M. I.; Bright, V. B.; North, R.; Stewart, G.; Kaye, P. H.; Jones, R. L.


    also presented. In this paper we show how SNAQ can provide measurement data useful for validation of air quality models currently used for LHR, the generation of emission inventories for the airport as well as pollution source attribution within and around LHR. This work shows the first attempt at using high density spatial network of low-cost sensor network within LHR, thereby facilitating the quantitative and qualitative analysis of air pollution in real world operations at LHR. K- cluster plot and diurnal profile of CO from one sensor node located to the west of the southern runway at London Heathrow airport.

  10. Transient cavitation in high-quality-factor resonators at high static pressures. (United States)

    Gaitan, D Felipe; Tessien, Ross A; Hiller, Robert A; Gutierrez, Joel; Scott, Corey; Tardif, Henry; Callahan, Brant; Matula, Thomas J; Crum, Lawrence A; Holt, R Glynn; Church, Charles C; Raymond, Jason L


    It is well known that cavitation collapse can generate intense concentrations of mechanical energy, sufficient to erode even the hardest metals and to generate light emissions visible to the naked eye [sonoluminescence (SL)]. Considerable attention has been devoted to the phenomenon of "single bubble sonoluminescence" (SBSL) in which a single stable cavitation bubble radiates light flashes each and every acoustic cycle. Most of these studies involve acoustic resonators in which the ambient pressure is near 0.1 MPa (1 bar), and with acoustic driving pressures on the order of 0.1 MPa. This study describes a high-quality factor, spherical resonator capable of achieving acoustic cavitation at ambient pressures in excess of 30 MPa (300 bars). This system generates bursts of violent inertial cavitation events lasting only a few milliseconds (hundreds of acoustic cycles), in contrast with the repetitive cavitation events (lasting several minutes) observed in SBSL; accordingly, these events are described as "inertial transient cavitation." Cavitation observed in this high pressure resonator is characterized by flashes of light with intensities up to 1000 times brighter than SBSL flashes, as well as spherical shock waves with amplitudes exceeding 30 MPa at the resonator wall. Both SL and shock amplitudes increase with static pressure.

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

    African Journals Online (AJOL)


    security and the general livelihood conditions of any population. Agriculture, being one of the most weather-dependent of all human activities is highly vulnerable to climate change. African countries are particularly vulnerable to climate change because of their dependence on rain fed agriculture, high levels of poverty, low.

  12. A high-quality annotated transcriptome of swine peripheral blood (United States)

    Background: High throughput gene expression profiling assays of peripheral blood are widely used in biomedicine, as well as in animal genetics and physiology research. Accurate, comprehensive, and precise interpretation of such high throughput assays relies on well-characterized reference genomes an...

  13. I Am Aware of My Inconsistencies but Can Tolerate Them: The Effect of High Quality Listening on Speakers' Attitude Ambivalence. (United States)

    Itzchakov, Guy; Kluger, Avraham N; Castro, Dotan R


    We examined how listeners characterized by empathy and a non-judgmental approach affect speakers' attitude structure. We hypothesized that high quality listening decreases speakers' social anxiety, which in turn reduces defensive processing. This reduction in defensive processing was hypothesized to result in an awareness of contradictions (increased objective-attitude ambivalence), and decreased attitude extremity. Moreover, we hypothesized that experiencing high quality listening would enable speakers to tolerate contradictory responses, such that listening would attenuate the association between objective- and subjective-attitude ambivalence. We obtained consistent support for our hypotheses across four laboratory experiments that manipulated listening experience in different ways on a range of attitude topics. The effects of listening on objective-attitude ambivalence were stronger for higher dispositional social anxiety and initial objective-attitude ambivalence (Study 4). Overall, the results suggest that speakers' attitude structure can be changed by a heretofore unexplored interpersonal variable: merely providing high quality listening.

  14. Medical School Anatomy and Pathology Workshops for High School Students Enhance Learning and Provide Inspiration for Careers in Medicine (United States)

    Fenderson, Bruce A.; Veloski, J. Jon; Livesey, Michael; Wojdon-Smith, Tracey


    “Anatomy and Pathology Workshop” is a cadaver-based outreach program that models medical education to large groups of high school students. This study was designed to evaluate the impact of this program on students’ knowledge of anatomy and interest in biomedical science. A total of 144 high school students participated in the workshop in 2015. Preworkshop and postworkshop assessments were administered to assess students’ learning. A postworkshop survey was conducted to solicit students’ reflections and feedback. It was found that student performance in the postworkshop examination (mean 78%) had significantly improved when compared to the performance in the preexamination (mean 54%), indicating that this program enhances learning. Students were also inspired to consider opportunities in medicine and allied health professions—97% indicated that they had a better understanding of medical education; 95% agreed that they had better understanding of the human body; 84% thought anatomy was interesting and exciting; and 62% of the students indicated that they looked forward to studying medicine or another health profession. Students rated the instructors highly—95% agreed that the instructors were professional and served as role models. Medical/graduate student instructors were also highly regarded by the high school students—96% thought it was valuable to have student instructors and 94% thought that student instructors were caring and enthusiastic about teaching. In summary, this study demonstrates that outreach programs provided by medical schools help young adults during their formative years by modeling professionalism, providing role models, enhancing learning, and encouraging many to consider opportunities in the health professions. PMID:28725784

  15. Anomalous Behavior of High Quality Factor Planar Superconducting Resonators (United States)

    Megrant, Anthony; Chen, Zijun; Chiaro, Ben; Dunsworth, Andrew; Quintana, Chris; Campbell, Brooks; Kelly, Julian; Barends, Rami; Chen, Yu; Jeffrey, Evan; Mutus, Josh; Neill, Charles; O'Malley, Peter; Sank, Daniel; Vainsencher, Amit; Wenner, Jim; White, Ted; Bochmann, Jorg; Hoi, Iochun; Palmstrom, Christopher; Martinis, John; Cleland, Andrew


    Superconducting coplanar waveguide resonators have proven to be invaluable tools in studying some of the decoherence mechanisms found in superconducting qubits. Surface two-level states tend to dominate decoherence at temperatures below Tc/10 and at very low microwave powers, assuming loss through other channels (e.g. quasiparticles, vortices, and radiation loss) has been mitigated through proper shielding and design. I will present recent measurements of resonators whose behavior diverges significantly from the standard two-level state model at low temperatures and low excitation energies, resulting in startling behavior of the internal quality factor. This research was funded by the Office of the Director of National Intelligence (ODNI), Intelligence Advanced Research Projects Activity (IARPA), through the Army Research Office grant W911NF-09-1-0375.

  16. Possibilities of obtaining and controlling high-quality pressure castings

    Directory of Open Access Journals (Sweden)

    S. Pietrowski


    Full Text Available The paper presents the influence of the type of furnace charging melting, refining and modification silumins 226 and 231 on the porosity and microstructure of castings. It was shown that in order to reduce or eliminate the porosity of the castings is necessary to the refining ECOSAL-AL113 of liquid silumin both in the melting furnace, and in the ladle and an additional nitrogen, in the heat furnace modified and refining with nitrogen. To control the effects of refining and modifying the TDA method was used. It was found that based on crystal- lization curve can be qualitatively assess the gas porosity of the castings. In order to control and quality control silumins author developed a computer program using the method of TDA, which sets out: Rm, A5, HB and casting porosity P and the concentration of hydrogen in them. The program also informs the technological procedures to be performed for liquid silumin improper preparation.

  17. Effect of using HIV and infant feeding counselling cards on the quality of counselling provided to HIV positive mothers: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Babaniyi Olusegun


    Full Text Available Abstract Background Counselling human immunodeficiency virus (HIV positive mothers on safer infant and young child feeding (IYCF options is an important component of programmes to prevent mother to child transmission of HIV, but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options. Method This was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards or non- intervention arm (IYCF counselling without counselling cards. Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants. Results Totals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility. The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member (RR = 1.46, 95% CI [1.11, 1.92]; used visual aids in explaining the risk of HIV transmission through breast milk (RR = 4.65, 95% CI [2.28, 9.46]; and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers (all p values Conclusion The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session.

  18. Large-scale whole genome sequencing of M. tuberculosis provides insights into transmission in a high prevalence area. (United States)

    Guerra-Assunção, J A; Crampin, A C; Houben, R M G J; Mzembe, T; Mallard, K; Coll, F; Khan, P; Banda, L; Chiwaya, A; Pereira, R P A; McNerney, R; Fine, P E M; Parkhill, J; Clark, T G; Glynn, J R


    To improve understanding of the factors influencing tuberculosis transmission and the role of pathogen variation, we sequenced all available specimens from patients diagnosed over 15 years in a whole district in Malawi. Mycobacterium tuberculosis lineages were assigned and transmission networks constructed, allowing ≤10 single nucleotide polymorphisms (SNPs) difference. We defined disease as due to recent infection if the network-determined source was within 5 years, and assessed transmissibility from forward transmissions resulting in disease. High-quality sequences were available for 1687 disease episodes (72% of all culture-positive episodes): 66% of patients linked to at least one other patient. The between-patient mutation rate was 0.26 SNPs/year (95% CI 0.21-0.31). We showed striking differences by lineage in the proportion of disease due to recent transmission and in transmissibility (highest for lineage-2 and lowest for lineage-1) that were not confounded by immigration, HIV status or drug resistance. Transmissions resulting in disease decreased markedly over time.

  19. High-quality lossy compression: current and future trends (United States)

    McLaughlin, Steven W.


    This paper is concerned with current and future trends in the lossy compression of real sources such as imagery, video, speech and music. We put all lossy compression schemes into common framework where each can be characterized in terms of three well-defined advantages: cell shape, region shape and memory advantages. We concentrate on image compression and discuss how new entropy constrained trellis-based compressors achieve cell- shape, region-shape and memory gain resulting in high fidelity and high compression.

  20. HiRadMat at CERN/SPS - A dedicated facility providing high intensity beam pulses to material samples

    CERN Multimedia

    Charitonidis, N; Efthymiopoulos, I


    HiRadMat (High Radiation to Materials), constructed in 2011, is a facility at CERN designed to provide high‐intensity pulsed beams to an irradiation area where material samples as well as accelerator component assemblies (e.g. vacuum windows, high power beam targets, collimators…) can be tested. The facility uses a 440 GeV proton beam extracted from the CERN SPS with a pulse length of up to 7.2 us, and with a maximum pulse energy of 3.4 MJ (3xE13 proton/pulse). In addition to protons, ion beams with energy of 440 GeV/charge and total pulse energy of 21 kJ can be provided. The beam parameters can be tuned to match the needs of each experiment. HiRadMat is not an irradiation facility where large doses on equipment can be accumulated. It is rather a test area designed to perform single pulse experiments to evaluate the effect of high‐intensity pulsed beams on materials or accelerator component assemblies in a controlled environment. The fa‐ cility is designed for a maximum of 1E16 protons per year, dist...

  1. Differences in Use of High-quality and Low-quality Hospitals Among Working-age Individuals by Insurance Type. (United States)

    Popescu, Ioana; Heslin, Kevin C; Coffey, Rosanna M; Washington, Raynard E; Barrett, Marguerite L; Karnell, Lucy H; Escarce, José J


    Research suggests that individuals with Medicaid or no insurance receive fewer evidence-based treatments and have worse outcomes than those with private insurance for a broad range of conditions. These differences may be due to patients' receiving care in hospitals of different quality. We used the Healthcare Cost and Utilization Project State Inpatient Databases 2009-2010 data to identify patients aged 18-64 years with private insurance, Medicaid, or no insurance who were hospitalized with acute myocardial infarction, heart failure, pneumonia, stroke, or gastrointestinal hemorrhage. Multinomial logit regressions estimated the probability of admissions to hospitals classified as high, medium, or low quality on the basis of risk-adjusted, in-hospital mortality. Compared with patients who have private insurance, those with Medicaid or no insurance were more likely to be minorities and to reside in areas with low-socioeconomic status. The probability of admission to high-quality hospitals was similar for patients with Medicaid (23.3%) and private insurance (23.0%) but was significantly lower for patients without insurance (19.8%, Pinsurance groups. Accounting for demographic, socioeconomic, and clinical characteristics did not influence the results. Previously noted disparities in hospital quality of care for Medicaid recipients are not explained by differences in the quality of hospitals they use. Patients without insurance have lower use of high-quality hospitals, a finding that needs exploration with data after 2013 in light of the Affordable Care Act, which is designed to improve access to medical care for patients without insurance.

  2. High resolution multi-scale air quality modelling for all streets in Denmark

    DEFF Research Database (Denmark)

    Jensen, Steen Solvang; Ketzel, Matthias; Becker, Thomas


    The annual concentrations of NO2, PM2.5 and PM10 in 2012 have for the first time been modelled for all 2.4 million addresses in Denmark based on a multi-scale air quality modelling approach. All addresses include residential, industrial, institutional, shop, school, restaurant addresses etc.......70) and fairly good agreement in Aalborg (r2 = 0.60). The target groups for the air quality mapping of all Danish addresses are the general public for information and awareness about air quality, and local and national authorities whom may use the information as a screening tool for air quality assessment....... The air quality map has been provided on a WebGIS platform on the internet in September 2016 ( The air quality map is named AirStreet for Air Quality at Your Street....

  3. Novel High Spatiotemporal Resolution Versus Standard-of-Care Dynamic Contrast-Enhanced Breast MRI: Comparison of Image Quality. (United States)

    Morrison, Courtney K; Henze Bancroft, Leah C; DeMartini, Wendy B; Holmes, James H; Wang, Kang; Bosca, Ryan J; Korosec, Frank R; Strigel, Roberta M


    Currently, dynamic contrast-enhanced (DCE) breast magnetic resonance imaging (MRI) prioritizes spatial resolution over temporal resolution given the limitations of acquisition techniques. The purpose of our intrapatient study was to assess the ability of a novel high spatial and high temporal resolution DCE breast MRI method to maintain image quality compared with the clinical standard-of-care (SOC) MRI. Thirty patients, each demonstrating a focal area of enhancement (29 benign, 1 cancer) on their SOC MRI, consented to undergo a research DCE breast MRI on a second date. For the research DCE MRI, a method (DIfferential Subsampling with Cartesian Ordering [DISCO]) using pseudorandom k-space sampling, view sharing reconstruction, 2-point Dixon fat-water separation, and parallel imaging was used to produce images with an effective temporal resolution 6 times faster than the SOC MRI (27 vs 168 seconds, respectively). Both the SOC and DISCO MRI scans were acquired with matching spatial resolutions of 0.8 × 0.8 × 1.6 mm. Image quality (distortion/artifacts, resolution, fat suppression, lesion conspicuity, perceived signal-to-noise ratio, and overall image quality) was scored by 3 radiologists in a blinded reader study. Differences in image quality scores between the DISCO and SOC images were all less than 0.8 on a 10-point scale, and both methods were assessed as providing diagnostic image quality in all cases. DISCO images with the same high spatial resolution, but 6 times the effective temporal resolution as the SOC MRI scans, were produced, yielding 20 postcontrast time points with DISCO compared with 3 for the SOC MRI, over the same total time interval. DISCO provided comparable image quality compared with the SOC MRI, while also providing 6 times faster effective temporal resolution and the same high spatial resolution.

  4. Enabling 'Togetherness' in High-Quality Domestic Video Conferencing

    NARCIS (Netherlands)

    I. Kegel; P.S. Cesar Garcia (Pablo Santiago); A.J. Jansen (Jack); D.C.A. Bulterman (Dick); J. Kort; T. Stevens; N. Farber


    htmlabstractLow-cost video conferencing systems have provided an existence proof for the value of video communication in a home setting. At the same time, current systems have a number of fundamental limitations that inhibit more general social interactions among multiple groups of participants. In

  5. Enabling 'togetherness' in high-quality domestic video conferencing

    NARCIS (Netherlands)

    Kegel, I.; Cesar, P.; Jansen, J.; Bulterman, D.C.A.; Stevens, T.; Kort, J.; Färber, N.


    Low-cost video conferencing systems have provided an existence proof for the value of video communication in a home setting. At the same time, current systems have a number of fundamental limitations that inhibit more general social interactions among multiple groups of participants. In our work, we

  6. Editorial: High quality health information system for improved health ...

    African Journals Online (AJOL)

    If you would like more information about how to print, save, and work with PDFs, Highwire Press provides a helpful Frequently Asked Questions about PDFs. Alternatively, you can download the PDF file directly to your computer, from where it can be opened using a PDF reader. To download the PDF, click the Download link ...

  7. Instructional Coaching as High-Quality Professional Development (United States)

    Desimone, Laura M.; Pak, Katie


    In response to policy initiatives calling for the implementation of evidence-based classroom practice, instructional coaches are frequently utilized as providers of professional development (PD). Despite the demand for instructional coaches, there is little empirical evidence that coaching improves teacher practice. We address this limitation by…

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

    African Journals Online (AJOL)


    parties, provide useful and unbiased information, and avoid advocating for any of the parties (WRDC, 1993). Some policy educators have developed skills that will enable policy educators to become involv