WorldWideScience

Sample records for quality reporting initiative

  1. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  2. Baseline Utilization of Breast Radiotherapy Before Institution of the Medicare Practice Quality Reporting Initiative

    International Nuclear Information System (INIS)

    Smith, Benjamin D.; Smith, Grace L.; Roberts, Kenneth B.; Buchholz, Thomas A.

    2009-01-01

    Purpose: In 2007, Medicare implemented the Physician Quality Reporting Initiative (PQRI), which provides financial incentives to physicians who report their performance on certain quality measures. PQRI measure no. 74 recommends radiotherapy for patients treated with conservative surgery (CS) for invasive breast cancer. As a first step in evaluating the potential impact of this measure, we assessed baseline use of radiotherapy among women diagnosed with invasive breast cancer before implementation of PQRI. Methods and Materials: Using the SEER-Medicare data set, we identified women aged 66-70 diagnosed with invasive breast cancer and treated with CS between 2000 and 2002. Treatment with radiotherapy was determined using SEER and claims data. Multivariate logistic regression tested whether receipt of radiotherapy varied significantly across clinical, pathologic, and treatment covariates. Results: Of 3,674 patients, 94% (3,445) received radiotherapy. In adjusted analysis, the presence of comorbid illness (odds ratio [OR] 1.69; 95% confidence interval [CI], 1.19-2.42) and unmarried marital status were associated with omission of radiotherapy (OR 1.65; 95% CI, 1.22-2.20). In contrast, receipt of chemotherapy was protective against omission of radiotherapy (OR 0.25; 95% CI, 0.16-0.38). Race and geographic region did not correlate with radiotherapy utilization. Conclusions: Utilization of radiotherapy following CS was high for patients treated before institution of PQRI, suggesting that at most 6% of patients could benefit from measure no. 74. Further research is needed to determine whether institution of PQRI will affect radiotherapy utilization.

  3. Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative.

    Science.gov (United States)

    Lobaugh, Lauren M Y; Martin, Lizabeth D; Schleelein, Laura E; Tyler, Donald C; Litman, Ronald S

    2017-09-01

    Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies. In September 2016, we analyzed approximately 6 years' worth of medication error events reported to Wake Up Safe. Medication errors were classified by: (1) medication category; (2) error type by phase of administration: prescribing, preparation, or administration; (3) bolus or infusion error; (4) provider type and level of training; (5) harm as defined by the National Coordinating Council for Medication Error Reporting and Prevention; and (6) perceived preventability. From 2010 to the time of our data analysis in September 2016, 32 institutions had joined and submitted data on 2087 adverse events during 2,316,635 anesthetics. These reports contained details of 276 medication errors, which comprised the third highest category of events behind cardiac and respiratory related events. Medication errors most commonly involved opioids and sedative/hypnotics. When categorized by phase of handling, 30 events occurred during preparation, 67 during prescribing, and 179 during administration. The most common error type was accidental administration of the wrong dose (N = 84), followed by syringe swap (accidental administration of the wrong syringe, N = 49). Fifty-seven (21%) reported medication errors involved medications prepared as infusions as opposed to 1 time bolus administrations. Medication errors were committed by all types of anesthesia providers, most commonly by attendings. Over 80% of reported medication errors reached the patient and more than half of these events caused patient harm. Fifteen events (5%) required a life sustaining intervention. Nearly all cases (97%) were judged to be either likely or certainly preventable. Our findings

  4. Cardio-renal syndromes : report from the consensus conference of the Acute Dialysis Quality Initiative

    NARCIS (Netherlands)

    Ronco, Claudio; McCullough, Peter; Anker, Stefan D.; Anand, Inder; Aspromonte, Nadia; Bagshaw, Sean M.; Bellomo, Rinaldo; Berl, Tomas; Bobek, Ilona; Cruz, Dinna N.; Daliento, Luciano; Davenport, Andrew; Haapio, Mikko; Hillege, Hans; House, Andrew A.; Katz, Nevin; Maisel, Alan; Mankad, Sunil; Zanco, Pierluigi; Mebazaa, Alexandre; Palazzuoli, Alberto; Ronco, Federico; Shaw, Andrew; Sheinfeld, Geoff; Soni, Sachin; Vescovo, Giorgio; Zamperetti, Nereo; Ponikowski, Piotr

    A consensus conference on cardio-renal syndromes (CRS) was held in Venice Italy, in September 2008 under the auspices of the Acute Dialysis Quality Initiative (ADQI). The following topics were matter of discussion after a systematic literature review and the appraisal of the best available evidence:

  5. How eight primary care practices initiated and maintained quality monitoring and reporting.

    Science.gov (United States)

    Sloane, Philip D; Wroth, Thomas; Halladay, Jacquie; Bray, Paul; Spragens, Lynn; Stearns, Sally; Zimmerman, Sheryl

    2011-01-01

    Primary care medical practices increasingly are asked by payers, employers, and government agencies to report quality data, but the process of doing so is not well delineated. Providers and office staff in a diverse sample of eight primary care practices in North Carolina comprised this study population. Interviews were conducted and self-administered questionnaires were disseminated in practices that were successfully reporting data to one or more of 4 reporting programs. Our measures included responses to open-ended and Likert scale questions about experiences and potential facilitators and barriers, as well as subscales of the Practice Assessment tool and the Culture of Group Practices instrument. Study practices had stronger change histories, higher information and quality emphases, and lower business emphases than historical comparison practices. Motivation to participate, a leader who catalyzes the process, and establishment of new systems characterized successful practices. Staff time, information technology challenges, and resistance from some providers were common barriers. Practices achieve a sustainability state when numerous barriers have been successfully overcome and tangible results achieved from the process. Implementing and sustaining quality reporting requires a complex set of motivators, facilitators, and strategies to overcome inherent barriers that can present themselves in practices that seek to implement changes in this direction.

  6. Provincial development of a patient-reported outcome initiative to guide patient care, quality improvement, and research.

    Science.gov (United States)

    Olson, Robert A; Howard, Fuchsia; Lapointe, Vincent; Schellenberg, Devin; Nichol, Alan; Bowering, Gale; Curtis, Susan; Walter, Allison; Brown, Steven; Thompson, Corinne; Bergin, Jackie; Lomas, Sheri; French, John; Halperin, Ross; Tyldesley, Scott; Beckham, Wayne

    2018-01-01

    The BC Cancer Agency Radiotherapy (RT) program started the Prospective Outcomes and Support Initiative (POSI) at all six centres to utilize patient-reported outcomes for immediate clinical care, quality improvement, and research. Patient-reported outcomes were collected at time of computed tomography simulation via tablet and 2 to 4 weeks post-RT via either tablet or over the phone by a registered nurse. From 2013 to 2016, patients were approached on 20,150 attempts by POSI for patients treated with RT for bone metastases (52%), brain metastases (11%), lung cancer (17%), gynecological cancer (16%), head and neck cancer (2%), and other pilots (2%). The accrual rate for all encounters was 85% (n = 17,101), with the accrual rate varying between the lowest and the highest accruing centre from 78% to 89% ( P < .001) and varying by tumour site ( P < .001). Using the POSI database, we have performed research and quality improvement initiatives that have changed practice.

  7. Letter Report Yucca Mountain Environmental Monitoring Systems Initiative - Air Quality Scoping Study for Pahranagat National Wildlife Refuge, Lincoln County, Nevada

    International Nuclear Information System (INIS)

    Engelbrecht, J.; Kavouras, I.; Campbell, D.; Campbell, S.; Kohl, S.; Shafer, D.

    2009-01-01

    The Desert Research Institute (DRI) is performing a scoping study as part of the U.S. Department of Energy's Yucca Mountain Environmental Monitoring Systems Initiative (EMSI). The main objective is to obtain baseline air quality information for Yucca Mountain and an area surrounding the Nevada Test Site (NTS). Air quality and meteorological monitoring and sampling equipment housed in a mobile trailer (shelter) is collecting data at eight sites outside the NTS, including Ash Meadows National Wildlife Refuge (NWR), Pahranagat NWR, Beatty, Rachel, Caliente, Crater Flat, and Tonopah Airport, and at four sites on the NTS (Engelbrecht et al., 2007a-d). The trailer is stationed at any one site for approximately eight weeks at a time. This letter report provides a summary of air quality and meteorological data on completion of the site's sampling program

  8. Letter Report Yucca Mountain Environmental Monitoring Systems Initiative - Air Quality Scoping Study for Tonopah Airport, Nye County, Nevada

    International Nuclear Information System (INIS)

    Engelbrecht, J.; Kavouras, I.; Campbell, D.; Campbell, S.; Kohl, S.; Shafer, D.

    2009-01-01

    The Desert Research Institute (DRI) is performing a scoping study as part of the U.S. Department of Energy's Yucca Mountain Environmental Monitoring Systems Initiative (EMSI). The main objective is to obtain baseline air quality information for Yucca Mountain and an area surrounding the Nevada Test Site (NTS). Air quality and meteorological monitoring and sampling equipment housed in a mobile trailer (shelter) is collecting data at eight sites outside the NTS, including Ash Meadows National Wildlife Refuge (NWR), Tonopah Airport, Beatty, Rachel, Caliente, Pahranagat NWR, Crater Flat, and the Tonopah Airport, and at four sites on the NTS (Engelbrecht et al., 2007a-d). The trailer is stationed at any one site for approximately eight weeks at a time. This letter report provides a summary of air quality and meteorological data, on completion of the site's sampling program

  9. Letter Report Yucca Mountain Environmental Monitoring Systems Initiative - Air Quality Scoping Study for Caliente, Lincoln County, Nevada

    International Nuclear Information System (INIS)

    Engelbrecht, J.; Kavouras, I.; Campbell, D.; Campbell, S.; Kohl, S.; Shafer, D.

    2009-01-01

    The Desert Research Institute (DRI) is performing a scoping study as part of the U.S. Department of Energy's Yucca Mountain Environmental Monitoring Systems Initiative (EMSI). The main objective is to obtain baseline air quality information for Yucca Mountain and an area surrounding the Nevada Test Site (NTS). Air quality and meteorological monitoring and sampling equipment housed in a mobile trailer (shelter) is collecting data at eight sites outside the NTS, including Ash Meadows National Wildlife Refuge (NWR), Beatty, Sarcobatus Flats, Rachel, Caliente, Pahranagat NWR, Crater Flat, and Tonopah Airport, and at four sites on the NTS (Engelbrecht et al., 2007a-d). The trailer is stationed at any one site for approximately eight weeks at a time. This letter report provides a summary of air quality and meteorological data, on completion of the site's sampling program

  10. The Legal Quality of Articles Published in School Psychology Journals: An Initial Report Card

    Science.gov (United States)

    Zirkel, Perry A.

    2014-01-01

    As a follow-up to a companion study (Zaheer & Zirkel, in press) that focused on the legal content in school psychology, this analysis examined legal quality. The companion study found that only 35 of the more than 7,000 articles in five leading journals of school psychology for the period 1970-2013 met rather relaxed standards for being law…

  11. 1996 environmental initiatives report

    International Nuclear Information System (INIS)

    1996-01-01

    Progress by Consumers Gas in addressing environmental challenges were reviewed. Proposed environmental initiatives for the next fiscal year and beyond were introduced. Proposed initiatives were placed into three priority categories, high, medium or low, which together with the environmental management framework form the the utility's overall environmental agenda. High on the list of environmental priorities for the company are atmospheric air emissions, planning and construction practices, energy conservation and efficiency, environmental compliance, and methane emissions. The present state of the initiatives by the various company divisions and regions, compiled from the respective business plans, were reported. 21 figs

  12. Home Health Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — The instrument-data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS)....

  13. Health Insurance Marketplace Quality Initiatives

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act requires the U.S. Department of Health and Human Services (HHS) to develop quality data collection and reporting tools such as a Quality...

  14. Nursing Facility Initiative Annual Report

    Data.gov (United States)

    U.S. Department of Health & Human Services — This annual report summarizes impacts from the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents in 2014. This initiative is designed...

  15. Great Lakes water quality initiative technical support document for the procedure to determine bioaccumulation factors. Draft report

    International Nuclear Information System (INIS)

    1993-03-01

    The purpose of the document is to provide the technical information and rationale in support of the proposed procedures to determine bioaccumulation factors. Bioaccumulation factors, together with the quantity of aquatic organisms eaten, determine the extent to which people and wildlife are exposed to chemicals through the consumption of aquatic organisms. The more bioaccumulative a pollutant is, the more important the consumption of aquatic organisms becomes as a potential source of contaminants to humans and wildlife. Bioaccumulation factors are needed to determine both human health and wildlife tier I water quality criteria and tier II values. Also, they are used to define Bioaccumulative Chemicals of Concern among the Great Lakes Initiative universe of pollutants. Bioaccumulation factors range from less than one to several million

  16. Hospital Quality Initiative - Outcome Measures

    Data.gov (United States)

    U.S. Department of Health & Human Services — In the interest of promoting high-quality, patient-centered care and accountability, the Centers for Medicare and Medicaid Services (CMS) and Hospital Quality...

  17. Smart roadside initiative : final report.

    Science.gov (United States)

    2015-09-01

    This is the Final Report for the Smart Roadside Initiative (SRI) prototype system deployment project. The SRI prototype was implemented at weigh stations in Grass Lake, Michigan and West Friendship, Maryland. The prototype was developed to integrate ...

  18. Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

    Science.gov (United States)

    White, Mark; Butterworth, Tony; Wells, John S G

    2017-10-01

    To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

  19. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.

    Science.gov (United States)

    Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; Fiore, Julio F; Shaw, Andrew D; Thacker, Julie K M; Gan, Tong J; Miller, Timothy E; Hedrick, Traci L; McEvoy, Matthew D; Mythen, Michael G; Bergamaschi, Roberto; Gupta, Ruchir; Holubar, Stefan D; Senagore, Anthony J; Wischmeyer, Paul E; Carli, Franco; Evans, David C; Guilbert, Sarah; Kozar, Rosemary; Pryor, Aurora; Thiele, Robert H; Everett, Sotiria; Grocott, Mike

    2017-12-29

    Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using

  20. Physician Quality Reporting System

    Data.gov (United States)

    U.S. Department of Health & Human Services — PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible...

  1. EERE Quality Control Workshop Final Report: Proceedings from the EERE Quality Control Workshop, in support of the DOE Clean Energy Manufacturing Initiative; Golden, Colorado, December 9-10, 2013

    Energy Technology Data Exchange (ETDEWEB)

    2014-05-01

    The U.S. Department of Energy Office of Energy Efficiency & Renewable Energy (EERE) has recognized the cross-cutting, pre-competitive and enabling nature of quality control for a wide range of clean energy technologies. As such, the Fuel Cell Technologies Office, Solar Energy Technologies Office, Vehicle Technologies Office, Building Technologies Office, and Advanced Manufacturing Office decided to explore needs and potential cross-office synergies in this area by holding the EERE Quality Control Workshop, in support of the DOE Clean Energy Manufacturing Initiative. This report summarizes the purpose and scope of the workshop; reviews the current status and state-of-the-art for in-line quality control; summarizes the results from three breakout sessions; and presents conclusions and recommendations.

  2. Laser fusion project: initial report

    International Nuclear Information System (INIS)

    Boyd, D.C.; Dumbaugh, W.H.; Morgan, D.W.; Spivack, B.D.

    1977-01-01

    The objective of the first year program is to explore and characterize fluoride glass systems to find a glass with the lowest possible nonlinear refractive index, satisfactory chemical durability, and physical properties which enable casting large optical quality pieces. A second part of this objective is to explore techniques for forming optical quality fluoride glass. Beryllium fluoride type glasses offer the best approach. In order to achieve the objectives, the first main task is to provide a facility and equipment to safely work in beryllium fluoride type systems. The main emphasis of this report is a description of facility and equipment along with a schedule for the first year's research. Some preliminary exploration of the beryllium fluoride type glasses has indicated that achievement of the objectives is feasible. Expansion coefficients (25 to 300 0 C) are in the 150 x 10 -7 / 0 C region and annealing points are around 350 0 C. A number of beryllium-free fluoride glasses have also been made in small quantities

  3. Hanford Tanks Initiative quality assurance implementation plan

    International Nuclear Information System (INIS)

    Huston, J.J.

    1998-01-01

    Hanford Tanks Initiative (HTI) Quality Assurance Implementation Plan for Nuclear Facilities defines the controls for the products and activities developed by HTI. Project Hanford Management Contract (PHMC) Quality Assurance Program Description (QAPD)(HNF-PRO599) is the document that defines the quality requirements for Nuclear Facilities. The QAPD provides direction for compliance to 10 CFR 830.120 Nuclear Safety Management, Quality Assurance Requirements. Hanford Tanks Initiative (HTI) is a five-year activity resulting from the technical and financial partnership of the US Department of Energy's Office of Waste Management (EM-30), and Office of Science and Technology Development (EM-50). HTI will develop and demonstrate technologies and processes for characterization and retrieval of single shell tank waste. Activities and products associated with HTI consist of engineering, construction, procurement, closure, retrieval, characterization, and safety and licensing

  4. Initial report of the osteogenesis imperfecta adult natural history initiative.

    Science.gov (United States)

    Tosi, Laura L; Oetgen, Matthew E; Floor, Marianne K; Huber, Mary Beth; Kennelly, Ann M; McCarter, Robert J; Rak, Melanie F; Simmonds, Barbara J; Simpson, Melissa D; Tucker, Carole A; McKiernan, Fergus E

    2015-11-14

    A better understanding of the natural history of osteogenesis imperfecta (OI) in adulthood should improve health care for patients with this rare condition. The Osteogenesis Imperfecta Foundation established the Adult Natural History Initiative (ANHI) in 2010 to give voice to the health concerns of the adult OI community and to begin to address existing knowledge gaps for this condition. Using a web-based platform, 959 adults with self-reported OI, representing a wide range of self-reported disease severity, reported symptoms and health conditions, estimated the impact of these concerns on present and future health-related quality of life (QoL) and completed a Patient-Reported Outcomes Measurement Information System (PROMIS®) survey of health issues. Adults with OI report lower general physical health status (p report generally similar mental health status. Musculoskeletal, auditory, pulmonary, endocrine, and gastrointestinal issues are particular future health-related QoL concerns for these adults. Numerous other statistically significant differences exist among adults with OI as well as between adults with OI and the referent PROMIS® population, but the clinical significance of these differences is uncertain. Adults with OI report lower general health status but are otherwise more similar to the general population than might have been expected. While reassuring, further analysis of the extensive OI-ANHI databank should help identify areas of unique clinical concern and for future research. The OI-ANHI survey experience supports an internet-based strategy for successful patient-centered outcomes research in rare disease populations.

  5. Quality Improvement Initiatives in Inflammatory Bowel Disease.

    Science.gov (United States)

    Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

    2017-08-01

    This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

  6. Comprehensive School Safety Initiative Report

    Science.gov (United States)

    National Institute of Justice, 2014

    2014-01-01

    The National Institute of Justice (NIJ) developed the Comprehensive School Safety Initiative in consultation with federal partners and Congress. It is a research-focused initiative designed to increase the safety of schools nationwide through the development of knowledge regarding the most effective and sustainable school safety interventions and…

  7. Guam Initial Technical Assessment Report

    Energy Technology Data Exchange (ETDEWEB)

    Baring-Gould, I.; Conrad, M.; Haase, S.; Hotchkiss, E.; McNutt, P.

    2011-04-01

    Under an interagency agreement, funded by the Department of Interior's (DOI) Office of Insular Affairs (OIA), the National Renewable Energy Laboratory (NREL) was tasked to deliver technical assistance to the island of Guam by conducting an island initial technical assessment that would lay out energy consumption and production data and establish a baseline. This assessment will be used to conduct future analysis and studies by NREL that will estimate energy efficiency and renewable energy potential for the island of Guam.

  8. HUD Initiated Activity Cancellation Reports

    Data.gov (United States)

    Department of Housing and Urban Development — This monthly report displays all HOME activities automatically cancelled by IDIS. Effective January 1, 2011, and the beginning of every month thereafter, committed...

  9. Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: Initial report

    International Nuclear Information System (INIS)

    Jabbari, Siavash; Kim, Hyungjin M.; Feng, Mary; Lin, Alexander; Tsien, Christina; Elshaikh, Mohamed; Terrel, Jeffrey E.; Murdoch-Kinch, Carol; Eisbruch, Avraham

    2005-01-01

    Purpose: To compare quality of life (QOL) and xerostomia between head-and-neck cancer patients who received standard radiotherapy (RT) and patients matched by factors known to affect QOL who received intensity-modulated RT (IMRT). Methods and Materials: This was a prospective, longitudinal study of patients with head-and-neck cancer requiring bilateral neck irradiation who received IMRT at the University of Michigan and patients who received standard RT at affiliated clinics. Each patient received a validated head-and-neck cancer-related QOL questionnaire (HNQOL) consisting of four multi-item domains-Eating, Communication, Pain, and Emotion-and a validated patient-reported xerostomia questionnaire (XQ). In both questionnaires, the answers were scored 0-100, with higher scores denoting worse QOL or xerostomia. The questionnaires were given before therapy and at 1, 3, 6, 12, 18, and 24 months after the completion of therapy. Each standard RT patient was matched with several IMRT patients according to tumor site, stage, RT status (postoperative or definitive), and age. A linear mixed-effects model was fit to compare outcomes between the two treatment groups and to model trends over time. To account for matching, the differences in scores between the matched sets of patients were fit as a random intercept. Also, matching was taken into account in the model by using the standard error of the within-paired-groups differences. Results: Between 1997 and 2002, 10 patients who had received standard RT and answered the XQ and HNQOL through at least 1 year were included in the study. Each of these patients was matched with a subgroup of 2-5 patients (median, 3) who had received IMRT, had similar patient and tumor characteristics, and answered the same questionnaires. A total of 30 patients were included in the IMRT group. During the initial months after therapy, the XQ and HNQOL summary scores worsened significantly in both groups compared with the pretherapy scores. Starting

  10. Quality criteria for micronutrient powder products: report of a meeting organized by the World Food Programme and Sprinkles Global Health Initiative.

    Science.gov (United States)

    de Pee, Saskia; Kraemer, Klaus; van den Briel, Tina; Boy, Erick; Grasset, Christopher; Moench-Pfanner, Regina; Zlotkin, Stanley; Bloem, Martin W

    2008-09-01

    Distribution of micronutrient powder (MNP), also known as Sprinkles", is becoming a preferred strategy for addressing micronutrient deficiencies. In response, different formulations are being developed, different producers manufacture MNP and several organizations coordinate distribution. However, as yet, the supply of MNP as well as experience with large-scale MNP programs is limited. To facilitate expansion of MNP use such that acceptability and compliance are high and effectiveness maintained, product quality, of both powder and packaging, good advocacy among decision makers, and providing good information to the target population are crucial. A meeting was organized in Toronto by the Sprinkles Global Health Initiative and the World Food Programme to review and reach consensus on quality criteria for composition, manufacturing, packaging, and labeling of MNP propose guidelines for wide-scale production, and discuss MNP program experience. It was recognized that the durability of some of the more sensitive micronutrients in their powdered form in the harsh climatic conditions of many countries has implications for formulation, packaging, storage, and handling of the MNP product. A question-and-answer manual would greatly facilitate program design and implementation. It was agreed to form an interim Technical Advisory Group to prepare for formation of a Technical Advisory Group with agreed-upon tasks and responsibilities. The MNP manufacturing manual of the Sprinkles Global Health Initiative can continue to be used, with reference to the recommendations from the Toronto Meeting outlined in this paper. Meanwhile, the Sprinkles Global Health Initiative will not place any encumbrances on production using its manual; however, the brand name Sprinkles" will stay protected under various trademark laws.

  11. End-Stage Renal Disease (ESRD) Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — The End Stage Renal Disease (ESRD) Quality Initiative promotes ongoing CMS strategies to improve the quality of care provided to ESRD patients. This initiative...

  12. Worldwide Report, Environmental Quality

    National Research Council Canada - National Science Library

    1983-01-01

    ..., Environmental Impact, Forest Policy, Endangers, Water Level, Air Quality, Water Shortage, Protecting Environment,Wood Resource, Drough, Crop Failure, Water Crisis, Dams, Government Aid, Water Quality...

  13. Construction quality assurance report

    International Nuclear Information System (INIS)

    Roscha, V.

    1994-01-01

    This report provides a summary of the construction quality assurance (CQA) observation and test results, including: The results of the geosynthetic and soil materials conformance testing. The observation and testing results associates with the installation of the soil liners. The observation and testing results associated with the installation of the HDPE geomembrane liner systems. The observation and testing results associated with the installation of the leachate collection and removal systems. The observation and testing results associated with the installation of the working surfaces. The observation and testing results associated with in-plant manufacturing process. Summary of submittal reviews by Golder Construction Services, Inc. The submittal and certification of the piping material specifications. The observation and verification associated of the Acceptance Test Procedure results of the operational equipment functions. Summary of the ECNs which are incorporated into the project

  14. Current Editorial Initiatives: A Progress Report

    Directory of Open Access Journals (Sweden)

    Werner Ulrich

    2013-01-01

    Full Text Available This editorial article reports on the progress that the Journal of Research Practice (JRP has achieved in its ongoing development since November 2011, when a number of editorial initiatives were announced. Several new initiatives are also proposed. In addition, there are some current announcements, including a number of recent awards, distinctions, and nominations.

  15. [Reporting initiatives. An update on treatment in radiology].

    Science.gov (United States)

    Hempel, J-M; Pinto dos Santos, D; Kloeckner, R; Dueber, C; Mildenberger, P

    2014-07-01

    The written radiological report is the most important means of communication between the radiologist and the referring medical doctor. There is no universal definition of a radiological report concerning its structure and content. The majority of clinicians and radiologists prefer structured reporting rather than free text reports of findings. Structured reporting does not increase the quality of a radiological report but has many advantages in research, teaching and quality management. Using standard RadLex terms facilitates translation and ontological assignment of a report. The Reporting Initiative of the Radiological Society of North America (RSNA) offers free and freely available extensively validated best practices radiology report templates in the new management of radiology report templates (MRRT) format according to the guidelines of the Integrating the Healthcare Enterprise (IHE).

  16. Status Report on the MCNP 2020 Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Forrest B. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Rising, Michael Evan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-10-02

    The discussion below provides a status report on the MCNP 2020 initiative. It includes discussion of the history of MCNP 2020, accomplishments during 2013-17, priorities for near-term development, other related efforts, a brief summary, and a list of references for the plans and work accomplished.

  17. Satellite Monitoring of Boston Harbor Water Quality: Initial Investigations

    Science.gov (United States)

    Sheldon, P.; Chen, R. F.; Schaaf, C.; Pahlevan, N.; Lee, Z.

    2016-02-01

    The transformation of Boston Harbor from the "dirtiest in America" to a National Park Area is one of the most remarkable estuarine recoveries in the world. A long-term water quality dataset from 1991 to present exists in Boston Harbor due to a $3. 8 billion lawsuit requiring the harbor clean-up. This project uses discrete water sampling and underway transects with a towed vehicle coordinated with Landsat 7 and Landsat 8 to create surface maps of chlorophyll a (Chl a), dissolved organic matter (CDOM and DOC), total suspended solids (TSS), diffuse attenuation coefficient (Kd_490), and photic depth in Boston Harbor. In addition, 3 buoys have been designed, constructed, and deployed in Boston Harbor that measure Chl a and CDOM fluorescence, optical backscatter, salinity, temperature, and meteorological parameters. We are initially using summer and fall of 2015 to develop atmospheric corrections for conditions in Boston Harbor and develop algorithms for Landsat 8 data to estimate in water photic depth, TSS, Chl a, Kd_490, and CDOM. We will report on initial buoy and cruise data and show 2015 Landsat-derived distributions of water quality parameters. It is our hope that once algorithms for present Landsat imagery can be developed, historical maps of water quality can be constructed using in water data back to 1991.

  18. Validity and usefulness of members reports of implementation progress in a quality improvement initiative: findings from the Team Check-up Tool (TCT

    Directory of Open Access Journals (Sweden)

    Marsteller Jill A

    2011-10-01

    Full Text Available Abstract Background Team-based interventions are effective for improving safety and quality of healthcare. However, contextual factors, such as team functioning, leadership, and organizational support, can vary significantly across teams and affect the level of implementation success. Yet, the science for measuring context is immature. The goal of this study is to validate measures from a short instrument tailored to track dynamic context and progress for a team-based quality improvement (QI intervention. Methods Design: Secondary cross-sectional and longitudinal analysis of data from a clustered randomized controlled trial (RCT of a team-based quality improvement intervention to reduce central line-associated bloodstream infection (CLABSI rates in intensive care units (ICUs. Setting: Forty-six ICUs located within 35 faith-based, not-for-profit community hospitals across 12 states in the U.S. Population: Team members participating in an ICU-based QI intervention. Measures: The primary measure is the Team Check-up Tool (TCT, an original instrument that assesses context and progress of a team-based QI intervention. The TCT is administered monthly. Validation measures include CLABSI rate, Team Functioning Survey (TFS and Practice Environment Scale (PES from the Nursing Work Index. Analysis: Temporal stability, responsiveness and validity of the TCT. Results We found evidence supporting the temporal stability, construct validity, and responsiveness of TCT measures of intervention activities, perceived group-level behaviors, and barriers to team progress. Conclusions The TCT demonstrates good measurement reliability, validity, and responsiveness. By having more validated measures on implementation context, researchers can more readily conduct rigorous studies to identify contextual variables linked to key intervention and patient outcomes and strengthen the evidence base on successful spread of efficacious team-based interventions. QI teams

  19. Report of Committee for JAEA Internationalization Initiative

    International Nuclear Information System (INIS)

    2013-03-01

    In global circumstances surrounding nuclear energy, the role expected to Japan Atomic Energy Agency (JAEA) is becoming increasingly important. JAEA has been promoted an initiative for the international hub in order to increase the scientific competitiveness of Japan and make international contributions, by gathering excellent researchers from the entire world with the latest facilities. Also, JAEA established 'Committee for JAEA Internationalization Initiative', which will discuss issues such as environmental improvement for accepted foreigners, direction of efforts for internationalization initiative and strategies to improve current situation. This report mentions the results of the committee's discussion including current issues for the initiative and recommendations for their solution, as well as the issues to be discussed in order to enhance international awareness of JAEA staff. The following is the summary of the recommendations for the initiative: Set up local teams that focus on the situation of each site in order to provide detailed support for foreigners from diversified backgrounds. Develop systems for emergency situations to provide information for safety swiftly for foreigners and confirm their safety, in addition to preparing emergency goods. Prepare bilingual documents and systems that foreigners need to use for their work based on importance and frequency of use of such systems and documents. (author)

  20. SAMIRA - SAtellite based Monitoring Initiative for Regional Air quality

    Science.gov (United States)

    Schneider, Philipp; Stebel, Kerstin; Ajtai, Nicolae; Diamandi, Andrei; Horalek, Jan; Nicolae, Doina; Stachlewska, Iwona; Zehner, Claus

    2016-04-01

    Here, we present a new ESA-funded project entitled Satellite based Monitoring Initiative for Regional Air quality (SAMIRA), which aims at improving regional and local air quality monitoring through synergetic use of data from present and upcoming satellites, traditionally used in situ air quality monitoring networks and output from chemical transport models. Through collaborative efforts in four countries, namely Romania, Poland, the Czech Republic and Norway, all with existing air quality problems, SAMIRA intends to support the involved institutions and associated users in their national monitoring and reporting mandates as well as to generate novel research in this area. Despite considerable improvements in the past decades, Europe is still far from achieving levels of air quality that do not pose unacceptable hazards to humans and the environment. Main concerns in Europe are exceedances of particulate matter (PM), ground-level ozone, benzo(a)pyrene (BaP) and nitrogen dioxide (NO2). While overall sulfur dioxide (SO2) emissions have decreased in recent years, regional concentrations can still be high in some areas. The objectives of SAMIRA are to improve algorithms for the retrieval of hourly aerosol optical depth (AOD) maps from SEVIRI, and to develop robust methods for deriving column- and near-surface PM maps for the study area by combining satellite AOD with information from regional models. The benefit to existing monitoring networks (in situ, models, satellite) by combining these datasets using data fusion methods will be tested for satellite-based NO2, SO2, and PM/AOD. Furthermore, SAMIRA will test and apply techniques for downscaling air quality-related EO products to a spatial resolution that is more in line with what is generally required for studying urban and regional scale air quality. This will be demonstrated for a set of study sites that include the capitals of the four countries and the highly polluted areas along the border of Poland and the

  1. Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial

    International Nuclear Information System (INIS)

    Pow, Edmond; Kwong, Dora; McMillan, Anne S.; Wong, May; Sham, Jonathan; Leung, Lucullus; Leung, W. Keung

    2006-01-01

    Purpose: To compare directly the effect of intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) on salivary flow and quality of life (QoL) in patients with early-stage nasopharyngeal carcinoma (NPC). Methods and Materials: Fifty-one patients with T2, N0/N1, M0 NPC took part in a randomized controlled clinical study and received IMRT or CRT. Stimulated whole (SWS) and parotid (SPS) saliva flow were measured and Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core quetionnaire, and EORTC head-and-neck module (QLQ-H and N35) were completed at baseline and 2, 6, and 12 months after radiotherapy. Results: Forty-six patients (88%) were in disease remission 12 months after radiotherapy. At 12 months postradiotherapy, 12 (50.0%) and 20 patients (83.3%) in the IMRT group had recovered at least 25% of preradiotherapy SWS and SPS flow respectively, compared with 1 (4.8%) and 2 patients (9.5%), respectively, in the CRT group. Global health scores showed continuous improvement in QoL after both treatments (p < 0.001). However, after 12 months subscale scores for role-physical, bodily pain, and physical function were significantly higher in the IMRT group, indicating a better condition (p < 0.05). Dry mouth and sticky saliva were problems in both groups 2 months after treatment. In the IMRT group, there was consistent improvement over time with xerostomia-related symptoms significantly less common than in the CRT group at 12 months postradiotherapy. Conclusions: IMRT was significantly better than CRT in terms of parotid sparing and improved QoL for early-stage disease. The findings support the case for assessment of health-related QoL in relation to head-and-neck cancer using a site-specific approach

  2. Integrated corridor management initiative : demonstration phase evaluation, San Diego air quality test plan.

    Science.gov (United States)

    2012-08-01

    This report presents the test plan for conducting the Air Quality Analysis for the United States Department of Transportation (U.S. DOT) evaluation of the San Diego Integrated Corridor Management (ICM) Initiative Demonstration. The ICM projects being...

  3. Integrated corridor management initiative : demonstration phase evaluation, Dallas air quality test plan.

    Science.gov (United States)

    2012-08-01

    This report presents the test plan for conducting the Air Quality Analysis for the United States : Department of Transportation (U.S. DOT) evaluation of the Dallas U.S. 75 Integrated Corridor : Management (ICM) Initiative Demonstration. The ICM proje...

  4. Quality improvement initiatives: the missed opportunity for health plans.

    Science.gov (United States)

    Fernandez-Lopez, Sara; Lennert, Barbara

    2009-11-01

    The increase in healthcare cost without direct improvements in health outcomes, coupled with a desire to expand access to the large uninsured population, has underscored the importance of quality initiatives and organizations that provide more affordable healthcare by maximizing value. To determine the knowledge of managed care organizations about quality organizations and initiatives and to identify potential opportunities in which pharmaceutical companies could collaborate with health plans in the development and implementation of quality initiatives. We conducted a survey of 36 pharmacy directors and 15 medical directors of different plans during a Managed Care Network meeting in 2008. The represented plans cover almost 74 million lives in commercial, Medicare, and Medicaid programs, or a combination of them. The responses show limited knowledge among pharmacy and medical directors about current quality organizations and initiatives, except for quality organizations that provide health plan quality accreditation. The results also reveal an opportunity for pharmaceutical companies to collaborate with private health plans in the development of quality initiatives, especially those related to drug utilization, such as patient adherence and education and correct drug utilization. Our survey shows clearly that today's focus for managed care organizations is mostly limited to the organizations that provide health plan quality accreditation, with less focus on other organizations.

  5. Persistence of Initial Conditions in Continental Scale Air Quality Simulations

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset contains the data used in Figures 1 – 6 and Table 2 of the technical note "Persistence of Initial Conditions in Continental Scale Air Quality...

  6. Final Report: Multi-State Sharing Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Begoli, Edmon [ORNL; Boehmann, Brant [ORNL; DeNap, Frank A [ORNL

    2012-04-01

    In 2003 a joint effort between the U.S. Department of Homeland Security (DHS) and the U.S. Department of Justice created state and metropolitan intelligence fusion centers. These fusion centers were an effort to share law enforcement, disaster, and terrorism related information and intelligence between state and local jurisdictions and to share terrorism related intelligence between state and local law enforcement agencies and various federal entities. In 2006, DHS commissioned the Oak Ridge National Laboratory to establish and manage a groundbreaking program to assist local, state, and tribal leaders in developing the tools and methods required to anticipate and forestall terrorist events and to enhance disaster response. This program, called the Southeast Region Research Initiative (SERRI), combines science and technology with validated operational approaches to address regionally unique requirements and suggest regional solutions with the potential for national application. In 2009, SERRI sponsored the Multistate Sharing Initiative (MSSI) to assist state and metropolitan intelligence fusion centers with sharing information related to a wider variety of state interests than just terrorism. While these fusion centers have been effective at sharing data across organizations within their respective jurisdictions, their organizational structure makes bilateral communication with federal entities convenient and also allows information to be further disbursed to other local entities when appropriate. The MSSI-developed Suspicious Activity Report (SAR) sharing system allows state-to-state sharing of non-terrorism-related law enforcement and disaster information. Currently, the MSSI SAR system is deployed in Alabama, Kentucky, Tennessee, and South Carolina. About 1 year after implementation, cognizant fusion center personnel from each state were contacted to ascertain the status of their MSSI SAR systems. The overwhelming response from these individuals was that the MSSI

  7. Quality-of-care initiative in patients treated surgically for perforated peptic ulcer

    DEFF Research Database (Denmark)

    Møller, M H; Larsson, Heidi Jeanet; Rosenstock, S

    2013-01-01

    Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present...... study reports the results of this initiative....

  8. Modern Grid Initiative Distribution Taxonomy Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, Kevin P.; Chen, Yousu; Chassin, David P.; Pratt, Robert G.; Engel, David W.; Thompson, Sandra E.

    2008-11-01

    This is the final report for the development of a toxonomy of prototypical electrical distribution feeders. Two of the primary goals of the Department of Energy's (DOE) Modern Grid Initiative (MGI) are 'to accelerate the modernization of our nation's electricity grid' and to 'support demonstrations of systems of key technologies that can serve as the foundation for an integrated, modern power grid'. A key component to the realization of these goals is the effective implementation of new, as well as existing, 'smart grid technologies'. Possibly the largest barrier that has been identified in the deployment of smart grid technologies is the inability to evaluate how their deployment will affect the electricity infrastructure, both locally and on a regional scale. The inability to evaluate the impacts of these technologies is primarily due to the lack of detailed electrical distribution feeder information. While detailed distribution feeder information does reside with the various distribution utilities, there is no central repository of information that can be openly accessed. The role of Pacific Northwest National Laboratory (PNNL) in the MGI for FY08 was to collect distribution feeder models, in the SynerGEE{reg_sign} format, from electric utilities around the nation so that they could be analyzed to identify regional differences in feeder design and operation. Based on this analysis PNNL developed a taxonomy of 24 prototypical feeder models in the GridLAB-D simulations environment that contain the fundamental characteristics of non-urban core, radial distribution feeders from the various regions of the U.S. Weighting factors for these feeders are also presented so that they can be used to generate a representative sample for various regions within the United States. The final product presented in this report is a toolset that enables the evaluation of new smart grid technologies, with the ability to aggregate their effects

  9. Caregiver reports of patient-initiated violence in psychosis.

    Science.gov (United States)

    Onwumere, Juliana; Grice, Sarah; Garety, Philippa; Bebbington, Paul; Dunn, Graham; Freeman, Daniel; Fowler, David; Kuipers, Elizabeth

    2014-07-01

    Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes. Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence. One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence. Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.

  10. Initial waste package interaction tests: status report

    International Nuclear Information System (INIS)

    Shade, J.W.; Bradley, D.J.

    1980-12-01

    This report describes the results of some initial investigations of the effects of rock media on the release of simulated fission products from a sngle waste form, PNL reference glass 76-68. All tests assemblies contained a minicanister prepared by pouring molten, U-doped 76-68 glass into a 2-cm-dia stanless steel tube closed at one end. The tubes were cut to 2.5 to 7.5 cm in length to expose a flat glass surface rimmed by the canister wall. A cylindrical, whole rock pellet, cut from one of the rock materials used, was placed on the glass surface then both the canister and rock pellet were packed in the same type of rock media ground to about 75 μm to complete the package. Rock materials used were a quartz monzonite basalt and bedded salt. These packages were run from 4 to 6 weeks in either 125 ml digestion bombs or 850 ml autoclaves capable of direct solution sampling, at either 250 or 150 0 C. Digestion bomb pressures were the vapor pressure of water, 600 psig at 250 0 C, and the autoclaves were pressurized at 2000 psig with an argon overpressure. In general, the solution chemistry of these initial package tests suggests that the rock media is the dominant controlling factor and that rock-water interaction may be similar to that observed in some geothermal areas. In no case was uranium observed in solution above 15 ppB. The observed leach rates of U glass not in contact with potential sinks (rock surfaces and alteration products) have been observed to be considerably higher. Thus the use of leach rates and U concentrations observed from binary leach experiments (waste-form water only) to ascertain long-term environmental consequences appear to be quite conservative compared to actual U release in the waste package experiments. Further evaluation, however, of fission product transport behavior and the role of alteration phases as fission product sinks is required

  11. Career Technical Education Pathways Initiative Annual Report

    Science.gov (United States)

    California Community Colleges, Chancellor's Office, 2014

    2014-01-01

    California's education system--the largest in the United States--is an essential resource for ensuring strong economic growth in the state. The Career Technical Education Pathways Initiative (the Initiative) became law in 2005 with Senate Bills 70 and 1133 and provided more than $380 million over eight years to improve career technical education…

  12. Early Development of Entrepreneurial Qualities: the Role of Initial Education

    OpenAIRE

    Isobel van der Kuip; Ingrid Verheul

    2003-01-01

    This study attempts to create a better understanding of the role of entrepreneurship education in developing entrepreneurial qualities. Theory and practice are confronted. The paper discusses the extent to which entrepreneurship can be taught, and the way in which it should be taught. The focus is on the phase of initial education.

  13. OPSAID Initial Design and Testing Report.

    Energy Technology Data Exchange (ETDEWEB)

    Hurd, Steven A.; Stamp, Jason Edwin [Sandia National Laboratories, Albuquerque, NM; Chavez, Adrian R. [Sandia National Laboratories, Albuquerque, NM

    2007-11-01

    and inherently secure PCS in the future. All activities are closely linked to industry outreach and advisory efforts.Generally speaking, the OPSAID project is focused on providing comprehensive security functionality to PCS that communicate using IP. This is done through creating an interoperable PCS security architecture and developing a reference implementation, which is tested extensively for performance and reliability.This report first provides background on the PCS security problem and OPSAID, followed by goals and objectives of the project. The report also includes an overview of the results, including the OPSAID architecture and testing activities, along with results from industry outreach activities. Conclusion and recommendation sections follow. Finally, a series of appendices provide more detailed information regarding architecture and testing activities.Summarizing the project results, the OPSAID architecture was defined, which includes modular security functionality and corresponding component modules. The reference implementation, which includes the collection of component modules, was tested extensively and proved to provide more than acceptable performance in a variety of test scenarios. The primary challenge in implementation and testing was correcting initial configuration errors.OPSAID industry outreach efforts were very successful. A small group of industry partners were extensively involved in both the design and testing of OPSAID. Conference presentations resulted in creating a larger group of potential industry partners.Based upon experience implementing and testing OPSAID, as well as through collecting industry feedback, the OPSAID project has done well and is well received. Recommendations for future work include further development of advanced functionality, refinement of interoperability guidance, additional laboratory and field testing, and industry outreach that includes PCS owner education. 4 5 --This page intentionally left blank --

  14. Key issues affecting quality of life and patient-reported outcomes in prostate cancer: an analysis conducted in 2128 patients with initial psychometric assessment of the prostate cancer symptom scale (PCSS).

    Science.gov (United States)

    Msaouel, Pavlos; Gralla, Richard J; Jones, Randy A; Hollen, Patricia J

    2017-09-01

    Evidence-based quality of life (QL) questionnaires require the identification of issues of importance to patients. The primary aim of this study was to inform providers on patient-expressed issues while enhancing the content validity of instruments assessing QL and patient-reported outcomes (PROs) in prostate cancer. The study provided additional psychometric properties for the new PRO and QL instrument, the Prostate Cancer Symptom Scale (PCSS). An anonymous web-based survey of 2128 patients with prostate cancer was conducted with patients rating 18 QL items on a five-point scale. Most respondents (74%) were aged 55-74 years, had early stage disease at diagnosis (81%) and were diagnosed within 2 years of the survey (81%). The top five-rated issues were: overall QL, ability to perform normal activities, maintaining independence, ability to sleep and not being a burden. These items were ranked as either 'very important' or 'important' by at least 88% of patients. None of the most highly ranked issues were symptoms. Instead, the highest ranked items were global issues reflecting the impact of symptoms on patients. In addition to the enhanced content validity findings, good reliability results and initial support for construct validity are reported for the PCSS. This is the largest survey providing patient-expressed background for content validity for QL and PRO measures. The findings of this study should aid development of newer practical questionnaires, such as the PCSS, which can be adapted to electronic platforms enhancing rapid and accurate PRO and QL evaluation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Highlights of contractor initiatives in quality enhancement and productivity improvement

    Science.gov (United States)

    1986-01-01

    The NASA/Contractor Team efforts are presented as part of NASA's continuing effort to facilitate the sharing of quality and productivity improvement ideas among its contractors. This complilation is not meant to be a comprehensive review of contractor initiative nor does it necessarily express NASA's views. The submissions represent samples from a general survey, and were not edited by NASA. The efforts are examples of quality and productivity programs in private industry, and as such, highlight company efforts in individual areas. Topics range from modernization of equipment, hardware, and technology to management of human resources. Of particular interest are contractor initiatives which deal with measurement and evaluation data pertaining to quality and productivity performance.

  16. The European initiative for quality management in lung cancer care

    DEFF Research Database (Denmark)

    Blum, Torsten G; Rich, Anna; Baldwin, David

    2014-01-01

    . The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility...... study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide...... countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe....

  17. Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

    OpenAIRE

    Kissam, Stephanie; Gifford, David; Parks, Peggy; Patry, Gail; Palmer, Laura; Wilkes, Linda; Fitzgerald, Matthew; Petrulis, Alice Stollenwerk; Barnette, Leslie

    2003-01-01

    Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) tha...

  18. Medicares Physician Quality Reporting System (PQRS)...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicares Physician Quality Reporting System (PQRS) allows providers to report measures of process quality and health outcomes. The authors of Medicares Physician...

  19. Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

    Science.gov (United States)

    Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

    Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support

  20. The Vermont Bioenergy Initiative: Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Callahan, Chris [Vermont Sustainable Jobs Fund, Montpelier, VT (United States); Sawyer, Scott [Vermont Sustainable Jobs Fund, Montpelier, VT (United States); Kahler, Ellen [Vermont Sustainable Jobs Fund, Montpelier, VT (United States)

    2016-11-30

    The purpose of the Vermont Bioenergy Initiative (VBI) was to foster the development of sustainable, distributed, small-scale biodiesel and grass/mixed fiber industries in Vermont in order to produce bioenergy for local transportation, agricultural, and thermal applications, as a replacement for fossil fuel based energy. The VBI marked the first strategic effort to reduce Vermont’s dependency on petroleum through the development of homegrown alternatives.

  1. Annual report on electricity quality - 2013 results

    International Nuclear Information System (INIS)

    2014-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2013 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  2. Annual report on electricity quality - 2008 results

    International Nuclear Information System (INIS)

    2009-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2008 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  3. Annual report on electricity quality - 2009 results

    International Nuclear Information System (INIS)

    2010-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2009 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  4. Annual report on electricity quality - 2011 results

    International Nuclear Information System (INIS)

    2012-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2011 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  5. Annual report on electricity quality - 2016 results

    International Nuclear Information System (INIS)

    2016-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2016 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  6. Annual report on electricity quality - 2014 results

    International Nuclear Information System (INIS)

    2015-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2014 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  7. Annual report on electricity quality - 2015 results

    International Nuclear Information System (INIS)

    2016-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2015 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  8. Annual report on electricity quality - 2012 results

    International Nuclear Information System (INIS)

    2013-01-01

    Every year, RTE, the French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2012 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  9. Annual report on electricity quality - 2010 results

    International Nuclear Information System (INIS)

    2011-01-01

    Every year, RTE, The French transmission system operator, evaluates the electricity quality of the French grid. Quality covers two aspects: the continuity of supply (percentage of outages) and the voltage wave quality (temporary or continuous disturbances). This report presents: the 2010 key figures and highlights, RTE's electricity quality commitments, RTE's technical results and quality assurance, and RTE's action for grid performances improvement

  10. Efficiency Improvement and Quality Initiatives Application in Financial Institutions

    Directory of Open Access Journals (Sweden)

    MSc. Ajtene Avdullahi

    2015-06-01

    Full Text Available Financial institutions in today’s economy have no longer the luxury to improve profit simply by increasing revenue. These firms, due to the significant measuring reductions in the financial services industry needed to improve operational efficiencies and merely support existing processes with fewer resources. This paper explains the benefits of Lean, Six Sigma, Total Quality Management and Lean Six Sigma that have improved organization's performance, by cutting costs and waste, improving their products or services, increasing profitability as well as enhancing customer satisfaction. The applicability of quality management practices in financial institutions in Kosovo is presented and also their efficiency and effectiveness. By analyzing data from Raiffeisen Bank Kosovo, this paper highlights the benefits of Individual and Micro companies customer segment as the result of organizational change and successful application of quality initiatives from financial institutions in Kosovo.

  11. Optimizing the prevention of venous thromboembolism: recent quality initiatives and strategies to drive improvement.

    Science.gov (United States)

    Amin, Alpesh N; Deitelzweig, Steven B

    2009-11-01

    Venous thromboembolism (VTE) is associated with a substantial health care and economic burden, yet many VTE events are preventable. Despite the availability of evidence-based guidelines derailing effective thromboprophylaxis strategies, the underuse and inappropriate prescribing of VTE prophylaxis are common. Current national quality initiatives were reviewed to identify strategies that may help hospitals and health care professionals optimize current VTE prophylaxis practices. A computerized literature search was performed using PubMed and MEDLINE, and this was complemented by hand searches of relevant journals and Web sites to identify additional literature related to VTE prevention and quality improvement. Many organizations, including the Centers for Medicare & Medicaid Services, the National Quality Forum, the Joint Commission, and the Agency for Healthcare Research and Quality have developed performance measures, quality indicators, public reporting initiatives, incentive programs, and "negative reimbursement" that are designed to help improve VTE prevention. It remains the responsibility of individual hospitals to identify specific areas in which they can improve their VTE prophylaxis rates to obtain positive results from the reporting initiatives and incentive programs. If performance measures are to be met, all hospital departments will need to implement effective VTE prevention policies, including early risk assessment, appropriate prophylaxis prescribing, monitoring, and follow-up. Multifaceted, integrated initiatives involving risk assessment tools, decision support, electronic alert systems, and hospitalwide education, with a mechanism for audit and feedback, may help ensure that all health care professionals comply with VTE-prevention policies and initiatives.

  12. American Samoa Initial Technical Assessment Report

    Energy Technology Data Exchange (ETDEWEB)

    Busche, S.; Conrad, M.; Funk, K.; Kandt, A.; McNutt, P.

    2011-09-01

    This document is an initial energy assessment for American Samoa, the first of many steps in developing a comprehensive energy strategy. On March 1, 2010, Assistant Secretary of the Interior Tony Babauta invited governors and their staff from the Interior Insular Areas to meet with senior principals at the National Renewable Energy Laboratory (NREL). Meeting discussions focused on ways to improve energy efficiency and increase the deployment of renewable energy technologies in the U.S. Pacific Territories. In attendance were Governors Felix Camacho (Guam), Benigno Fitial (Commonwealth of the Northern Mariana Islands), and Togiola Tulafono, (American Samoa). This meeting brought together major stakeholders to learn and understand the importance of developing a comprehensive strategic plan for implementing energy efficiency measures and renewable energy technologies. For several decades, dependence on fossil fuels and the burden of high oil prices have been a major concern but never more at the forefront as today. With unstable oil prices, the volatility of fuel supply and the economic instability in American Samoa, energy issues are a high priority. In short, energy security is critical to American Samoa's future economic development and sustainability. Under an interagency agreement, funded by the Department of Interior's Office of Insular Affairs, NREL was tasked to deliver technical assistance to the islands of American Samoa. Technical assistance included conducting an initial technical assessment to define energy consumption and production data, establish an energy consumption baseline, and assist with the development of a strategic plan. The assessment and strategic plan will be used to assist with the transition to a cleaner energy economy. NREL provided an interdisciplinary team to cover each relevant technical area for the initial energy assessments. Experts in the following disciplines traveled to American Samoa for on-island site assessments: (1

  13. Progress Report 2013. Turnaround Arts Initiative

    Science.gov (United States)

    Stoelinga, Sara Ray; Joyce, Katie; Silk, Yael

    2013-01-01

    This interim progress report provides a look at Turnaround Arts schools in their first year, including: (1) a summary of the evaluation design and research questions; (2) a preliminary description of strategies used to introduce the arts in Turnaround Arts schools; and (3) a summary of school reform indicators and student achievement data at…

  14. Frameworks for Change: Four Recurrent Themes for Quality in Early Childhood Curriculum Initiatives

    Science.gov (United States)

    Burgess, Jennifer; Fleet, Alma

    2009-01-01

    This paper reports on the first phase of a case study that investigated how early childhood teachers experience organisational change. As one of three levels of quality improvement, State government-funded curriculum initiatives were developed with an aim to promote change. Three curriculum documents, one each focusing on literacy, pedagogy and…

  15. The Global Reporting Initiative: What Value is Added?

    OpenAIRE

    W. Richard Sherman

    2011-01-01

    This paper explores the extent to which the Global Reporting Initiative G3 Reporting Framework adds value to the external reporting of a companys financial, environmental and social performance. This inquiry takes the form of analyzing the content of the published sustainability reports of well-known companies to compare and contrast the information communicated in these reports.

  16. Oil for development initiative annual report 2010

    International Nuclear Information System (INIS)

    2011-01-01

    In 2010, Oil for Development continued to develop its role as a key actor within the field of petroleum related development assistance. Five years after the programme started, we experience a steady demand for our product, which is to provide advice and competence building within petroleum sector management. Our cooperating partners are government agencies and to a lesser extent civil society organizations and parliamentary committees.Main trends in 2010 include the following: OfD continued to be a high priority programme in Norwegian development cooperation. The budget spending was Nok 222 million, 15 million higher than in 2009. The programme provided tailor made assistance to more than 20 countries, taking a holistic approach towards petroleum sector management. This implies that resource management, revenue management and environmental management are addressed in a coordinated manner, and that principles of good governance, such as anti-corruption, transparency and accountability, are cross-cutting. The funding for regional initiatives and South-South cooperation was doubled. (au)

  17. Oil for development initiative annual report 2010

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    In 2010, Oil for Development continued to develop its role as a key actor within the field of petroleum related development assistance. Five years after the programme started, we experience a steady demand for our product, which is to provide advice and competence building within petroleum sector management. Our cooperating partners are government agencies and to a lesser extent civil society organizations and parliamentary committees.Main trends in 2010 include the following: OfD continued to be a high priority programme in Norwegian development cooperation. The budget spending was Nok 222 million, 15 million higher than in 2009. The programme provided tailor made assistance to more than 20 countries, taking a holistic approach towards petroleum sector management. This implies that resource management, revenue management and environmental management are addressed in a coordinated manner, and that principles of good governance, such as anti-corruption, transparency and accountability, are cross-cutting. The funding for regional initiatives and South-South cooperation was doubled. (au)

  18. Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results.

    Science.gov (United States)

    Doggen, Kris; Van Acker, Kristien; Beele, Hilde; Dumont, Isabelle; Félix, Patricia; Lauwers, Patrick; Lavens, Astrid; Matricali, Giovanni A; Randon, Caren; Weber, Eric; Van Casteren, Viviane; Nobels, Frank

    2014-07-01

    This article aims to describe the implementation and initial results of an audit-feedback quality improvement initiative in Belgian diabetic foot clinics. Using self-developed software and questionnaires, diabetic foot clinics collected data in 2005, 2008 and 2011, covering characteristics, history and ulcer severity, management and outcome of the first 52 patients presenting with a Wagner grade ≥ 2 diabetic foot ulcer or acute neuropathic osteoarthropathy that year. Quality improvement was encouraged by meetings and by anonymous benchmarking of diabetic foot clinics. The first audit-feedback cycle was a pilot study. Subsequent audits, with a modified methodology, had increasing rates of participation and data completeness. Over 85% of diabetic foot clinics participated and 3372 unique patients were sampled between 2005 and 2011 (3312 with a diabetic foot ulcer and 111 with acute neuropathic osteoarthropathy). Median age was 70 years, median diabetes duration was 14 years and 64% were men. Of all diabetic foot ulcers, 51% were plantar and 29% were both ischaemic and deeply infected. Ulcer healing rate at 6 months significantly increased from 49% to 54% between 2008 and 2011. Management of diabetic foot ulcers varied between diabetic foot clinics: 88% of plantar mid-foot ulcers were off-loaded (P10-P90: 64-100%), and 42% of ischaemic limbs were revascularized (P10-P90: 22-69%) in 2011. A unique, nationwide quality improvement initiative was established among diabetic foot clinics, covering ulcer healing, lower limb amputation and many other aspects of diabetic foot care. Data completeness increased, thanks in part to questionnaire revision. Benchmarking remains challenging, given the many possible indicators and limited sample size. The optimized questionnaire allows future quality of care monitoring in diabetic foot clinics. Copyright © 2014 John Wiley & Sons, Ltd.

  19. Report on the Human Genome Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Tinoco, I.; Cahill, G.; Cantor, C.; Caskey, T.; Dulbecco, R.; Engelhardt, D. L.; Hood, L.; Lerman, L. S.; Mendelsohn, M. L.; Sinsheimer, R. L.; Smith, T.; Soll, D.; Stormo, G.; White, R. L.

    1987-04-01

    The report urges DOE and the Nation to commit to a large. multi-year. multidisciplinary. technological undertaking to order and sequence the human genome. This effort will first require significant innovation in general capability to manipulate DNA. major new analytical methods for ordering and sequencing. theoretical developments in computer science and mathematical biology, and great expansions in our ability to store and manipulate the information and to interface it with other large and diverse genetic databases. The actual ordering and sequencing involves the coordinated processing of some 3 billion bases from a reference human genome. Science is poised on the rudimentary edge of being able to read and understand human genes. A concerted. broadly based. scientific effort to provide new methods of sufficient power and scale should transform this activity from an inefficient one-gene-at-a-time. single laboratory effort into a coordinated. worldwide. comprehensive reading of "the book of man". The effort will be extraordinary in scope and magnitude. but so will be the benefit to biological understanding. new technology and the diagnosis and treatment of human disease.

  20. NYIT Energy Advisory Service initial evaluation report

    Energy Technology Data Exchange (ETDEWEB)

    Tenen, G.B.

    1977-01-31

    The Center for Energy Policy and Research of the New York Institute of Technology has organized an ENERGY ADVISORY SERVICE for information dissemination on energy conservation techniques to various target audiences in the New York, New Jersey, and Connecticut area. The Service, in operation since June 1, 1976 established four channels of communication to disseminate energy conservation information and technical assistance: The NYIT Energy Hot Line, the NYIT/ERDA (MRC-TV) Energy Management Seminar program, the Energy Information Center, and the Referral Service. The purposes of this report are two-fold: (1) to provide expanded and up-dated information on operating experiences associated with the NYIT Energy Hot Line and the NYIT/ERDA (MRC-TV) Energy Management Seminar Program, and (2) to provide recently analyzed data emerging from a study designed to investigate the two channels for their absolute and comparative effectiveness in energy technology transfer. Specifically research was designed to cast light on the following questions: (a) in terms of demographics and prior energy attitudes, what kinds of people tend to use the hot line or be drawn to the television seminar; (b) how did channel users feel about the channel after experiencing it; (c) how did channel users perform on energy-transfer effectiveness measures of knowledge and intention to act; and (d) was there any relationship between performance or effectiveness measures and selected demographic and attitudinal variables associated with channel users.

  1. Ramakrishna Mission initiative impact study: final report

    Energy Technology Data Exchange (ETDEWEB)

    Chaurey, A.

    2000-07-06

    This report has been prepared by the Tata Energy Research Institute (TERI) for the National Renewable Energy Laboratory. It presents the results of the evaluation and impact assessment of solar photovoltaic lighting systems in the region of Sunderbans, West Bengal, that were deployed by a reputable non-governmental organization (Ramakrishna Mission) under the auspices of the INDO-US collaborative project. The objectives of the study were to evaluate the solar photovoltaic systems for their impact on the individual households as well as on the community, to assess the effectiveness of the implementation and financial mechanisms, and to draw a long-term strategy for NREL's activities in Sunderbans based on case studies of similar interventions. Under the project, provision was made to supply 300 domestic lighting systems (DLS) based on 53-Wp module capacity to individual households and a few other systems such as for lighting, medical refrigeration, and pumping water to community centers. For this study, 152 households were surveyed, of which 29 had also been a part of earlier pre- and post-installation surveys, 47 had been a part of the earlier post-installation survey, and 76 were households that were surveyed for the first time. A set of 46, out of the total 152 households, was selected for evaluating the systems for their technical performance with respect to module output, condition of the battery, and daily energy consumption. Of the total 300 modules, 2 had been stolen, 9 out of the total 300 batteries needed to be replaced, and 10 out of the 300 charge controllers were non-functional. The statistics for the surveyed households indicate 32 luminaire-related faults (blackening or flickering of compact fluorescent lights) and 11 other faults related to fuses, switches, etc.

  2. Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

    Directory of Open Access Journals (Sweden)

    Palmer Laura

    2003-05-01

    Full Text Available Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs that led quality improvement efforts in nursing homes from the six pilot states. Results QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. Conclusion The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.

  3. Quality of life among HIV-infected patients in Brazil after initiation of treatment

    Directory of Open Access Journals (Sweden)

    Lorenza Nogueira Campos

    2009-01-01

    Full Text Available INTRODUCTION: Despite improvement in clinical treatment for HIV-infected patients, the impact of antiretroviral therapy on the overall quality of life has become a major concern. OBJECTIVE: To identify factors associated with increased levels of self-reported quality of life among HIV-infected patients after four months of antiretroviral therapy. METHODS: Patients were recruited at two public health referral centers for AIDS, Belo Horizonte, Brazil, for a prospective adherence study. Patients were interviewed before initiating treatment (baseline and after one and four months. Quality of life was assessed using a psychometric instrument, and factors associated with good/very good quality of life four months after the initiation of antiretroviral therapy were assessed using a cross-sectional approach. Logistic regression was used for analysis. RESULTS: Overall quality of life was classified as 'very good/good' by 66.4% of the participants four months after initiating treatment, while 33.6% classified it as 'neither poor nor good/poor/very poor'. Logistic regression indicated that >8 years of education, none/mild symptoms of anxiety and depression, no antiretroviral switch, lower number of adverse reactions and better quality of life at baseline were independently associated with good/very good quality of life over four months of treatment. CONCLUSIONS: Our results highlight the importance of modifiable factors such as psychiatric symptoms and treatment-related variables that may contribute to a better quality of life among patients initiating treatment. Considering that poor quality of life is related to non-adherence to antiretroviral therapy, careful clinical monitoring of these factors may contribute to ensuring the long-term effectiveness of antiretroviral regimens.

  4. Air quality in Europe - 2011 report

    Energy Technology Data Exchange (ETDEWEB)

    Guerreiro, C.; Larssen, S. (Norsk Inst. for Luftforskning (NILU), Lillestroem (Norway)); Leeuw, F. de (RIVM, Bilthoven (Netherlands)); Foltescu, V. (EEA, Copenhagen (Denmark))

    2011-11-15

    The annual report 'Air quality in Europe' summarises the most recent evaluation of Europe's air quality status. It is mainly based on air quality measurement data that have been made available officially by 32 EEA member countries as well as 6 EEA cooperating countries. The report includes maps and analyses of air quality status over the calendar year 2009. It also analyses air quality trends over the past years. The evaluation of the status and trends of air quality is based on ambient air measurements, in conjunction with reported anthropogenic emissions. The report summarizes the main effects of different air pollutants on human health, the environment and the climate. An overview of policies and measures at European level is also given for each pollutant. This report reviews progress towards meeting the requirements of the two air quality directives in force as well as the air quality guidelines set by the World Health Organization (WHO). The report is produced in support of European and national policy development and implementation in the field of air quality. It also supports air quality management and informs the general public on the current status and trends of air quality in Europe. (Author)

  5. Quality improvement initiatives in a case management service: case study.

    Science.gov (United States)

    Davies, Deborah J

    2015-01-01

    This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.

  6. Dam water quality study. Report to Congress

    International Nuclear Information System (INIS)

    1989-05-01

    The objective of the report is to identify water quality effects attributable to the impoundment of water by dams as required by Section 524 of the Water Quality Act of 1987. The document presents a study of water quality effects associated with impoundments in the U.S.A

  7. Quality of life after quitting smoking and initiating aerobic exercise.

    Science.gov (United States)

    Bloom, Erika Litvin; Minami, Haruka; Brown, Richard A; Strong, David R; Riebe, Deborah; Abrantes, Ana M

    2017-10-01

    Quitting smoking and aerobic exercise each improve health. Although smokers may be concerned that quitting smoking will reduce their quality of life (QOL), recent research has shown that cessation is associated with QOL benefits. Elements of smoking cessation interventions, such as exercise, may contribute to changes in QOL. However, it is unknown whether initiating exercise in the context of smoking cessation is associated with greater or different effects on QOL than smoking cessation alone. The current study is a secondary analysis of data from a randomized trial (n = 61) of an exercise intervention for smoking cessation. We hypothesized that smoking abstinence and engagement in exercise would have positive, additive effects on QOL at end-of-treatment, 6- and, 12-month follow-ups. Sedentary adult smokers were randomized to the exercise intervention or a health education control (HEC) group. Additionally, all participants received smoking cessation counseling and nicotine patches. Data were analyzed using actual engagement in exercise, rather than group assignment as a proxy for exercise engagement, because some HEC participants also began exercising. Abstinence was positively associated with higher total and physical health QOL at follow-up. Exercise was not associated with total QOL and only marginally associated with physical health QOL, but was positively related to overall sense of well-being. Emphasizing that smoking cessation is associated with higher QOL may help motivate smokers to initiate quit attempts.

  8. Improving energy audit process and report outcomes through planning initiatives

    Science.gov (United States)

    Sprau Coulter, Tabitha L.

    Energy audits and energy models are an important aspect of the retrofit design process, as they provide project teams with an opportunity to evaluate a facilities current building systems' and energy performance. The information collected during an energy audit is typically used to develop an energy model and an energy audit report that are both used to assist in making decisions about the design and implementation of energy conservation measures in a facility. The current lack of energy auditing standards results in a high degree of variability in energy audit outcomes depending on the individual performing the audit. The research presented is based on the conviction that performing an energy audit and producing a value adding energy model for retrofit buildings can benefit from a revised approach. The research was divided into four phases, with the initial three phases consisting of: 1.) process mapping activity - aimed at reducing variability in the energy auditing and energy modeling process. 2.) survey analysis -- To examine the misalignment between how industry members use the top energy modeling tools compared to their intended use as defined by software representatives. 3.) sensitivity analysis -- analysis of the affect key energy modeling inputs are having on energy modeling analysis results. The initial three phases helped define the need for an improved energy audit approach that better aligns data collection with facility owners' needs and priorities. The initial three phases also assisted in the development of a multi-criteria decision support tool that incorporates a House of Quality approach to guide a pre-audit planning activity. For the fourth and final research phase explored the impacts and evaluation methods of a pre-audit planning activity using two comparative energy audits as case studies. In each case, an energy audit professionals was asked to complete an audit using their traditional methods along with an audit which involved them first

  9. Implementing quality/productivity improvement initiatives in an engineering environment

    Science.gov (United States)

    Ruda, R. R.

    1985-01-01

    Quality/Productivity Improvement (QPI) initiatives in the engineering environment at McDonnell Douglas-Houston include several different, distinct activities, each having its own application, yet all targeted toward one common goal - making continuous improvement a way of life. The chief executive and the next two levels of management demonstrate their commitment to QPI with hands-on involvement in several activities. Each is a member of a QPI Council which consists of six panels - Participative Management, Communications, Training, Performance/Productivity, Human Resources Management and Strategic Management. In addition, each manager conducts Workplace Visits and Bosstalks, to enhance communications with employees and to provide a forum for the identification of problems - both real and perceived. Quality Circles and Project Teams are well established within McConnel Douglas as useful and desirable employee involvement teams. The continued growth of voluntary membership in the circles program is strong evidence of the employee interest and management support that have developed within the organization.

  10. Mexico City Air Quality Research Initiative; Volume 5, Strategic evaluation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-03-01

    Members of the Task HI (Strategic Evaluation) team were responsible for the development of a methodology to evaluate policies designed to alleviate air pollution in Mexico City. This methodology utilizes information from various reports that examined ways to reduce pollutant emissions, results from models that calculate the improvement in air quality due to a reduction in pollutant emissions, and the opinions of experts as to the requirements and trade-offs that are involved in developing a program to address the air pollution problem in Mexico City. The methodology combines these data to produce comparisons between different approaches to improving Mexico City`s air quality. These comparisons take into account not only objective factors such as the air quality improvement or cost of the different approaches, but also subjective factors such as public acceptance or political attractiveness of the different approaches. The end result of the process is a ranking of the different approaches and, more importantly, the process provides insights into the implications of implementing a particular approach or policy.

  11. Practice and documentation of palliative sedation: a quality improvement initiative

    Science.gov (United States)

    McKinnon, M.; Azevedo, C.; Bush, S.H.; Lawlor, P.; Pereira, J.

    2014-01-01

    Background Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu). Methods A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards. Results Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg). Conclusions The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. PMID:24764700

  12. Quality Disclosure in Sustainability Reporting: Evidence From Universities

    Directory of Open Access Journals (Sweden)

    Alberto ROMOLINI

    2015-02-01

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

  13. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  14. Air quality in Europe - 2012 report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-09-15

    This report presents an overview and analysis of the status and trends of air quality in Europe based on concentration measurements in ambient air and data on anthropogenic emissions and trends from 2001 - when mandatory monitoring of ambient air concentrations of selected pollutants first produced reliable air quality information - to 2010. (Author)

  15. Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

    Science.gov (United States)

    Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

    2010-03-01

    Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

  16. Results From the Audit of DOD’s American Recovery and Reinvestment Act of 2009 Initial Data Quality Review Implementation

    Science.gov (United States)

    2009-11-03

    Results From the Audit of DoD’s American Recovery and Reinvestment Act of 2009 Initial Data Quality Review Implementation Memorandum No. D-2010-RAM...number. 1. REPORT DATE 03 NOV 2009 2. REPORT TYPE 3. DATES COVERED 00-00-2009 to 00-00-2009 4. TITLE AND SUBTITLE Results From the Audit of...SUBJECT: Results From the Audit of DOD’ s American Recovery and Reinvestment Act of2009 Initial Data Quality Review Implementation (Report No. D

  17. A perinatal care quality and safety initiative: are there financial rewards for improved quality?

    Science.gov (United States)

    Kozhimannil, Katy B; Sommerness, Samantha A; Rauk, Phillip; Gams, Rebecca; Hirt, Charles; Davis, Stanley; Miller, Kristi K; Landers, Daniel V

    2013-08-01

    Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues. In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative. For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

  18. Data Sharing Between Providers and Quality Initiatives Eliminate Unnecessary Nursing Home Admissions.

    Science.gov (United States)

    Charles, Ryan J; Singal, Bonita M; Urquhart, Andrew G; Masini, Michael A; Hallstrom, Brian R

    2017-05-01

    The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. NASA total quality management 1989 accomplishments report

    Science.gov (United States)

    Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)

    1990-01-01

    NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.

  20. The process of managerial control in quality improvement initiatives.

    Science.gov (United States)

    Slovensky, D J; Fottler, M D

    1994-11-01

    The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

  1. Quality of reporting of diagnostic accuracy studies

    NARCIS (Netherlands)

    Smidt, N.; Rutjes, A.W.; Windt - Mens, van der D.A.W.M.; Ostelo, R.W.J.G.; Reitsma, J.B.; Bouter, L.M.; Vet, de H.C.W.

    2005-01-01

    PURPOSE: To evaluate quality of reporting in diagnostic accuracy articles published in 2000 in journals with impact factor of at least 4 by using items of Standards for Reporting of Diagnostic Accuracy (STARD) statement published later in 2003. MATERIALS AND METHODS: English-language articles on

  2. Peripheral intravenous and central catheter algorithm: a proactive quality initiative.

    Science.gov (United States)

    Wilder, Kerry A; Kuehn, Susan C; Moore, James E

    2014-12-01

    Peripheral intravenous (PIV) infiltrations causing tissue damage is a global issue surrounded by situations that make vascular access decisions difficult. The purpose of this quality improvement project was to develop an algorithm and assess its effectiveness in reducing PIV infiltrations in neonates. The targeted subjects were all infants in our neonatal intensive care unit (NICU) with a PIV catheter. We completed a retrospective chart review of the electronic medical record to collect 4th quarter 2012 baseline data. Following adoption of the algorithm, we also performed a daily manual count of all PIV catheters in the 1st and 2nd quarters 2013. Daily PIV days were defined as follows: 1 patient with a PIV catheter equals 1 PIV day. An infant with 2 PIV catheters in place was counted as 2 PIV days. Our rate of infiltration or tissue damage was determined by counting the number of events and dividing by the number of PIV days. The rate of infiltration or tissue damage was reported as the number of events per 100 PIV days. The number of infiltrations and PIV catheters was collected from the electronic medical record and also verified manually by daily assessment after adoption of the algorithm. To reduce the rate of PIV infiltrations leading to grade 4 infiltration and tissue damage by at least 30% in the NICU population. Incidence of PIV infiltrations/100 catheter days. The baseline rate for total infiltrations increased slightly from 5.4 to 5.68/100 PIV days (P = .397) for the NICU. We attributed this increase to heightened awareness and better reporting. Grade 4 infiltrations decreased from 2.8 to 0.83/100 PIV catheter days (P = .00021) after the algorithm was implemented. Tissue damage also decreased from 0.68 to 0.3/100 PIV days (P = .11). Statistical analysis used the Fisher exact test and reported as statistically significant at P < .05. Our findings suggest that utilization of our standardized decision pathway was instrumental in providing guidance for

  3. Small Island States Green Energy Initiative. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Khattak, Nasir [Climate Inst., Washington, DC (United States)

    1999-10-15

    This report covers the activities carried out during a one year period from 7/15/99 to 7/15/00 as part of the Small Islands Green Energy Initiative. The three activities were: 1) Energy Ministerial conference in the Caribbean; 2) Training session on renewable energy for utility engineers; and 3) Case studies compilation on renewable energy in the Caribbean.

  4. The School Meals Initiative Implementation Study. First Year Report.

    Science.gov (United States)

    Abraham, Sameer; Chattopadhyay, Manas; Sullivan, Colleen; Mallory, Larry; Steiger, Darby Miller; Daft, Lynn; Arcos, Alyssa; Wilbraham, Brooke

    This report, authorized by the Food and Nutrition Service of the U.S. Department of Agriculture, contains information on the School Meals Initiative for Healthy Children (SMI), a reform of school-meals programs aimed at upgrading the nutritional content of school meals. The purpose of the study was to describe and evaluate: (1) overall…

  5. OPTICA: Our Path Together Initiating Cultural Access. Final Report.

    Science.gov (United States)

    Jackson, Susan, Comp.

    This final report describes the activities and outcomes of OPTICA (Our Path Together Initiating Cultural Access) programs. For each program an information sheet indicates the goal, total participation, status of the goal, and activities of the program. Programs included: (1) Hands On: ASL Creative Story Telling, a program that used children's…

  6. Enabling Success: 2011-2012 Think Tank Initiative Annual Report ...

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

    2013-06-12

    In addition to a review of the Initiative's overall progress, this year's annual report, Enabling Success, captures the conversations at last year's TTI Exchange in Cape Town about what it means to be a ... English · Français ... June 12, 2013.

  7. Initiating a national program in Brazil for the implementation of quality control procedures for radionuclide ''Dose Calibrators and Scintillation Cameras in Nuclear Medicine''. Final report for the period 1987 -1988

    International Nuclear Information System (INIS)

    Mendes, L.

    1988-01-01

    In 1984 the Nuclear Energy Commission of Brazil and the IAEA established a research programme on Nuclear Medicine Quality Control. The programme will be carried out using educational, technical and clinical means to ensure the quality control of the dose calibrators and scintillation cameras

  8. Implementing a Structured Reporting Initiative Using a Collaborative Multistep Approach.

    Science.gov (United States)

    Goldberg-Stein, Shlomit; Walter, William R; Amis, E Stephen; Scheinfeld, Meir H

    To describe the successful implementation of a structured reporting initiative in a large urban academic radiology department. We describe our process, compromises, and top 10 lessons learned in overhauling traditional reporting practices and comprehensively implementing structured reporting at our institution. To achieve our goals, we took deliberate steps toward consensus building, undertook multistep template refinement, and achieved close collaboration with the technical staff, department coders, and hospital information technologists. Following institutional review board exemption, we audited radiologist compliance by evaluating 100 consecutive cases of 12 common examination types. Fisher exact test was applied to determine significance of association between trainee initial report drafting and template compliance. We produced and implemented structured reporting templates for 95% of all departmental computed tomography, magnetic resonance, and ultrasound examinations. Structured templates include specialized reports adhering to the American College of Radiology's Reporting and Data Systems (ACR's RADS) recommendations (eg, Lung-RADS and Li-RADS). We attained 94% radiologist compliance within 2 years, without any financial incentives. We provide a blueprint of how to successfully achieve structured reporting using a collaborative multistep approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

    Science.gov (United States)

    Dale, Stacy B; Ghosh, Arkadipta; Peikes, Deborah N; Day, Timothy J; Yoon, Frank B; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Conway, Patrick H; Rajkumar, Rahul; Press, Matthew J; Sessums, Laura; Brown, Randall

    2016-06-16

    The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (Pinitiative practices relative to comparison practices (P=0.006 and Pinitiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after

  10. The Total Quality Initiative at South Bank University.

    Science.gov (United States)

    Geddes, Tommy

    1993-01-01

    Application of the Total Quality Management approach to one aspect of the administration of South Bank University (England), the relationship between student as customer and university as supplier, is described. The technique includes development of service quality standards and agreements for each service, support, and academic department. (MSE)

  11. Reporting guidelines and journal quality in otolaryngology.

    Science.gov (United States)

    Henderson, A H; Upile, T; Pilavakis, Y; Patel, N N

    2016-10-01

    Journals increasingly use reporting guidelines to standardise research papers, partly to improve quality. Although defining journal quality is difficult, various calculated metrics are used. This study investigates guideline adoption by otolaryngology journals and whether a relationship exists between this and journal quality. Retrospective MEDLINE database review for English language, Index Medicus, journals of interest to otolaryngologists (October 2013). The resulting journals were examined for the number of guidelines endorsed and then tabulated against surrogate measures of journal quality (Impact factor, Eigenfactor, SCImago, Source-Normalised rank). The primary outcome measure was the number of recognised reporting guidelines endorsed per journal. This was then correlated against journal quality scores. For comparison, a further small sample correlation was performed with 6 randomly selected and 6 high-profile clinical non-otolaryngology journals. 37 otolaryngology journals were identified. Number of guidelines used and quality scores were not normally distributed. Mean guideline usage was 1.0 for otolaryngology journals, 1.5 for randomly selected, and 5.5 for the high-profile journals. Only 18/37 (49%) otolaryngology journals endorsed any guidelines, compared with 11/12 non-otolaryngology journals. Within otolaryngology, Eigenfactor positively correlated with guideline use (r = 0.4, n = 44, p otolaryngology journals is low. Although it might be expected that use of reporting guidelines improved quality, this is not reflected in the derived quality scores in otolaryngology. This may reflect low levels of use/enforcement, that quality indicators are inherently flawed, or that generalised guidelines are not always appropriate or valued by editors. © 2015 John Wiley & Sons Ltd.

  12. Structured data quality reports to improve EHR data quality.

    Science.gov (United States)

    Taggart, Jane; Liaw, Siaw-Teng; Yu, Hairong

    2015-12-01

    To examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs. The intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices. The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets. Birth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (pImprovement was greatest with allergies. There was no significant change in duplicate records. SDQRs and feedback sessions support general practitioners and practice managers to focus on improving the recording of patient information. However, improved practice DQ, was not sufficient to meet RACGP targets. Randomised controlled studies are required to evaluate strategies to improve data quality and any associated improved safety and quality of care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Report of Committee for JAEA Internationalization Initiative (Translated document)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-07-15

    In global circumstances surrounding nuclear energy, the role expected by the Japan Atomic Energy Agency (JAEA) is becoming increasingly important. JAEA has promoted an initiative for an international hub in order to increase the scientific competitiveness of Japan and make international contributions, by gathering excellent researchers from the entire world with the latest facilities. Also, JAEA has established the 'Committee for JAEA Internationalization Initiative', which will discuss issues such as environmental improvement for accepted foreigners, direction of efforts for internationalization initiative and strategies to improve the current situation. This report mentions the results of the committee's discussion including current issues for the initiative and recommendations for their solution, as well as issues to be discussed in order to enhance international awareness of JAEA staff. The following is the summary of the recommendations for the initiative: Set up local teams that focus on the situation of each site in order to provide detailed support for foreigners from diversified backgrounds. Develop systems for emergency situations to provide information for safety swiftly for foreigners and confirm their safety, in addition to preparing emergency goods. Prepare bilingual documents and systems that foreigners need to use for their work based on importance and frequency of use of such systems and documents. (author)

  14. Report of Committee for JAEA Internationalization Initiative (Translated document)

    International Nuclear Information System (INIS)

    2013-07-01

    In global circumstances surrounding nuclear energy, the role expected by the Japan Atomic Energy Agency (JAEA) is becoming increasingly important. JAEA has promoted an initiative for an international hub in order to increase the scientific competitiveness of Japan and make international contributions, by gathering excellent researchers from the entire world with the latest facilities. Also, JAEA has established the 'Committee for JAEA Internationalization Initiative', which will discuss issues such as environmental improvement for accepted foreigners, direction of efforts for internationalization initiative and strategies to improve the current situation. This report mentions the results of the committee's discussion including current issues for the initiative and recommendations for their solution, as well as issues to be discussed in order to enhance international awareness of JAEA staff. The following is the summary of the recommendations for the initiative: Set up local teams that focus on the situation of each site in order to provide detailed support for foreigners from diversified backgrounds. Develop systems for emergency situations to provide information for safety swiftly for foreigners and confirm their safety, in addition to preparing emergency goods. Prepare bilingual documents and systems that foreigners need to use for their work based on importance and frequency of use of such systems and documents. (author)

  15. Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows' Applied Quality Training (FAQT) Curriculum.

    Science.gov (United States)

    Winchester, David E; Burkart, Thomas A; Choi, Calvin Y; McKillop, Matthew S; Beyth, Rebecca J; Dahm, Phillipp

    2016-06-01

    Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects. Fellows completed didactic training from the Institute for Healthcare Improvement's Open School and then designed and completed a project to improve quality of care or patient safety. Self-assessments were completed by the fellows before, during, and after the first year of the curriculum. The primary outcome for our curriculum was the median score reported by the fellows regarding their self-confidence to complete QI activities. Self-assessments were completed by 23 fellows. The majority of fellows (15 of 23, 65.2%) reported no prior formal QI training. Median score on baseline self-assessment was 3.0 (range, 1.85-4), which was significantly increased to 3.27 (range, 2.23-4; P = 0.004) on the final assessment. The distribution of scores reported by the fellows indicates that 30% were slightly confident at conducting QI activities on their own, which was reduced to 5% after completing the FAQT curriculum. An interim assessment was conducted after the fellows completed didactic training only; median scores were not different from the baseline (mean, 3.0; P = 0.51). After completion of the FAQT, cardiology fellows reported higher self-confidence to complete QI activities. The increase in self-confidence seemed to be limited to the applied component of the curriculum, with no significant change after the didactic component.

  16. Assessing immunization data quality from routine reports in Mozambique

    Directory of Open Access Journals (Sweden)

    Mavimbe João C

    2005-10-01

    Full Text Available Abstract Background Worldwide immunization coverage shows an increase in the past years but the validity of the official reports for measuring change over time has been questioned. Facing this problem, donor supported initiatives like the Global Alliance for Vaccine and Immunizations, have been putting a lot of effort into assessing the quality of data used, since accurate immunization information is essential for the Expanded Program on Immunization managers to track and improve program performance. The present article, discusses the practices on record keeping, reporting and the support mechanism to ensure data quality in Mozambique. Methods A process evaluation study was carried out in Mozambique in one district (Cuamba in Niassa Province, between January and March 2003. The study was based on semi-structured interviews, participant observation and review of the data collection materials. Results Differences were found for all vaccine types when comparing facility reports with the tally sheets. The same applies when comparing facility reports with district reports. The study also showed that a routine practice during supervision visits was data quality assessment for the outpatient services but none related to data consistency between the tally sheets and the facility report. For the Expanded Program on Immunization, supervisors concentrated more on the consistency checks between data in the facility reports and the number of vaccines received during the same period. Meetings were based on criticism, for example, why health workers did not reach the target. Nothing in terms of data quality was addressed nor validation rules. Conclusion In this paper we have argued that the quality of data, and consequently of the information system, must be seen in a broader perspective not focusing only on technicalities (data collection tools and the reporting system but also on support mechanisms. Implications of a poor data quality system will be

  17. The Satellite based Monitoring Initiative for Regional Air quality (SAMIRA): Project summary and first results

    Science.gov (United States)

    Schneider, Philipp; Stebel, Kerstin; Ajtai, Nicolae; Diamandi, Andrei; Horalek, Jan; Nemuc, Anca; Stachlewska, Iwona; Zehner, Claus

    2017-04-01

    We present a summary and some first results of a new ESA-funded project entitled Satellite based Monitoring Initiative for Regional Air quality (SAMIRA), which aims at improving regional and local air quality monitoring through synergetic use of data from present and upcoming satellite instruments, traditionally used in situ air quality monitoring networks and output from chemical transport models. Through collaborative efforts in four countries, namely Romania, Poland, the Czech Republic and Norway, all with existing air quality problems, SAMIRA intends to support the involved institutions and associated users in their national monitoring and reporting mandates as well as to generate novel research in this area. The primary goal of SAMIRA is to demonstrate the usefulness of existing and future satellite products of air quality for improving monitoring and mapping of air pollution at the regional scale. A total of six core activities are being carried out in order to achieve this goal: Firstly, the project is developing and optimizing algorithms for the retrieval of hourly aerosol optical depth (AOD) maps from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) onboard of Meteosat Second Generation. As a second activity, SAMIRA aims to derive particulate matter (PM2.5) estimates from AOD data by developing robust algorithms for AOD-to-PM conversion with the support from model- and Lidar data. In a third activity, we evaluate the added value of satellite products of atmospheric composition for operational European-scale air quality mapping using geostatistics and auxiliary datasets. The additional benefit of satellite-based monitoring over existing monitoring techniques (in situ, models) is tested by combining these datasets using geostatistical methods and demonstrated for nitrogen dioxide (NO2), sulphur dioxide (SO2), and aerosol optical depth/particulate matter. As a fourth activity, the project is developing novel algorithms for downscaling coarse

  18. Application of Global Reporting Initiative (GRI) in the sustainability reporting of financial services

    OpenAIRE

    MONTE, TOMAS

    2009-01-01

    Sustainability reporting refers to the process in which an organization gives an account of issues related to corporate sustainability over a particular reporting period. The report is meant for both internal and external use. Sustainability reporting gives information about the organization’s interactions with its social and ecological environment. The Global Reporting Initiative (GRI) has pioneered the development of the world’s most widely used sustainability reporting framework. GRI Repor...

  19. Staff report on Ontario gas distributor service quality regulation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-29

    This report provides the basis for consultation regarding a framework for building principles and minimum standards regarding service quality measures for gas distributors. It begins with a general overview of current concerns expressed by Ontario natural gas consumers regarding service quality. Customer complaints logged with the Ontario Energy Board between 2003 and 2004 include common issues such as slow telephone response time, failure to obtain regular meter reads, inaccurate billing, long payment processing times, long reconnection times, long new connection times, and slow response to emergencies. This report also presents the historical experience in Ontario's energy sector regarding performance monitoring of services within an incentive based rate making framework for electricity and gas distributors. The Ontario Energy Board's Natural Gas Forum report reveals that a service quality framework would ensure that cost saving initiatives are not implemented at the expense of customer service or safe operation of the distribution system. Although the Board intends to implement a service quality framework, it will not include direct financial incentives. Rather, it will monitor service quality performance and utilities will be subject to a compliance process. A brief summary was also included of service quality regulations in the electricity sector and in other jurisdictions such as Australia, the United Kingdom, Pennsylvania, and Alberta. A list of issues that remain to be addressed before implementing a framework in Ontario was then presented. 2 appendices.

  20. Report the Africa renewable energy initiative launched at COP21

    International Nuclear Information System (INIS)

    Royal, Segolene

    2016-09-01

    Segolene Royal, President of COP21, presents in this report the specific renewable energy projects to be embarked on in Africa without delay. On the basis of the COP21 President's visits to 17 African countries, her discussions with African leaders and analysis by groups of experts, a list of 240 projects accounting for more than 45 GW of renewable capacity is being made public: 13 geothermal energy projects: 7 GW; 58 hydroelectricity projects: 20 GW; 62 solar energy projects: 6 GW; 16 wind energy projects: 5 GW; 35 projects combining more than one technology: 1 GW; 4 national strategies (solar and wind energy): 8 GW. Launched by African heads of state on 1 December 2015 in the presence of French President Francois Hollande, the Africa Renewable Energy Initiative aims to increase the continent's installed capacity of renewable energy by 10 GW by 2020 and 300 GW by 2030. During COP21. To achieve this goal, Segolene Royal has pledged to facilitate the implementation of the initiative throughout the French COP21 presidency. The report proposes a review of the energy situation in Africa and sets out 10 recommendations to speed up the deployment of renewable energy on the continent: 1. To identify a list of priority projects to implement by 2020, and projects to begin before and during COP22; 2. To bring the partners together around each project to share out responsibilities; 3. To initiate dialogue with the private sector about the initiative and projects; 4. To strengthen participatory citizenship regarding energy; 5. To involve African women in renewable energy; 6. To draw on the International Solar Alliance, launched at COP21, and the Global Geothermal Alliance; 7. To put in place innovative financial instruments, such as loan-grant blending; 8. To allow for climate change in the projects; 9. To strengthen the independent body responsible for implementing the initiative, hosted and supported by the African Development Bank; 10. To finalize a map of existing

  1. Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions.

    Science.gov (United States)

    Jarrar, Mu'taman; Abdul Rahman, Hamzah; Don, Mohammad Sobri

    2015-10-20

    Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme "1 Care for 1 Malaysia" in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.

  2. Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

    Science.gov (United States)

    Jarrar, Mu’taman; Rahman, Hamzah Abdul; Don, Mohammad Sobri

    2016-01-01

    Background and Objective: Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Design: Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. Results: The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. Conclusions: There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia. PMID:26755459

  3. 40 CFR Appendix B to Part 132 - Great Lakes Water Quality Initiative

    Science.gov (United States)

    2010-07-01

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

  4. Mission analysis report for the Hanford Tanks Initiative

    International Nuclear Information System (INIS)

    Schaus, P.S.

    1997-01-01

    This mission analysis report for the Hanford Tanks Initiative (HTI) supports the Hanford Site's Single-Shell Tank (SST) Waste Retrieval Program in its commitment to remove waste from the SSTs for treatment and final closure of the tanks. The results of the HTI will support the US Department of Energy's (DOE) privatization of retrieval efforts. This report addresses the HTI problem statement: Alternative technologies to past practice sluicing (PPS) have not yet been demonstrated to remove the hard heel from a sluiced tank or to remove waste from a leaking SST. Nor have performance-based criteria for cleanout and closure been demonstrated to the degree necessary to validate them as technically and economically achievable. This report also defines the mission statement and mission boundaries; the known interfaces, both programmatic and project; the mission level requirements; the test and evaluation methodology; and measures of success

  5. The North Seas Countries' Offshore Grid Initiative. Initial Findings. Final Report. Working Group 1 - Grid Configuration

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-11-15

    This report focuses on the tasks and results from Working Group 1 (WG1), grid configuration and integration, chaired jointly by representatives from Denmark and the Netherlands. The methodology, assumptions concerning generation portfolio, load situation, available technology and results are presented. This report presents the WG1 Offshore Grid Study that supports the North Seas Countries' Offshore Grid Initiative (NSCOGI) final report. The information contained in this report aims to evaluate the long-term development of an offshore grid structure in the North Seas by providing a view on how such a grid may possibly develop in the future, based on the assumptions made for this study. The report aims to compare and evaluate the possible advantages and disadvantages of the long term development of an optimised, integrated (or meshed) offshore grid in the North Seas by providing a view of how that possible grid might develop in the future against changes to the electricity energy requirements. To evaluate basic variants, different transmission design topologies (radial and meshed) were compared and analysed with respect to various aspects, such as cost/benefits, import and export levels and the systems' CO2 emissions.

  6. Improving the quality of lung cancer care in Ontario: the lung cancer disease pathway initiative.

    Science.gov (United States)

    Evans, William K; Ung, Yee C; Assouad, Nathalie; Chyjek, Anna; Sawka, Carol

    2013-07-01

    Before 2008, Cancer Care Ontario (CCO) undertook provincial cancer control quality-improvement initiatives on a programmatic basis. CCO has now added Disease Pathway Management (DPM) to its quality improvement strategy, with the intent of achieving high-quality care, processes, and patient experience across the patient pathway for specific cancers. The three goals of DPM are: to describe and share evidence-based best practice along the cancer continuum for specific cancers; identify quality-improvement priorities for specific cancers and catalyze action; monitor performance against best practice for specific cancers. The objective of this article is to describe the process by which the CCO lung cancer (LC) DPM was initiated and some of its early successes. In 2009, LC DPM began with a draft LC disease pathway map and the establishment of five multidisciplinary working groups, each focused on a phase of the LC patient journey: prevention, screening, and early detection; diagnosis; treatment; palliative care, end-of-life care, and survivorship; and patient experience. The working groups held 25 meetings of 2-hour duration and developed concepts for 17 quality-improvement projects across the patient journey. Eight were selected for detailed discussion at a provincial consensus conference, which provided input on priorities for action. A report on the priorities for action was prepared and widely circulated, and regional roadshows were held in all 14 regions of the province of Ontario. Region-specific data on incidence, stage, treatment compliance, and wait times among other issues relevant to LC, were shared with the regional care providers at these roadshows. Funding was provided by CCO to address opportunities for regional improvement based on the data and the priorities identified. The LC disease pathways were refined through substantial multidisciplinary discussion, and the diagnostic pathway was posted on CCO's Web site in February 2012. The treatment pathways

  7. Open and endovascular aneurysm repair in the Society for Vascular Surgery Vascular Quality Initiative.

    Science.gov (United States)

    Spangler, Emily L; Beck, Adam W

    2017-12-01

    The Society for Vascular Surgery Vascular Quality Initiative is a patient safety organization and a collection of procedure-based registries that can be utilized for quality improvement initiatives and clinical outcomes research. The Vascular Quality Initiative consists of voluntary participation by centers to collect data prospectively on all consecutive cases within specific registries which physicians and centers elect to participate. The data capture extends from preoperative demographics and risk factors (including indications for operation), through the perioperative period, to outcomes data at up to 1-year of follow-up. Additionally, longer-term follow-up can be achieved by matching with Medicare claims data, providing long-term longitudinal follow-up for a majority of patients within the Vascular Quality Initiative registries. We present the unique characteristics of the Vascular Quality Initiative registries and highlight important insights gained specific to open and endovascular abdominal aortic aneurysm repair. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Report to DOE on the evaluation of initial trapping studies

    International Nuclear Information System (INIS)

    Breun, R.A.; Kesner, J.; Nonn, P.; Pian, T.; Post, R.S.; Scharer, J.; Smatlak, D.; Smith, D.; Yugo, J.; Yujiri, L.

    1978-12-01

    This report summarizes work up to Dec. 1, 1978 on the single mirror plug of Phaedrus. The design, construction and initial experiments proceeded without major problems. The results on RF trapping and heating steadily improved during the months of October and November with our best results being obtained during the last two weeks of November. These positive results are encouraging for RF heating in mirrors. The experiments to date have concentrated on heating stream gun plasmas. This plasma source has been well suited for our initial studies as it produces a hot, dense plasma over a long duration (approx. 1 msec). This has made diagnostics particularly straight forward. Because of the time scale we have carried out most of our work with the 200 kW source which is capable of running for long pulses

  9. A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals.

    Science.gov (United States)

    Whitfill, Travis; Gawel, Marcie; Auerbach, Marc

    2017-07-17

    The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12

  10. Breckinridge Project, initial effort. Report III, Volume 2. Specifications

    Energy Technology Data Exchange (ETDEWEB)

    None

    1982-01-01

    Report III, Volume 2 contains those specifications numbered K through Y, as follows: Specifications for Compressors (K); Specifications for Piping (L); Specifications for Structures (M); Specifications for Insulation (N); Specifications for Electrical (P); Specifications for Concrete (Q); Specifications for Civil (S); Specifications for Welding (W); Specifications for Painting (X); and Specifications for Special (Y). The standard specifications of Bechtel Petroleum Incorporated have been amended as necessary to reflect the specific requirements of the Breckinridge Project and the more stringent specifications of Ashland Synthetic Fuels, Inc. These standard specifications are available for the Initial Effort (Phase Zero) work performed by all contractors and subcontractors.

  11. American College of Surgeons NSQIP: quality in-training initiative pilot study.

    Science.gov (United States)

    Sellers, Morgan M; Reinke, Caroline E; Kreider, Susan; Meise, Chelsey; Nelis, Kara; Volpe, Anita; Anzlovar, Nancy; Ko, Clifford; Kelz, Rachel R

    2013-11-01

    Clinical outcomes data are playing an increasingly important role in medical decision-making, reimbursement, and provider evaluation, but there are no documented programs that provide outcomes data to surgical residents as part of a structured curriculum. Our objectives were to develop a national collaborative of training programs to unify the efforts between quality and education personnel and demonstrate the feasibility of generating customized reports of patient outcomes for use in surgical education. The pool of potential hospitals was evaluated by comparing ACS NSQIP participants with the roster of clinical sites for general surgery residency programs maintained by FREIDA Online. A program and user guide was developed to generate custom reports based on institutional data, and a voluntary pilot was conducted, consisting of initial development, implementation, and feedback stages. Programs that successfully completed installation and report generation were queried for feedback on time and resources used. Of 245 general surgery residency programs, 47% had a NSQIP-affiliated sponsor institution, and an additional 31% had at least 1 NSQIP-affiliated participant institution. Sixty general surgery residency programs have expressed interest in collaboration. Seventeen pilot sites completed training and installation, and were able to independently generate custom reports. The response rate for the post-report survey was 50%. Participants reported that training and installation typically required one 2-hour phone call, and that total time devoted to the project was less than 8 hours. Collaboration between educators and quality improvement personnel from a diverse group of organizations to integrate outcomes data into surgical education is feasible. Obtaining resident and team reports from ACS NSQIP can be done with minimal effort. Future efforts will be aimed at developing a national data-centered curriculum for general surgery programs. Copyright © 2013 American

  12. Systematic evaluation program. Status report and initial evaluation

    International Nuclear Information System (INIS)

    1983-06-01

    The MHB Ongoing Systematic Evaluation Program (SEP) Assessment Study was initiated by the Swedish Nuclear Power Inspectorate (SKI) in 1980. This MHB report is a status report and initial evaluation of SEP. The methodology and results of SEP are disscused with particular emphasis on the first two SEP plant reviews - the Palisades and R.E. Ginna nuclear power plants. The comments of cognizant persons in the NRC and the ACRS, as well as private consultants, are included herein. MHBs major findings are as follows: The SEP plant review methodology was acceptable to the NRC Commissioners, the ACRS, and the NRC Staffs consultants who evaluated the first two SEP plant reviews. A concern raised by all who commented on SEP was the absence of Three Mile Island Action Plan Items and Unresolved Safety Issues from current SEP reviews. The SEP reviews of the Palisades and R.E. Ginna plants concluded that the two plant designs were adequate with respect to a majority of safety topics. Several topics remain unresolved in both the Palisades and R.E. Ginna SEP reviews. In the case of the Ginna plant, several related topics have been grouped together in a major structural reevaluation study. In general, due to the number of unresolved and excluded topics, SEP has not at this time produced a plant safety evaluation which can be considered complete and integrated. (author)

  13. Impact of Advanced Practice Registered Nurses on Quality Measures: The Missouri Quality Initiative Experience.

    Science.gov (United States)

    Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Murray, Cathy; Crecelius, Charles; Ge, Bin; Petroski, Gregory

    2018-06-01

    The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services Innovations Center. While the goals of the MOQI for long-stay nursing home residents did not specifically include improvement of the QM scores, it was anticipated that improvement most likely would occur. Primary goals of the MOQI were to reduce the frequency of avoidable hospital admissions and readmissions; improve resident health outcomes; improve the process of transitioning between inpatient hospitals and nursing facilities; and reduce overall healthcare spending without restricting access to care or choice of providers. A 2-group comparison analysis was conducted using statewide QMs; a matched comparison group was selected from facilities in the same counties as the intervention homes, similar baseline QM scores, similar size and ownership. MOQI nursing homes each had an APRN embedded full-time to improve care and help the facility achieve MOQI goals. Part of their clinical work with residents and staff was to focus on quality improvement strategies with potential to influence healthcare outcomes. Trajectories of QM scores for the MOQI intervention nursing homes and matched comparison group homes were tested with nonparametric tests to examine for change in the desired direction between the 2 groups from baseline to 36 months. A composite QM score for each facility was constructed, and baseline to 36-month average change scores were examined using nonparametric tests. Then, adjusting for baseline, a repeated measures analysis using analysis of covariance as conducted. Composite QM scores of the APRN intervention group were significantly better (P = .025) than the comparison group

  14. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

    National Cancer Institute; Jewell, Ph.D., Scott D.; Seijo, M.S., Edward; Kelly, Ph.D., Andrea; Somiari, Ph.D., Stella; B.Chir., M.B.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., M.S., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Moore, Ph.D., Helen M.; Vaught, Ph.D., Jim; Watson, Peter

    2010-09-02

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  15. Biospecimen Reporting for Improved Study Quality

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Ph.D., Helen M.; Kelly, Ph.D., Andrea B.; Jewell, Ph.D., Scott D.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas P.; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth A.; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Seijo, M.S., Edward; Somiari, Ph.D., Stella; Chir., B; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Vaught, Ph.D., Jim; Watson,M.B., Peter

    2010-12-27

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  16. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Ph.D., Helen M.; Kelly Ph.D., Andrea; Jewell Ph.D., Scott D.; McShane Ph.D., Lisa M.; Clark M.D., Douglas P.; Greenspan M.D., Renata; Hayes M.D., Daniel F.; Hainaut Ph.D.,, Pierre; Kim, Paula; Mansfield Ph.D., Elizabeth; Potapova Ph.D., Olga; Riegman Ph.D., Peter; Rubinstein Ph.D., Yaffa; Seijo M.S., Edward; Somiari Ph.D., Stella; Watson M.B., Peter; Weier Ph.D., Heinz-Ulrich; Zhu Ph.D., Claire; Vaught Ph.D., Jim

    2011-04-26

    Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.

  17. 41 CFR 101-26.803-2 - Reporting quality deficiencies.

    Science.gov (United States)

    2010-07-01

    ... Discrepancy Reports Center regarding defective items will be maintained as a quality history file for use in... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Reporting quality... § 101-26.803-2 Reporting quality deficiencies. (a) Quality deficiencies are defined as defects or...

  18. 40 CFR 130.8 - Water quality report.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Water quality report. 130.8 Section... QUALITY PLANNING AND MANAGEMENT § 130.8 Water quality report. (a) Each State shall prepare and submit biennially to the Regional Administrator a water quality report in accordance with section 305(b) of the Act...

  19. Wood energy and air quality. Synthetic report

    International Nuclear Information System (INIS)

    2009-07-01

    This report presents and comments some reference data about the current and prospective (2010, 2020) pollutant emissions through wood combustion as a source of energy. It indicates and compares greenhouse gas emissions by the different sources for household, collective and industrial heating (fuel, gas, electricity, pellets, logs, grinds, wood wastes), gives an overview of atmospheric emissions due to biomass combustion. It compares emissions due to wood combustion with respect to the activity sectors and to combustion equipment. It highlights the challenges of the development of the household sector in terms of improvement and renewal of the quality of the burning equipment. It comments the implemented policies which notably aim at reducing the emission of particles, and at defining quality labels

  20. Syncope as initial symptom for nephrotic syndrome: a case report

    Science.gov (United States)

    Wu, Xuemei; Wang, Guangliang; Feng, Jiachun

    2015-01-01

    Although syncope and nephrotic syndrome are frequently encountered independently in pediatric practice, syncope as the initial symptom for nephrotic syndrome is rarely observed in the pediatric age group. In this report, we present the case of 3-year-old boy with nephrotic syndrome who presented with a history of three episodes of syncope before admission. The syncope occurred after excessive fluid loss or inadequate intake of fluids and was relieved spontaneously. History taking revealed that the early morning palpebral edema, and laboratory tests showed decreased plasma protein levels and elevated serum lipid levels. Nephrotic syndrome was diagnosed, but could not be confirmed histopathologically because the patient’s parent refused consent for biopsy. The patient was managed with fluid expansion, correction of acidosis, and improvement of microcirculation to prevent recurrence of syncope, and glucocorticoids were administered to prevent disease progression. PMID:26629237

  1. Fast-mixed spectrum reactor interim report initial feasibility study

    International Nuclear Information System (INIS)

    Fischer, G.J.; Cerbone, R.J.

    1979-01-01

    The report summarizes the results of an initial four-month feasibility study of the Fast-Mixed Spectrum Reactor (FMSR). Reactor physics, fuel cycle, and thermal-hydraulic analyses were performed on a reference design. These results when coupled to a fuel and materials evaluation performed in cooperation with the Argonne National Laboratory indicate that the FMSR is feasible provided the fuels, cladding, and subassembly ducts can survive a peak fuel burnup of 15 to 20 atom percent heavy metal and peak fluences of 8 x 10 23 (nvt > 0.1 MeV). The results of this short study have also provided a basis for exploring alternative designs requiring significantly lower peak burnup and fluences for their operation

  2. Tumescent liposuction report performance measurement initiative: national survey results.

    Science.gov (United States)

    Hanke, William; Cox, Sue Ellen; Kuznets, Naomi; Coleman, William P

    2004-07-01

    This study was created by the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement to measure clinical performance and improvement opportunities for physicians and ambulatory health-care organizations. Data were collected prospectively between February 2001 and August 2002. Thirty-nine study centers participated, and 688 patients who had tumescent liposuction were surveyed and followed for 6 months. The objective was to determine patient satisfaction with tumescent liposuction and examine current liposuction practice and the safety of tumescent liposuction in a representative cohort of patients. The Accreditation Association for Ambulatory Health Care Institute for Quality Improvement collected prospective data from February 2001 to August 2002 from 68 organizations registered for this study. Ultimately 39 organizations submitted 688 useable cases performed totally with local anesthesia, "tumescent technique." The overall clinical complication rate found in the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement study was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1-5) and 84% had high levels (4 or 5 on a scale of 1-5) of overall satisfaction with the procedure. Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction.

  3. The Pennsylvania quality initiative : a synthesis of customer satisfaction and additional research needs

    Science.gov (United States)

    1999-10-29

    Customer satisfaction is at the heart of the Pennsylvania Quality Initiative (PQI), which was created in 1994 to build a more effective partnership among all the stakeholders involved in the process of designing, building, operating, and maintaining ...

  4. Re-Engineering a Small Oncology Practice for Quality Using the ASCO Quality Oncology Practice Initiative

    OpenAIRE

    Hendricks, Carolyn B.

    2013-01-01

    The field of quality improvement is expanding rapidly, and small oncology practices need to adapt and rise to future challenges. Additional quality measures from ASCO and other organizations will likely focus on palliative care, the Top Five, and electronic measures.

  5. Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting.

    Science.gov (United States)

    Strenk, Mariann L; Kiger, Michelle; Hawke, Jesse L; Mischnick, Amy; Quatman-Yates, Catherine

    2017-06-01

    The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. This was a quality improvement study. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved. © 2017 American Physical Therapy Association

  6. Assurance of Myeloid Growth Factor Administration in an Infusion Center: Pilot Quality Improvement Initiative.

    Science.gov (United States)

    Ramirez, Pamela Maree; Peterson, Barry; Holtshopple, Christine; Borja, Kristina; Torres, Vincent; Valdivia-Peppers, Lucille; Harriague, Julio; Joe, Melanie D

    2017-12-01

    Four incident reports involving missed doses of myeloid growth factors (MGFs) triggered the need for an outcome-driven initiative. From March 1, 2015, to February 29, 2016, at University of California Irvine Health Chao Infusion Center, 116 of 3,300 MGF doses were missed (3.52%), including pegfilgrastim, filgrastim, and sargramostim. We hypothesized that with the application of Lean Six Sigma methodology, we would achieve our primary objective of reducing the number of missed MGF doses to < 0.5%. This quality improvement initiative was conducted at Chao Infusion Center as part of a Lean Six Sigma Green Belt Certification Program. Therefore, Lean Six Sigma principles and tools were used throughout each phase of the project. Retrospective and prospective medical record reviews and data analyses were performed to evaluate the extent of the identified problem and impact of the process changes. Improvements included systems applications, practice changes, process modifications, and safety-net procedures. Preintervention, 24 missed doses (20.7%) required patient supportive care measures, resulting in increased hospital costs and decreased quality of care. Postintervention, from June 8, 2016, to August 7, 2016, zero of 489 MGF doses were missed after 2 months of intervention ( P < .001). Chao Infusion Center reduced missed doses from 3.52% to 0%, reaching the goal of < 0.5%. The establishment of simplified and standardized processes with safety checks for error prevention increased quality of care. Lean Six Sigma methodology can be applied by other institutions to produce positive outcomes and implement similar practice changes.

  7. U.S. Geological Survey Science for the Wyoming Landscape Conservation Initiative-2009 Annual Report

    Science.gov (United States)

    Bowen, Zachary H.; Aldridge, Cameron L.; Anderson, Patrick J.; Assal, Timothy J.; Biewick, Laura R. H.; Blecker, Steven W.; Bristol, R. Sky; Carr, Natasha B.; Chalfoun, Anna D.; Chong, Geneva W.; Diffendorfer, James E.; Fedy, Bradley C.; Garman, Steven L.; Germaine, Stephen; Grauch, Richard I.; Holloway, JoAnn M.; Homer, Collin G.; Kauffman, Matthew J.; Keinath, Douglas; Latysh, Natalie; Manier, Daniel J.; McDougal, Robert R.; Melcher, Cynthia P.; Miller, Kirk A.; Montag, Jessica; Nutt, Constance J.; Potter, Christopher J.; Sawyer, Hall; Schell, Spencer; Shafer, Sarah L.; Smith, David B.; Stillings, Lisa L.; Tuttle, Michele L.W.; Wilson, Anna B.

    2010-01-01

    This is the second report produced by the U.S. Geological Survey (USGS) for the Wyoming Landscape Conservation Initiative (WLCI) to detail annual work activities. The first report described work activities for 2007 and 2008; this report covers work activities conducted in 2009. Important differences between the two reports are that (1) this report does not lump all the Effectiveness Monitoring activities together as last year's report did, which will allow WLCI partners and other readers to fully appreciate the scope and accomplishments of those activities, and (2) this report does not include a comprehensive appendix of the background details for each work activity. In 2009, there were 29 ongoing or completed activities, and there were 5 new work activities conducted under the 5 original major multi-disciplinary science and technical assistance activities: (1) Baseline Synthesis; (2) Targeted Monitoring and Research; (3) Data and Information Management; (4) Integration and Coordination; and (5) Decisionmaking and Evaluation. New work included (1) developing a soil-quality index, (2) developing methods for assessing levels of and relationships between mercury and soil organic matter, and (3) ascertaining element source, mobility, and fate. Additionally, (4) remotely sensed imagery was used to assess vegetation as an indicator of soil condition and geology, and (5) an Integrated Assessment (IA) was initiated to synthesize what has been learned about WLCI systems to date, and to develop associated decision tools, maps, and a comprehensive report.

  8. Addressing Opioid-Associated Constipation Using Quality Oncology Practice Initiative Scores and Plan-Do-Study-Act Cycles.

    Science.gov (United States)

    Kaur, Varinder; Haider, Sajjad; Sasapu, Appalanaidu; Mehta, Paulette; Arnaoutakis, Konstantinos; Makhoul, Issam

    2017-01-01

    Using the Quality Oncology Practice Initiative, an affiliate program of ASCO, we outlined opioid-associated constipation (OAC) as a subject in need of quality improvement (QI) in our fellowship program at the University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System. We initiated a fellow-led QI project to advance the quality of patient care and provide a valuable avenue for QI training of young physicians. Fellows organized meetings with all stakeholders, addressed the scope of the problem, and devised strategies for OAC management. Monthly meetings were organized using Plan-Do-Study-Act principles. Mandatory check boxes were inserted into our electronic medical record templates to remind all physicians to identify patients on opioid medications and assess and address OAC. Final chart audit and patient satisfaction surveys were performed 6 months after project initiation. Assessment of OAC improved from 52% at baseline to 92% ( P < .003). This improvement corresponded with high patient satisfaction scores, with 90% of surveyed patients reporting adequate management of their constipation. In this QI initiative, we showed that participation in ASCO's Quality Oncology Practice Initiative helps identify areas in need of QI, and such fellow-led QI projects can serve as models for QI training of young physicians.

  9. Quality of reporting in infertility journals.

    Science.gov (United States)

    Glujovsky, Demian; Boggino, Carolina; Riestra, Barbara; Coscia, Andrea; Sueldo, Carlos E; Ciapponi, Agustín

    2015-01-01

    To evaluate whether fertility and top gynecology journals indexed in PubMed require the use of reporting guidelines and to identify the percentage of randomized controlled trials (RCTs) published in 2013 that were written following CONSORT guidelines in the top four fertility journals (by their highest impact factor). Cross-sectional study evaluating instructions for authors and RCTs published in fertility journals. Academic institution. None. None. Proportion of instruction-for-authors documents that suggested or required the use of reporting guidelines, and proportion of RCTs published in 2013 that accomplished the CONSORT checklist. In 47% (16/34) of the journals one or more reporting guidelines were mentioned in the instructions for authors' documents. PRISMA and CONSORT were the most commonly mentioned reporting guidelines. None of the analyzed RCTs completed the 25 items of CONSORT guideline. Sequence generation or allocation concealment was not described in 69% of the studies. One-third of the journals did not publish a flowchart, 72% did not show relative and absolute size-effect measures, and 42% did not use measures of imprecision. In the summaries, 42% did not discuss the limitations of the study and 78% did not mention the generalizability of the results. Less than half of the analyzed peer-reviewed journals request the authors to use reporting guidelines. Nevertheless, among the top fertility and gynecology journals, reporting guidelines are widely mentioned. Overall, accomplishment of CONSORT items was suboptimal. Editorial boards, reviewers, and authors should join efforts to improve the quality of reporting. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. An Initial Look at the Quality of Life of Malaysian Families That Include Children with Disabilities

    Science.gov (United States)

    Clark, M.; Brown, R.; Karrapaya, R.

    2012-01-01

    Background: While there is a growing body of literature in the quality of life of families that include children with disabilities, the majority of research has been conducted in western countries. The present study provides an initial exploration of the quality of life of Malaysian families that include children with developmental/intellectual…

  11. The "Consumer Report" version of Earth Science Data Quality description

    Science.gov (United States)

    Vicente, G. A.

    2014-12-01

    The generation, delivery and access of Earth Observation (EO) data quality information is a difficult problem because it is not uniquely defined, user dependent, difficult to be quantified, handled differently by different teams and perceived differently by data providers and data users. Initiatives such as the International Organization for Standards (ISO) 19115 and 19157 are important steps forward but difficult to implement, too complex and out of reach for the majority of data producers and users. This is because most users only want a quick and intelligible way to compare data sets from different providers to find the ones that best fit their interest. Therefore we need to simplify the problem by focusing on a few relevant quality parameters and develop a common framework to deliver them. This work is intended to tap into the data producers and user's knowledge and expertise on data quality for the development and adoption of a "Consumer Report" version of a "Data Quality Matrix". The goal is to find the most efficient and friendly approach to displays a selected number of quality parameters rated to each product and to target group of users.

  12. Iowa Department of Environmental Quality, 1976-1977. Annual report

    International Nuclear Information System (INIS)

    1978-01-01

    The Iowa Department of Environmental Quality's Annual Report for fiscal year 1976-77 is organized into three major program areas: Air Quality, Land Quality and Water Quality. Activities of each area are reviewed along with goals for the future. The Department's organizational structure and financial summary complete the report

  13. Brain Metastasis as Initial Manifestation of Melanoma (A Case Report

    Directory of Open Access Journals (Sweden)

    Vitorino Modesto Santos

    2016-06-01

    Full Text Available Background: Melanoma is a malignancy derived from the neural crest, constituted of melanocytes found in the basal layer of epidermis, with the main function of melanin production. Case: A 64-year-old woman was admitted with headache and dyslalia and reported some episodes of vertigo and falls in the last six months. A superficial red and dark skin discoloration in the scalp and a node in the right parotid gland were observed. Computed tomography of the brain showed nodular lesions in the left parietal and right temporal and occipital lobes with hemorrhagic features, in addition to mass effect. Furthermore, PET-CT images were suggestive of brain, lung, and adrenal metastasis. The patient evolved with intracranial hypertension and a neurosurgery was performed. Histopathological and immunohistochemistry studies revealed metastatic melanoma. Conclusions: She underwent schedules of radiation therapy and chemotherapy, but developed uncontrolled sepsis and died in spite of clinical management and intensive care support. Cutaneous primary site of this malignancy in the scalp was previously neglected; therefore, neurological disturbances were the initial manifestations of melanoma. Immunohistochemistry findings allowed ruling out the main differential hypotheses.

  14. The School Meals Initiative Implementation Study. Second Year Report. Nutrition Assistance Program Report Series.

    Science.gov (United States)

    Abraham, Sameer; Chattopadhyay, Manas; Montgomery, Margrethe; Steiger, Darby Miller; Daft, Lynn; Wilbraham, Brooke

    This report, authorized by the Food and Nutrition Service of the U.S. Department of Agriculture, contains information on the School Meals Initiative for Healthy Children (SMI), a reform of school-meals programs aimed at upgrading the nutritional content of school meals. The purpose of the study was to describe and evaluate: (1) overall…

  15. The School Meals Initiative Implementation Study. Third Year Report. Nutrition Assistance Program Report Series.

    Science.gov (United States)

    Abraham, Sameer; Chattopadhyay, Manas; Montgomery, Margrethe; Steiger, Darby Miller; Daft, Lynn; Wilbraham, Brooke

    This report, authorized by the Food and Nutrition Service of the U.S. Department of Agriculture, contains information on the School Meals Initiative for Healthy Children (SMI), a reform of school-meals programs aimed at upgrading the nutritional content of school meals. The purpose of the study was to describe and evaluate: (1) overall…

  16. Measuring quality in health care and its implications for pay-for-performance initiatives.

    Science.gov (United States)

    Chung, Kevin C; Shauver, Melissa J

    2009-02-01

    The quality of health care is important to American consumers, and discussion on quality will be a driving force toward improving the delivery of health care in America. Funding agencies are proposing a variety of quality measures, such as centers of excellence, pay-for-participation, and pay-for-performance initiatives, to overhaul the health care delivery system in this country. It is quite uncertain, however, whether these quality initiatives will succeed in curbing the unchecked growth in health care spending in this country, and physicians understandably are concerned about more intrusion into the practice of medicine. This article outlines the genesis of the quality movement and discusses its effect on the surgical community.

  17. Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

    Science.gov (United States)

    Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

    2013-12-01

    The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

  18. Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy.

    Science.gov (United States)

    Poulin, Tenley J; Bain, Kevin T; Balderose, Bonnie K

    2015-09-01

    The development and implementation of quality-improvement initiatives to enhance customer service in an outpatient pharmacy of a Veterans Affairs (VA) medical center are described. Historically low customer service satisfaction rates with the outpatient pharmacy at the Philadelphia Veterans Affairs Medical Center prompted this quality-improvement project. A three-question survey was designed to be easily and quickly administered to veterans in the outpatient pharmacy waiting area. Using 5-point Likert scale, veterans were asked to rate (1) their overall experience with the outpatient pharmacy service and (2) their satisfaction with the customer service provided by the pharmacy department. They were also asked how they thought the pharmacy department could improve its customer service. After receiving feedback from the survey, several quality-improvement initiatives were developed. The initiatives were categorized as environmental, personnel, communicative, and technological. For each initiative, one or more tasks were developed and the initiatives were subsequently implemented over eight months. After each task was completed, veterans were surveyed to measure the impact of the change. A total of 79 veterans were surveyed before the implementation of the quality-improvement initiatives, and 49% and 68% rated their experience with the outpatient pharmacy and customer service favorably, respectively. Twenty-five veterans were surveyed after the implementation of numerous quality-improvement interventions, with 44% and 72% rating their experience with the outpatient pharmacy and customer service favorably. Customer service satisfaction with an outpatient pharmacy service at a VA medical center was enhanced through the implementation of various quality-improvement initiatives. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  19. Technical progress report. Private sector initiatives between the United States and Japan. January 1992 - December 1992

    International Nuclear Information System (INIS)

    1993-01-01

    OAK A271 This annual report for calendar year 1992 describes the efforts performed under the Private Sector Initiatives contract. The report also describes those efforts that have continued with private funding after being initiated under this contract

  20. Technical progress report. Private sector initiatives between the United States and Japan. January 1990 - December 1990

    International Nuclear Information System (INIS)

    1993-01-01

    OAK A271 This annual report for calendar year 1990 describes the efforts performed under the Private Sector Initiatives contract. The report also describes those efforts that have continued with private funding after being initiated under this contract

  1. Corporate responsibility reporting according to Global Reporting Initiative: an international comparison

    Directory of Open Access Journals (Sweden)

    Ionela-Corina CHERSAN

    2016-04-01

    Full Text Available The Global Reporting Initiative (GRI is an organization that has managed to impose its reporting practices on corporate responsibility among large transnational companies. The model proposed by GRI is based on the supposed convergence between the economic, social and environmental dimensions of sustainable development. This convergence can be presumed at macroeconomic level, but at the level of enterprises, the three dimensions are often divergent. By analyzing the structure of reports included in the GRI database, our article aims to identify the factors that impact on company’s behavior in the corporate responsibility reporting process. In addition, our research invites to answer the following question: is it not possible that these reports attempt to exaggerate company environmental and social performance, rather than to cause a change in their conduct?

  2. Designing a Clinical Data Warehouse Architecture to Support Quality Improvement Initiatives.

    Science.gov (United States)

    Chelico, John D; Wilcox, Adam B; Vawdrey, David K; Kuperman, Gilad J

    2016-01-01

    Clinical data warehouses, initially directed towards clinical research or financial analyses, are evolving to support quality improvement efforts, and must now address the quality improvement life cycle. In addition, data that are needed for quality improvement often do not reside in a single database, requiring easier methods to query data across multiple disparate sources. We created a virtual data warehouse at NewYork Presbyterian Hospital that allowed us to bring together data from several source systems throughout the organization. We also created a framework to match the maturity of a data request in the quality improvement life cycle to proper tools needed for each request. As projects progress in the Define, Measure, Analyze, Improve, Control stages of quality improvement, there is a proper matching of resources the data needs at each step. We describe the analysis and design creating a robust model for applying clinical data warehousing to quality improvement.

  3. Irish Sea Marine Aggregate Initiative (IMAGIN) Technical Synthesis Report

    OpenAIRE

    Sutton, G.

    2008-01-01

    The Irish Sea Marine Aggregates Initiative (IMAGIN) is a collaborative project between Ireland and Wales focused on the sustainable management of marine aggregate resources. IMAGIN was a 2-year project with a total budget of €1.1 million. IMAGIN was part funded (66%) under the Ireland/Wales Inter Regional (INTERREG) IIIA Community Initiative Programme 2000-2006. The remaining project budget was met by contributions from partner organisations (19%) and aggregate companies – CEMEX, Lagan Ltd., ...

  4. QUALITY OF INITIAL TEACHER EDUCATION: REFLECTIONS ON WHAT IS BEING RESEARCHED

    Directory of Open Access Journals (Sweden)

    Josimar de Aparecido Vieira

    2009-12-01

    Full Text Available This work is discussed, in general, the state of knowledge on research dealing with the quality of the initial training of teachers. Presents an analytical and critical reading of the situation of the quality of the initial training of teachers from the analysis of the theoretical bases produced in the last decade. For this, initially, are presented some considerations on the development of this process, followed by an analysis on the issue of training. Following are considered some of the dilemmas or problems that have been addressed in the study area, suggesting mechanisms or alternative solutions. The main source of data used is the Bank of the CAPES Theses which is available on the home page http://servicos.capes.gov.br/capesdw/, for the period from 2004 until 2006. Was used to search by typing the words "initial teacher training" in the "subject", which in 2004 were examined 33 abstracts were selected and these 15, in 2005 were examined 42 abstracts, of which 07 were deployed in 2006 and were seen 44 abstracts of which 21 have been considered because they relate to the quality of initial teacher education. Involved in this analysis, this study points out some principles and data that can help with the process of initial teacher training, pointing to possible review some indicators of pedagogical projects of degree courses. Emphasizes that the specificity and multidimensionality of the performance of the teacher raises the formulation of a set of information relevant to the qualification of objectives and practices of the initial key step in the process of learning to teach. Key words: Quality of education, initial training, university education, state of knowledge; indicators.

  5. Student laboratory reports: an approach to improving feedback and quality

    Science.gov (United States)

    Ellingsen, Pål Gunnar; Støvneng, Jon Andreas

    2018-05-01

    We present an ongoing effort in improving the quality of laboratory reports written by first and second year physics students. The effort involves a new approach where students are given the opportunity to submit reports at intermediate deadlines, receive feedback, and then resubmit for the final deadline. In combination with a differential grading system, instead of pass/fail, the improved feedback results in higher quality reports. Improvement in the quality of the reports is visible through the grade statistics.

  6. REPORTING SOCIETAL : LIMITES ET ENJEUX DE LA PROPOSITION DE NORMALISATION INTERNATIONALE " GLOBAL REPORTING INITIATIVE "

    OpenAIRE

    Michel Capron; Françoise Quairel

    2003-01-01

    International audience; En s'inspirant de la normalisation comptable anglo-saxonne, la Global Reporting Initiative (GRI) propose un référentiel de publication volontaire d'informations sociétales. La transposition présente des limites qui rendent en fait ses principes inapplicables. Néanmoins il tend à s'imposer et les grandes entreprises peuvent y trouver le moyen d'éviter une régulation contraignante.

  7. One-Year Mortality Rates Before and After Implementing Quality-Improvement Initiatives to Prevent Inpatient Falls (2012–2016

    Directory of Open Access Journals (Sweden)

    Inderpal Singh

    2018-03-01

    Full Text Available Single-room ward design has previously been associated with increased risk of inpatient falls and adverse outcomes. However, following quality initiatives, the incidence of inpatient falls has shown a sustained reduction. Benefits have also been observed in the reduction of hip fractures. However, one-year mortality trends have not been reported. The aim of this observational study is to report the trends in one-year mortality rates before and after implementing quality-improvement initiatives to prevent inpatient falls over the last 5 years (2012–2016. This retrospective observational study was conducted for all patients who had sustained an inpatient fall between January 2012 and December 2016. All the incident reports in DATIX patient-safety software which were completed for each inpatient fall were studied, and the clinical information was extracted from Clinical Work Station software. Mortality data were collected on all patients for a minimum of one year following the discharge from the hospital. The results show that 95% patients were admitted from their own homes; 1704 patients had experienced 3408 incidents of an inpatient fall over 5 years. The mean age of females (82.61 ± 10.34 years was significantly higher than males (79.36 ± 10.14 years. Mean falls/patient = 2.0 ± 2.16, range 1–33. Mean hospital stay was 45.43 ± 41.42 days. Mean hospital stay to the first fall was 14.5 ± 20.79 days, and mean days to first fall prior to discharge was 30.8 ± 34.33 days. The results showed a significant and sustained reduction in the incidence of inpatient falls. There was a downward trend in the incidence of hip fractures over the last two years. There was no significant difference in the inpatient and 30-day mortality rate over the last five years. However, mortality trends appear to show a significant downward trend in both six-month and one-year mortality rates over the last two years following the implementation of quality initiatives

  8. Financial Reporting Quality, Free Cash Flow, and Investment Efficiency

    Directory of Open Access Journals (Sweden)

    Wang Fusheng

    2015-01-01

    Full Text Available This paper based on the perspective of firm’s agency conflicts to examine the relationship between financial reporting quality and investment efficiency and to analyze the interaction effect between financial reporting and free cash flow on investment efficiency. We use 3,726 samples of Chinese listed firms during the period 2008–2012 to test the empirical models and find that financial reporting quality is negatively associated with both underinvestment and overinvestment. Further, we find that financial reporting quality is more strongly associated with overinvestment for firms with large free cash flow, which suggests that financial reporting quality can reduce information asymmetry arising from agency conflicts between the managers and investors. This paper extends the field of application of financial reporting quality and investment efficiency in the emerging capital markets in the world. Moreover, this is the first study that analyzes the interaction effect between financial reporting quality and free cash flow on investment efficiency.

  9. Creating an Overall Environmental Quality Index - Technical Report

    Science.gov (United States)

    A better estimate of overall environmental quality is needed to improve our understanding of the relationship between environmental conditions and humanhealth. Described in this report is the effort to construct an environmental quality index representing multiple domains of the ...

  10. The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative.

    Science.gov (United States)

    Chang, Victor; Schwalb, Jason M; Nerenz, David R; Pietrantoni, Lisa; Jones, Sharon; Jankowski, Michelle; Oja-Tebbe, Nancy; Bartol, Stephen; Abdulhak, Muwaffak

    2015-12-01

    OBJECT Given the scrutiny of spine surgery by policy makers, spine surgeons are motivated to demonstrate and improve outcomes, by determining which patients will and will not benefit from surgery, and to reduce costs, often by reducing complications. Insurers are similarly motivated. In 2013, Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) established the Michigan Spine Surgery Improvement Collaborative (MSSIC) as a Collaborative Quality Initiative (CQI). MSSIC is one of the newest of 21 other CQIs that have significantly improved-and continue to improve-the quality of patient care throughout the state of Michigan. METHODS MSSIC focuses on lumbar and cervical spine surgery, specifically indications such as stenosis, disk herniation, and degenerative disease. Surgery for tumors, traumatic fractures, deformity, scoliosis, and acute spinal cord injury are currently not within the scope of MSSIC. Starting in 2014, MSSIC consisted of 7 hospitals and in 2015 included another 15 hospitals, for a total of 22 hospitals statewide. A standardized data set is obtained by data abstractors, who are funded by BCBSM/BCN. Variables of interest include indications for surgery, baseline patient-reported outcome measures, and medical history. These are obtained within 30 days of surgery. Outcome instruments used include the EQ-5D general health state score (0 being worst and 100 being the best health one can imagine) and EQ-5D-3 L. For patients undergoing lumbar surgery, a 0 to 10 numeric rating scale for leg and back pain and the Oswestry Disability Index for back pain are collected. For patients undergoing cervical surgery, a 0 to 10 numeric rating scale for arm and neck pain, Neck Disability Index, and the modified Japanese Orthopaedic Association score are collected. Surgical details, postoperative hospital course, and patient-reported outcome measures are collected at 90-day, 1-year, and 2-year intervals. RESULTS As of July 1, 2015, a total of 6397 cases

  11. 7 CFR 1945.19 - Reporting potential natural disasters and initial actions.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 13 2010-01-01 2009-01-01 true Reporting potential natural disasters and initial... Assistance-General § 1945.19 Reporting potential natural disasters and initial actions. (a) Purpose. The purpose of reporting potential natural disasters is to provide a systematic procedure for rapid reporting...

  12. An Ontology of Quality Initiatives and a Model for Decentralized, Collaborative Quality Management on the (Semantic) World Wide Web

    Science.gov (United States)

    2001-01-01

    This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be. PMID:11772549

  13. Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative.

    Science.gov (United States)

    Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory

    2017-11-01

    The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  14. Initial Single-Shell Tank Retrieval System mission analysis report

    International Nuclear Information System (INIS)

    Hertzel, J.S.

    1996-03-01

    This document provides the mission analysis for the Initial Single-Shell Tank Retrieval System task, which supports the Single-Shell Tank Waste Retrieval Program in its commitment to remove waste from single-shell tanks for treatment and final closure

  15. 78 FR 45231 - Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality...

    Science.gov (United States)

    2013-07-26

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3280-FN] Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality's (CIHQ's) Hospital Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION: Final...

  16. National Water Quality Inventory, 1975 Report to Congress.

    Science.gov (United States)

    Environmental Protection Agency, Washington, DC. Office of Water Programs.

    This document summarizes state submissions and provides a national overview of water quality as requested in Section 305(b) of the 1972 Federal Water Pollution Control Act Amendments (P.L. 92-500). This report provides the first opportunity for states to summarize their water quality and to report to EPA and Congress. Chapters of this report deal…

  17. Technical report for effective estimation and improvement of quality system

    International Nuclear Information System (INIS)

    Kim, Kwan Hyun

    2000-06-01

    This technical report provides the methods on how to improve the Quality System, in R and D part. This report applies on the quality assurance(QA) programmes of the design, fabrication in nuclear projects. The organization having overall responsibility for the nuclear power item design, preservation, fabrication shall be described in this report in each stage of improvement of QA systems

  18. A novel colonoscopy reporting system enabling quality assurance

    NARCIS (Netherlands)

    van Doorn, Sascha C.; van Vliet, Joost; Fockens, Paul; Dekker, Evelien

    2014-01-01

    The quality of colonoscopy can only be measured if colonoscopy reports include all key quality indicators. In daily practice, reporting is often incomplete and not standardized. This study describes a novel, structured colonoscopy reporting system, which aims to generate standardized and complete

  19. Delving into the 'emotional storms': A thematic analysis of psychoanalysts' initial consultation reports.

    Science.gov (United States)

    Pérez, Alejandra; Crick, Penelope; Lawrence, Susan

    2015-06-01

    Psychoanalysts' written reports on initial consultations are a window into the complexities of a crucial aspect of psychoanalytic work. However, systematic research in this area has largely focused on patients' demographic factors or standardized measures. The present study looked at reports of all the consultations taking place at the London Clinic of Psychoanalysis over one calendar year (N = 100). The aim was to explore psychoanalysts' different explicit styles of working and reporting as well as further understanding implicit processes used in thinking and writing about each particular consultation experience. A thematic analysis revealed a set of themes that related to a style of working and thinking about the consultation process as a dyadic experience, where the interaction, affective reactions and contact made between the two are the focus when thinking of making a recommendation for psychoanalysis. The majority of the reports had an open, exploratory quality. The writing of reports appears to give the analyst an opportunity to process the consultation experience and arrive at a more triangular position. Writing reports is a more valuable part of the consultation process than has formally been recognized and acknowledged. The limitations of this study as well as the relevance of these findings for future research are discussed. Copyright © 2015 Institute of Psychoanalysis.

  20. Demystifying process mapping: a key step in neurosurgical quality improvement initiatives.

    Science.gov (United States)

    McLaughlin, Nancy; Rodstein, Jennifer; Burke, Michael A; Martin, Neil A

    2014-08-01

    Reliable delivery of optimal care can be challenging for care providers. Health care leaders have integrated various business tools to assist them and their teams in ensuring consistent delivery of safe and top-quality care. The cornerstone to all quality improvement strategies is the detailed understanding of the current state of a process, captured by process mapping. Process mapping empowers caregivers to audit how they are currently delivering care to subsequently strategically plan improvement initiatives. As a community, neurosurgery has clearly shown dedication to enhancing patient safety and delivering quality care. A care redesign strategy named NERVS (Neurosurgery Enhanced Recovery after surgery, Value, and Safety) is currently being developed and piloted within our department. Through this initiative, a multidisciplinary team led by a clinician neurosurgeon has process mapped the way care is currently being delivered throughout the entire episode of care. Neurosurgeons are becoming leaders in quality programs, and their education on the quality improvement strategies and tools is essential. The authors present a comprehensive review of process mapping, demystifying its planning, its building, and its analysis. The particularities of using process maps, initially a business tool, in the health care arena are discussed, and their specific use in an academic neurosurgical department is presented.

  1. [Initiation, promotion, initiation experiments with radon and cigarette smoke: Lung tumors in rats]. Progress report

    International Nuclear Information System (INIS)

    Moolgavkar, S.H.

    1994-01-01

    During the past several years, the authors have made considerable progress in modeling carcinogenesis in general, and in modeling radiation carcinogenesis, in particular. They present an overview of their progress in developing stochastic carcinogenesis models and applying them to experimental and epidemiologic data sets. Traditionally, cancer models have been used for the analysis of incidence (or prevalence) data in epidemiology and time to tumor data in experimental studies. The relevant quantities for the analysis of these data are the hazard function and the probability of tumor. The derivation of these quantities is briefly described here. More recently, the authors began to use these models for the analysis of data on intermediate lesions on the pathway to cancer. Such data are available in experimental carcinogenesis studies, in particular in initiation and promotion studies on the mouse skin and the rat liver. If however, quantitative information on intermediate lesions on the pathway to lung cancer were to be come available at some future date, the methods that they have developed for the analysis of initiation-promotion experiments could easily be applied to the analysis of these lesions. The mathematical derivations here are couched in terms of a particular two-mutation model of carcinogenesis. Extension to models postulating more than two mutations is not always straightforward

  2. The Amphibian Research and Monitoring Initiative (ARMI): 5-year report

    Science.gov (United States)

    Muths, Erin; Gallant, Alisa L.; Campbell Grant, Evan H.; Battaglin, William A.; Green, David E.; Staiger, Jennifer S.; Walls, Susan C.; Gunzburger, Margaret S.; Kearney, Rick F.

    2006-01-01

    The Amphibian Research and Monitoring Initiative (ARMI) is an innovative, multidisciplinary program that began in 2000 in response to a congressional directive for the Department of the Interior to address the issue of amphibian declines in the United States. ARMI’s formulation was cross-disciplinary, integrating U.S. Geological Survey scientists from Biology, Water, and Geography to develop a course of action (Corn and others, 2005a). The result has been an effective program with diverse, yet complementary, expertise.

  3. Organic pork: Consumer quality perception: Final report

    DEFF Research Database (Denmark)

    Scholderer, Joachim; Nielsen, Niels Asger; Bredahl, Lone

    2004-01-01

    Previous research indicates that consumers expect substantially higher eating quality in pork that was produced in organic and free-range systems. Sensory studies and comparisons of objective quality suggest that these expectations are not completely realistic: in most cases, the performance...... of organic and free-range pork is equal to, and in some times even lower than that of conventional pork. However, consumers' expectations may be so strong that they may override differences in experienced quality. An experiment was conducted with 185 consumers to separate these effects and estimate...... were (a) organic pork, (b) free-range pork, (c) conventional pork, and (d) no information. Samples were prepared at a sensory lab following a standardised protocol. Serial positions of samples were counterbalanced across subjects. Before tasting each sample, consumers rated expected quality. After...

  4. Initial state report for the safety assessment SR-Can

    Energy Technology Data Exchange (ETDEWEB)

    Pers, Karin (ed.) [Kemakta Konsult AB, Stockholm (Sweden)

    2006-10-15

    A comprehensive description of the initial state of the engineered parts of the repository system is one of the main bases for the safety assessment. There is no obvious definition of the time of the initial state. For the engineered part of their repository system, the time of deposition is a natural starting point and the initial state in SR-Can is, therefore, defined as the state at the time of deposition for the engineered barrier system. The initial state of the engineered parts of the repository system is largely obtained from the design specifications of the repository, including allowed tolerances or allowance for deviations. Also the manufacturing, excavation and control methods have to be described in order to adequately discuss and handle hypothetical initial states outside the allowed limits in the design specifications. It should also be noted that many parts of the repository system are as yet not finally designed, there can be many changes in the future. The design and technical solutions presented here are representative of the current stage of development. The repository system is based on the KBS-3 method, in which copper canisters with a cast iron insert containing spent nuclear fuel are surrounded by bentonite clay and deposited at 400-700 m depth in saturated granitic rock. The facility design comprises rock caverns, tunnels, deposition positions etc. Deposition tunnels are linked by tunnels for transport and communication and shafts for ventilation. One ramp and five shafts connect the surface facility to the underground repository. The ramp is used for heavy and bulky transports and the shafts are for utility systems and for transport of excavated rock, backfill and staff. For the purposes of the safety assessment, the engineered parts of the repository system have been sub-divided into a number of components or sub-systems. These are: The fuel, (also including cavities in the canister since strong interactions between the two occur if the

  5. Initial state report for the safety assessment SR-Can

    International Nuclear Information System (INIS)

    Pers, Karin

    2006-10-01

    A comprehensive description of the initial state of the engineered parts of the repository system is one of the main bases for the safety assessment. There is no obvious definition of the time of the initial state. For the engineered part of their repository system, the time of deposition is a natural starting point and the initial state in SR-Can is, therefore, defined as the state at the time of deposition for the engineered barrier system. The initial state of the engineered parts of the repository system is largely obtained from the design specifications of the repository, including allowed tolerances or allowance for deviations. Also the manufacturing, excavation and control methods have to be described in order to adequately discuss and handle hypothetical initial states outside the allowed limits in the design specifications. It should also be noted that many parts of the repository system are as yet not finally designed, there can be many changes in the future. The design and technical solutions presented here are representative of the current stage of development. The repository system is based on the KBS-3 method, in which copper canisters with a cast iron insert containing spent nuclear fuel are surrounded by bentonite clay and deposited at 400-700 m depth in saturated granitic rock. The facility design comprises rock caverns, tunnels, deposition positions etc. Deposition tunnels are linked by tunnels for transport and communication and shafts for ventilation. One ramp and five shafts connect the surface facility to the underground repository. The ramp is used for heavy and bulky transports and the shafts are for utility systems and for transport of excavated rock, backfill and staff. For the purposes of the safety assessment, the engineered parts of the repository system have been sub-divided into a number of components or sub-systems. These are: The fuel, (also including cavities in the canister since strong interactions between the two occur if the

  6. NASA total quality management 1990 accomplishments report

    Science.gov (United States)

    1991-01-01

    NASA's efforts in Total Quality Management are based on continuous improvement and serve as a foundation for NASA's present and future endeavors. Given here are numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. These accomplishment benefit our Agency and help to achieve our primary goal, keeping American in the forefront of the aerospace industry.

  7. Strength Assessment of Broken Rock Postgrouting Reinforcement Based on Initial Broken Rock Quality and Grouting Quality

    Directory of Open Access Journals (Sweden)

    Hongfa Xu

    2017-01-01

    Full Text Available To estimate postgrouting rock mass strength growth is important for engineering design. In this paper, using self-developed indoor pressure-grouting devices, 19 groups of test cubic blocks were made of the different water cement ratio grouting into the broken rock of three kinds of particle sizes. The shear strength parameters of each group under different conditions were tested. Then this paper presents a quantitative calculation method for predicting the strength growth of grouted broken rock. Relational equations were developed to investigate the relationship between the growth rates of uniaxial compressive strength (UCS, absolute value of uniaxial tensile strength (AUTS, internal friction angle, and cohesion for post- to pregrouting broken rock based on Mohr-Coulomb strength criterion. From previous test data, the empirical equation between the growth rate of UCS and the ratio of the initial rock mass UCS to the grout concretion UCS has been determined. The equations of the growth rates of the internal friction coefficient and UCS for grouting broken rock with rock mass rating (RMR and its increment have been established. The calculated results are consistent with the experimental results. These observations are important for engineered design of grouting reinforcement for broken rock mass.

  8. Changes in the relationship between nursing home financial performance and quality of care under public reporting.

    Science.gov (United States)

    Park, Jeongyoung; Werner, Rachel M

    2011-07-01

    The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality. Copyright © 2010 John Wiley & Sons, Ltd.

  9. Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy.

    Science.gov (United States)

    Wysham, Nicholas G; Mularski, Richard A; Schmidt, David M; Nord, Shirley C; Louis, Deborah L; Shuster, Elizabeth; Curtis, J Randall; Mosen, David M

    2014-06-01

    Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients. We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention. Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities. Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Quality Assurance in Postgraduate Education. ENQA Workshop Report 12

    Science.gov (United States)

    Bitusikova, Alexandra; Bohrer, Janet; Borosic, Ivana; Costes, Nathalie; Edinsel, Kerim; Hollander, Karoline; Jacobsson, Gunilla; Jakopovic, Ivan Filip; Kearney, Mary-Louise; Mulder, Fred; Negyesi, Judith; Pietzonka, Manuel

    2010-01-01

    The present report follows an ENQA (European Association for Quality Assurance in Higher Education) Workshop on Quality Assurance and Postgraduate Education, hosted by the Romanian Agency for Quality Assurance in Higher Education (ARACIS) in Brasov, Romania on 12-13 March 2009. The workshop was an excellent opportunity for ENQA members to exchange…

  11. Quality Assurance in Transnational Higher Education. ENQA Workshop Report 11

    Science.gov (United States)

    Bennett, Paul; Bergan, Sjur; Cassar, Daniela; Hamilton, Marlene; Soinila, Michele; Sursock, Andree; Uvalic-Trumbic, Stamenka; Williams, Peter

    2010-01-01

    The present report is the product of an ENQA (European Association for Quality Assurance in Higher Education) Bologna Seminar "Quality Assurance in Transnational Education: from words to action" hosted by the Quality Assurance Agency (QAA, UK) in London in December, 2008. The seminar discussed the current trends in Transnational…

  12. Best Fed Beginnings: A Nationwide Quality Improvement Initiative to Increase Breastfeeding.

    Science.gov (United States)

    Feldman-Winter, Lori; Ustianov, Jennifer; Anastasio, Julius; Butts-Dion, Sue; Heinrich, Patricia; Merewood, Anne; Bugg, Kimarie; Donohue-Rolfe, Sarah; Homer, Charles J

    2017-07-01

    In response to a low number of Baby-Friendly-designated hospitals in the United States, the Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation. The intervention period lasted from July 2012 to August 2014. During that period, data on process indicators aligned with the Ten Steps to Successful Breastfeeding and outcome measures (overall and exclusively related to breastfeeding) were collected. In addition, data on the Baby-Friendly designation were collected after the end of the intervention through April 2016. Hospitals assembled multidisciplinary teams that included parent partners and community representatives. Three in-person learning sessions were interspersed with remote learning and tests of change, and a Web-based platform housed resources and data for widespread sharing. By April 2016, a total of 72 (80%) of the 90 hospitals received the Baby-Friendly designation, nearly doubling the number of designated hospitals in the United States. Participation in the Best Fed Beginnings initiative had significantly high correlation with designation compared with hospital applicants not in the program (Pearson's r [235]: 0.80; P initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding. Copyright © 2017 by the American Academy of Pediatrics.

  13. Who is watching the watchmen: Is quality reporting ever harmful?

    Directory of Open Access Journals (Sweden)

    R Scott Braithwaite

    2014-02-01

    Full Text Available Background: Quality reporting is increasingly used as a tool to encourage health systems, hospitals, and their practitioners to deliver the greatest health benefit. However, quality reporting systems may have unintended negative consequences, such as inadvertently encouraging “cherry-picking” by inadequately adjusting for patients who are challenging to take care of, or underpowering to reliably detect meaningful differences in care. There have been no reports seeking to identify a minimum level of accuracy that ought to be viewed as a prerequisite for quality reporting. Method: Using a decision analytic model, we seek to delineate minimal standards for quality measures to meet, using the simplest assumptions to illustrate what those standards may be. Results: We find that even under assumptions regarding optimal performance of the quality reporting system (sensitivity and specificity of 1, we can identify a minimal level of accuracy required for the quality reporting system to “do no harm”: the increase in health-related quality of life from a higher rather than lower quality practitioner must be greater than the number of practitioners per patient divided by the proportion of patients willing to switch from a lower to a higher quality provider. Conclusion: Quality measurement systems that have not been demonstrated to improve health outcomes should be held to a specific standard of measurement accuracy.

  14. Safety of a DVT chemoprophylaxis protocol following traumatic brain injury: a single center quality improvement initiative.

    Science.gov (United States)

    Nickele, Christopher M; Kamps, Timothy K; Medow, Joshua E

    2013-04-01

    Venous thromboembolism (VTE) is a complication that affects approximately 30 % of moderate and severe traumatic brain injury (TBI) patients when pharmacologic prophylaxis is not used. Following TBI, specifically in the case of contusions, the safety and efficacy of pharmacologic thromboembolism prophylaxis (PTP) has been studied only in small sample sizes. In this study, we attempt to assess the safety and efficacy of a PTP protocol for TBI patients, as a quality improvement (QI) initiative, in the neuroscience intensive care unit (NSICU). Between January 1st and December 31st, 2009, consecutive patients discharged from the University of Wisconsin NSICU after >a 48 h minimum stay were evaluated as part of a QI project. A protocol for the initiation of PTP was designed and implemented for NSICU patients. The protocol did not vary based on type of intracranial injury. The rate of VTE was reported as was heparin-induced thrombocytopenia and PTP-related expansion of intracranial hemorrhage (IH) requiring reoperation. The number of patients receiving PTP and the timing of therapy were tracked. Patients were excluded for persistent coagulopathy, other organ system bleeding (such as the gastrointestinal tract), or pregnancy. Faculty could opt out of the protocol without reason. Using the same criteria, patients discharged during the preceding 6 months, from July 1st to December 31st, 2008, were evaluated as controls as the PTP protocol was not in effect during this time. During the control period, there were 48 head trauma admissions who met the inclusion criteria. In 22 patients (45.8 %), PTP was initiated at an average of 4.9 ± 5.4 days after admission. During the protocol period, there were 87 head trauma admissions taken from 1,143 total NSICU stays who met criteria. In 63 patients (72.4 %), the care team in the NSICU successfully initiated PTP, at an average of 3.4 ± 2.8 days after admission. All 87 trauma patients were analyzed, and the rate of clinically

  15. Gynecologic Oncology Group quality assurance audits: analysis and initiatives for improvement.

    Science.gov (United States)

    Blessing, John A; Bialy, Sally A; Whitney, Charles W; Stonebraker, Bette L; Stehman, Frederick B

    2010-08-01

    The Gynecologic Oncology Group (GOG) is a multi-institution, multi-discipline Cooperative Group funded by the National Cancer Institute (NCI) to conduct clinical trials which investigate the treatment, prevention, control, quality of survivorship, and translational science of gynecologic malignancies. In 1982, the NCI initiated a program of on-site quality assurance audits of participating institutions. Each is required to be audited at least once every 3 years. In GOG, the audit mandate is the responsibility of the GOG Quality Assurance Audit Committee and it is centralized in the Statistical and Data Center (SDC). Each component (Regulatory, Investigational Drug Pharmacy, Patient Case Review) is classified as Acceptable, Acceptable, follow-up required, or Unacceptable. To determine frequently occurring deviations and develop focused innovative solutions to address them. A database was created to examine the deviations noted at the most recent audit conducted at 57 GOG parent institutions during 2004-2007. Cumulatively, this involved 687 patients and 306 protocols. The results documented commendable performance: Regulatory (39 Acceptable, 17 Acceptable, follow-up, 1 Unacceptable); Pharmacy (41 Acceptable, 3 Acceptable, follow-up, 1 Unacceptable, 12 N/A): Patient Case Review (31 Acceptable, 22 Acceptable, follow-up, 4 Unacceptable). The nature of major and lesser deviations was analyzed to create and enhance initiatives for improvement of the quality of clinical research. As a result, Group-wide proactive initiatives were undertaken, audit training sessions have emphasized recurring issues, and GOG Data Management Subcommittee agendas have provided targeted instruction and training. The analysis was based upon parent institutions only; affiliate institutions and Community Clinical Oncology Program participants were not included, although it is assumed their areas of difficulty are similar. The coordination of the GOG Quality Assurance Audit program in the SDC has

  16. The Battle Command Sustainment Support System: Initial Analysis Report

    Science.gov (United States)

    2016-09-01

    products including jet fuels, distillate fuels, residual fuels, automotive gasoline , specified bulk lubricating oils, aircraft engine oils, fuel...contained within this report. 15. SUBJECT TERMS Mission command Software Tactical applications (TacApps) Command post ...computing environment (CPCE) Command post client Battle command sustainment support System (BCS3) Logistics

  17. Latin American Technology Initiative (LAT). Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    Gallegos, Rolando

    2000-08-04

    This report explains why Monterrey, Mexico was chosen for the site of the Alternative Fuels Trade Mission (April 12-14, 2000), identifies some of the opportunities and challenges for U.S. businesses in Monterrey, identifies useful resources for U.S. companies doing business in Mexico, and details the process, execution, and results leading from the Trade Mission.

  18. Developing a caries risk registry to support caries risk assessment and management for children: A quality improvement initiative.

    Science.gov (United States)

    Ruff, Jesley C; Herndon, Jill Boylston; Horton, Roger A; Lynch, Julie; Mathwig, Dawn C; Leonard, Audra; Aravamudhan, Krishna

    2017-10-27

    Health registries are commonly used in medicine to support public health activities and are increasingly used in quality improvement (QI) initiatives. Illustrations of dental registries and their QI applications are lacking. Within dentistry, caries risk assessment implementation and documentation are vital to optimal patient care. The purpose of this article is to describe the processes used to develop a caries risk assessment registry as a QI initiative to support clinical caries risk assessment, caries prevention, and disease management for children. Developmental steps reflected Agency for Healthcare Research and Quality recommendations for planning QI registries and included engaging "champions," defining the project, identifying registry features, defining performance dashboard indicators, and pilot testing with participant feedback. We followed Standards for Quality Improvement Reporting Excellence guidelines. Registry eligibility is patients aged 0-17 years. QI tools include prompts to register eligible patients; decision support tools grounded in evidence-based guidelines; and performance dashboard reports delivered at the provider and aggregated levels at regular intervals. The registry was successfully piloted in two practices with documented caries risk assessment increasing from 57 percent to 92 percent and positive feedback regarding the potential to improve dental practice patient centeredness, patient engagement and education, and quality of care. The caries risk assessment registry demonstrates how dental registries may be used in QI efforts to promote joint patient and provider engagement, foster shared decision making, and systematically collect patient information to generate timely and actionable data to improve care quality and patient outcomes at the individual and population levels. © 2017 American Association of Public Health Dentistry.

  19. Quality assurance program. Topical report, GIBSAR-7

    International Nuclear Information System (INIS)

    1975-09-01

    The quality assurance program developed by Gibbs and Hill to satisfy the requirement that design, engineering, procurement, fabrication, and construction activities for nuclear power plants are performed in accordance with applicable codes, standards, and regulatory criteria is outlined. The program was developed to conform to the criteria of Appendix B to 10 CFR Part 50 and is presented in such a manner that each of the 18 criteria are individually set forth. The Gibbs and Hill program, implemented by the procedures of the corporate Quality Assurance Manual also follows the guidelines of the NRC Gray Book, WASH 1283, Rev. 1, May 24, 1974, and Green Book, WASH 1309, May 10, 1974. (auth)

  20. Diagnosing and reporting of occupational diseases: a quality improvement study

    NARCIS (Netherlands)

    Spreeuwers, D.; de Boer, A. G. E. M.; Verbeek, J. H. A. M.; van Beurden, M. M.; van Dijk, F. J. H.

    2008-01-01

    AIM: To assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder. METHODS: Performance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were

  1. Studies on Determinants and Consequences of Financial Reporting Quality

    NARCIS (Netherlands)

    A. Elemes (Tassos)

    2015-01-01

    markdownabstractAbstract The purpose of this dissertation is to investigate determinants and consequences of financial reporting quality. The first study examines the impact of high quality financial reporting on private firms’ access to bank debt and trade credit capital. The results

  2. Clarus quality checking algorithm documentation report.

    Science.gov (United States)

    2010-12-21

    With funding and support from the USDOT RITA IntelliDrive(SM) initiative and direction from the FHWA Road Weather Management Program, NCAR enhanced QCh algorithms that are a part of the current Clarus System. Moreover, NCAR developed new QCh algorith...

  3. Hazardous Waste Minimization Initiation Decision Report. Volume 2. Appendixes.

    Science.gov (United States)

    1988-06-01

    8217-, ,,-----.; , i bu 31ŕ Il ... IIII,’ Ua li II, I II P ’ • ) |i ,,w i’’’i ., IJ..li’ 0 Unclassified * " REPORT DOCUMENTATION PAGE I’J:2F M,’ LT!N HRM AECR...a pilot unit of 1 ton/h capacity. This work was done for a major automobile manufacturer’s foundry and the reclaimed sand was found to be reusable in

  4. An initial report of polaprezinc suppositories to radiation proctitis

    International Nuclear Information System (INIS)

    Doi, Hiroshi; Kamikonya, Norihiko; Takada, Yasuhiro

    2010-01-01

    Although radiation proctitis is one of popular adverse effects, standard treatments are not established. We reported 5 cases with the administration of polaprezinc suppositories to radiation proctitis. We made polaprezinc suppositories and administered to 5 patients with radiation proctitis. It was possible to administer it safely. 3 cases have the improvement of the symptoms. And one case had endoscopic findings improved significantly. Polaprezinc may be one of the treatments to radiation proctitis. (author)

  5. Science Teacher Education in Australia: Initiatives and Challenges to Improve the Quality of Teaching

    Science.gov (United States)

    Treagust, David F.; Won, Mihye; Petersen, Jacinta; Wynne, Georgie

    2015-02-01

    In this article, we describe how teachers in the Australian school system are educated to teach science and the different qualifications that teachers need to enter the profession. The latest comparisons of Australian students in international science assessments have brought about various accountability measures to improve the quality of science teachers at all levels. We discuss the issues and implications of government initiatives in preservice and early career teacher education programs, such as the implementation of national science curriculum, the stricter entry requirements to teacher education programs, an alternative pathway to teaching and the measure of effectiveness of teacher education programs. The politicized discussion and initiatives to improve the quality of science teacher education in Australia are still unfolding as we write in 2014.

  6. Proposed minimum reporting standards for chemical analysis Chemical Analysis Working Group (CAWG) Metabolomics Standards Initiative (MSI)

    Science.gov (United States)

    Amberg, Alexander; Barrett, Dave; Beale, Michael H.; Beger, Richard; Daykin, Clare A.; Fan, Teresa W.-M.; Fiehn, Oliver; Goodacre, Royston; Griffin, Julian L.; Hankemeier, Thomas; Hardy, Nigel; Harnly, James; Higashi, Richard; Kopka, Joachim; Lane, Andrew N.; Lindon, John C.; Marriott, Philip; Nicholls, Andrew W.; Reily, Michael D.; Thaden, John J.; Viant, Mark R.

    2013-01-01

    There is a general consensus that supports the need for standardized reporting of metadata or information describing large-scale metabolomics and other functional genomics data sets. Reporting of standard metadata provides a biological and empirical context for the data, facilitates experimental replication, and enables the re-interrogation and comparison of data by others. Accordingly, the Metabolomics Standards Initiative is building a general consensus concerning the minimum reporting standards for metabolomics experiments of which the Chemical Analysis Working Group (CAWG) is a member of this community effort. This article proposes the minimum reporting standards related to the chemical analysis aspects of metabolomics experiments including: sample preparation, experimental analysis, quality control, metabolite identification, and data pre-processing. These minimum standards currently focus mostly upon mass spectrometry and nuclear magnetic resonance spectroscopy due to the popularity of these techniques in metabolomics. However, additional input concerning other techniques is welcomed and can be provided via the CAWG on-line discussion forum at http://msi-workgroups.sourceforge.net/ or http://Msi-workgroups-feedback@lists.sourceforge.net. Further, community input related to this document can also be provided via this electronic forum. PMID:24039616

  7. The impact on air quality of energy saving measures in the major cities signatories of the Covenant of Mayors initiative.

    Science.gov (United States)

    Monforti-Ferrario, Fabio; Kona, Albana; Peduzzi, Emanuela; Pernigotti, Denise; Pisoni, Enrico

    2018-06-08

    This study is a first attempt to evaluate how the major efforts made by several European cities in the frame of the Covenant of Mayors (CoM) initiative can impact the air pollution levels in the participating cities. CoM is by no mean one of the major cities initiatives aimed at mitigating climate change, supporting local authorities in the implementation of their climate action plans. Energy savings measures reported in the CoM cities' action plans have been analysed from the air quality perspective in order to find quantitative relations in the way local authorities deal with mitigation and how these practices are expected to have consequences on the air quality at urban level and finally positively impacting the citizens' health. In the paper, the air quality 2713 energy saving measures proposed by 146 cities located in 23 countries in the frame of the CoM are selected and their co-benefits for air quality and public health estimated by means of SHERPA, a fast modelling tool that mimics the behaviour of a full physically-based Chemical Transport Model. Besides evaluating the overall benefits of this subset of mitigation measures for the air quality, the study also investigates the relevance of some factors such as the implementation sector, the city size and the pollution levels in achieving the highest possible co-benefits. The results presented refer to the special field covered by the study, i.e. energy saving measures and are not automatically referable to other types of measures. Nevertheless, they clearly show how climate mitigation and air quality policies are deeply interconnected at the urban level. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Water quality criteria for hexachloroethane: Final report

    Energy Technology Data Exchange (ETDEWEB)

    Davidson, K.A.; Hovatter, P.S.; Ross, R.H.

    1988-03-01

    The available data regarding the environmental fate, aquatic toxicity, and mammalian toxicity of hexachloroethane, which is used in military screening smokes, were reviewed. The USEPA guidelines were used to generate water quality criteria for the protection of aquatic life and its uses and of human health. 16 tabs.

  9. Biofuel Production Initiative at Claflin University Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Chowdhury, Kamal

    2011-07-20

    For US transportation fuel independence or reduced dependence on foreign oil, the Federal Government has mandated that the country produce 36 billion gallons (bg) of renewable transportation fuel per year for its transportation fuel supply by 2022. This can be achieved only if development of efficient technology for second generation biofuel from ligno-cellulosic sources is feasible. To be successful in this area, development of a widely available, renewable, cost-effective ligno-cellulosic biomass feedstock that can be easily and efficiently converted biochemically by bacteria or other fast-growing organisms is required. Moreover, if the biofuel type is butanol, then the existing infrastructure to deliver fuel to the customer can be used without additional costs and retrofits. The Claflin Biofuel Initiative project is focused on helping the US meet the above-mentioned targets. With support from this grant, Claflin University (CU) scientists have created over 50 new strains of microorganisms that are producing butanol from complex carbohydrates and cellulosic compounds. Laboratory analysis shows that a number of these strains are producing higher percentages of butanol than other methods currently in use. All of these recombinant bacterial strains are producing relatively high concentrations of acetone and numerous other byproducts as well. Therefore, we are carrying out intense mutations in the selected strains to reduce undesirable byproducts and increase the desired butanol production to further maximize the yield of butanol. We are testing the proof of concept of producing pre-industrial large scale biobutanol production by utilizing modifications of currently commercially available fermentation technology and instrumentation. We have already developed an initial process flow diagram (PFD) and selected a site for a biobutanol pilot scale facility in Orangeburg, SC. With the recent success in engineering new strains of various biofuel producing bacteria at CU

  10. Association Between Echocardiography Laboratory Accreditation and the Quality of Imaging and Reporting for Valvular Heart Disease.

    Science.gov (United States)

    Thaden, Jeremy J; Tsang, Michael Y; Ayoub, Chadi; Padang, Ratnasari; Nkomo, Vuyisile T; Tucker, Stephen F; Cassidy, Cynthia S; Bremer, Merri; Kane, Garvan C; Pellikka, Patricia A

    2017-08-01

    It is presumed that echocardiographic laboratory accreditation leads to improved quality, but there are few data. We sought to compare the quality of echocardiographic examinations performed at accredited versus nonaccredited laboratories for the evaluation of valvular heart disease. We enrolled 335 consecutive valvular heart disease subjects who underwent echocardiography at our institution and an external accredited or nonaccredited institution within 6 months. Completeness and quality of echocardiographic reports and images were assessed by investigators blinded to the external laboratory accreditation status and echocardiographic results. Compared with nonaccredited laboratories, accredited sites more frequently reported patient sex (94% versus 78%; P heart disease. Future quality improvement initiatives should highlight the importance of high-quality color Doppler imaging and echocardiographic quantification to improve the accuracy, reproducibility, and quality of echocardiographic studies for valvular heart disease. © 2017 American Heart Association, Inc.

  11. Annual Report: Carbon Capture Simulation Initiative (CCSI) (30 September 2013)

    Energy Technology Data Exchange (ETDEWEB)

    Miller, David C. [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United States); Syamlal, Madhava [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United States); Cottrell, Roger [URS Corporation. (URS), San Francisco, CA (United States); National Energy Technology Lab. (NETL), Morgantown, WV (United States); Kress, Joel D. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Sundaresan, S. [Princeton Univ., NJ (United States); Sun, Xin [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Storlie, C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Bhattacharyya, D. [West Virginia Univ., Morgantown, WV (United States); National Energy Technology Lab. (NETL), Morgantown, WV (United States); Tong, Charles [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Zitney, Stephen E [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United States); Dale, Crystal [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Engel, Dave [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Agarwal, Deb [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Calafiura, Paolo [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shinn, John [SynPatEco, Pleasant Hill, CA (United States)

    2013-09-30

    The Carbon Capture Simulation Initiative (CCSI) is a partnership among national laboratories, industry and academic institutions that is developing and deploying state-of-the-art computational modeling and simulation tools to accelerate the commercialization of carbon capture technologies from discovery to development, demonstration, and ultimately the widespread deployment to hundreds of power plants. The CCSI Toolset will provide end users in industry with a comprehensive, integrated suite of scientifically validated models, with uncertainty quantification (UQ), optimization, risk analysis and decision making capabilities. The CCSI Toolset incorporates commercial and open-source software currently in use by industry and is also developing new software tools as necessary to fill technology gaps identified during execution of the project. Ultimately, the CCSI Toolset will (1) enable promising concepts to be more quickly identified through rapid computational screening of devices and processes; (2) reduce the time to design and troubleshoot new devices and processes; (3) quantify the technical risk in taking technology from laboratory-scale to commercial-scale; and (4) stabilize deployment costs more quickly by replacing some of the physical operational tests with virtual power plant simulations. CCSI is led by the National Energy Technology Laboratory (NETL) and leverages the Department of Energy (DOE) national laboratories’ core strengths in modeling and simulation, bringing together the best capabilities at NETL, Los Alamos National Laboratory (LANL), Lawrence Berkeley National Laboratory (LBNL), Lawrence Livermore National Laboratory (LLNL), and Pacific Northwest National Laboratory (PNNL). The CCSI’s industrial partners provide representation from the power generation industry, equipment manufacturers, technology providers and engineering and construction firms. The CCSI’s academic participants (Carnegie Mellon University, Princeton University, West

  12. ENEA initiatives in Southern Italy: Progress report, analysis, prospects

    International Nuclear Information System (INIS)

    Santandrea, E.

    1991-01-01

    In the past, technological development in Italy was concentrated in the country's heavily industrialized northern regions. The motive for this choice was the conception that to be successful in a highly competitive market, research investment had necessarily to favour those developed areas with an already proven capacity for guaranteed fast and high returns. Unfortunately this policy has created a technologically and economically depressed area, known as Mezzogiorno, in southern Italy. Within the framework of new national energy and economic policies calling for balanced economic and technological development, ENEA (Italian Commission for New Technologies, Energy and the Environment) has been entrusted with the planning and managing of research, commercialization and technology transfer programs designed to stimulate high-technology industrial activity in Italy's southern regions so as to allow them to become more competitive in the upcoming European free trade market. Small business concerns shall be favoured in this new development scheme which shall respect the existing local social-economic framework. Emphasis shall be placed on privileging such elements as quality, flexibility and versatility, as opposed to lost cost mass production. Priority is to be given to the development of renewable energy sources, energy conservation techniques and environmentally compatible technologies

  13. Statewide Quality Improvement Initiative to Reduce Early Elective Deliveries and Improve Birth Registry Accuracy.

    Science.gov (United States)

    Kaplan, Heather C; King, Eileen; White, Beth E; Ford, Susan E; Fuller, Sandra; Krew, Michael A; Marcotte, Michael P; Iams, Jay D; Bailit, Jennifer L; Bouchard, Jo M; Friar, Kelly; Lannon, Carole M

    2018-04-01

    To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio. Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects. Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2-3.2%, Pinitiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80-90%, P=.017; wave 2: 80-100%, P=.002; wave 3: 75-100%, Pinitiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.

  14. Automatic initialization and quality control of large-scale cardiac MRI segmentations.

    Science.gov (United States)

    Albà, Xènia; Lekadir, Karim; Pereañez, Marco; Medrano-Gracia, Pau; Young, Alistair A; Frangi, Alejandro F

    2018-01-01

    Continuous advances in imaging technologies enable ever more comprehensive phenotyping of human anatomy and physiology. Concomitant reduction of imaging costs has resulted in widespread use of imaging in large clinical trials and population imaging studies. Magnetic Resonance Imaging (MRI), in particular, offers one-stop-shop multidimensional biomarkers of cardiovascular physiology and pathology. A wide range of analysis methods offer sophisticated cardiac image assessment and quantification for clinical and research studies. However, most methods have only been evaluated on relatively small databases often not accessible for open and fair benchmarking. Consequently, published performance indices are not directly comparable across studies and their translation and scalability to large clinical trials or population imaging cohorts is uncertain. Most existing techniques still rely on considerable manual intervention for the initialization and quality control of the segmentation process, becoming prohibitive when dealing with thousands of images. The contributions of this paper are three-fold. First, we propose a fully automatic method for initializing cardiac MRI segmentation, by using image features and random forests regression to predict an initial position of the heart and key anatomical landmarks in an MRI volume. In processing a full imaging database, the technique predicts the optimal corrective displacements and positions in relation to the initial rough intersections of the long and short axis images. Second, we introduce for the first time a quality control measure capable of identifying incorrect cardiac segmentations with no visual assessment. The method uses statistical, pattern and fractal descriptors in a random forest classifier to detect failures to be corrected or removed from subsequent statistical analysis. Finally, we validate these new techniques within a full pipeline for cardiac segmentation applicable to large-scale cardiac MRI databases. The

  15. Nett Warrior: Initial Operational Test and Evaluation Report

    Science.gov (United States)

    2015-05-01

    Chemlight - K05.19/8 Aircraft/Anti-aircraft - K05.19/8 Artillery - K05.19/8 Dismounted Personnel - K05.19/8 Spot Report - K05.19/9 Other-Entity...network capable of displaying PLI (e.g., Blue Force Tracker ), display the Nett Warrior PLI. During missions, knowledge of the location of troops...digital communications message traffic and such data were harvested from the EUDs daily. The Multiple Integrated Laser Engagement System executed and

  16. Bibliography of Water Quality Research Reports.

    Science.gov (United States)

    Environmental Protection Agency, Washington, DC. Office of Research and Development.

    Prepared for the Environmental Protection Agency (EPA), this bibliography of published reports covers information concerning the advancement of water pollution control technology and knowledge. The reports provide a central source of information on the research, development, and demonstration activities in the water research program of the EPA,…

  17. Annual Report: Carbon Capture Simulation Initiative (CCSI) (30 September 2012)

    Energy Technology Data Exchange (ETDEWEB)

    Miller, David C. [National Energy Technology Lab. (NETL), Morgantown, WV (United States); Syamlal, Madhava [National Energy Technology Lab. (NETL), Morgantown, WV (United States); Cottrell, Roger [URS Corporation. (URS), San Francisco, CA (United States); National Energy Technology Lab. (NETL), Morgantown, WV (United States); Kress, Joel D. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Sun, Xin [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Sundaresan, S. [Princeton Univ., NJ (United States); Sahinidis, Nikolaos V. [Carnegie Mellon Univ., Pittsburgh, PA (United States); National Energy Technology Lab. (NETL), Morgantown, WV (United States); Zitney, Stephen E. [NETL; Bhattacharyya, D. [West Virginia Univ., Morgantown, WV (United States); National Energy Technology Lab. (NETL), Morgantown, WV (United States); Agarwal, Deb [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Tong, Charles [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Lin, Guang [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Dale, Crystal [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Engel, Dave [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Calafiura, Paolo [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Beattie, Keith [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shinn, John [SynPatEco. Pleasant Hill, CA (United States)

    2012-09-30

    The Carbon Capture Simulation Initiative (CCSI) is a partnership among national laboratories, industry and academic institutions that is developing and deploying state-of-the-art computational modeling and simulation tools to accelerate the commercialization of carbon capture technologies from discovery to development, demonstration, and ultimately the widespread deployment to hundreds of power plants. The CCSI Toolset will provide end users in industry with a comprehensive, integrated suite of scientifically validated models, with uncertainty quantification (UQ), optimization, risk analysis and decision making capabilities. The CCSI Toolset incorporates commercial and open-source software currently in use by industry and is also developing new software tools as necessary to fill technology gaps identified during execution of the project. Ultimately, the CCSI Toolset will (1) enable promising concepts to be more quickly identified through rapid computational screening of devices and processes; (2) reduce the time to design and troubleshoot new devices and processes; (3) quantify the technical risk in taking technology from laboratory-scale to commercial-scale; and (4) stabilize deployment costs more quickly by replacing some of the physical operational tests with virtual power plant simulations. CCSI is organized into 8 technical elements that fall under two focus areas. The first focus area (Physicochemical Models and Data) addresses the steps necessary to model and simulate the various technologies and processes needed to bring a new Carbon Capture and Storage (CCS) technology into production. The second focus area (Analysis & Software) is developing the software infrastructure to integrate the various components and implement the tools that are needed to make quantifiable decisions regarding the viability of new CCS technologies. CCSI also has an Industry Advisory Board (IAB). By working closely with industry from the inception of the project to identify

  18. Initial results from the Auto/Oil Air Quality Improvement Research Program

    International Nuclear Information System (INIS)

    McCabe, L.J.

    1993-01-01

    The Auto/Air Quality Improvement Research Program (AQIRP), a cooperative effort by the three major US auto companies and fourteen oil companies, is the most comprehensive research effort ever undertaken to develop data on the air quality effects of the use of various motor fuels in various automotive systems and the relative cost-effectiveness of various fuel/vehicle combinations. Phase 1 of the Program, at a cost of about $15 million, is examining emissions and air quality impacts from current and older vehicles using reformulated gasolines with widely different values of aromatics content, olefin content, oxygenate content and type, sulfur content, vapor pressure (RVP) and 90% distillation temperature. Emissions from Flexible and Variable Fuel vehicles using methanol/gasoline mixtures are also being examined. A second phase with a $25 million budget over three years has also been approved. Initial findings for the Phase 1 study and Phase 2 plans are presented

  19. GKI water quality studies. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    Hutchinson, D L

    1980-01-01

    GKI water quality data collected in 1978 and early 1979 was evaluated with the objective of developing preliminary characterizations of native groundwater and retort water at Kamp Kerogen, Uintah County, Utah. Restrictive analytical definitions were developed to describe native groundwater and GKI retort water in an effort to eliminate from the sample population both groundwater samples affected by retorting and retort water samples diluted by groundwater. Native groundwater and retort water sample analyses were subjected to statistical manipulation and testing to summarize the data to determine the statistical validity of characterizations based on the data available, and to identify probable differences between groundwater and retort water based on available data. An evaluation of GKI water quality data related to developing characterizations of native groundwater and retort water at Kamp Kerogen was conducted. GKI retort water and the local native groundwater both appeared to be of very poor quality. Statistical testing indicated that the data available is generally insufficient for conclusive characterizations of native groundwater and retort water. Statistical testing indicated some probable significant differences between native groundwater and retort water that could be determined with available data. Certain parameters should be added to and others deleted from future laboratory analyses suites of water samples.

  20. Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels.

    Science.gov (United States)

    Rankin, Kristin M; Gavin, Loretta; Moran, John W; Kroelinger, Charlan D; Vladutiu, Catherine J; Goodman, David A; Sappenfield, William M

    2016-11-01

    Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes.

  1. Development and participant assessment of a practical quality improvement educational initiative for surgical residents.

    Science.gov (United States)

    Sellers, Morgan M; Hanson, Kristi; Schuller, Mary; Sherman, Karen; Kelz, Rachel R; Fryer, Jonathan; DaRosa, Debra; Bilimoria, Karl Y

    2013-06-01

    As patient-safety and quality efforts spread throughout health care, the need for physician involvement is critical, yet structured training programs during surgical residency are still uncommon. Our objective was to develop an extended quality-improvement curriculum for surgical residents that included formal didactics and structured practical experience. Surgical trainees completed an 8-hour didactic program in quality-improvement methodology at the start of PGY3. Small teams developed practical quality-improvement projects based on needs identified during clinical experience. With the assistance of the hospital's process-improvement team and surgical faculty, residents worked through their selected projects during the following year. Residents were anonymously surveyed after their participation to assess the experience. During the first 3 years of the program, 17 residents participated, with 100% survey completion. Seven quality-improvement projects were developed, with 57% completing all DMAIC (Define, Measure, Analyze, Improve, Control) phases. Initial projects involved issues of clinical efficiency and later projects increasingly focused on clinical care questions. Residents found the experience educationally important (65%) and believed they were well equipped to lead similar initiatives in the future (70%). Based on feedback, the timeline was expanded from 12 to 24 months and changed to start in PGY2. Developing an extended curriculum using both didactic sessions and applied projects to teach residents the theory and implementation of quality improvement is possible and effective. It addresses the ACGME competencies of practice-based improvement and learning and systems-based practice. Our iterative experience during the past 3 years can serve as a guide for other programs. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Highlight report local initiatives. Experiences with electric transport; Highlight report lokale initiatieven. Ervaringen met elektrisch vervoer

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-15

    In March 2013 Linkingreen and XTNT started a survey on local electric transportation initiatives. The aim is to learn from the experiences, problems and obstacles of business users of electric vehicles: cars, vans or trucks, scooters, boats and special vehicles (e.g. garbage trucks) that are all-electric or plug-in (with plug). In this brief report, the main results are presented [Dutch] In maart 2013 is door Linkingreen en XTNT in opdracht van Agentschap NL een enquete uitgezet naar lokale initiatieven elektrisch vervoer. Doel is te leren wat de ervaringen, knelpunten en belemmeringen zijn van zakelijke gebruikers van elektrisch vervoer: personenauto's, bestel- of vrachtauto's, scooters, vaartuigen en bijzondere voertuigen (vuilniswagens etc.) die volledig elektrische of plug in (met stekker) zijn. In dit korte verslag zijn de belangrijkste resultaten opgenomen.

  3. Inspecting the Inspectors: Race Equality and Quality in Initial Teacher Education

    Science.gov (United States)

    Wilkins, Chris

    2014-01-01

    Equalities legislation in Britain has in recent years shifted towards requiring public bodies to proactively promote equality rather than simply prevent discrimination. This paper reports on a study of how this requirement, with specific reference to race equality, is enacted in the regulation and inspection of initial teacher education (ITE) in…

  4. Supporting diverse data providers in the open water data initiative: Communicating water data quality and fitness of use

    Science.gov (United States)

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

    2016-01-01

    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.

  5. Advanced Fuel Cycle Initiative University Fellowship Program. Final Progress Report

    International Nuclear Information System (INIS)

    Dixon, Cathy

    2012-01-01

    2004-2011 Final Report for AFCI University Fellowship Program. The goal of this effort was to be supportive of university students and university programs - particularly those students and programs that will help to strengthen the development of nuclear-related fields. The program also supported the stability of the nuclear infrastructure and developed research partnerships that are helping to enlarge the national nuclear science technology base. In this fellowship program, the U.S. Department of Energy sought master's degree students in nuclear, mechanical, or chemical engineering, engineering/applied physics, physics, chemistry, radiochemistry, or fields of science and engineering applicable to the AFCI/Gen IV/GNEP missions in order to meet future U.S. nuclear program needs. The fellowship program identified candidates and selected full time students of high-caliber who were taking nuclear courses as part of their degree programs. The DOE Academic Program Managers encouraged fellows to pursue summer internships at national laboratories and supported the students with appropriate information so that both the fellows and the nation's nuclear energy objectives were successful.

  6. Breckinridge Project, initial effort. Report VII, Volume II. Environmental baseline report

    Energy Technology Data Exchange (ETDEWEB)

    None

    1982-01-01

    Ashland Synthetic Fuels, Inc. (ASFI) and Airco Energy Company, Inc. (AECI) have recently formed the Breckinridge Project and are currently conducting a process and economic feasibility study of a commercial scale facility to produce synthetic liquid fuels from coal. The coal conversion process to be used is the H-COAL process, which is in the pilot plant testing stage under the auspices of the US Department of Energy at the H-COAL Pilot Plant Project near Catlettsburg, Kentucky. The preliminary plans for the commercial plant are for a 18,140 metric ton/day (24,000 ton/day) nominal coal assumption capacity utilizing the abundant high sulfur Western Kentucky coals. The Western Kentucky area offers a source of the coal along with adequate water, power, labor, transportation and other factors critical to the successful siting of a plant. Various studies by federal and state governments, as well as private industry, have reached similar conclusions regarding the suitability of such plant sites in western Kentucky. Of the many individual sites evaluated, a site in Breckinridge County, Kentucky, approximately 4 kilometers (2.5 miles) west of the town of Stephensport, has been identified as the plant location. Actions have been taken to obtain options to insure that this site will be available when needed. This report contains an overview of the regional setting and results of the baseline environmental studies. These studies include collection of data on ambient air and water quality, sound, aquatic and terrestrial biology and geology. This report contains the following chapters; introduction, review of significant findings, ambient air quality monitoring, sound, aquatic ecology, vegetation, wildlife, geology, soils, surface water, and ground water.

  7. Report on Survey of Industry Needs for Quality. Summary Report.

    Science.gov (United States)

    Neylon, Kevin; And Others

    The TAFE (Technical and Further Education) National Centre for Research and Development conducted a survey to determine industry needs for quality training in Australia. Interviews were conducted with managers in manufacturing and tourism/hospitality companies throughout Australia, especially with firms with a high reputation. Interview forms were…

  8. Initial report for magnetostratigraphy of IODP Site U1490

    Science.gov (United States)

    Kumagai, Y.; Hatfield, R. G.; Nakamura, N.; Yamazaki, T.

    2017-12-01

    We report preliminary paleomagnetic results from between 175-296 meters composite depth (Miocene in age) of IODP Site U1490 recovered during Expedition 363. Site U1490 is located at 05°48.95´N, 142°39.27´E (the northern edge of the Eauripik Rise in the equatorial Pacific) in 2341 m water depth. A primary objective of Expedition 363 was to reconstruct the regional climate variability within the Western Pacific Warm Pool (WPWP) in a broad spatial coverage and different temporal resolutions through the time interval from the middle Miocene to late Pleistocene. The recovered pelagic sediments contains calcareous and siliceous nannofossils with varying proportions of clay and ash. It is also characterized by current-controlled mud waves with gradually decreasing amplitude upsection (Rosenthal et al., 2017). Since deep water is enriched in dissolved oxygen due to downwelling in polar regions, the mud waves were probably formed in an oxic environment by bottom currents, hindering the dissolution of magnetic minerals in the sediments. Shipboard analysis revealed that magnetic minerals between 20-175 m composite depth at Site U1490 have been dissolved by diagenetic alteration and the paleomagnetic data is uninterpretable. But the upper 20 m and below 175 m have a stable magnetization that spans from present to early Pleistocene (0-1.9 Ma) and middle to late Miocene period ( 9-19 Ma), respectively. The latter is an exceptionally long-time range continuous core sample, so it provides us an opportunity to reveal long-range variations of paleomagnetic field. We will show stepwise alternate-field (AF) demagnetization of the natural remanent magnetization on U-channel samples from the composite stratigraphic section to establish magnetostratigraphy at this site.

  9. Ten years after the IOM report: Engaging residents in quality and patient safety by creating a House Staff Quality Council.

    Science.gov (United States)

    Fleischut, Peter M; Evans, Adam S; Nugent, William C; Faggiani, Susan L; Lazar, Eliot J; Liebowitz, Richard S; Forese, Laura L; Kerr, Gregory E

    2011-01-01

    Ten years after the 1999 Institute of Medicine report, it is clear that despite significant progress, much remains to be done to improve quality and patient safety (QPS). Recognizing the critical role of postgraduate trainees, an innovative approach was developed at New York-Presbyterian Hospital, Weill Cornell Medical Center to engage residents in QPS by creating a Housestaff Quality Council (HQC). HQC leaders and representatives from each clinical department communicate and partner regularly with hospital administration and other key departments to address interdisciplinary quality improvement (QI). In support of the mission to improve patient care and safety, QI initiatives included attaining greater than 90% compliance with medication reconciliation and reduction in the use of paper laboratory orders by more than 70%. A patient safety awareness campaign is expected to evolve into a transparent environment where house staff can openly discuss patient safety issues to improve the quality of care.

  10. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

    Science.gov (United States)

    Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul

    2016-02-01

    The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.

  11. Impact of initial surface parameters on the final quality of laser micro-polished surfaces

    Science.gov (United States)

    Chow, Michael; Bordatchev, Evgueni V.; Knopf, George K.

    2012-03-01

    Laser micro-polishing (LμP) is a new laser-based microfabrication technology for improving surface quality during a finishing operation and for producing parts and surfaces with near-optical surface quality. The LμP process uses low power laser energy to melt a thin layer of material on the previously machined surface. The polishing effect is achieved as the molten material in the laser-material interaction zone flows from the elevated regions to the local minimum due to surface tension. This flow of molten material then forms a thin ultra-smooth layer on the top surface. The LμP is a complex thermo-dynamic process where the melting, flow and redistribution of molten material is significantly influenced by a variety of process parameters related to the laser, the travel motions and the material. The goal of this study is to analyze the impact of initial surface parameters on the final surface quality. Ball-end micromilling was used for preparing initial surface of samples from H13 tool steel that were polished using a Q-switched Nd:YAG laser. The height and width of micromilled scallops (waviness) were identified as dominant parameter affecting the quality of the LμPed surface. By adjusting process parameters, the Ra value of a surface, having a waviness period of 33 μm and a peak-to-valley value of 5.9 μm, was reduced from 499 nm to 301 nm, improving the final surface quality by 39.7%.

  12. Does information matter? Competition, quality, and the impact of nursing home report cards.

    Science.gov (United States)

    Grabowski, David C; Town, Robert J

    2011-12-01

    We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. © Health Research and Educational Trust.

  13. Quality assurance in the treatment of colorectal cancer: the EURECCA initiative.

    Science.gov (United States)

    Breugom, A J; Boelens, P G; van den Broek, C B M; Cervantes, A; Van Cutsem, E; Schmoll, H J; Valentini, V; van de Velde, C J H

    2014-08-01

    Colorectal cancer is one of the most common cancers in Europe. Over the past few decades, important advances have been made in screening, staging and treatment of colorectal cancer. However, considerable variation between and within European countries remains, which implies that further improvements are possible. The most important remaining question now is: when are we, health care professionals, delivering the best available care to patients with colon or rectal cancer? Currently, quality assurance is a major issue in colorectal cancer care and quality assurance awareness is developing in almost all disciplines involved in the treatment of colorectal cancer patients. Quality assurance has shown to be effective in clinical trials. For example, standardisation and quality control were introduced in the Dutch TME trial and led to marked improvements of local control and survival in rectal cancer patients. Besides, audit structures can also be very effective in monitoring cancer management and national audits showed to further improve outcome in colorectal cancer patients. To reduce the differences between European countries, an international, multidisciplinary, outcome-based quality improvement programme, European Registration of Cancer Care (EURECCA), has been initiated. In the near future, the EURECCA dataset will perform research on subgroups as elderly patients or patients with comorbidities, which are often excluded from trials. For optimal colorectal cancer care, quality assurance in guideline formation and in multidisciplinary team management is also of great importance. The aim of this review was to create greater awareness and to give an overview of quality assurance in the management of colorectal cancer. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  14. A Report Card on Continuous Quality Improvement

    Science.gov (United States)

    Blumenthal, David; Kilo, Charles M.

    1998-01-01

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

  15. Quality assurance program. Braun topical report 21

    International Nuclear Information System (INIS)

    1975-01-01

    The Quality Assurance (QA) policies and procedures described have been developed specifically for use in commercial nuclear projects. These policies and procedures are intended to provide assurance to Braun Management and the client that the plant will be safe, reliable, and operable, plus meet the requirements of the Nuclear Regulatory Commission, NRC. The Braun QA Manual provides QA procedures for (1) engineering and design, (2) procurement of materials, equipment, and services, and (3) construction and installation. The controls for safety-related systems established in the manual cover all phases of work from project inception to plant completion prior to operation by the owner. The manual standardizes Braun QA control procedures. These procedures are supplemented by Project QA Instructions prepared for each project. (U.S.)

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

    Science.gov (United States)

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

    2014-06-01

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

  17. Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

    OpenAIRE

    Jarrar, Mu?taman; Rahman, Hamzah Abdul; Don, Mohammad Sobri

    2015-01-01

    Background and Objective: Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Design: Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patie...

  18. Quality of care in patients with psoriasis: an initial clinical study of an international disease management programme.

    Science.gov (United States)

    de Korte, J; Van Onselen, J; Kownacki, S; Sprangers, M A G; Bos, J D

    2005-01-01

    Patients with psoriasis have to cope with their disease for many years or even throughout their entire life. To provide optimal care, a disease management programme was developed. This programme consisted of disease education, disease management training, and psychological support, together with topical treatment. To test a disease management programme in dermatological practice, to assess patients' satisfaction with this programme, and adherence to topical treatment. Additionally, disease severity and quality of life were assessed. An initial clinical investigation was conducted in 10 European treatment centres. A total of 330 patients were included. Patient satisfaction, adherence, disease severity and quality of life were measured with study-specific and standardized self-report questionnaires. Patients reported a high degree of satisfaction with the programme, and a high degree of adherence to topical treatment. Disease severity and quality of life significantly improved. The programme was well received by the participating professionals. The disease management programme was found to be a useful tool in the management of psoriasis, providing patients with relief from the burden of psoriasis in everyday life. A full-scale evaluation is recommended.

  19. Effect of benchmarking projects on outcomes of coronary artery bypass graft surgery: challenges and prospects regarding the quality improvement initiative.

    Science.gov (United States)

    Miyata, Hiroaki; Motomura, Noboru; Murakami, Arata; Takamoto, Shinichi

    2012-06-01

    The Japan Cardiovascular Surgery Database (JCVSD) was established in 2000 and initiated a benchmarking project to improve the quality of cardiovascular surgery. Although the importance of quality improvement initiatives has been emphasized, few studies have reported the effects on outcomes. To examine the time-trend effects in initial JCVSD participants (n = 44), we identified 8224 isolated coronary artery bypass graft (CABG) procedures performed between 2004 and 2007. The impact of surgery year was examined using a multiple logistic regression model that set previously identified clinical risk factors and surgery year as fixed effects. To examine the difference in outcomes between initial participants (n = 44) and halfway participants (n = 55), we identified 3882 isolated CABG procedures performed in 2007. The differences between the 2 hospital groups were examined using a multiple logistic regression model that set clinical risk factors, hospital procedure volume, and hospital groups as fixed effects. For operative mortality, the odds ratio of surgery year was 0.88 (P = .083). Observed/expected (OE) ratios for operative mortality were 0.71 in 2004, 0.73 in 2005, 0.63 in 2006, and 0.54 in 2007. As for composite mortality and major morbidities (reoperation, stroke, dialysis, infection, and prolonged ventilation), odds ratio of surgery year was 0.97 (P = .361). OE ratios for composite mortality and morbidities were 1.01 in 2004, 1.04 in 2005, 1.04 in 2006, and 0.94 in 2007. Compared with halfway participants, initial participants had a significantly lower rate of operative mortality (odds ratio = 0.527; P = .008) and composite mortality and major morbidities (odds ratio 0.820; P = .047). This study demonstrated that a quality improvement initiative for cardiovascular surgery has positive impacts on risk-adjusted outcomes. Although the primary target of benchmarking was 30-day mortality in Japan, major morbidities were less affected by those activities. Copyright

  20. Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment.

    Directory of Open Access Journals (Sweden)

    Ann Green

    Full Text Available INTRODUCTION: To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses. METHODS: A before-after cross-sectional study was conducted on nurses completing the mentorship programme in Khayelitsha, South Africa, from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 self-assessment questionnaires was collected to determine the number of patients initiated on ART by nurses; quality of ART management before-after mentorship; patient characteristics for doctor and nurse ART initiations; and nurse self-assessments after mentorship. RESULTS: Twenty one nurses were authorized by one nurse mentor with one part-time medical officer's support, resulting in nurses initiating 77% of ART eligible patients. Improvements in ART management were found for drawing required bloods (91% vs 99%, p = 0.03, assessing adherence (50% vs 78%, p<0.001 and WHO staging (63% vs 91%, p<0.001. Nurse ART initiation indicators were successfully completed at 95-100% for 11 of 16 indicators: clinical presentation; patient weight; baseline blood work (CD4, creatinine, haemoglobin; STI screening; WHO stage, correlating medical history; medications prescribed appropriately; ART start date; and documented return date. Doctors initiated more patients with TB/HIV co-infection and WHO Stage 3 and 4 disease than nurses. Nurse confidence improved for managing HIV-infected children and pregnant women, blood result interpretation and long-term side effects. CONCLUSIONS: Implementation of a clinical mentorship programme in Khayelitsha led to nurse initiation of a

  1. Regulating and Quality-Assuring VET: International Developments. Research Report

    Science.gov (United States)

    Misko, Josie

    2015-01-01

    The opening-up of the market for education and training, including vocational education and training (VET), has increased the importance of regulation and quality assurance mechanisms in ensuring the integrity of qualifications. This report investigates approaches to the regulation and quality assurance of vocational education and training in a…

  2. Quality of pathology reports for advanced ovarian cancer

    DEFF Research Database (Denmark)

    Verleye, Leen; Ottevanger, Petronella B; Kristensen, Gunnar B

    2011-01-01

    To assess the quality of surgical pathology reports of advanced stage ovarian, fallopian tube and primary peritoneal cancer. This quality assurance project was performed within the EORTC-GCG 55971/NCIC-CTG OV13 study comparing primary debulking surgery followed by chemotherapy with neoadjuvant...

  3. Current Trends in European Quality Assurance. ENQA Workshop Report 8

    Science.gov (United States)

    Bozo, Dhurata; Damian, Radu; Gonzalez, Cecilia de la Rosa; Helle, Emmi; Imoda, Franco; Kohler, Alexander; Papazoglou, Vassilios J.; Dalmau, Gemma Rauret; Shopov, Todor

    2009-01-01

    The present report is a product of two ENQA (European Association for Quality Assurance in Higher Education) seminars, held in 2007, on current trends in European Quality Assurance. The first seminar, hosted by the Bulgarian National Evaluation and Accreditation Agency (NEAA), examined the situation in South-Eastern Europe. The second seminar…

  4. The Effect of Financial Reporting Quality on Financing and Investment

    Directory of Open Access Journals (Sweden)

    Windy Angela

    2017-03-01

    Full Text Available This paper analysis the effect of reporting quality on financing and investment. It is important for us to understand the relation among them in order to prepare Indonesian companies for ASEAN Economic Community in 2015. The study examines the effect of financial reporting quality on financing and investment of 15 Indonesian companies with large market capitalization based on the Standard and Poor’s Rating Services in its first survey of the major corporate credit trends in the Association of Southeast Asian Nations (ASEAN. Those companies may still be under-investing in relation to its regional peers. The results suggest that (1 financial reporting quality has negative effect on financing. (2 financial reporting quality has positive effect on investment among companies with higher likelihood of over-investing and negative effect on investment among those with higher likelihood of under-investing.DOI: 10.15408/etk.v16i1.4600 

  5. Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative.

    Science.gov (United States)

    Markel, David C; Allen, Mark W; Zappa, Nicole M

    2016-01-01

    Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks' (AABB) transfusion guidelines would result in decreased transfusions. (1) Can an established arthroplasty registry help implement a quality initiative (QI) designed to decrease the proportion of transfused postoperative patients undergoing TJA? (2) Do data-driven transfusion protocols decrease length of stay without increasing ischemic complications (myocardial infarctions and cerebrovascular accidents)? (3) Are decreased transfusion proportions associated with decreased readmissions, nonischemic morbidity (including deep vein thrombosis and deep prosthetic infection), and mortality in postoperative patients who had undergone TJA? After reviewing data from the recently established MARCQI registry, the orthopaedic department noticed many discrepancies and practice variances regarding blood transfusions among their providers. In October 2013, a QI was implemented to raise awareness of the discrepancies and education about the AABB guidelines was presented at the monthly orthopaedic service line meeting. A total of 1872 TJA cases were reviewed; 50 were excluded for incomplete data and two for intraoperative transfusions for the period before education (May 2012 to June 2013, n = 1240) and after education (November 2013 to April 2014, n = 580). Data

  6. Paediatric early warning scores on a children's ward: a quality improvement initiative.

    LENUS (Irish Health Repository)

    Ennis, Linda

    2014-09-09

    The aim of this quality improvement initiative was to incorporate a paediatric early warning score (PEWS) and track and trigger system in the routine care of children in an acute general children\\'s ward at a regional hospital in the Republic of Ireland. In the absence of a nationally recommended specific PEWS strategy, a local plan was developed. The experience of structuring and implementing the PEWS and track and trigger system is presented in this article. Data from the first year of use were collected to evaluate the clinical utility and effectiveness of this system. In the busy acute children\\'s service, the PEWS initiative was found to benefit processes of early detection, prompt referral and timely, appropriate management of children at potential risk of clinical deterioration. Nursing staff were empowered and supported to communicate concerns immediately and to seek rapid medical review, according to an agreed PEWS escalation plan. Outcomes were significantly improved.

  7. International Financial Reporting Standards Convergence and Quality of Accounting Information: Evidence from Indonesia

    OpenAIRE

    Yusrina, Hasyyati; Mukhtaruddin, Mukhtaruddin; Fuadah, Luk Luk; Sulong, Zunaidah

    2017-01-01

    The International Financial Reporting Standards (IFRS) initiated by International Accounting Standard Board (IASB) are principle-based standard that require extensive disclosure of financial statements and accounting information as compared to prior standard that is the Generally Accepted Accounting Principles (GAAP) to better reflect the overall quality of company’s performance. Therefore, the IFRS convergence is expected to improve the reliability of financial reporting by limiting opportun...

  8. Reducing hospital admissions of healthy children with functional constipation: a quality initiative.

    Science.gov (United States)

    Deneau, Mark; Mutyala, Ramakrishna; Sandweiss, David; Harnsberger, Janet; Varier, Raghu; Pohl, John F; Allen, Lauren; Thackeray, Callie; Zobell, Sarah; Maloney, Christopher

    2017-01-01

    Functional constipation (FC) is a common medical problem in children, with minimal risk of long-term complications. We determined that a large number of children were being admitted to our children's hospital for FC in which there was no neurological or anatomical cause. Our hospital experienced a patient complication in which a patient died after inpatient treatment of FC. Subsequently, we developed a standardised approach to determine when paediatric patients needed hospitalisation for FC, as well as to develop a regimented outpatient therapeutic approach for such children to prevent hospitalisation. Our quality improvement initiative resulted in a large decrease in the number of children with FC admitted into the hospital as well as a decrease in the number of children needing faecal disimpaction in the operating room. Our quality improvement process can be used to decrease hospitalisations, decrease healthcare costs and improve patient care for paediatric FC.

  9. Project Specific Quality Assurance Plan Project (QAPP) W-211 Initial Tank Retrieval Systems (ITRS)

    International Nuclear Information System (INIS)

    HALL, L.R.

    2000-01-01

    This Quality Assurance Program Plan (QAPP) provides information on how the Project Hanford Quality Assurance Program is implemented by CH2M HILL Hanford Group Inc (CHG) for managing the Initial Tank Retrieval Systems (ITRS), Project W-211. This QAPP is responsive to the CHG Quality Assurance Program Description (QAPD) (LMH-MP-599) which provides direction for compliance to 10 CFR 830 120, ''Nuclear Safety Management, Quality Assurance Requirements'', and DOE Order 5700 6C, ''Quality Assurance'' Project W-211 modifies existing facilities and provides systems for retrieval of radioactive wastes from selected double-shell tanks (DST). The contents of these tanks are a combination of supernatant liquids and settled solids. To retrieve waste from the tanks, it is first necessary to mix the liquid and solids prior to transferring the slurry to alternative storage or treatment facilities. The ITRS will provide systems to mobilize the settled solids and transfer the wastes out of the tanks. In so doing, ITRS provides feed for future processing plants, allows for consolidation of tank solids to manage space within existing DST storage capacity, and supports continued safe storage of tank waste. This project includes the design, procurement, construction, startup and turnover of these retrieval systems This QAPP identifies organizational structures and responsibilities. Implementing procedures used by CHG project management can be found in the CHG Quality Assurance Program (CHG QAP) Implementation Matrix located in HNF-IP-0842, Volume XI, Attachment Proposed verification and inspection activities for critical items within the scope of project W-211 are identified in Attachment 1 W-211. Project participants will identify the implementing procedures used by their organization within their QAF'Ps. This project specific QAPP is used to identify requirements in addition to the QAPD and provide, by reference, additional information to other project documents

  10. Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Wray Julie

    2011-11-01

    Full Text Available Abstract Background Despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods A Continuous Quality Improvement (CQI approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results Questionnaires were received from 68 (46% of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions This was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their

  11. IFRS Adoption and Financial Reporting Quality: Taiwan Experience

    OpenAIRE

    Ching-Chieh Lin; Chi-Yun Hua; Wen-Hsiang Lin; Wen-Chih Lee

    2012-01-01

    Taiwan’s financial accounting regulatory amendment directions shift the framework from the U.S. GAAP-based to International Financial Reporting Standards (IFRS)-based to accelerate the pace of progress towards convergence with IFRS. In the amendment process, the converge outcomes of earnings quality become an important and urgent issue. The purpose of this study is to investigate the converge impacts on reporting quality over 1999 to 2009, which divided into three timeframes: the U.S. GAAP-ba...

  12. The eighth NASA total quality management accomplishments report, 1990

    Science.gov (United States)

    1990-01-01

    The eighth annual accomplishments report provides numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. NASA's continuous improvement efforts can provide insight for others to succeed in their own endeavors. The report covers: top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

  13. Sandia National Laboratories, California Air Quality Program annual report.

    Energy Technology Data Exchange (ETDEWEB)

    Gardizi, Leslee P.; Smith, Richard (ERM, Walnut Creek, CA)

    2009-06-01

    The annual program report provides detailed information about all aspects of the SNL/CA Air Quality Program. It functions as supporting documentation to the SNL/CA Environmental Management System Program Manual. The program report describes the activities undertaken during the past year, and activities planned in future years to implement the Air Quality Program, one of six programs that supports environmental management at SNL/CA.

  14. Quality Oncology Practice Initiative Can Guide and Improve Oncology Providers’ Training in Brazil

    Directory of Open Access Journals (Sweden)

    Cristiane Decat Bergerot

    2017-06-01

    Full Text Available Purpose: It has become crucial to translate scientific findings and to find ways by which to mobilize local resources to improve the quality and accessibility of cancer care in developing countries. This study seeks to provide insight into challenge through examining differences in clinician documentation of patients with cancer treated at a Brazilian Public University Hospital. Methods: ASCO Quality Oncology Practice Initiative (QOPI measures were used to examine the care provided in the departments of breast, colorectal, lymphoma, gynecology, and lung cancers. For this study, data from a representative sample of patients receiving chemotherapy in the previous month were extracted and quality of cancer care indicators examined. Results: Certain elements of medical care were consistently and appropriately documented, including cancer diagnosis and stage, chemotherapy planning, administration, and summary. In general, considering the specific cancer management measures, patients received recommended care in accordance with recognized guidelines. Despite this, a number of important gaps in care were identified, including the assessment and treatment of pain, documentation of chemotherapy intention, symptom and toxicity management, patients’ psychosocial status, and provision of a treatment summary at care completion. Conclusion: These findings are encouraging in terms of adherence to core treatment guidelines in cancer care in Brazil. However, results suggest important opportunities for improving care across a number of domains, many of which represent a challenge throughout both developing and developed countries. This study may also provide preliminary guidance for enhancing educational and training programs for professionals and students alike, to implement high-quality, comprehensive cancer care.

  15. Improving Indicators in a Brazilian Hospital Through Quality-Improvement Programs Based on STS Database Reports

    Directory of Open Access Journals (Sweden)

    Pedro Gabriel Melo de Barros e Silva

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.

  16. Cooper-Harper Experience Report for Spacecraft Handling Qualities Applications

    Science.gov (United States)

    Bailey, Randall E.; Jackson, E. Bruce; Bilimoria, Karl D.; Mueller, Eric R.; Frost, Chad R.; Alderete, Thomas S.

    2009-01-01

    A synopsis of experience from the fixed-wing and rotary-wing aircraft communities in handling qualities development and the use of the Cooper-Harper pilot rating scale is presented as background for spacecraft handling qualities research, development, test, and evaluation (RDT&E). In addition, handling qualities experiences and lessons-learned from previous United States (US) spacecraft developments are reviewed. This report is intended to provide a central location for references, best practices, and lessons-learned to guide current and future spacecraft handling qualities RDT&E.

  17. The North Seas Countries' Offshore Grid Initiative. Initial Findings. Final Report. Working Group 1 - Grid Configuration

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-11-15

    This report focuses on the tasks and results from Working Group 1 (WG1), grid configuration and integration, chaired jointly by representatives from Denmark and the Netherlands. The methodology, assumptions concerning generation portfolio, load situation, available technology and results are presented. This report presents the WG1 Offshore Grid Study that supports the North Seas Countries' Offshore Grid Initiative (NSCOGI) final report. The information contained in this report aims to evaluate the long-term development of an offshore grid structure in the North Seas by providing a view on how such a grid may possibly develop in the future, based on the assumptions made for this study. The report aims to compare and evaluate the possible advantages and disadvantages of the long term development of an optimised, integrated (or meshed) offshore grid in the North Seas by providing a view of how that possible grid might develop in the future against changes to the electricity energy requirements. To evaluate basic variants, different transmission design topologies (radial and meshed) were compared and analysed with respect to various aspects, such as cost/benefits, import and export levels and the systems' CO2 emissions.

  18. Initial contents of residue quality parameters predict effects of larger soil fauna on decomposition of contrasting quality residues

    Directory of Open Access Journals (Sweden)

    Ratikorn Sanghaw

    2017-10-01

    Full Text Available A 52-week decomposition study employing the soil larger fauna exclusion technique through litter bags of two mesh sizes (20 and 0.135 mm was conducted in a long-term (18 yr field experiment. Organic residues of contrasting quality of N, lignin (L, polyphenols (PP and cellulose (CL all in grams per kilogram: rice straw (RS: 4.5N, 22.2L, 3.9PP, 449CL, groundnut stover (GN: 21.2N, 71.4L, 8.1PP, 361CL, dipterocarp leaf litter (DP: 5.1N, 303L, 68.9PP, 271CL and tamarind leaf litter (TM: 11.6N, 190L, 27.7PP, 212CL were applied to soil annually to assess and predict soil larger fauna effects (LFE on decomposition based on the initial contents of the residue chemical constituents. Mass losses in all residues were not different under soil fauna inclusion and exclusion treatments during the early stage (up to week 4 after residue incorporation but became significantly higher under the inclusion than the exclusion treatments during the later stage (week 8 onwards. LFE were highest (2–51% under the resistant DP at most decomposition stages. During the early stage (weeks 1–4, both the initial contents of labile (N and CL and recalcitrant C, and recalcitrant C interaction with labile constituents of residues showed significant correlations (r = 0.64–0.90 with LFE. In the middle stage (week 16, LFE under resistant DP and TM had significant positive correlations with L, L + PP and L/CL. They were also affected by these quality parameters as shown by the multiple regression analysis. In the later stages (weeks 26–52, the L/CL ratio was the most prominent quality parameter affecting LFE. Keywords: Mesofauna and macrofauna, Microorganisms, Recalcitrant and labile compounds, Residue chemical composition, Tropical sandy soil

  19. Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery.

    Science.gov (United States)

    Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric

    2018-02-01

    Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

  20. Quality Improvement in Pediatric Endoscopy: A Clinical Report From the NASPGHAN Endoscopy Committee.

    Science.gov (United States)

    Kramer, Robert E; Walsh, Catharine M; Lerner, Diana G; Fishman, Douglas S

    2017-07-01

    The current era of healthcare reform emphasizes the provision of effective, safe, equitable, high-quality, and cost-effective care. Within the realm of gastrointestinal endoscopy in adults, renewed efforts are in place to accurately define and measure quality indicators across the spectrum of endoscopic care. In pediatrics, however, this movement has been less-defined and lacks much of the evidence-base that supports these initiatives in adult care. A need, therefore, exists to help define quality metrics tailored to pediatric practice and provide a toolbox for the development of robust quality improvement (QI) programs within pediatric endoscopy units. Use of uniform standards of quality reporting across centers will ensure that data can be compared and compiled on an international level to help guide QI initiatives and inform patients and their caregivers of the true risks and benefits of endoscopy. This report is intended to provide pediatric gastroenterologists with a framework for the development and implementation of endoscopy QI programs within their own centers, based on available evidence and expert opinion from the members of the NASPGHAN Endoscopy Committee. This clinical report will require expansion as further research pertaining to endoscopic quality in pediatrics is published.

  1. The probable effect of integrated reporting on audit quality

    Directory of Open Access Journals (Sweden)

    Tamer A. El Nashar

    2016-06-01

    Full Text Available This paper examines a probable effect of integrated reporting on improving the audit quality of organizations. I correlate the hypothesis of this paper in relation to the current trends of protecting the economies, the financial markets and the societies. I predict an improvement of the audit quality, as a result to an estimated percentage of organizations’ reliance on the integrated reporting in their accountability perspective. I used a decision tree and a Bayes’ theorem approach, to predict the probabilities of the significant effect on improving the auditing quality. I find the overall result of this paper, indicates that the probability of organizations to rely on the integrated reporting by a significant percentage, predicts also a significant improvement in audit quality.

  2. A Novel Quality Measure and Correction Procedure for the Annotation of Microbial Translation Initiation Sites.

    Directory of Open Access Journals (Sweden)

    Lex Overmars

    Full Text Available The identification of translation initiation sites (TISs constitutes an important aspect of sequence-based genome analysis. An erroneous TIS annotation can impair the identification of regulatory elements and N-terminal signal peptides, and also may flaw the determination of descent, for any particular gene. We have formulated a reference-free method to score the TIS annotation quality. The method is based on a comparison of the observed and expected distribution of all TISs in a particular genome given prior gene-calling. We have assessed the TIS annotations for all available NCBI RefSeq microbial genomes and found that approximately 87% is of appropriate quality, whereas 13% needs substantial improvement. We have analyzed a number of factors that could affect TIS annotation quality such as GC-content, taxonomy, the fraction of genes with a Shine-Dalgarno sequence and the year of publication. The analysis showed that only the first factor has a clear effect. We have then formulated a straightforward Principle Component Analysis-based TIS identification strategy to self-organize and score potential TISs. The strategy is independent of reference data and a priori calculations. A representative set of 277 genomes was subjected to the analysis and we found a clear increase in TIS annotation quality for the genomes with a low quality score. The PCA-based annotation was also compared with annotation with the current tool of reference, Prodigal. The comparison for the model genome of Escherichia coli K12 showed that both methods supplement each other and that prediction agreement can be used as an indicator of a correct TIS annotation. Importantly, the data suggest that the addition of a PCA-based strategy to a Prodigal prediction can be used to 'flag' TIS annotations for re-evaluation and in addition can be used to evaluate a given annotation in case a Prodigal annotation is lacking.

  3. Report: Quality Control Review of EPA OIG Reports Issued in Fiscal Year 2015

    Science.gov (United States)

    Report #16-N-0223, July 18, 2016. OIG reports issued in FY 2015 demonstrated high levels of compliance with OIG quality assurance procedures, and received average compliance scores of 90 percent or greater.

  4. Integrative Report on a culture-sensitive quality & curriculum framework

    NARCIS (Netherlands)

    Sylva, Kathy; Ereky-Stevens, Katharina; Pastori, Giulia; Slot, P.L.; Lerkkanen, Marja-Kristiina

    This report draws together research findings that support a comprehensive culture-sensitive European curriculum and quality assessment framework that can inform practice, teacher education and policy. The aim of this integrative report is to inform the development of a comprehensive,

  5. DANIDA; Air Quality Monitoring Programme. Mission 3 Report

    Energy Technology Data Exchange (ETDEWEB)

    Sivertsen, B.; Marsteen, L.

    1996-12-31

    In the development of the Environmental Information and Monitoring Programme for the Arab Republic of Egypt (EIMP), NILU is responsible for the establishment of an air pollution monitoring system. This report summarizes the third mission to Egypt and includes meetings and site visit reports. Air quality sites in Alexandria are described and comments are given to earlier selected sites in Cairo

  6. Deep Vadose Zone–Applied Field Research Initiative Fiscal Year 2012 Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    Wellman, Dawn M.; Truex, Michael J.; Johnson, Timothy C.; Bunn, Amoret L.; Golovich, Elizabeth C.

    2013-03-14

    This annual report describes the background of the Deep Vadose Zone-Applied Field Research Initiative, and some of the programmatic approaches and transformational technologies in groundwater and deep vadose zone remediation developed during fiscal year 2012.

  7. 76 FR 82311 - Food and Drug Administration Transparency Initiative: Food and Drug Administration Report on Good...

    Science.gov (United States)

    2011-12-30

    ...] Food and Drug Administration Transparency Initiative: Food and Drug Administration Report on Good Guidance Practices: Improving Efficiency and Transparency; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice of availability; request for comments. SUMMARY: As part of the Transparency...

  8. Scientific symposium on the North Sea quality status report 1993

    International Nuclear Information System (INIS)

    Andersen, J.; Karup, H.; Nielsen, U.B.

    1996-01-01

    The Scientific Symposium on the 1993 North Sea quality Status Report took place in Ebeltoft, Denmark from 18 to 21 April 1994. The aim was to bring together scientists, researchers and administrators from governments, industries and environmental organizations from the countries around the North Sea in order to review new information which may supplements the 1993 North Sea Quality Status Report and to discuss the Quality Status Report and its possible implications. The 1993 North Sea Quality Status Report has been prepared by the North Sea Task force as a comprehensive statement of circulation patterns, inputs and dispersion of contaminants, ecological conditions and effects of human activities in the North Sea including the Skagerrak and the Kattegat. The programme of the Scientific Symposium on the 1993 North Sea Quality Status Report included 8 sessions for oral presentations, a poster session presenting the North Sea Task Force subregional reports and a poster session presenting individual posters. The headings of the sessions were as follows: Oceanography, Models and Remote Sensing; Ecosystem Structure; Contaminants -Distribution and Effects; Nutrients and Eutrophication Problems; Effects of Fishery; Habitats and Species; Management Implications; Conclusions and Recommendations. The proceedings includes a total of 45 contributed papers. (EG)

  9. Initial Steps for Quality Improvement of Obesity Care Across Divisions at a Tertiary Care Pediatric Hospital

    Directory of Open Access Journals (Sweden)

    Sheila Z. Chang

    2014-09-01

    Full Text Available Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity.

  10. Quality Improvement Initiative to Increase the Use of Nasogastric Hydration in Infants With Bronchiolitis.

    Science.gov (United States)

    Srinivasan, Mythili; Pruitt, Cassandra; Casey, Erin; Dhaliwal, Keerat; DeSanto, Cori; Markus, Richard; Rosen, Ayelet

    2017-08-01

    Intravenous (IV) hydration is used primarily in children with bronchiolitis at our institution. Because nasogastric (NG) hydration can provide better nutrition, the goal of our quality improvement (QI) initiative was to increase the rate of NG hydration in eligible children 1 to 23 months old with bronchiolitis by 20% over 6 months. We used Plan-Do-Study-Act cycles to increase the use of NG hydration in eligible children. Interventions included educational and system-based changes and sharing parental feedback with providers. Chart reviews were performed to identify the rates of NG hydration, which were plotted over time in a statistical process control p chart. The balancing measure was the rate of complications in children with NG versus IV hydration. Two hundred and ninety-three children who were hospitalized with bronchiolitis needed supplemental hydration during the QI initiative (January 2016-April 2016). Ninety-one children were candidates for NG hydration, and 53 (58%) received NG hydration. The rates of NG hydration increased from a baseline of 0% pre-QI bronchiolitis season (January 2015-April 2015) to 58% during the initiative. There was no aspiration and no accidental placement of the NG tube into a child's airway. Nine patients (17%) in the NG group had a progression of disease requiring nil per os status, and 6 of these were transferred to the PICU whereas none of those in the IV group were transferred to the PICU. Post-QI initiative, the majority of nurses (63%) and physicians (95%) stated that they are more likely to consider NG hydration in children with bronchiolitis. We successfully increased the rates of NG hydration in eligible children with bronchiolitis by using educational and system-based interventions. Copyright © 2017 by the American Academy of Pediatrics.

  11. A Strategic Approach for Funding Research: The Agency for Healthcare Research and Quality's Patient Safety Initiative 2000-2004

    National Research Council Canada - National Science Library

    Keyes, Margaret A; Ortiz, Eduardo; Queenan, Deborah; Hughes, Ronda; Chesley, Francis; Hogan, Eileen M

    2005-01-01

    .... While the Agency for Healthcare Research and Quality (AHRQ) has historically funded some research on patient safety, much of that support was driven by a small number of highquality investigator-initiated research projects...

  12. Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative

    Directory of Open Access Journals (Sweden)

    B Myers

    2017-02-01

    Full Text Available Background. A performance measurement system – the Service Quality Measures (SQM initiative – has been developed to monitor the quality of South Africa (SA’s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation. Objective. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers. Methods. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system. Results. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63. In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df=3.70, p=0.015, awareness (r=0.78, p<0.0001, leadership support (r=0.70, p<0.0001, resources (r=0.65, p<0.0001, openness to change (r=0.372, p=0.001, and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE 0.08, t=4.4, p<0.0001 and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001 were significantly associated with readiness to adopt this system. Conclusion. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation.

  13. SU-E-T-191: PITSTOP: Process Improvement Techniques, Software Tools, and Operating Principles for a Quality Initiative Discovery Framework.

    Science.gov (United States)

    Siochi, R

    2012-06-01

    To develop a quality initiative discovery framework using process improvement techniques, software tools and operating principles. Process deviations are entered into a radiotherapy incident reporting database. Supervisors use an in-house Event Analysis System (EASy) to discuss incidents with staff. Major incidents are analyzed with an in-house Fault Tree Analysis (FTA). A meta-Analysis is performed using association, text mining, key word clustering, and differential frequency analysis. A key operating principle encourages the creation of forcing functions via rapid application development. 504 events have been logged this past year. The results for the key word analysis indicate that the root cause for the top ranked key words was miscommunication. This was also the root cause found from association analysis, where 24% of the time that an event involved a physician it also involved a nurse. Differential frequency analysis revealed that sharp peaks at week 27 were followed by 3 major incidents, two of which were dose related. The peak was largely due to the front desk which caused distractions in other areas. The analysis led to many PI projects but there is still a major systematic issue with the use of forms. The solution we identified is to implement Smart Forms to perform error checking and interlocking. Our first initiative replaced our daily QA checklist with a form that uses custom validation routines, preventing therapists from proceeding with treatments until out of tolerance conditions are corrected. PITSTOP has increased the number of quality initiatives in our department, and we have discovered or confirmed common underlying causes of a variety of seemingly unrelated errors. It has motivated the replacement of all forms with smart forms. © 2012 American Association of Physicists in Medicine.

  14. Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative.

    Science.gov (United States)

    Myers, B; Petersen Williams, P; Johnson, K; Govender, R; Manderscheid, R; Koch, J R

    2017-01-30

    A performance measurement system - the Service Quality Measures (SQM) initiative - has been developed to monitor the quality of South Africa (SA)'s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63). In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df)=3.70), p=0.015), awareness (r=0.78, p<0.0001), leadership support (r=0.70, p<0.0001), resources (r=0.65, p<0.0001), openness to change (r=0.372, p=0.001), and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE) 0.08, t=4.4, p<0.0001) and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001) were significantly associated with readiness to adopt this system. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation.

  15. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

    Science.gov (United States)

    Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

    Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

  16. Stepping up Information Infrastructures and Statistical Reporting: Monitoring the German Excellence Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Reinhold, A.

    2016-07-01

    The Excellence Initiative has not only been the most prominent funding scheme in German research policy in recent years, but has also had important side effects on research management. This paper argues that the Excellence Initiative was indeed a “boost” for improving the data infrastructure and statistical reporting of the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation). The learning effects are now transferred to the line business and serve as a good starting point for the reporting on a potential third phase of the Excellence Initiative. (Author)

  17. Evolving Role of the Power Sector Regulator: A Clean Energy Regulators Initiative Report

    Energy Technology Data Exchange (ETDEWEB)

    Zinaman, O.; Miller, M.; Bazilian, M.

    2014-04-01

    This paper seeks to briefly characterize the evolving role of power sector regulation. Given current global dynamics, regulation of the power sector is undergoing dramatic changes. This transformation is being driven by various factors including technological advances and cost reductions in renewable energy, energy efficiency, and demand management; increasing air pollution and climate change concerns; and persistent pressure for ensuring sustainable economic development and increased access to energy services by the poor. These issues add to the already complex task of power sector regulation, of which the fundamental remit remains to objectively and transparently ensure least-cost service delivery at high quality. While no single regulatory task is trivial to undertake, it is the prioritization and harmonization of a multitude of objectives that exemplifies the essential challenge of power sector regulation. Evolving regulatory roles can be understood through the concept of existing objectives and an additional layer of emerging objectives. Following this categorization, we describe seven existing objectives of power sector regulators and nine emerging objectives, highlighting key challenges and outlining interdependencies. This essay serves as a preliminary installment in the Clean Energy Regulatory Initiative (CERI) series, and aims to lay the groundwork for subsequent reports and case studies that will explore these topics in more depth.

  18. Final Scientific/Technical Report Solar America Initiative: Solar Outreach and Communications

    Energy Technology Data Exchange (ETDEWEB)

    Weissman, Jane M

    2011-09-10

    The purpose of the Solar America Initiative: Solar Outreach and Communications grant was to promote better communications among stakeholders; address infrastructure barriers to solar energy; and coordinate with industry, the U.S. Department of Energy, national laboratories, states, cities and counties. The Interstate Renewable Energy Council (IREC), a non-profit organization formed in 1982, approached this grant project by establishing a wide range of communication and outreach activities including newsletters, workshops, webinars, model practices and publications; by advancing easy and fair hook-up rules to the utility grid; and by upgrading training based on industry competency standards. The Connecting to the Grid project and the Solar Codes and Standards Public Hearings project offered communication coupled with technical assistance to overcome interconnection, net metering and other regulatory and program barriers. The Workforce Development Project tackled building a strong workforce through quality training and competency assessment programs. IREC's web site, the semi-monthly state and stakeholder newsletter and the metrics report resulted in better communications among stakeholders. Workshops and phone seminars offered technical assistance and kept stakeholders up-to-date on key issues. All of these activities resulted in implementing sustainable solutions to institutional and market barriers to solar energy and getting the right information to the right people.

  19. Application of QC_DR software for acceptance testing and routine quality control of direct digital radiography systems: initial experiences using the Italian Association of Physicist in Medicine quality control protocol.

    Science.gov (United States)

    Nitrosi, Andrea; Bertolini, Marco; Borasi, Giovanni; Botti, Andrea; Barani, Adriana; Rivetti, Stefano; Pierotti, Luisa

    2009-12-01

    Ideally, medical x-ray imaging systems should be designed to deliver maximum image quality at an acceptable radiation risk to the patient. Quality assurance procedures are employed to ensure that these standards are maintained. A quality control protocol for direct digital radiography (DDR) systems is described and discussed. Software to automatically process and analyze the required images was developed. In this paper, the initial results obtained on equipment of different DDR manufacturers were reported. The protocol was developed to highlight even small discrepancies in standard operating performance.

  20. QUALITY IMPROVEMENT INITIATIVES FOR SUPPORT FUNCTIONS IN AN INDUSTRY: TWO CASES

    Directory of Open Access Journals (Sweden)

    Shirshendu Roy

    2011-09-01

    Full Text Available The concept of quality improvement in industry has originated from the involvement of inspector which has become the most important part of manufacturing process or development activity. Over years, this initiative is migrated to various support functions of the industry. In this paper, emphasis has been given particularly in the areas related to support functions where improvement project s can be effectively done and hence organization wide impact is assessed. Two case studies are presented here in this context. The first study shows how smaller change in content structure and delivery met hod can drastically improve the training feedback and the second one demonstrates minimizing lead time to recruitment with a cost-effective process modification.

  1. DETERMINANT FACTORS OF FINANCIAL REPORTING QUALITY AND ECONOMIC CONSEQUENCES

    Directory of Open Access Journals (Sweden)

    Zaenal Fanani

    2017-03-01

    Full Text Available The aim of this research was to prove empirically the determining factors that influence the quality of financialreporting and the economic consequences, and there were influence differences of quality attributes of financialreporting to the economic consequences. The research samples were taken by purposive sampling so it obtained141 listed manufacturing businesses from 2001 to 2006. The research used four data analysis technique:auxiliary regression R2, confirmatory factor analysis, simple regression, and multiple regressions. The resultsshowed seven attributes, there were five attributes that gave contribution for financial reporting quality namelyaccrual quality, predictability, smoothness, relevance value, and conservatism while the persistence and timelinessgave small contribution. The five attributes were also different each other. From the thirteen determiningfactors, it showed nine factors that produced significant influences namely operation cycle, sales volatility,firm size, firm age, loss proportion, leverage, environmental risk, institutional ownership, market concentration,and auditor quality, while the other three, they were liquidity, managerial ownership, and investmentgrowth that were not significant. Testing results of economic consequences of quality of financial reportingshowed that the quality of factorial financial reporting influenced negatively and significantly toward informationasymmetry.

  2. A quality assurance initiative for commercial-scale production in high-throughput cryopreservation of blue catfish sperm.

    Science.gov (United States)

    Hu, E; Liao, T W; Tiersch, T R

    2013-10-01

    Cryopreservation of fish sperm has been studied for decades at a laboratory (research) scale. However, high-throughput cryopreservation of fish sperm has recently been developed to enable industrial-scale production. This study treated blue catfish (Ictalurus furcatus) sperm high-throughput cryopreservation as a manufacturing production line and initiated quality assurance plan development. The main objectives were to identify: (1) the main production quality characteristics; (2) the process features for quality assurance; (3) the internal quality characteristics and their specification designs; (4) the quality control and process capability evaluation methods, and (5) the directions for further improvements and applications. The essential product quality characteristics were identified as fertility-related characteristics. Specification design which established the tolerance levels according to demand and process constraints was performed based on these quality characteristics. Meanwhile, to ensure integrity throughout the process, internal quality characteristics (characteristics at each quality control point within process) that could affect fertility-related quality characteristics were defined with specifications. Due to the process feature of 100% inspection (quality inspection of every fish), a specific calculation method, use of cumulative sum (CUSUM) control charts, was applied to monitor each quality characteristic. An index of overall process evaluation, process capacity, was analyzed based on in-control process and the designed specifications, which further integrates the quality assurance plan. With the established quality assurance plan, the process could operate stably and quality of products would be reliable. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. 75 FR 82397 - Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults

    Science.gov (United States)

    2010-12-30

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary [CMS-2420-NC] Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults AGENCY: Office of the Secretary... quality measures recommended for Medicaid-eligible adults, as required by section 2701 of the Affordable...

  4. Pipelines of Progress: An Update on the Glass Ceiling Initiative. A Status Report.

    Science.gov (United States)

    Department of Labor, Washington, DC.

    The "glass ceiling" refers to those barriers that have prevented the advancement of women and minorities into the top levels of executive management in major U.S. corporations. In 1991, the U.S. Department of Labor released a report describing the Glass Ceiling Initiative. This document reports on what occurred in the year following the…

  5. Highly Adoptable Improvement: A Practical Model and Toolkit to Address Adoptability and Sustainability of Quality Improvement Initiatives.

    Science.gov (United States)

    Hayes, Christopher William; Goldmann, Don

    2018-03-01

    Failure to consider the impact of change on health care providers is a barrier to success. Initiatives that increase workload and have low perceived value are less likely to be adopted. A practical model and supporting tools were developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches. Models and theories from the diffusion of innovation and work stress literature were reviewed, and key-informant interviews and site visits were conducted to develop a draft Highly Adoptable Improvement (HAI) Model. A list of candidate factors considered for inclusion in the draft model was presented to an expert panel. A modified Delphi process was used to narrow the list of factors into main themes and refine the model. The resulting model and supporting tools were pilot tested by 16 improvement advisors for face validity and usability. The HAI Model depicts how workload and perceived value influence adoptability of QI initiatives. The supporting tools include an assessment guide and suggested actions that QI programs can use to help design interventions that are likely to be adopted. Improvement advisors reported good face validity and usability and found that the model and the supporting tools helped address key issues related to adoption and reported that they would continue to use them. The HAI Model addresses important issues regarding workload and perceived value of improvement initiatives. Pilot testing suggests that the model and supporting tools are helpful and practical in guiding design and implementation of adoptable and sustainable QI interventions. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  6. A frequency-domain approach to improve ANNs generalization quality via proper initialization.

    Science.gov (United States)

    Chaari, Majdi; Fekih, Afef; Seibi, Abdennour C; Hmida, Jalel Ben

    2018-08-01

    The ability to train a network without memorizing the input/output data, thereby allowing a good predictive performance when applied to unseen data, is paramount in ANN applications. In this paper, we propose a frequency-domain approach to evaluate the network initialization in terms of quality of training, i.e., generalization capabilities. As an alternative to the conventional time-domain methods, the proposed approach eliminates the approximate nature of network validation using an excess of unseen data. The benefits of the proposed approach are demonstrated using two numerical examples, where two trained networks performed similarly on the training and the validation data sets, yet they revealed a significant difference in prediction accuracy when tested using a different data set. This observation is of utmost importance in modeling applications requiring a high degree of accuracy. The efficiency of the proposed approach is further demonstrated on a real-world problem, where unlike other initialization methods, a more conclusive assessment of generalization is achieved. On the practical front, subtle methodological and implementational facets are addressed to ensure reproducibility and pinpoint the limitations of the proposed approach. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Sleep quality among relatively younger patients with initial diagnosis of hypertension: dippers versus non-dippers.

    Science.gov (United States)

    Yilmaz, Mehmet Birhan; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Ahmet; Yucel, Oguzhan; Bektasoglu, Gokhan; Tandogan, Izzet

    2007-01-01

    Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure (BP) and heart rate. Those, who do not have expected decrease in their BP are considered "non-dippers". We aimed to determine if there was any association between the non-dipping status and sleep quality, designed a cross-sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. Seventy-five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti-hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. There were 42 non-dipper patients (mean age = 47.5+/-11.9 years, 24 male/18 female), as a definition, 31 dipper hypertensive patients (mean age = 48.5+/-12.8 years, 21 male/10 female) and two with white coat hypertension. Daytime systolic and diastolic mean BPs were not significantly different between the two groups. Night-time mean systolic and diastolic BPs were significantly higher in non-dippers compared with dippers. PSQI scores, globally, were significantly higher in non-dippers compared with dippers. Total PSQI score was not correlated with body mass index. It was noticed that, individually, sleep quality, sleep efficiency and sleep disturbance scores were significantly higher in non-dippers. Being a poor sleeper in terms of high PSQI score (total score>5) was associated with 2.955-fold increased risk of being a non-dipper (95% confidence interval 1.127-7.747). We showed that the risk of having non-dipping hypertension, a risk factor for poor cardiovascular outcomes among hypertensive individuals, was tripled (odds ratios) among poor sleepers. We think that

  8. Quality of narrative operative reports in pancreatic surgery.

    Science.gov (United States)

    Wiebe, Meagan E; Sandhu, Lakhbir; Takata, Julie L; Kennedy, Erin D; Baxter, Nancy N; Gagliardi, Anna R; Urbach, David R; Wei, Alice C

    2013-10-01

    Quality in health care can be evaluated using quality indicators (QIs). Elements contained in the surgical operative report are potential sources for QI data, but little is known about the completeness of the narrative operative report (NR). We evaluated the completeness of the NR for patients undergoing a pancreaticoduodenectomy. We reviewed NRs for patients undergoing a pancreaticoduodenectomy over a 1-year period. We extracted 79 variables related to patient and narrator characteristics, process of care measures, surgical technique and oncology-related outcomes by document analysis. Data were coded and evaluated for completeness. We analyzed 74 NRs. The median number of variables reported was 43.5 (range 13-54). Variables related to surgical technique were most complete. Process of care and oncology-related variables were often omitted. Completeness of the NR was associated with longer operative duration. The NRs were often incomplete and of poor quality. Important elements, including process of care and oncology-related data, were frequently missing. Thus, the NR is an inadequate data source for QI. Development and use of alternative reporting methods, including standardized synoptic operative reports, should be encouraged to improve documentation of care and serve as a measure of quality of surgical care.

  9. Marijuana Use and Self-reported Quality of Eyesight.

    Science.gov (United States)

    Akano, Obinna F

    2017-05-01

    There is increasing use of marijuana among young adults and more states in the United States are legalizing medical marijuana use. A number of studies have revealed both the beneficial and harmful effects of marijuana to the human system. Despite some beneficial effects, studies have shown marijuana to have a lot of deleterious effects on the visual system, which subsequently reduces the quality of eyesight. The aim of this study was to investigate if heavy marijuana smoking is associated with a poor quality of eyesight compared with light/no use of marijuana. The National Longitudinal Survey of Youths (NLSY79), a nationally representative sample of 12,686 young men and women surveyed in 1979 to 2010 was used for this study. The quality of eyesight of 1304 heavy marijuana users was compared with 1304 respondents with light or no marijuana use. The t test, multivariate and weighted logistic regression were used in the data analysis. There was no statistically significant difference in the self-reported quality of eyesight among heavy marijuana smokers compared with youths who never used marijuana or are light marijuana users. Among heavy marijuana smokers, males and high school graduates have decreased odds of reporting a poor quality of eyesight, whereas blacks have increased odds of reporting a poor quality of eyesight. The self-reported quality of eyesight among marijuana users can aid clinicians and other health practitioners facilitate the development of sex-, racial/ethnic-, and educational level-informed prevention and early intervention programs and also help characterize public opinions regarding cannabis, which are particularly relevant given the ongoing debate concerning the medicalization and legalization of cannabis in the United States.

  10. U.S. Geological Survey Science for the Wyoming Landscape Conservation Initiative-2010 Annual Report

    Science.gov (United States)

    Bowen, Zachary H.; Aldridge, Cameron L.; Anderson, Patrick J.; Assal, Timothy J.; Biewick, Laura; Blecker, Steven W.; Boughton, Gregory K.; Bristol, R. Sky; Carr, Natasha B.; Chalfoun, Anna D.; Chong, Geneva W.; Clark, Melanie L.; Diffendorfer, Jay E.; Fedy, Bradley C.; Foster, Katharine; Garman, Steven L.; Germaine, Stephen S.; Holloway, JoAnn; Homer, Collin G.; Kauffman, Matthew J.; Keinath, Douglas; Latysh, Natalie; Manier, Daniel J.; McDougal, Robert R.; Melcher, Cynthia P.; Miller, Kirk A.; Montag, Jessica; Potter, Christopher J.; Schell, Spencer; Shafer, Sarah L.; Smith, David B.; Stillings, Lisa L.; Tuttle, Michele L.W.; Wilson, Anna B.

    2011-01-01

    This is the third report produced by the U.S. Geological Survey (USGS) for the Wyoming Landscape Conservation Initiative (WLCI) to detail annual work activities. The first report described activities for 2007 and 2008, and the second report covered work activities for FY09. This third report covers work activities conducted in FY2010, and it continues the 2009 approach of reporting on all the individual activities to help give WLCI partners and other readers the full scope of what has been accomplished. New in this year's report is an additional section for each work activity that outlines the work planned for the following fiscal year. In FY2010, there were 35 ongoing/expanded, completed, or new projects conducted under the five major multi-disciplinary science and technical-assistance activities: (1) Baseline Synthesis; (2) Targeted Monitoring and Research; (3) Data and Information Management; (4) Integration and Coordination; and (5) Decisionmaking and Evaluation. The three new work activities were to (1) compile existing water data for the entire WLCI region and (2) develop regional curves (statistical models) for relating bankfull-channel geometry and discharge to drainages in the WLCI region, both of which will help guide long-term monitoring of water resources; and (3) initiate a groundwater-monitoring network to evaluate potential effects of energy-development activities on groundwater quality where groundwater is an important source of public/private water supplies. Results of the FY2009 work to develop methods for assessing soil organic matter and mercury indicated that selenium and arsenic levels may be elevated in the Muddy Creek Basin; thus, the focus of that activity was shifted in FY2010 to evaluate biogeochemical cycling of elements in the basin. In FY2010, two ongoing activities were expanded with the addition of more sampling plots: (a) the study of how greater sage-grouse (Centrocercus urophasianus) use vegetation-treatment areas (sites added to

  11. Evaluating the police service quality for handling traffic crash reporting

    DEFF Research Database (Denmark)

    Janstrup, Kira Hyldekær; Kaplan, Sigal; Barfod, Michael Bruhn

    2017-01-01

    Purpose The phenomenon of traffic crash under-reporting has been extensively documented in terms of its extent, but not equally analysed in terms of its reasons. As police distrust has been recently identified as a major reason for crash under-reporting, the purpose of this paper is to look...... at the police service quality for handling the reporting of traffic crashes. Design/methodology/approach This study introduces a novel approach to evaluate service quality that combines multi-criteria decision analysis (MCDA) with latent class analysis (LCA). Moreover, this study presents the design of a web......-based survey on the basis of the SERVQUAL approach to detecting strengths, opportunities and threats with crash reporting to the police at a strategic level. Transportation stakeholders (e.g. researchers, authorities, consultants, NGO representatives, suppliers) with an interest in traffic safety in Denmark...

  12. Captive rearing initiative for Salmon River chinook salmon; Report period: January 1998-January 1999; Annual report

    International Nuclear Information System (INIS)

    Hassemer, Peter; Kline, Paul; Heindel, Jeff; Plaster, Kurtis

    1999-01-01

    The IDFG initiated a captive rearing program for populations at high risk of extinction to maintain metapopulation structure. Captive rearing is a short-term approach to species preservation. The main goal of the captive rearing approach is to avoid demographic and environmental risks of cohort extinction; maintaining the genetic identity of the breeding unit is an important but secondary objective

  13. Association of initial CT findings with quality-of-life outcomes for traumatic brain injury in children

    Energy Technology Data Exchange (ETDEWEB)

    Swanson, Jonathan O. [Seattle Children' s Hospital and University of Washington, Department of Radiology, Seattle, WA (United States); Vavilala, Monica S.; Wang, Jin; Rivara, Frederick P. [Harborview Medical Center, University of Washington, Department of Pediatrics, Seattle, WA (United States); Pruthi, Sumit [Monroe Carell Jr. Children' s Hospital at Vanderbilt University, Department of Radiology, Nashville, TN (United States); Fink, James [University of Washington, Department of Radiology, Seattle, WA (United States); Jaffe, Kenneth M. [University of Washington, Department of Rehabilitation Medicine, Seattle, WA (United States); Durbin, Dennis [University of Pennsylvania, Department of Pediatrics, Center for Injury Research and Prevention, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Koepsell, Thomas [University of Washington, Department of Epidemiology, Seattle, WA (United States); Temkin, Nancy [University of Washington, Biostatistics, Seattle, WA (United States)

    2012-08-15

    Traumatic brain injury (TBI) is a leading cause of acquired disability in children and adolescents. To demonstrate the association between specific findings on initial noncontrast head CT and long-term outcomes in children who have suffered TBI. This was an IRB-approved prospective study of children ages 2-17 years treated in emergency departments for TBI and who underwent a head CT as part of the initial work-up (n = 347). The change in quality of life at 12 months after injury was measured by the PedsQL scale. Children with TBI who had intracranial injuries identified on the initial head CT had a significantly lower quality-of-life scores compared to children with TBI whose initial head CTs were normal. In multivariate analysis, children whose initial head CT scans demonstrated intraventricular hemorrhage, parenchymal injury, midline shift {>=}5 mm, hemorrhagic shear injury, abnormal cisterns or subdural hematomas {>=}3 mm had lower quality of life scores 1 year after injury than children whose initial CTs did not have these same injuries. Associations exist between findings from the initial noncontrast head CT and quality of life score 12 months after injury in children with TBI. (orig.)

  14. DANIDA; Air Quality Monitoring Programme. Mission 4 Report

    Energy Technology Data Exchange (ETDEWEB)

    Sivertsen, B.

    1997-12-31

    In the development of the Environmental Information and Monitoring Programme for the Arab Republic of Egypt (EIMP), NILU is responsible for the establishment of an air pollution monitoring system. This report summarizes the fourth mission to Egypt, including planning of the second phase meetings and site visits. Additional air quality sites in Cairo have been described. A project group meeting and a visit to Egypt Meteorological Service have been reported

  15. Technical progress report. Private sector initiatives between the United States and Japan. January 1989 - December 1989; ANNUAL

    International Nuclear Information System (INIS)

    1990-01-01

    This annual report for calendar year 1989 describes the efforts performed under the Private Sector Initiatives contract. The report also describes those efforts that have continued with private funding after being initiated under this contract

  16. Technical progress report. Private sector initiatives between the United States and Japan. January 1991 - December 1991; ANNUAL

    International Nuclear Information System (INIS)

    1993-01-01

    This annual report for calendar year 1991 describes the efforts performed under the Private Sector Initiatives contract. The report also describes those efforts that have continued with private funding after being initiated under this contract

  17. Report of AAPM TG 135: quality assurance for robotic radiosurgery.

    Science.gov (United States)

    Dieterich, Sonja; Cavedon, Carlo; Chuang, Cynthia F; Cohen, Alan B; Garrett, Jeffrey A; Lee, Charles L; Lowenstein, Jessica R; d'Souza, Maximian F; Taylor, David D; Wu, Xiaodong; Yu, Cheng

    2011-06-01

    The task group (TG) for quality assurance for robotic radiosurgery was formed by the American Association of Physicists in Medicine's Science Council under the direction of the Radiation Therapy Committee and the Quality Assurance (QA) Subcommittee. The task group (TG-135) had three main charges: (1) To make recommendations on a code of practice for Robotic Radiosurgery QA; (2) To make recommendations on quality assurance and dosimetric verification techniques, especially in regard to real-time respiratory motion tracking software; (3) To make recommendations on issues which require further research and development. This report provides a general functional overview of the only clinically implemented robotic radiosurgery device, the CyberKnife. This report includes sections on device components and their individual component QA recommendations, followed by a section on the QA requirements for integrated systems. Examples of checklists for daily, monthly, annual, and upgrade QA are given as guidance for medical physicists. Areas in which QA procedures are still under development are discussed.

  18. Evaluating the police service quality for handling traffic crash reporting

    DEFF Research Database (Denmark)

    Janstrup, Kira Hyldekær; Kaplan, Sigal; Barfod, Michael Bruhn

    2017-01-01

    at the police service quality for handling the reporting of traffic crashes. Design/methodology/approach This study introduces a novel approach to evaluate service quality that combines multi-criteria decision analysis (MCDA) with latent class analysis (LCA). Moreover, this study presents the design of a web....../value This study advances the knowledge about police service quality with a novel expert-based decision support tool based on SERVQUAL, MCDA and LCA, demonstrates its applicability in countries with a high-police service, and opportunities and barriers for increasing the crash reporting rate....... participated in the survey that yielded 86 complete responses. Findings The novel approach was successfully applied and its implementation demonstrated the usefulness of the tool even in countries with a high police service. Results showed that the participating stakeholders perceived human factors as more...

  19. Report. no. 20. Sensory evaluation of indoor air quality

    DEFF Research Database (Denmark)

    Berglund, Birgitta; Bluyssen, Philomena; Clausen, Geo

    Human subjects are indispensable in the measurement of perceived indoor air quality. Chemical and physical methods of characterisation often are insensitive to odorous and sensory irritating air pollutants, or do not take account of combinations of singular pollutants in a biologically meaningful...... way. Therefore, sensory methods many times are the only or the preferred tool for evaluation of perceived indoor air quality. This report presents background to and advice on methodologies for sensory evaluation of perceived indoor air quality. It proposes methods which apply to source assessments...... as well as field investigations. The methods will assist in labelling of building materials, characterising air quality in indoor spaces, controlling ventilation performance, and measuring occupant responses in questionnaire field studies of the sick building syndrome. The proposed methods will enable...

  20. White Sands Missile Range 2011 Drinking Water Quality Report

    Science.gov (United States)

    2012-01-01

    acerca de su agua potable . Haga que alguien lo traduzca para usted, o hable con alguien que lo entienda. Main Post White Sands Missile Range 2011...standards. What is This Water Quality Report? Este informe contiene informacion importante acerca de su agua potable . Haga que alguien lo traduzca

  1. National Water Quality Inventory, 1976 Report to Congress.

    Science.gov (United States)

    Environmental Protection Agency, Washington, DC. Office of Water Programs.

    This report summarizes the state submissions and provides a national overview of water quality as required in Section 305(b) of the 1972 Federal Water Pollution Control Act Amendments (P.L. 92-500). Topics receiving the greatest coverage include toxic substances, quantitative assessments of the percentage of waters currently meeting the goals of…

  2. Water quality report of Nordrhein-Westfalen 1991

    International Nuclear Information System (INIS)

    Kirchner, W.; Holbeck, I.; Vogt, K.

    1992-10-01

    The water quality in Nordrhein-Westfalen improved in 1991. The report, compiled in cooperation with the 8 state Authorities for Water and Waste Management and the Land Authority for the Fishing Industry, shows that water purification measures are successful, and that the technical standard of surface water monitoring in Nordrhein-Westfalen is remarkably high. (orig.) [de

  3. Assessment report for Hanford analytical services quality assurance plan

    International Nuclear Information System (INIS)

    Taylor, L.H.

    1994-11-01

    This report documents the assessment results of DOE/RL-94-55, Hanford Analytical Services Quality Assurance Plan. The assessment was conducted using the Requirement and Self-Assessment Database (RSAD), which contains mandatory and nonmandatory DOE Order statements for the relevant DOE orders

  4. Improving Reports Turnaround Time: An Essential Healthcare Quality Dimension.

    Science.gov (United States)

    Khan, Mustafa; Khalid, Parwaiz; Al-Said, Youssef; Cupler, Edward; Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Turnaround time is one of the most important healthcare performance indicators. King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia worked on reducing the reports turnaround time of the neurophysiology lab from more than two weeks to only five working days for 90% of cases. The main quality improvement methodology used was the FOCUS PDCA. Using root cause analysis, Pareto analysis and qualitative survey methods, the main factors contributing to the delay of turnaround time and the suggested improvement strategies were identified and implemented, through restructuring transcriptionists daily tasks, rescheduling physicians time and alerting for new reports, engaging consultants, consistent coordination and prioritizing critical reports. After implementation; 92% of reports are verified within 5 days compared to only 6% before implementation. 7% of reports were verified in 5 days to 2 weeks and only 1% of reports needed more than 2 weeks compared to 76% before implementation.

  5. Quality Improvement Initiative on Pain Knowledge, Assessment, and Documentation Skills of Pediatric Nurses.

    Science.gov (United States)

    Margonary, Heather; Hannan, Margaret S; Schlenk, Elizabeth A

    2017-01-01

    Pain treatment begins with a nurse’s assessment, which relies on effective assessment skills. Hospital settings have implemented pain assessment education, but there is limited evidence in pediatric transitional care settings. The purpose of this quality improvement (QI) initiative was to develop, implement, and evaluate an evidence-based pain education session with 20 nurses in a pediatric specialty hospital that provides transitional care. Specific aims were to assess nurses’ knowledge and attitudes of pain, and evaluate assessment skills based on nurses’ documentation. A prospective pre-post design with three assessments (baseline, post-intervention, and one-month follow-up) was used. The Shriner’s Pediatric Nurses’ Knowledge and Attitudes Regarding Pain questionnaire and an electronic health record review were completed at each assessment. There was significant improvement in nurses’ knowledge and attitudes of pain after the education session (F[2,6] = 50.281, p nurses significantly increased from 43.1% at baseline to 64.8% at post-intervention, and 67.7% at follow-up (χ²[2] = 20.55, p Nursing interventions for pain increased significantly, from 33.3% at baseline to 84.0% at post-intervention, and stabilized at 80.0% at follow-up (χ²[2] = 8.91, p = 0.012). Frequency of pain reassessments did not show a statistically significant change, decreasing from 77.8% at baseline to 44.0% at post-intervention and 40.0% at follow-up (χ²[2]= 3.538, p = 0.171). Nurses’ pain knowledge and documentation of assessment skills were improved in this QI initiative.

  6. On the effectiveness of private transnational governance regimes - evaluating corporate sustainability reporting according to the Global Reporting Initiative

    OpenAIRE

    Barkemeyer, Ralf; Preuss, Lutz; Lee, Lindsay

    2015-01-01

    The increasing involvement of multinational enterprises (MNEs) in global governance has been both applauded for its potential to make governance more effective and criticized for lacking democratic legitimization. Hence we investigate the effectiveness of one transnational governance regime, corporate sustainability reporting according to the Global Reporting Initiative (GRI). We found that the GRI has been successful in terms of output effectiveness by promoting the dissemination of sustaina...

  7. Criteria for evaluating programme theory diagrams in quality improvement initiatives: a structured method for appraisal.

    Science.gov (United States)

    Issen, Laurel; Woodcock, Thomas; McNicholas, Christopher; Lennox, Laura; Reed, Julie E

    2018-04-09

    Despite criticisms that many quality improvement (QI) initiatives fail due to incomplete programme theory, there is no defined way to evaluate how programme theory has been articulated. The objective of this research was to develop, and assess the usability and reliability of scoring criteria to evaluate programme theory diagrams. Criteria development was informed by published literature and QI experts. Inter-rater reliability was tested between two evaluators. About 63 programme theory diagrams (42 driver diagrams and 21 action-effect diagrams) were reviewed to establish whether the criteria could support comparative analysis of different approaches to constructing diagrams. Components of the scoring criteria include: assessment of overall aim, logical overview, clarity of components, cause-effect relationships, evidence and measurement. Independent reviewers had 78% inter-rater reliability. Scoring enabled direct comparison of different approaches to developing programme theory; action-effect diagrams were found to have had a statistically significant but moderate improvement in programme theory quality over driver diagrams; no significant differences were observed based on the setting in which driver diagrams were developed. The scoring criteria summarise the necessary components of programme theory that are thought to contribute to successful QI projects. The viability of the scoring criteria for practical application was demonstrated. Future uses include assessment of individual programme theory diagrams and comparison of different approaches (e.g. methodological, teaching or other QI support) to produce programme theory. The criteria can be used as a tool to guide the production of better programme theory diagrams, and also highlights where additional support for QI teams could be needed.

  8. Impact of peer review audit on occupational health report quality.

    Science.gov (United States)

    Lalloo, D; Demou, E; Macdonald, E B

    2015-08-01

    In a previous report, we described the implementation of a formal process for peer review of occupational health (OH) reports and a method of assessment of the outcomes of this process. The initial audit identified that 27% of OH reports required modifications. To assess formally, following implementation of this process, if changes in practice had occurred, i.e. whether fewer deficiencies were being identified in reports. We repeated a prospective internal audit of all peer reviewed OH reports between September and November 2011. We used an abbreviated assessment form, based on questions 4-8 and 10-12 of the modified SAIL (Sheffield Assessment Instrument for Letters), with four possible outcomes: no action, no changes made to report following discussion with author, changes made without discussion with author and changes made following discussion with author. One hundred seventy-three reports by 10 clinicians were audited. The audit identified a 13% reduction in OH reports requiring modifications (from 27 to 14%) compared with the previous cycle. Where modifications were required, 8% of these were related to minor typographical, spelling and grammar errors and 6% were for more complex reasons. Implementation of this process also produced a reduction in clinical complaints about OH reports from customers, from three in the preceding year to none 2 years later. Peer review improved the standard of OH reports and was associated with a reduction in customer complaints about reports. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

  9. Metro Vancouver air quality management plan : progress report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-10-15

    The Greater Vancouver Regional District (GVRD) developed an air quality management plan (AQMP) in 2005 as a means of addressing air quality issues in the region. The plan required progress reports every 2 years as well as a comprehensive review every 5 years. The AQMP established goals to minimize risk to public health from air pollution, improve visibility, and minimize the region's contributions to global climatic change by reducing emissions; implementing local air quality management programs; and enhancing air quality information and public awareness. The AQMP also included a sustainability framework for GVRD's policies and regulations related to regional growth, service delivery and political leadership. Regional strategies for solid waste and liquid waste management were developed in 2008. The sustainability framework has developed 3 priority goals: (1) to reduce diesel particulates by 75 per cent from Metro Vancouver corporate sources by 2012, (2) to be carbon neutral by 2012 excluding solid waste operations, and (3) to reduce regional GHGs by 15 per cent by 2015, and 33 per cent by 2020. Progress updates on regional planning efforts for the AQMP were presented. The report also outlined trends and performance measures used by the GVRD, and discussed changes in air quality issues and priorities that have occurred since the AQMP was adopted in 2005. 1 tab., 8 figs.

  10. Metro Vancouver air quality management plan : progress report

    International Nuclear Information System (INIS)

    2008-10-01

    The Greater Vancouver Regional District (GVRD) developed an air quality management plan (AQMP) in 2005 as a means of addressing air quality issues in the region. The plan required progress reports every 2 years as well as a comprehensive review every 5 years. The AQMP established goals to minimize risk to public health from air pollution, improve visibility, and minimize the region's contributions to global climatic change by reducing emissions; implementing local air quality management programs; and enhancing air quality information and public awareness. The AQMP also included a sustainability framework for GVRD's policies and regulations related to regional growth, service delivery and political leadership. Regional strategies for solid waste and liquid waste management were developed in 2008. The sustainability framework has developed 3 priority goals: (1) to reduce diesel particulates by 75 per cent from Metro Vancouver corporate sources by 2012, (2) to be carbon neutral by 2012 excluding solid waste operations, and (3) to reduce regional GHGs by 15 per cent by 2015, and 33 per cent by 2020. Progress updates on regional planning efforts for the AQMP were presented. The report also outlined trends and performance measures used by the GVRD, and discussed changes in air quality issues and priorities that have occurred since the AQMP was adopted in 2005. 1 tab., 8 figs

  11. Reduction of hyperthermia in pediatric patients with severe traumatic brain injury: a quality improvement initiative.

    Science.gov (United States)

    Lovett, Marlina E; Moore-Clingenpeel, Melissa; Ayad, Onsy; O'Brien, Nicole

    2018-02-01

    OBJECTIVE Severe traumatic brain injury remains a leading cause of morbidity and mortality in the pediatric population. Providers focus on reducing secondary brain injury by avoiding hypoxemia, avoiding hypotension, providing normoventilation, treating intracranial hypertension, and reducing cerebral metabolic demand. Hyperthermia is frequently present in patients with severe traumatic brain injury, contributes to cerebral metabolic demand, and is associated with prolonged hospital admission as well as impaired neurological outcome. The objective of this quality improvement initiative was to reduce the duration of hyperthermia for pediatric patients with severe traumatic brain injury during the initial 72 hours of admission to the pediatric intensive care unit. METHODS A retrospective chart review was performed to evaluate the incidence and duration of hyperthermia within a preintervention cohort. The retrospective phase was followed by three 6-month intervention periods (intervention Phase 1, the maintenance phase, and intervention Phase 2). Intervention Phase 1 entailed placement of a cooling blanket on the bed prior to patient arrival and turning it on once the patient's temperature rose above normothermia. The maintenance phase focused on sustaining the results of Phase 1. Intervention Phase 2 focused on total prevention of hyperthermia by initiating cooling blanket use immediately upon patient arrival to the intensive care unit. RESULTS The median hyperthermia duration in the preintervention cohort (n = 47) was 135 minutes. This was reduced in the Phase 1 cohort (n = 9) to 45 minutes, increased in the maintenance phase cohort (n = 6) to 88.5 minutes, and decreased again in the Phase 2 cohort (n = 9) to a median value of 0 minutes. Eight percent of patients in the intervention cohorts required additional sedation to tolerate the cooling blanket. Eight percent of patients in the intervention cohorts became briefly hypothermic while on the cooling blanket. No

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

    Directory of Open Access Journals (Sweden)

    John H. Burton

    2016-05-01

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

  13. Audit Committee Quality and Financial Reporting Quality: A Study of Selected Indian Companies

    Directory of Open Access Journals (Sweden)

    Kanukuntla Shankaraiah

    2017-03-01

    Full Text Available This study examines audit committee quality and its relationship with financial reporting quality. The population of this study consists of the companies listed in Bombay Stock Exchange (BSE between years 2002 and 2012. Using Godden sample size formula, 133 companies are selected randomly for the study. It is found that in most of the equity based listed companies at BSE under study have complied with the legal formalities, for instance, appointment of independent directors, number of meetings, size of the audit committee, legal qualifications and financial qualifications of the directors, as they were required for the listing at a stock exchange in India. Further, the analysis and tests state that board size, audit committee meetings and its size have relationship with the financial reporting practices, but the CEO tenure and hold, board independence, net income, proportion of independent directors on board, legal qualifications and financial qualifications of the directors and overlap of audit committee members on compensation committee, have no influence on the financial reporting practices. Thus, it may be inferred that the companies may improve the financial reporting quality, by managing the board size, audit committee meetings and size, as these characteristics have significant relationship with financial reporting quality.

  14. Application of quality-improvement methods in a community practice: the Sandhills Pediatrics Asthma Initiative.

    Science.gov (United States)

    Wroth, Thomas H; Boals, Joseph C

    2005-01-01

    leadership and support. The leaders of the practice saw beyond the usual metrics of patient visit counts and relative value units (RVUs) to embrace the concept of population health: the notion that practices are not only responsible for providing acute, episodic care in the office, but also for improving health outcomes in the community in which they serve. Other important factors included ensuring a basic agreement among providers on the need for improvement and frequent communication about the goals of the project. Although the champions of the project tried to minimize formal meeting time, there was frequent informal communication between team members. In the future, there is a need to develop other approaches to stimulate these endeavors in community practices, such as "pay for performance" programs, continuing education credit, and tying maintenance of board certification to quality improvement initiatives.

  15. A quality assessment of randomized controlled trial reports in endodontics.

    Science.gov (United States)

    Lucena, C; Souza, E M; Voinea, G C; Pulgar, R; Valderrama, M J; De-Deus, G

    2017-03-01

    To assess the quality of the randomized clinical trial (RCT) reports published in Endodontics between 1997 and 2012. Retrieval of RCTs in Endodontics was based on a search of the Thomson Reuters Web of Science (WoS) database (March 2013). Quality evaluation was performed using a checklist based on the Jadad criteria, CONSORT (Consolidated Standards of Reporting Trials) statement and SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials). Descriptive statistics were used for frequency distribution of data. Student's t-test and Welch test were used to identify the influence of certain trial characteristics upon report quality (α = 0.05). A total of 89 RCTs were evaluated, and several methodological flaws were found: only 45% had random sequence generation at low risk of bias, 75% did not provide information on allocation concealment, and 19% were nonblinded designs. Regarding statistics, only 55% of the RCTs performed adequate sample size estimations, only 16% presented confidence intervals, and 25% did not provide the exact P-value. Also, 2% of the articles used no statistical tests, and in 87% of the RCTs, the information provided was insufficient to determine whether the statistical methodology applied was appropriate or not. Significantly higher scores were observed for multicentre trials (P = 0.023), RCTs signed by more than 5 authors (P = 0.03), articles belonging to journals ranked above the JCR median (P = 0.03), and articles complying with the CONSORT guidelines (P = 0.000). The quality of RCT reports in key areas for internal validity of the study was poor. Several measures, such as compliance with the CONSORT guidelines, are important in order to raise the quality of RCTs in Endodontics. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  16. Using a web-based image quality assurance reporting system to improve image quality.

    Science.gov (United States)

    Czuczman, Gregory J; Pomerantz, Stuart R; Alkasab, Tarik K; Huang, Ambrose J

    2013-08-01

    The purpose of this study is to show the impact of a web-based image quality assurance reporting system on the rates of three common image quality errors at our institution. A web-based image quality assurance reporting system was developed and used beginning in April 2009. Image quality endpoints were assessed immediately before deployment (period 1), approximately 18 months after deployment of a prototype reporting system (period 2), and approximately 12 months after deployment of a subsequent upgraded department-wide reporting system (period 3). A total of 3067 axillary shoulder radiographs were reviewed for correct orientation, 355 shoulder CT scans were reviewed for correct reformatting of coronal and sagittal images, and 346 sacral MRI scans were reviewed for correct acquisition plane of axial images. Error rates for each review period were calculated and compared using the Fisher exact test. Error rates of axillary shoulder radiograph orientation were 35.9%, 7.2%, and 10.0%, respectively, for the three review periods. The decrease in error rate between periods 1 and 2 was statistically significant (p < 0.0001). Error rates of shoulder CT reformats were 9.8%, 2.7%, and 5.8%, respectively, for the three review periods. The decrease in error rate between periods 1 and 2 was statistically significant (p = 0.03). Error rates for sacral MRI axial sequences were 96.5%, 32.5%, and 3.4%, respectively, for the three review periods. The decrease in error rates between periods 1 and 2 and between periods 2 and 3 was statistically significant (p < 0.0001). A web-based system for reporting image quality errors may be effective for improving image quality.

  17. Feasibility and efficacy of sepsis management guidelines in a pediatric intensive care unit in Saudi Arabia: a quality improvement initiative.

    Science.gov (United States)

    Hasan, Gamal M; Al-Eyadhy, Ayman A; Temsah, Mohamed-Hani A; Al-Haboob, Ali A; Alkhateeb, Mohammad A; Al-Sohime, Fahad

    2018-04-25

    Evaluation of feasibility and effectiveness of Surviving Sepsis Campaign (SSC) Guidelines implementation at a Pediatric Intensive Care Unit (PICU) in Saudi Arabia to reduce severe sepsis associated mortality. Retrospective data analysis for a prospective quality improvement (QI) initiative. PICU at King Saud University Medical City, Saudi Arabia. Children ≤14 years of age admitted to the PICU from July 2010 to March 2011 with suspected or proven sepsis. Comparisons were made to a previously admitted group of patients with sepsis from October 2009 to June 2010. Adaptation and implementation of the Surviving Sepsis Campaign-Clinical Practice Guidelines (SSC-CPGs) through AGREE instrument and ADAPTE process. We reported pre- and post-implementation outcome of interest for this QI initiative, annual sepsis-related mortality rate. Furthermore, we reported follow-up of annual mortality rate until December 2016. Sixty-five patients was included in the study (42 in post-guidelines implementation group and 23 in pre-guidelines implementation group). Mortality was insignificantly lower in the post-implementation group (26.2% vs. 47.8%; P = 0.079). However, when adjusted for severity, identified by number of failing organs in the multivariate regression analysis, the mortality difference was favorable for the post-implementation group (P = 0.006). The lower sepsis-related mortality rate was also sustained, with an average mortality rate of 15.11% for the subsequent years (2012-16). Adaptation and implementation of SSC Guidelines in our setting support its feasibility and potential benefits. However, a larger study is recommended to explore detailed compliance rates.

  18. Effects of the Biofuels Initiative on Water Quality and Quantity in the Mississippi Alluvial Plain

    Science.gov (United States)

    Welch, H. L.; Green, C. T.; Coupe, R. H.

    2010-12-01

    In the search for renewable fuel alternatives, biofuels have gained strong political momentum. In the last decade, extensive mandates, policies, and subsidies have been adopted to foster the development of a biofuels industry in the United States. The manifestation of the Biofuels Initiative in the Mississippi Delta was a 47-percent decrease in cotton acreage with a concurrent 288 percent increase in corn acreage in 2007. Because corn uses 80 percent more water for irrigation than cotton, and more nitrogen fertilizer is recommended for corn cultivation, this crop type change has implications for water quantity and quality in the Delta. Increased water use for corn is accelerating water-level declines in the Mississippi River Valley alluvial aquifer at a time when conservation is being encouraged due to concerns about sustainability. A mathematical model calibrated to existing conditions in the Delta shows that increased fertilizer applications on corn will increase the extent of nitrate movement into the alluvial aquifer. Estimates based on surface-water modeling results indicate that higher application rates of nitrogen from increased corn production increases the amount of nitrogen exported from the Yazoo River basin to the Gulf of Mexico by about 7 percent; increasing the Delta’s contribution to hypoxic conditions in the Gulf of Mexico.

  19. Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.

    Science.gov (United States)

    Afsar-Manesh, Nasim; Lonowski, Sarah; Namavar, Aram A

    2017-12-01

    UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05). To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Impact of Educational Activities in Reducing Pre-Analytical Laboratory Errors: A quality initiative.

    Science.gov (United States)

    Al-Ghaithi, Hamed; Pathare, Anil; Al-Mamari, Sahimah; Villacrucis, Rodrigo; Fawaz, Naglaa; Alkindi, Salam

    2017-08-01

    Pre-analytic errors during diagnostic laboratory investigations can lead to increased patient morbidity and mortality. This study aimed to ascertain the effect of educational nursing activities on the incidence of pre-analytical errors resulting in non-conforming blood samples. This study was conducted between January 2008 and December 2015. All specimens received at the Haematology Laboratory of the Sultan Qaboos University Hospital, Muscat, Oman, during this period were prospectively collected and analysed. Similar data from 2007 were collected retrospectively and used as a baseline for comparison. Non-conforming samples were defined as either clotted samples, haemolysed samples, use of the wrong anticoagulant, insufficient quantities of blood collected, incorrect/lack of labelling on a sample or lack of delivery of a sample in spite of a sample request. From 2008 onwards, multiple educational training activities directed at the hospital nursing staff and nursing students primarily responsible for blood collection were implemented on a regular basis. After initiating corrective measures in 2008, a progressive reduction in the percentage of non-conforming samples was observed from 2009 onwards. Despite a 127.84% increase in the total number of specimens received, there was a significant reduction in non-conforming samples from 0.29% in 2007 to 0.07% in 2015, resulting in an improvement of 75.86% ( P educational activities directed primarily towards hospital nursing staff had a positive impact on the quality of laboratory specimens by significantly reducing pre-analytical errors.

  1. Development and initial validation of prescribing quality indicators for patients with chronic kidney disease

    NARCIS (Netherlands)

    Smits, Kirsten P J; Sidorenkov, Grigory; Bilo, Henk J G; Bouma, Margriet; van Ittersum, Frans J; Voorham, Jaco; Navis, Gerjan; Denig, Petra

    2016-01-01

    BACKGROUND: Quality assessment is a key element for improving the quality of care. Currently, a comprehensive indicator set for measuring the quality of medication treatment in patients with chronic kidney disease (CKD) is lacking. Our aim was to develop and validate a set of prescribing quality

  2. RQ-21A Blackjack Small Tactical Unmanned Aircraft System (STUAS): Initial Operational Test and Evaluation Report

    Science.gov (United States)

    2015-06-29

    Evaluation Report June 2015 This report on the RQ-21A Blackjack Small Tactical Unmanned Aircraft System fulfills the provisions of Title 10...suitability of the RQ-21A Blackjack Small Tactical Unmanned Aircraft System (STUAS) during Initial Operational Test and Evaluation (IOT&E). The Navy’s...66.9 percent). The average service life of the propulsion modules was 48.9 hours, which does not meet the manufacturer’s stated 100-hour

  3. DOE-HUD Initiative on Energy Efficiency in Housing: A federal partnership. Program summary report

    Energy Technology Data Exchange (ETDEWEB)

    Brinch, J. [Energetics, Inc., Columbia, MD (United States)

    1996-06-01

    One of the primary goals of the US Department of Housing and urban Development (HUD) is the expansion of home ownership and affordable housing opportunities. Recognizing that energy efficiency is a key component in an affordable housing strategy, HUD and the US Department of Energy (DOE) created the DOE-HUD Initiative on Energy Efficiency in Housing. The DOE-HUD Initiative was designed to share the results of DOE research with housing providers throughout the nation, to reduce energy costs in federally-subsidized dwelling units and improve their affordability and comfort. This Program Summary Report provides an overview of the DOE-HUD Initiative and detailed project descriptions of the twenty-seven projects carried out with Initiative funding.

  4. Nível de disclosure nos relatórios de sustentabilidade em conformidade com o Global Reporting Initiative (GRI = Level of disclosure in sustainability reports in compliance with Global Reporting Initiative (GRI

    Directory of Open Access Journals (Sweden)

    Daniela Di Domenico

    2017-12-01

    Full Text Available O objetivo do artigo é analisar o nível de disclosure nos relatórios de sustentabilidade em conformidade com o Global Reporting Initiative (GRI nas empresas listadas na BM&FBovespa. Nesse sentido, realizou-se pesquisa descritiva com procedimentos de coleta documental e abordagem quantitativa. A amostra analisada ficou composta por 93 empresas listadas na BM&FBovespa, que divulgaram o relatório de sustentabilidade no ano de 2014 em conformidade com o modelo GRI. Os resultados mostram que à medida em que há maior complexidade nas informações, que compreendem os grupos de indicadores apresentados nos relatórios de sustentabilidade, reduz o nível de evidenciação pelas empresas. Com relação ao nível de evidenciação, percebe-se que o maior grupo de empresas se concentra com baixa evidenciação. Representa cerca de 30% das empresas analisadas, atendendo até 50 itens dos 150 que o relatório propõe. Quanto ao setor econômico, utilidade pública apresentou maior nível de evidenciação nos relatórios de sustentabilidade em conformidade com o modelo GRI. Conclui-se que, embora tenha havido aumento na divulgação dos relatórios de sustentabilidade, as empresas ainda carecem de adaptação para atender aos indicadores do GRI, melhorando a qualidade dos relatórios divulgados e elevando a transparência aos diversos públicos de interesse. The objective of the study is to analyze the level of disclosure in the sustainability reports in compliance with the Global Reporting Initiative (GRI in the companies listed on the BM&FBovespa. In this sense, a descriptive research was carried out with procedures of documentary collection and quantitative approach. The sample analyzed was composed of 93 companies listed on the BM&FBovespa, which published the sustainability report in 2014 in compliance with the GRI model. The results show that to the extent that there is more complexity in the information that comprises the groups of indicators

  5. Exploring Outcomes and Initial Self-Report of Client Motivation in a College Counseling Center

    Science.gov (United States)

    Ilagan, Guy; Vinson, Michael L.; Sharp, Julia L.; Ilagan, Jill; Oberman, Aaron

    2015-01-01

    Objective: To explore the association between college counseling center clients' initial self-report of motivation and counseling outcome. Participants: The sample was composed of 331 student clients who utilized a college counseling center from August 2007 to August 2009. The college is a public, mid-size, urban university in the Southeast.…

  6. Using a multifaceted quality improvement initiative to reverse the rising trend of cesarean births.

    Science.gov (United States)

    Ogunyemi, Dotun; McGlynn, Sara; Ronk, Anne; Knudsen, Patricia; Andrews-Johnson, Tonyie; Raczkiewicz, Angeline; Jovanovski, Andrew; Kaur, Sangeeta; Dykowski, Mark; Redman, Mark; Bahado-Singh, Ray

    2018-03-01

    National efforts exist to safely reduce the rate of cesarean delivery, a major source of increased morbidity and healthcare costs. This is a report of a quality improvement study targeting reduction of primary cesarean deliveries. From March 2014 to March 2016, interventions included a nested case-control review of local risk factors, provider and patient education, multidisciplinary reviews based on published guidelines with feedback, provider report cards, commitment to labor duration guidelines, and a focus on natural labor. Primary outcomes were the total primary singleton vertex and the nulliparous term singleton vertex (NTSV) cesarean delivery rates. Secondary outcome measures were postpartum hemorrhage, chorioamnionitis, perineal laceration, operative delivery, neonatal intensive care unit (NICU) admission, stillbirth, and neonatal mortality. Statistical process control charts identified significant temporal trends. Control chart analysis demonstrated that the institutional cesarean delivery rate was due to culture and not "outlier" obstetricians. The primary singleton vertex cesarean rate decreased from 23.4% to 14.1% and the NTSV rate decreased from 34.5% to 19.2% (both p cesarean deliveries without increasing maternal or perinatal morbidity.

  7. Effect of alternate day collection on semen quality of Asian elephants (Elephas maximus) with poor initial fresh semen quality

    NARCIS (Netherlands)

    Imrat, P.; Mahasawangkul, Sittidet; Thitaram, Chatchote; Suthanmapinanth, P.; Kornkaewrat, K.; Sombutputorn, P.; Jansittiwate, S.; Thongtip, Nikorn; Pinyopummin, A.; Colenbrander, B.; Holt, W.V.; Stout, Tom

    2014-01-01

    In captivity, male Asian elephants often yield poor quality semen after transrectal manually assisted semen collection; however, the reasons for the disappointing semen quality are not clear. Here we test the hypothesis that accumulation of senescent spermatozoa is a contributory factor, and that

  8. Quality of complication reporting in the surgical literature.

    Science.gov (United States)

    Martin, Robert C G; Brennan, Murray F; Jaques, David P

    2002-06-01

    To identify 10 critical elements of accurate and comprehensive reports of surgical complications. Despite a venerable tradition of weekly morbidity and mortality conferences, inconsistent complication reporting is common in the surgical literature. An analysis of articles reporting short-term outcomes after pancreatectomy, esophagectomy, and hepatectomy was performed. Randomized clinical trials (RCTs) published from 1975 to 2001 and retrospective series of more than 100 patients published from 1990 to 2001 were reviewed. A total of 119 articles reporting outcomes in 22,530 patients were analyzed. This included 42 RCTs and 77 retrospective series. Of the 10 criteria developed, no articles met all criteria; 2% met 9 criteria, 38% 7 or 8, 34% 5 or 6, 40% 3 or 4, and 12% 1 or 2. Outpatient information (22% of articles), definitions of complications provided (34% of articles), severity grade used (20% of articles), and risk factors included in analysis (29% of articles) were the most commonly unmet quality reporting criteria. Type of study (RCT vs. retrospective), site of institution (U.S. vs. non-U.S.) and journal (U.S. vs. non-U.S.) did not influence the quality of complication reporting. Short-term surgical outcomes are routinely included in the data reported in the surgical literature. This is often used to show improvements over time or to assess the impact of therapeutic changes on patient outcome. The inconsistency of reporting and the lack of accepted principles of accrual, display, and analysis of complication data argue strongly for the creation and generalized use of standards for reporting this information.

  9. Self-report questionnaire for measuring presence: Development and initial validation

    NARCIS (Netherlands)

    Kuis, E.; Goossensen, M.A.; van Dijke, J.; Baart, A.J.

    2014-01-01

    Background: The concept of ‘presence’ appears frequently in the literature and seems to be a highly relevant concept in discussing and evaluating quality of relations in healthcare practices. However, no existing self-report measure of presence for health professionals was found. Purpose: The

  10. Integration of air quality-related planning processes : report

    International Nuclear Information System (INIS)

    2004-05-01

    Several communities in British Columbia have conducted air quality, greenhouse gas, or community energy management plans. This report explored the possibility of integrating 3 community-based air quality-related planning processes into a single process and evaluated the use of these 3 processes by local governments and First Nations in identifying and addressing air quality-related objectives, and determined to what extent they could be integrated to achieve planning objectives for air quality, greenhouse gas emissions, and energy supply and conservation. The lessons learned from 9 case studies in British Columbia were presented. The purpose of the case studies was to examine how communities handled emissions and energy related inventory and planning work, as well as their experiences with, or considerations for, an integrated process. The lessons were grouped under several key themes including organization and stakeholder involvement; messaging and focus; leadership/champions; and resources and capacity. The report also outlined a framework for an integrated planning process and provided recommendations regarding how an integrated or complementary process could be performed. A number of next steps were also offered for the provincial government to move the concept of an integrated process forward with the assistance of other partners. These included identifying the resources required to support communities engaging in an integrated process as well as discussing the series of options for provincial support with key stakeholders. refs., tabs., figs

  11. Quality assurance in X-ray diagnostic radiology - Report II

    International Nuclear Information System (INIS)

    Fosmark, H.; Rozycki, Z.

    1987-01-01

    In the context of an analysis of technical quality assurance in Norwegian X-ray departments, a survey has been carried out in 21 laboratories in 4 hospitals. The tests were restricted to equipment used in general radiography, and the parameters analysed were of kV (using an electronic penetrameter), exposure time, waveform, output and automatic exposure control systems. In addition, a trial to compare overall performance in radiography and fluoroscopy was performed with a PMMP test phantom (SPRI). The survey is presented in two reports. The first one covers details of procedures and equipment. In this second report results are given and discussed. The results show that most of the equipment does function satifactorily, but also demonstrate the need to introduce quality assurance in X-ray departments

  12. Smoking Habits of Patients Undergoing Treatment for Intermittent Claudication in the Vascular Quality Initiative.

    Science.gov (United States)

    Gabel, Joshua; Jabo, Brice; Patel, Sheela; Kiang, Sharon; Bianchi, Christian; Chiriano, Jason; Teruya, Theodore; Abou-Zamzam, Ahmed M

    2017-10-01

    Society for Vascular Surgery practice guidelines for the medical treatment of intermittent claudication give a GRADE 1A recommendation for smoking cessation. Active smoking is therefore expected to be low in patients suffering from intermittent claudication selected for vascular surgical intervention. The aim of this study is to evaluate the prevalence of smoking in patients undergoing intervention for intermittent claudication at the national level and to determine the relationship between smoking status and intervention. The Vascular Quality Initiative (VQI) registries for infra-inguinal bypass, supra-inguinal bypass, and peripheral vascular intervention (PVI) were queried to identify patients who underwent invasive treatment for intermittent claudication. Patient factors, procedure type (bypass versus PVI), and level of disease (supra-inguinal versus infra-inguinal) were evaluated for associations with smoking status (active smoking or nonsmoking) by univariate and covariate analysis. Between 2010 and 2015, 101,055 procedures were entered in the 3 registries, with 40,269 (40%) performed for intermittent claudication. Complete data for analysis were present in 37,632 cases. At the time of intervention, 44% of patients were active smokers, with wide variation by regional quality group (16-53%). In covariate analysis, active smoking at treatment was associated with age smoking status. During follow-up, 36% of patients had quit smoking. Predictors of smoking cessation included age ≥70 years (RR 1.45), ABI ≥0.9 (RR 1.12), and bypass procedures (RR 1.22). At the time of treatment, 44% of patients undergoing intervention for intermittent claudication in the VQI were active smokers and there was a wide regional variation. Prevalence of active smoking was greater in the presence of younger age, fewer comorbidities, lower ABI, and supra-inguinal disease. Type of procedure performed, and in turn level of invasiveness required, did not appear to be influenced by smoking

  13. DANIDA; Air Quality Monitoring Programme. Mission 2 Report

    Energy Technology Data Exchange (ETDEWEB)

    Sivertsen, B.

    1996-06-01

    The report deals with the EIMP (Environmental Information and Monitoring Programme for the Arab Republic of Egypt). The programme is funded by Danida which is a cooperation project between Norway and Denmark. The programme covers the monitoring of air pollution, coastal water monitoring, and the monitoring of pollution sources and emissions. This report pays the attention to the Norwegian part of the programme executed by NILU (Norwegian Institute for Air Research) which covers the development air quality monitoring network. 14 refs., 51 figs., 18 tabs.

  14. Notions of quality and standards for qualitative research reporting.

    Science.gov (United States)

    Pearson, Alan; Jordan, Zoe; Lockwood, Craig; Aromataris, Ed

    2015-10-01

    The utility of qualitative research findings in the health sciences has been the subject of considerable debate, particularly with the advent of qualitative systematic reviews in recent years. There has been a significant investment in the production of guidance to improve the reporting of quantitative research; however, comparatively little time has been spent on developing the same for qualitative research reporting. This paper sets out to examine the possibility of developing a framework for refereed journals to utilize when guiding authors on how to report the results of qualitative studies in the hope that this will improve the quality of reports and subsequently their inclusion in qualitative syntheses and guidelines to inform practice at the point of care. © 2014 Wiley Publishing Asia Pty Ltd.

  15. Tribal Colleges Initiative project. Quarterly report, April 1--June 30, 1998

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-07-01

    The Tribal Colleges Initiative (TCI) grant is in the second year of funding from the US Department of Energy Environmental Management program. This quarterly report includes activities for the first three months (April 1--June 30, 1998) of the Year 2 funding period. The TCI program office requested each Tribal College to write a quarterly report of activities at their respective institutions. These reports are attached. These institutions are Southwestern Indian Polytechnic Institute (SIPI), Crownpoint Institute of Technology (CIT) and the Dine` College (DC, formerly Navajo Community College). The purpose of this program is to offer educational opportunities to Native Americans in the environmental field.

  16. Closing the quality gap: revisiting the state of the science (vol. 5: public reporting as a quality improvement strategy).

    Science.gov (United States)

    Totten, Annette M; Wagner, Jesse; Tiwari, Arpita; O'Haire, Christen; Griffin, Jessica; Walker, Miranda

    2012-07-01

    The goal of this review was to evaluate the effectiveness of public reporting of health care quality information as a quality improvement strategy. We sought to determine if public reporting results in improvements in health care delivery and patient outcomes. We also considered whether public reporting affects the behavior of patients or of health care providers. Finally we assessed whether the characteristics of the public reports and the context affect the impact of public reports. Articles available between 1980 and 2011 were identified through searches of the following bibliographical databases: MEDLINE®, Embase, EconLit, PsychINFO, Business Source Premier, CINAHL, PAIS, Cochrane Database of Systematic Reviews, EPOC Register of Studies, DARE, NHS EED, HEED, NYAM Grey Literature Report database, and other sources (experts, reference lists, and gray literature). We screened citations based on inclusion and exclusion criteria developed based on our definition of public reporting. We initially did not exclude any studies based on study design. Of the 11,809 citations identified through title and abstract triage, we screened and reviewed 1,632 articles. A total of 97 quantitative and 101 qualitative studies were included, abstracted, entered into tables, and evaluated. The heterogeneity of outcomes as well as methods prohibited formal quantitative synthesis. Systematic reviews were used to identify studies, but their conclusions were not incorporated into this review. For most of the outcomes, the strength of the evidence available to assess the impact of public reporting was moderate. This was due in part to the methodological challenges researchers face in designing and conducting research on the impact of population-level interventions. Public reporting is associated with improvement in health care performance measures such as those included in Nursing Home Compare. Almost all identified studies found no evidence or only weak evidence that public reporting

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jennifer L. Wiler, MD, MBA

    2016-03-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

  20. Initial Characterization and Water Quality Assessment of Stream Landscapes in Northern Mongolia

    Directory of Open Access Journals (Sweden)

    Jürgen Hofmann

    2015-06-01

    Full Text Available A comprehensive monitoring project (2006–2013 provided data on hydrology, hydromorphology, climatology, water physico-chemistry, sedimentology, macroinvertebrate community and fish diversity in the Kharaa River basin in northern Mongolia, thus enabling, for the first time, a detailed characterization of the stream landscapes. Surface waters were categorized into separate “water bodies” according to their identifiable abiotic and biocoenotic features, subsequently creating the smallest management sub-units within the river basin. Following the approach of the European Water Framework Directive (EC-WFD, in order to obtain a good ecological status (GES, four clearly identifiable water bodies in the Kharaa River main channel and seven water bodies consisting of the basin’s tributaries were delineated. The type-specific undisturbed reference state of various aquatic ecosystems was identified in the assessment and used to set standards for restoration goals. With regards to water quality and quantity, the upper reaches of the Kharaa River basin in the Khentii Mountains were classified as having a “good” ecological and chemical status. Compared with these natural reference conditions in the upper reaches, the initial risk assessment identified several “hot spot” regions with impacted water bodies in the middle and lower basin. Subsequently, the affected water bodies are at risk of not obtaining a level of good ecological and/or chemical status for surface waters. Finally, a matrix of cause-response relationships and stressor complexes has been developed and is presented here. The applicability of management approaches is discussed to better foster the development of a sustainable river basin management plan. The application of natural references states offers a sound scientific base to assess the impact of anthropogenic activities across the Kharaa River basin.

  1. Analysis of Internet Usage Among Cancer Patients in a County Hospital Setting: A Quality Improvement Initiative

    Science.gov (United States)

    Lilley, Lisa; Lodrigues, William; Dreadin-Pulliam, Julie; Xie, Xian-Jin; Mathur, Sakshi; Rao, Madhu; Harvey, Valorie; Leitch, Ann Marilyn; Rao, Roshni

    2014-01-01

    Background Cancer is one of the most common diseases that patients research on the Internet. The Commission on Cancer (CoC) recommended that Parkland Memorial Hospital (PMH) improve the oncology services website. PMH is Dallas County’s public health care facility, serving a largely uninsured, minority population. Most research regarding patient Internet use has been conducted in insured, Caucasian populations, raising concerns that the needs of PMH patients may not be extrapolated from available data. The PMH Cancer Committee, therefore, adopted a quality improvement initiative to understand patients’ Internet usage. Objective The objective of the study was to obtain and analyze data regarding patients’ Internet usage in order to make targeted improvements to the oncology services section of the institutional website. Methods A task force developed an 11-question survey to ascertain what proportion of our patients have Internet access and use the Internet to obtain medical information as well as determine the specific information sought. Between April 2011 and August 2011, 300 surveys were administered to newly diagnosed cancer patients. Multivariate analyses were performed. Results Of 300 surveys, 291 were included. Minorities, primarily African-American and Hispanic, represented 78.0% (227/291) of patients. Only 37.1% (108/291) of patients had Internet access, most (256/291, 87.9%) having access at home. Younger patients more commonly had Internet access, with a mean age of 47 versus 58 years for those without (PInternet research was to develop questions for discussion with one’s physician. Patients most frequently sought information regarding cancer treatment options, outcomes, and side effects. Conclusions Less than one-half of PMH oncology patients have Internet access. This is influenced by age, educational level, and ethnicity. Those with access use it to obtain information related to their cancer diagnosis. The most effective way of addressing our

  2. Initiating statistical process control to improve quality outcomes in colorectal surgery.

    Science.gov (United States)

    Keller, Deborah S; Stulberg, Jonah J; Lawrence, Justin K; Samia, Hoda; Delaney, Conor P

    2015-12-01

    Unexpected variations in postoperative length of stay (LOS) negatively impact resources and patient outcomes. Statistical process control (SPC) measures performance, evaluates productivity, and modifies processes for optimal performance. The goal of this study was to initiate SPC to identify LOS outliers and evaluate its feasibility to improve outcomes in colorectal surgery. Review of a prospective database identified colorectal procedures performed by a single surgeon. Patients were grouped into elective and emergent categories and then stratified by laparoscopic and open approaches. All followed a standardized enhanced recovery protocol. SPC was applied to identify outliers and evaluate causes within each group. A total of 1294 cases were analyzed--83% elective (n = 1074) and 17% emergent (n = 220). Emergent cases were 70.5% open and 29.5% laparoscopic; elective cases were 36.8% open and 63.2% laparoscopic. All groups had a wide range in LOS. LOS outliers ranged from 8.6% (elective laparoscopic) to 10.8% (emergent laparoscopic). Evaluation of outliers demonstrated patient characteristics of higher ASA scores, longer operating times, ICU requirement, and temporary nursing at discharge. Outliers had higher postoperative complication rates in elective open (57.1 vs. 20.0%) and elective lap groups (77.6 vs. 26.1%). Outliers also had higher readmission rates for emergent open (11.4 vs. 5.4%), emergent lap (14.3 vs. 9.2%), and elective lap (32.8 vs. 6.9%). Elective open outliers did not follow trends of longer LOS or higher reoperation rates. SPC is feasible and promising for improving colorectal surgery outcomes. SPC identified patient and process characteristics associated with increased LOS. SPC may allow real-time outlier identification, during quality improvement efforts, and reevaluation of outcomes after introducing process change. SPC has clinical implications for improving patient outcomes and resource utilization.

  3. Reducing catheter-associated urinary tract infections: a quality-improvement initiative.

    Science.gov (United States)

    Davis, Katherine Finn; Colebaugh, Ann M; Eithun, Benjamin L; Klieger, Sarah B; Meredith, Dennis J; Plachter, Natalie; Sammons, Julia Shaklee; Thompson, Allison; Coffin, Susan E

    2014-09-01

    Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs. An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children's hospital over a 3-year period (June 2009 to June 2012). Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: -1.28 to -0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement. CAUTI is a common pediatric health care-associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children. Copyright © 2014 by the American Academy of Pediatrics.

  4. Doing the Right Thing for Women and Babies: Policy Initiatives to Improve Maternity Care Quality and Value

    Science.gov (United States)

    Corry, Maureen P; Jolivet, Rima

    2009-01-01

    When defined within the context of maternity care, the Institute of Medicine's six aims for health-care quality improvement provide a framework for Childbirth Connection's Maternity Quality Matters Initiative, a multipronged program agenda intended to foster a maternity care system that delivers care of the highest quality and value in order to achieve optimal health outcomes and experiences for mothers and babies. These aims also provide childbirth educators and others in the maternity care community with an ethical framework for efforts to serve childbearing women and families and ensure the best outcomes for women, babies, and families. PMID:19436596

  5. An Initial Evaluation of the Comprehensive Quality of Life Scale--Intellectual Disability.

    Science.gov (United States)

    Cummins, Robert A.; And Others

    1997-01-01

    A study of 59 Australian people with an intellectual disability and 69 university students evaluated a new scale to measure the life quality of people with an intellectual disability. The Comprehensive Quality of Life Scale--Intellectual Disability was found to be a useful instrument to measure comparative life quality. (Author/CR)

  6. 77 FR 286 - Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults

    Science.gov (United States)

    2012-01-04

    ... Program to fund development, testing, and validation of emerging and innovative evidence-based measures..., validation, and consensus process for the development of adult health quality measures. Include in the report to Congress mandated under section 1139A(a)(6) of the Act on the quality of health care of children...

  7. Use of a Geriatric Quality Initiative to Educate Internal Medicine Residents about Delirium and Its Risk Factors.

    Science.gov (United States)

    Olveczky, Daniele; Mattison, Melissa L P; Mukamal, Kenneth J

    2013-06-01

    Delirium is a common and debilitating complication of inpatient care for many older adults, yet internal medicine residents often do not recognize delirium or its risk factors. Integrating geriatric education (eg, delirium recognition) with inpatient quality improvement (QI) is not well tested. We developed an educational pilot program within an ongoing hospital-wide geriatric QI initiative (Global Risk Assessment and Careplan for the Elderly-Acute Care [GRACE-AC]). GRACE-AC modifies the inpatient computerized provider order entry system to meet the needs of vulnerable older adults and uses a bedside care checklist to identify patients with possible delirium and promote delirium prevention by checking on the need for "tethers" (intravenous fluids, Foley catheters, and telemetry). Residents were assessed before and after each inpatient rotation by using anonymous electronic surveys. A total of 167 eligible residents (91%) completed prerotation surveys, and 102 (56%) residents completed postrotation surveys. All but the first rotating resident group received a standardized 2-minute educational in-service orientation. In a comparison of postrotation responses before and after implementation of the in-service, the proportion of residents who reported improvement in their ability to recall which patients had tethers increased from 17% to 52% for intravenous fluids (P  =  .004), 28% to 75% for Foley catheters (P < .001), and 21% to 50% for telemetry (P  =  .02). Comparing pre- and postrotation surveys, the proportion of correct responses to questions on haloperidol dosing and the characteristics of delirium increased from 26% to 76% and 31% to 63%, respectively (both P < .001). Our pilot program demonstrated that inpatient geriatric QI initiatives can be successfully merged with a brief educational curriculum.

  8. Le reporting extra-financier selon la Global reporting initiative à l’épreuve du greenwashing

    OpenAIRE

    Huguet, Ivan

    2016-01-01

    La présente contribution vise à offrir une meilleure compréhension du reporting extra-financier et des enjeux, qu’ils soient théoriques ou pratiques, sous-jacents à ce dernier. Par ailleurs, en explorant cette pratique aux contours flous qu’est le greenwashing, le présent texte vise également à déterminer la crédibilité qu’il est possible d’accorder aux rapports extra-financiers établis selon la Global reporting initiative.

  9. Impact of initial spacing on yield per acre and wood quality of unthinned loblolly pine at age 21

    Science.gov (United States)

    Alexander, III Clark; Richard F. Daniels; Lewis Jordan; Laurie Schimleck

    2010-01-01

    The market for southern pine first thinnings is soft. Thus, forest managers are planting at wider spacings, and using weed control and fertilization to grow chipping-saw and sawtimber trees in shorter rotations. A 21-year-old unthinned spacing study was sampled to determine the effect of initial spacing on wood quality and yield per acre of planted loblolly pine (

  10. The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes.

    Science.gov (United States)

    Nakanishi, Miharu; Tei-Tominaga, Maki

    2018-05-08

    Background : Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods : A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results : Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions : Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

  11. Exploring the relationship between job quality, performance management, and career initiative : A two-level, two-actor study

    NARCIS (Netherlands)

    van Veldhoven, M.J.P.M.; Dorenbosch, L; Breugelmans, A; van de Voorde, F.C.

    2017-01-01

    This study examines how job quality and performance management influence career initiative in the workplace. Based on signaling theory and the notion of internal fit in performance management and HRM, we argue that performance management with a learning orientation further enhances career

  12. The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes

    Directory of Open Access Journals (Sweden)

    Miharu Nakanishi

    2018-05-01

    Full Text Available Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional, presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

  13. An initial test of a normative Figure Of Merit for the quality of overall task performance

    Science.gov (United States)

    Lemay, Moira; Comstock, J. R., Jr.

    1990-01-01

    An overall indicator, or Figure Of Merit (FOM), of the quality of crew/vehicle system performance is needed to establish the effect of workload on efficiency and to identify overload conditions. A normative FOM is proposed in which performance is measured on a representative task and a normative data base obtained. FOMs for subsequent executions of the task are then reported in terms of weighted deviations from average task performance. Performance of discrete tasks is measured primarily in terms of subtask time and errors. Discrete task performance is then combined with a measure of continuous vehicle control. In order to test the normative FOM procedure, the technique was applied to an existing set of data from a simulated landing task in which standard communications with ATC was compared with a data link communications system. The results indicated that while mean task performance was not affected, task variability, as measured by the FOM, was significantly higher when data link communications were used. In order to establish the sensitivity of the normative FOM method, further testing of the measure is recommended.

  14. HTGR accident initiation and progression analysis status report. Volume VIII. Responses to comments on AIPA status report

    Energy Technology Data Exchange (ETDEWEB)

    Raabe, P.H.

    1977-01-01

    The first seven volumes of the report series provide formal documentation of the status of the ERDA-sponsored Accident Initiation and Progression Analysis (AIPA) study as of the end of FY75. That portion of the report was given broad distribution to government agencies, industrial organizations, and academic institutions. Comments on the Status Report have been actively solicited from these and other organizations. The volume presented (the eighth in the AIPA Status Report) documents all of the formal written comments that have been received as of September 30, 1976, together with the responses to those comments. The comments as presented are direct quotations from the manuscripts as submitted by the reviewers; none have been paraphrased. The comments are presented in the same order as submitted by the reviewers and are generally addressed individually.

  15. HTGR accident initiation and progression analysis status report. Volume VIII. Responses to comments on AIPA status report

    International Nuclear Information System (INIS)

    Raabe, P.H.

    1977-01-01

    The first seven volumes of the report series provide formal documentation of the status of the ERDA-sponsored Accident Initiation and Progression Analysis (AIPA) study as of the end of FY75. That portion of the report was given broad distribution to government agencies, industrial organizations, and academic institutions. Comments on the Status Report have been actively solicited from these and other organizations. The volume presented (the eighth in the AIPA Status Report) documents all of the formal written comments that have been received as of September 30, 1976, together with the responses to those comments. The comments as presented are direct quotations from the manuscripts as submitted by the reviewers; none have been paraphrased. The comments are presented in the same order as submitted by the reviewers and are generally addressed individually

  16. U.S. Geological Survey Science for the Wyoming Landscape Conservation Initiative: 2012 annual report

    Science.gov (United States)

    Bowen, Zachary H.; Aldridge, Cameron L.; Anderson, Patrick J.; Assal, Timothy J.; Bern, Carleton R.; Biewick, Laura; Boughton, Gregory K.; Carr, Natasha B.; Chalfoun, Anna D.; Chong, Geneva W.; Clark, Melanie L.; Fedy, Bradford C.; Foster, Katharine; Garman, Steven L.; Germaine, Stephen S.; Hethcoat, Matthew G.; Homer, Collin G.; Kauffman, Matthew J.; Keinath, Douglas; Latysh, Natalie; Manier, Daniel J.; McDougal, Robert R.; Melcher, Cynthia P.; Miller, Kirk A.; Montag, Jessica; Potter, Christopher J.; Schell, Spencer; Shafer, Sarah L.; Smith, David B.; Sweat, Michael J.; Wilson, Anna B.

    2014-01-01

    Southwest Wyoming contains abundant energy resources, wildlife, habitat, open spaces, and outdoor recreational opportunities. Although energy exploration and development have been taking place in the region since the late 1800s, the pace of development for fossil fuels and renewable energy increased significantly in the early 2000s. This and the associated urban and exurban development are leading to landscape-level environmental and socioeconomic changes that have the potential to diminish wildlife habitat and other natural resources, and the quality of human lives, in Southwest Wyoming. The potential for negative effects of these changes prompted Federal, State, and local agencies to undertake the Wyoming Landscape Conservation Initiative for Southwest Wyoming.

  17. Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012.

    Science.gov (United States)

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-03-11

    Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to 'top hospital', best hospital', and 'hospital quality', as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by advertising on Google or Twitter and using social media interactively with consumers looking

  18. Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE).

    Science.gov (United States)

    Schleyer, Anneliese M; Best, Jennifer A; McIntyre, Lisa K; Ehrmantraut, Ross; Calver, Patty; Goss, J Richard

    2013-01-01

    Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

  19. Christchurch Bay Tower data archive. Quality assurance report

    Energy Technology Data Exchange (ETDEWEB)

    Bishop, J.R.

    1998-05-01

    Wave force experiments at the Christchurch Bay Tower yielded valuable data on wave forces on cylinders under the complex flows experienced in real sea conditions. The last experiments were conducted in 1987, but the data remain an important source of information on the wave forces on cylinders, together with the measured wave particle kinematics. The use of two columns with different diameters enabled the studies to extend over a large range of Keulegan Carpenter numbers and Reynolds numbers. The experiments included clean vertical and horizontal cylinders, cylinders with real kelp fouling, with simulated hard roughness and a flexible cylinder. Considerable effort was devoted to quality control of the measured data. The experiments were funded mainly by the UK Department of Energy, and ownership of the results has now been transferred to the Offshore Safety Division of the Health and Safety Executive. They have now commissioned the archiving of a set of important records from the experiments, covering clean cylinders, kelp fouling, hard roughness and a horizontal cylinder. The purpose is to make the data available for future work on wave loadings and the related wave particle kinematics. This Quality Assurance (QA) Report is the second of three reports and provides sets of graphical and tabular outputs for each of the 20 minute records which have been processed in this archiving work. The first report is the Principal Report and needs to be used in conjunction with this QA Report. The third report is a User Manual, which is a guide to extraction of the data from the CD ROMs. (author)

  20. Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

    Science.gov (United States)

    Garner, Kimberly K; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H

    2017-01-01

    The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers. Published by Elsevier Inc.

  1. Imaging Reporters for Proteasome Activity Identify Tumor- and Metastasis-Initiating Cells

    Directory of Open Access Journals (Sweden)

    Amanda C. Stacer

    2015-08-01

    Full Text Available Tumor-initiating cells, also designated as cancer stem cells, are proposed to constitute a subpopulation of malignant cells central to tumorigenesis, metastasis, and treatment resistance. We analyzed the activity of the proteasome, the primary organelle for targeted protein degradation, as a marker of tumor- and metastasis-initiating cells. Using human and mouse breast cancer cells expressing a validated fluorescent reporter, we found a small subpopulation of cells with low proteasome activity that divided asymmetrically to produce daughter cells with low or high proteasome activity. Breast cancer cells with low proteasome activity had greater local tumor formation and metastasis in immunocompromised and immunocompetent mice. To allow flexible labeling of cells, we also developed a new proteasome substrate based on HaloTag technology. Patient-derived glioblastoma cells with low proteasome activity measured by the HaloTag reporter show key phenotypes associated with tumor-initiating cells, including expression of a stem cell transcription factor, reconstitution of the original starting population, and enhanced neurosphere formation. We also show that patient-derived glioblastoma cells with low proteasome activity have higher frequency of tumor formation in mouse xenografts. These studies support proteasome function as a tool to investigate tumor- and metastasis-initiating cancer cells and a potential biomarker for outcomes in patients with several different cancers.

  2. Initiation of opiate addiction in a Canadian prison: a case report

    Directory of Open Access Journals (Sweden)

    Lim Ronald

    2006-03-01

    Full Text Available Abstract Background In North America, the harms of illicit drug use have been responded to primarily through law enforcement interventions. This strategy has resulted in record populations of addicted individuals being incarcerated in both Canada and the United States. The incarceration of non-violent drug offenders has become increasingly controversial as studies demonstrate the harms, including elevated HIV risk behavior, of incarcerating injection drug users. Other harms, such as the initiation of illicit drug use by prison inmates who previously did not use drugs, have been less commonly described. Case Presentation We report on the case of an individual who initiated non-injection opiate use in a Canadian prison and developed an addiction to the drug. Upon release into the community, the individual continued using opiates and sought treatment at a clinic. The patient feared that he might initiate injection use of opiates if his cravings could not be controlled. The patient was placed on methadone maintenance therapy. Conclusion While anecdotal reports indicate that initiation in prison of the use of addictive illicit substances is frequent, documentation through clinical experience is rare, and the public health implications of this behavior have not been given sufficient attention in the literature. Strategies of incarcerating non-violent drug offenders and attempting to keep illicit drugs out of prisons have not reduced the harms and costs of illicit drug use. Effective, practical alternatives are urgently needed; expanded community diversion programs for non-violent drug offenders deserve particular attention.

  3. Advanced corporate sustainability reporting - XBRL taxonomy for sustainability reports based on the G3-guidelines of the gobal reporting initiative

    OpenAIRE

    Isenmann, R.; Gomez, J.M.

    2009-01-01

    Sustainability reporting describes a development path towards a concept of balanced corporate reporting, usually communicating the three pillars of environmental, social, and economic performance and its mutual interrelations, what in business terms is often called the triple bottom line approach.While early sustainability reports merely have been available on print media, today most are accessible on the WWW as HTML files or as PDFs. Such a layout oriented data format however, does not seem ...

  4. The establishment of the GENEQOL consortium to investigate the genetic disposition of patient reported quality-of-life outcomes

    NARCIS (Netherlands)

    M.A.G. Sprangers (Mirjam); J.A. Sloan (Jeff); R. Veenhoven (Ruut); C.S. Cleeland (Charles); M.Y. Halyard (Michele); A.P. Abertnethy (Amy); F. Baas (Frank); A.M. Barsevick (Andrea); M. Bartels (Meike); D.I. Boomsma (Dorret); C. Chauhan (Cynthia); A.C. Dueck (Amylou); M.H. Frost (Marlene); P. Hall (Per); P. Klepstad (Pal); N.G. Martin (Nicholas); C. Miaskowski (Christine); M. Mosing (Miriam); B. Movsas (Benjamin); C.J.F. van Noorden (Cornelis); D.L. Patrick (Donald); N.L. Pedersen (Nancy); M.E. Ropka (Mary); Q. Shi (Quiling); G. Shinozaki (Gen); J.A. Singh (Jasvinder); P. Yang (Ping); A.H. Zwinderman (Ailko)

    2009-01-01

    textabstractTo our knowledge, no comprehensive, interdisciplinary initiatives have been taken to examine the role of genetic variants on patient-reported quality-of-life outcomes. The overall objective of this paper is to describe the establishment of an international and interdisciplinary

  5. The establishment of the GENEQOL consortium to investigate the genetic disposition of patient-reported quality-of-life outcomes

    NARCIS (Netherlands)

    Sprangers, Mirjam A. G.; Sloan, Jeff A.; Veenhoven, Ruut; Cleeland, Charles S.; Halyard, Michele Y.; Abertnethy, Amy P.; Baas, Frank; Barsevick, Andrea M.; Bartels, Meike; Boomsma, Dorret I.; Chauhan, Cynthia; Dueck, Amylou C.; Frost, Marlene H.; Hall, Per; Klepstad, Pål; Martin, Nicholas G.; Miaskowski, Christine; Mosing, Miriam; Movsas, Benjamin; van Noorden, Cornelis J. F.; Patrick, Donald L.; Pedersen, Nancy L.; Ropka, Mary E.; Shi, Quiling; Shinozaki, Gen; Singh, Jasvinder A.; Yang, Ping; Zwinderman, Ailko H.

    2009-01-01

    To our knowledge, no comprehensive, interdisciplinary initiatives have been taken to examine the role of genetic variants on patient-reported quality-of-life outcomes. The overall objective of this paper is to describe the establishment of an international and interdisciplinary consortium, the

  6. 7-GeV Advanced Photon Source Instrumentation Initiative conceptual design report

    International Nuclear Information System (INIS)

    1992-12-01

    In this APS Instrumentation Initiative, 2.5-m-long and 5-m-long insertion-device x-ray sources will be built on 9 straight sections of the APS storage ring, and an additional 9 bending-magnet sources will also be put in use. The front ends for these 18 x-ray sources will be built to contain and safeguard access to these bright x-ray beams. In addition, funds will be provided to build state-of-the-art insertion-device beamlines to meet scientific and technological research demands well into the next century. This new initiative will also include four user laboratory modules and a special laboratory designed to meet the x-ray imaging research needs of the users. The Conceptual Design Report (CDR) for the APS Instrumentation Initiative describes the scope of all the above technical and conventional construction and provides a detailed cost and schedule for these activities. According to these plans, this new initiative begins in FY 1994 and ends in FY 1998. The document also describes the preconstruction R ampersand D plans for the Instrumentation Initiative activities and provides the cost estimates for the required R ampersand D

  7. Self-reported quality care for knee osteoarthritis

    DEFF Research Database (Denmark)

    Østerås, N; Jordan, K P; Clausen, B

    2015-01-01

    OBJECTIVES: To assess and compare patient perceived quality of osteoarthritis (OA) management in primary healthcare in Denmark, Norway, Portugal and the UK. METHODS: Participants consulting with clinical signs and symptoms of knee OA were identified in 30 general practices and invited to complete...... a cross-sectional survey including quality indicators (QI) for OA care. A QI was considered as eligible if the participant had checked 'Yes' or 'No', and as achieved if the participant had checked 'Yes' to the indicator. The median percentage (with IQR and range) of eligible QIs achieved by country...... was determined and compared in negative binominal regression analysis. Achievement of individual QIs by country was determined and compared using logistic regression analyses. RESULTS: A total of 354 participants self-reported QI achievement. The median percentage of eligible QIs achieved (checked 'Yes') was 48...

  8. Fiscal Year 2014 Annual Report on BNLs Next Generation Safeguards Initiative Human Capital Development Activities

    Energy Technology Data Exchange (ETDEWEB)

    Pepper, Susan E. [Brookhaven National Lab. (BNL), Upton, NY (United States)

    2014-10-10

    Brookhaven National Laboratory’s (BNL’s) Nonproliferation and National Security Department contributes to the National Nuclear Security Administration Office of Nonproliferation and International Security Next Generation Safeguards Initiative (NGSI) through university engagement, safeguards internships, safeguards courses, professional development, recruitment, and other activities aimed at ensuring the next generation of international safeguards professionals is adequately prepared to support the U.S. safeguards mission. This report is a summary of BNL s work under the NGSI program in Fiscal Year 2014.

  9. Fatal Burkholderia pseudomallei Infection Initially Reported as a Bacillus Species, Ohio, 2013

    OpenAIRE

    Doker, Thomas J.; Quinn, Celia L.; Salehi, Ellen D.; Sherwood, Joshua J.; Benoit, Tina J.; Elrod, Mindy Glass; Gee, Jay E.; Shadomy, Sean V.; Bower, William A.; Hoffmaster, Alex R.; Walke, Henry T.; Blaney, David D.; DiOrio, Mary S.

    2014-01-01

    A fatal case of melioidosis was diagnosed in Ohio one month after culture results were initially reported as a Bacillus species. To identify a source of infection and assess risk in patient contacts, we abstracted patient charts; interviewed physicians and contacts; genetically characterized the isolate; performed a Burkholderia pseudomallei antibody indirect hemagglutination assay on household contacts and pets to assess seropositivity; and collected household plant, soil, liquid, and insect...

  10. Utilizing Social Media to Further the Nationwide Suspicious Activity Reporting Initiative

    Science.gov (United States)

    2012-09-01

    Initiative NYPD New York Police Department OSINT Open Source Intelligence P2P Peer to Patent SAR Suspicious Activity Report SMS Short Message (or...Media as an Open-Source Intelligence Tool Several government documents outline the use of social media as an Open Source intelligence tool ( OSINT ...social media to be an OSINT tool that federal, state, and local law enforcement agencies should use to develop timely, relevant, and actionable

  11. Self-reported adverse reactions among patients initiating antiretroviral therapy in Brazil

    OpenAIRE

    Pádua,Cristiane A. Menezes de; César,Cibele C.; Bonolo,Palmira F.; Acurcio,Francisco A.; Guimarães,Mark Drew C.

    2007-01-01

    A cross-sectional analysis was carried out to describe adverse reactions to antiretroviral therapy (ART) reported by HIV-infected patients initiating treatment at two public health AIDS referral centers in Belo Horizonte, Brazil, 2001-2003 and to verify their association with selected variables. Adverse reactions were obtained through interview at the first follow-up visit (first month) after the antiretroviral prescription. Socio-demographic and behavioral variables related to ART were obtai...

  12. The Global Tracheostomy Collaborative: one institution's experience with a new quality improvement initiative.

    Science.gov (United States)

    Lavin, Jennifer; Shah, Rahul; Greenlick, Hannah; Gaudreau, Philip; Bedwell, Joshua

    2016-01-01

    Given the low frequency of adverse events after tracheostomy, individual institutions struggle to collect outcome data to generate effective quality improvement protocols. The Global Tracheostomy Collaborative (GTC) is a multi-institutional, multi-disciplinary organization that utilizes a prospective database to collect data on patients undergoing tracheostomy. We describe our institution's preliminary experience with this collaborative. It was hypothesized that entry into the database would be non-burdensome and could be easily and accurately initiated by skilled specialists at the time of tracheostomy placement and completed at time of patient discharge. Demographic, diagnostic, and outcome data on children undergoing tracheostomy at our institution from January 2013 to June 2015 were entered into the GTC database, a database collected and managed by REDCap (Research Electronic Data Capture). All data entry was performed by pediatric otolaryngology fellows and all post-operative updates were completed by a skilled tracheostomy nurse. Tracked outcomes included accidental decannulation, failed decannulation, tracheostomy tube obstruction, bleeding/tracheoinnominate fistula, and tracheocutaneous fistula. Data from 79 patients undergoing tracheostomy at our institution were recorded. Database entry was straightforward and entry of patient demographic information, medical comorbidities, surgical indications, and date of tracheostomy placement was completed in less than 5min per patient. The most common indication for surgery was facilitation of ventilation in 65 patients (82.3%). Average time from admission to tracheostomy was 62.6 days (range 0-246). Stomal breakdown was seen in 1 patient. A total of 72 patients were tracked to hospital discharge with 53 patients surviving (88.3%). No mortalities were tracheostomy-related. The Global Tracheostomy Collaborative is a multi-institutional, multi-disciplinary collaborative that collects data on patients undergoing

  13. Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative.

    Science.gov (United States)

    Mohan, Sathish; Flahive, Julie M; Arous, Edward J; Judelson, Dejah R; Aiello, Francesco A; Schanzer, Andres; Simons, Jessica P

    2018-06-21

    Peripheral atherectomy has been shown to have technical success in single-arm studies, but clinical advantages over angioplasty and stenting have not been demonstrated, leaving its role unclear. We sought to describe patterns of atherectomy use in a real-world U.S. cohort to understand how it is currently being applied. The Vascular Quality Initiative was queried to identify all patients who underwent peripheral vascular intervention from January 2010 to September 2016. Descriptive statistics were performed to analyze demographics of the patients, comorbidities, indication, treatment modalities, and lesion characteristics. The intermittent claudication (IC) and critical limb ischemia (CLI) cohorts were analyzed separately. Of 85,605 limbs treated, treatment indication was IC in 51% (n = 43,506) and CLI in 49% (n = 42,099). Atherectomy was used in 15% (n = 13,092) of cases, equivalently for IC (15%; n = 6674) and CLI (15%; n = 6418). There was regional variation in use of atherectomy, ranging from a low of 0% in one region to a high of 32% in another region. During the study period, there was a significant increase in the proportion of cases that used atherectomy (11% in 2010 vs 18% in 2016; P < .0001). Compared with nonatherectomy cases, those with atherectomy use had higher incidence of prior peripheral vascular intervention (IC, 55% vs 43% [P < .0001]; CLI, 47% vs 41% [P < .0001]), greater mean number of arteries treated (IC, 1.8 vs 1.6 [P < .0001]; CLI, 2.1 vs 1.7 [P < .0001]), and lower proportion of prior leg bypass (IC, 10% vs 14% [P < .0001]; CLI, 11% vs 17% [P < .0001]). There was lower incidence of failure to cross the lesion (IC, 1% vs 4% [P < .0001]; CLI, 4% vs 7% [P < .0001]) but higher incidence of distal embolization (IC, 1.9% vs 0.8% [P < .0001]; CLI, 3.0% vs 1.4% [P < .0001]) and, in the CLI cohort, arterial perforation (1.4% vs 1.0%; P = .01). Despite a lack of evidence for atherectomy over angioplasty and stenting, its use has

  14. Amish-Initiated Burn Care Project: Case Report and Lessons Learned in Participatory Research.

    Science.gov (United States)

    Hess, Rosanna F

    2017-03-01

    This case report describes the phases of an Amish Burn Care Project and the lessons learned throughout the process. Data sources to construct the case report included participant observation, interviews, archival documents, and a focus group. The narrative is organized into five phases of a participatory research approach: engagement, formalization, mobilization, maintenance, and expansion. Community-initiated research led to legitimate change, working together for change took time, team members grew in mutual trust and respect for each other, cultural humility brought personal and professional growth, and capacity building took place through mutually supported efforts.

  15. Initial experience with a novel pre-sign-out quality assurance tool for review of random surgical pathology diagnoses in a subspecialty-based university practice.

    Science.gov (United States)

    Owens, Scott R; Wiehagen, Luke T; Kelly, Susan M; Piccoli, Anthony L; Lassige, Karen; Yousem, Samuel A; Dhir, Rajiv; Parwani, Anil V

    2010-09-01

    We recently implemented a novel pre-sign-out quality assurance tool in our subspecialty-based surgical pathology practice at the University of Pittsburgh Medical Center. It randomly selects an adjustable percentage of cases for review by a second pathologist at the time the originating pathologist's electronic signature is entered and requires that the review be completed within 24 hours, before release of the final report. The tool replaced a retrospective audit system and it has been in successful use since January 2009. We report our initial experience for the first 14 months of its service. During this time, the disagreement numbers and levels were similar to those identified using the retrospective system, case turnaround time was not significantly affected, and the number of case amendments generated decreased. The tool is a useful quality assurance instrument and its prospective nature allows for the potential prevention of some serious errors.

  16. A Real-Time Safety and Quality Reporting System: Assessment of Clinical Data and Staff Participation

    International Nuclear Information System (INIS)

    Rahn, Douglas A.; Kim, Gwe-Ya; Mundt, Arno J.; Pawlicki, Todd

    2014-01-01

    Purpose: To report on the use of an incident learning system in a radiation oncology clinic, along with a review of staff participation. Methods and Materials: On September 24, 2010, our department initiated an online real-time voluntary reporting system for safety issues, called the Radiation Oncology Quality Reporting System (ROQRS). We reviewed these reports from the program's inception through January 18, 2013 (2 years, 3 months, 25 days) to assess error reports (defined as both near-misses and incidents of inaccurate treatment). Results: During the study interval, there were 60,168 fractions of external beam radiation therapy and 955 brachytherapy procedures. There were 298 entries in the ROQRS system, among which 108 errors were reported. There were 31 patients with near-misses reported and 27 patients with incidents of inaccurate treatment reported. These incidents of inaccurate treatment occurred in 68 total treatment fractions (0.11% of treatments delivered during the study interval). None of these incidents of inaccurate treatment resulted in deviation from the prescription by 5% or more. A solution to the errors was documented in ROQRS in 65% of the cases. Errors occurred as repeated errors in 22% of the cases. A disproportionate number of the incidents of inaccurate treatment were due to improper patient setup at the linear accelerator (P<.001). Physician participation in ROQRS was nonexistent initially, but improved after an education program. Conclusions: Incident learning systems are a useful and practical means of improving safety and quality in patient care

  17. A Real-Time Safety and Quality Reporting System: Assessment of Clinical Data and Staff Participation

    Energy Technology Data Exchange (ETDEWEB)

    Rahn, Douglas A.; Kim, Gwe-Ya; Mundt, Arno J.; Pawlicki, Todd, E-mail: tpawlicki@ucsd.edu

    2014-12-01

    Purpose: To report on the use of an incident learning system in a radiation oncology clinic, along with a review of staff participation. Methods and Materials: On September 24, 2010, our department initiated an online real-time voluntary reporting system for safety issues, called the Radiation Oncology Quality Reporting System (ROQRS). We reviewed these reports from the program's inception through January 18, 2013 (2 years, 3 months, 25 days) to assess error reports (defined as both near-misses and incidents of inaccurate treatment). Results: During the study interval, there were 60,168 fractions of external beam radiation therapy and 955 brachytherapy procedures. There were 298 entries in the ROQRS system, among which 108 errors were reported. There were 31 patients with near-misses reported and 27 patients with incidents of inaccurate treatment reported. These incidents of inaccurate treatment occurred in 68 total treatment fractions (0.11% of treatments delivered during the study interval). None of these incidents of inaccurate treatment resulted in deviation from the prescription by 5% or more. A solution to the errors was documented in ROQRS in 65% of the cases. Errors occurred as repeated errors in 22% of the cases. A disproportionate number of the incidents of inaccurate treatment were due to improper patient setup at the linear accelerator (P<.001). Physician participation in ROQRS was nonexistent initially, but improved after an education program. Conclusions: Incident learning systems are a useful and practical means of improving safety and quality in patient care.

  18. Breckinridge Project, initial effort. Report XI, Volume V. Critical review of the design basis. [Critical review

    Energy Technology Data Exchange (ETDEWEB)

    None

    1982-01-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  19. Dose and volume specification for reporting NCT. An ICRU-IAEA initiative

    International Nuclear Information System (INIS)

    Wambersie, A.; Gahbauer, R.A.; Whitmore, G.; Levin, C.V.

    2000-01-01

    The present recommendations result from of an ICRU-IAEA initiative for harmonization of reporting NCT (Neutron Capture Therapy). As stated by the ISNCT, harmonization of reporting is required to understand what has actually been done and interpret the clinical results on the basis of reliable information. Prescription of a treatment remains the responsibility of the radiation oncologist in charge of the patient. Complete oncological data should be reported, including Gross Tumor Volume (GTV) and Clinical Target Volume (CTV) as well as Planning Target Volume (PTV), Treated Volume and Organs/Structures at Risk. A reference point for reporting dose should be selected in the central part of the PTV/CTV. At each point of interest, the four components contributing to the absorbed dose and the weighting factors applied to take account of the RBE (Relative Biological Effectiveness) differences should be specified. (author)

  20. Rendezvous, proximity operations and capture quality function deployment report

    Science.gov (United States)

    Lamkin, Stephen L. (Editor)

    1991-01-01

    Rendezvous, Proximity Operations, and Capture (RPOC) is a missions operations area which is extremely important to present and future space initiatives and must be well planned and coordinated. To support this, a study team was formed to identify a specific plan of action using the Quality Function Deployment (QFD) process. This team was composed of members from a wide spectrum of engineering and operations organizations which are involved in the RPOC technology area. The key to this study's success is an understanding of the needs of potential programmatic customers and the technology base available for system implementation. To this end, the study team conducted interviews with a variety of near term and future programmatic customers and technology development sponsors. The QFD activity led to a thorough understanding of the needs of these customers in the RPOC area, as well as the relative importance of these needs.

  1. Rendezvous, proximity operations and capture quality function deployment report

    Science.gov (United States)

    Lamkin, Stephen L.

    1991-12-01

    Rendezvous, Proximity Operations, and Capture (RPOC) is a missions operations area which is extremely important to present and future space initiatives and must be well planned and coordinated. To support this, a study team was formed to identify a specific plan of action using the Quality Function Deployment (QFD) process. This team was composed of members from a wide spectrum of engineering and operations organizations which are involved in the RPOC technology area. The key to this study's success is an understanding of the needs of potential programmatic customers and the technology base available for system implementation. To this end, the study team conducted interviews with a variety of near term and future programmatic customers and technology development sponsors. The QFD activity led to a thorough understanding of the needs of these customers in the RPOC area, as well as the relative importance of these needs.

  2. South Asia transboundary water quality monitoring workshop summary report.

    Energy Technology Data Exchange (ETDEWEB)

    Betsill, Jeffrey David; Littlefield, Adriane C.; Luetters, Frederick O.; Rajen, Gaurav

    2003-04-01

    The Cooperative Monitoring Center (CMC) promotes collaborations among scientists and researchers in several regions as a means of achieving common regional security objectives. To promote cooperation in South Asia on environmental research, an international working group made up of participants from Bangladesh, India, Nepal, Pakistan, and the United States convened in Kathmandu, Nepal, from February 17-23,2002. The workshop was held to further develop the South Asia Transboundary Water Quality Monitoring (SATWQM) project. The project is sponsored in part by the CMC located at Sandia National Laboratories in Albuquerque, New Mexico through funding provided by the US. Department of State, Regional Environmental Affairs Office, American Embassy, Kathmandu, Nepal, and the National Nuclear Security Administration's (NNSA) Office of Nonproliferation and National Security. This report summarizes the SATWQM project, the workshop objectives, process and results. The long-term interests of the participants are to develop systems for sharing regional environmental information as a means of building confidence and improving relations among South Asian countries. The more immediate interests of the group are focused on activities that foster regional sharing of water quality data in the Ganges and Indus River basins. Issues of concern to the SATWQM network participants include studying the impacts from untreated sewage and industrial effluents, agricultural run-off, salinity increases in fresh waters, the siltation and shifting of river channels, and the environmental degradation of critical habitats such as wetlands, protected forests, and endangered aquatic species conservation areas. The workshop focused on five objectives: (1) a deepened understanding of the partner organizations involved; (2) garnering the support of additional regional and national government and non-government organizations in South Asia involved in river water quality monitoring; (3) identification

  3. Quality assurance of 3-D conformal radiation therapy for a cooperative group trial - RTOG 3D QA center initial experience

    International Nuclear Information System (INIS)

    Michalski, Jeff M.; Purdy, James A.; Harms, William B.; Bosch, Walter R.; Oehmke, Frederick; Cox, James D.

    1996-01-01

    PURPOSE: 3-D conformal radiation therapy (3DCRT) holds promise in allowing safe escalation of radiation dose to increase the local control of prostate cancer. Prospective evaluation of this new modality requires strict quality assurance (QA). We report the results of QA review on patients receiving 3DCRT for prostate cancer on a cooperative group trial. MATERIALS and METHODS: In 1993 the NCI awarded the ACR/RTOG and nine institutions an RFA grant to study the use of 3DCRT in the treatment of prostate cancer. A phase I/II trial was developed to: a) test the feasibility of conducting 3DCRT radiation dose escalation in a cooperative group setting; b) establish the maximum tolerated radiation dose that can be delivered to the prostate; and c) quantify the normal tissue toxicity rate when using 3DCRT. In order to assure protocol compliance each participating institution was required to implement data exchange capabilities with the RTOG 3D QA center. The QA center reviews at a minimum the first five case from each participating center and spot checks subsequent submissions. For each case review the following parameters are evaluated: 1) target volume delineation, 2) normal structure delineation, 3) CT data quality, 4) field placement, 5) field shaping, and 6) dose distribution. RESULTS: Since the first patient was registered on August 23, 1994, an additional 170 patients have been accrued. Each of the nine original approved institutions has participated and three other centers have recently passed quality assurance bench marks for study participation. Eighty patients have been treated at the first dose level (68.4 Gy minimum PTV dose) and accrual is currently ongoing at the second dose level (73.8 Gy minimum PTV dose). Of the 124 cases that have undergone complete or partial QA review, 30 cases (24%) have had some problems with data exchange. Five of 67 CT scans were not acquired by protocol standards. Target volume delineation required the submitting institution

  4. Current discharge management of acute coronary syndromes: baseline results from a national quality improvement initiative.

    Science.gov (United States)

    Wai, A; Pulver, L K; Oliver, K; Thompson, A

    2012-05-01

    Evidence-practice gaps exist in the continuum of care for patients with acute coronary syndromes (ACS), particularly at hospital discharge. We aimed to describe the methodology and baseline results of the Discharge Management of Acute Coronary Syndromes (DMACS) project, focusing on the prescription of guideline-recommended medications, referral to cardiac rehabilitation and communication between the hospital, patient and their primary healthcare professionals. DMACS employed Drug Use Evaluation methodology involving data collection, evaluation and feedback, and targeted educational interventions. Adult patients with ACS discharged during a 4-month period were eligible to participate. Data were collected (maximum 50 patients) at each site through an inpatient medical record review, a general practitioner (GP) postal/fax survey conducted 14 days post discharge and a patient telephone survey 3 months post discharge. Forty-nine hospitals participated in the audit recruiting 1545 patients. At discharge, 57% of patients were prescribed a combination of antiplatelet agent(s), beta-blocker, statin and angiotensin-converting enzyme inhibitor and/or angiotensin II-antagonist. At 3 months post discharge, 48% of patients reported using the same combination. Some 67% of patients recalled being referred to cardiac rehabilitation; of these, 33% had completed the programme. In total, 83% of patients had a documented ACS management plan at discharge. Of these, 90% included a medication list, 56% a chest pain action plan and 54% risk factor modification advice. Overall, 65% of GPs rated the quality of information received in the discharge summary as 'very good' to 'excellent'. The findings of our baseline audit showed that despite the robust evidence base and availability of national guidelines, the management of patients with ACS can be improved. These findings will inform a multifaceted intervention strategy to improve adherence to guidelines for the discharge management of

  5. The reporting quality of randomized controlled trials in orthodontics.

    Science.gov (United States)

    Lempesi, Evangelia; Koletsi, Despina; Fleming, Padhraig S; Pandis, Nikolaos

    2014-06-01

    Accurate trial reporting facilitates evaluation and better use of study results. The objective of this article is to investigate the quality of reporting of randomized controlled trials (RCTs) in leading orthodontic journals, and to explore potential predictors of improved reporting. The 50 most recent issues of 4 leading orthodontic journals until November 2013 were electronically searched. Reporting quality assessment was conducted using the modified CONSORT statement checklist. The relationship between potential predictors and the modified CONSORT score was assessed using linear regression modeling. 128 RCTs were identified with a mean modified CONSORT score of 68.97% (SD = 11.09). The Journal of Orthodontics (JO) ranked first in terms of completeness of reporting (modified CONSORT score 76.21%, SD = 10.1), followed by American Journal of Orthodontics and Dentofacial Orthopedics (AJODO) (73.05%, SD = 10.1). Journal of publication (AJODO: β = 10.08, 95% CI: 5.78, 14.38; JO: β = 16.82, 95% CI: 11.70, 21.94; EJO: β = 7.21, 95% CI: 2.69, 11.72 compared to Angle), year of publication (β = 0.98, 95% CI: 0.28, 1.67 for each additional year), region of authorship (Europe: β = 5.19, 95% CI: 1.30, 9.09 compared to Asia/other), statistical significance (significant: β = 3.10, 95% CI: 0.11, 6.10 compared to non-significant) and methodologist involvement (involvement: β = 5.60, 95% CI: 1.66, 9.54 compared to non-involvement) were all significant predictors of improved modified CONSORT scores in the multivariable model. Additionally, median overall Jadad score was 2 (IQR = 2) across journals, with JO (median = 3, IQR = 1) and AJODO (median = 3, IQR = 2) presenting the highest score values. The reporting quality of RCTs published in leading orthodontic journals is considered suboptimal in various CONSORT areas. This may have a bearing in trial result interpretation and use in clinical decision making and evidence- based orthodontic treatment interventions. Copyright

  6. Quality assurance program description. Topical report SDQAPD-1

    International Nuclear Information System (INIS)

    1975-01-01

    The topical report presented describes the SDG and E QA Program that is applied to the design, procurement, construction, and preoperational testing of nuclear power plants. The QA plan describes the SDG and E organizational structure for quality assurance; identifies the functions, duties, and responsibilities of key departments and individuals; describes interrelationships and interfaces among internal groups and external organizations; delineates program requirements, and prescribes methods of implementation. SDG and E Procedures and Directives provide detailed direction for accomplishment of program requirements in consonance with the methods specified in the QA Plan

  7. Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012

    Science.gov (United States)

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-01-01

    Objectives Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. Setting and design A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to ‘top hospital’, best hospital’, and ‘hospital quality’, as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. Primary outcome measures (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. Results National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Conclusions Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by

  8. Quality Improvement Initiative in School-Based Health Centers across New Mexico

    Science.gov (United States)

    Booker, John M.; Schluter, Janette A.; Carrillo, Kris; McGrath, Jane

    2011-01-01

    Background: Quality improvement principles have been applied extensively to health care organizations, but implementation of quality improvement methods in school-based health centers (SBHCs) remains in a developmental stage with demonstration projects under way in individual states and nationally. Rural areas, such as New Mexico, benefit from the…

  9. Analysing data from patient-reported outcome and quality of life endpoints for cancer clinical trials

    DEFF Research Database (Denmark)

    Bottomley, Andrew; Pe, Madeline; Sloan, Jeff

    2016-01-01

    Measures of health-related quality of life (HRQOL) and other patient-reported outcomes generate important data in cancer randomised trials to assist in assessing the risks and benefits of cancer therapies and fostering patient-centred cancer care. However, the various ways these measures are anal......Measures of health-related quality of life (HRQOL) and other patient-reported outcomes generate important data in cancer randomised trials to assist in assessing the risks and benefits of cancer therapies and fostering patient-centred cancer care. However, the various ways these measures...... are analysed and interpreted make it difficult to compare results across trials, and hinders the application of research findings to inform publications, product labelling, clinical guidelines, and health policy. To address these problems, the Setting International Standards in Analyzing Patient......-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative has been established. This consortium, directed by the European Organisation for Research and Treatment of Cancer (EORTC), was convened to provide recommendations on how to standardise the analysis of HRQOL and other patient-reported outcomes...

  10. Comorbidity ascertainment from the ESRD Medical Evidence Report and Medicare claims around dialysis initiation: a comparison using US Renal Data System data.

    Science.gov (United States)

    Krishnan, Mahesh; Weinhandl, Eric D; Jackson, Scott; Gilbertson, David T; Lacson, Eduardo

    2015-11-01

    The end-stage renal disease Medical Evidence Report serves as a source of comorbid condition data for risk adjustment of quality metrics. We sought to compare comorbid condition data in the Medical Evidence Report around dialysis therapy initiation with diagnosis codes in Medicare claims. Observational cohort study using US Renal Data System data. Medicare-enrolled elderly (≥66 years) patients who initiated maintenance dialysis therapy July 1 to December 31, 2007, 2008, or 2009. 12 comorbid conditions ascertained from claims during the 6 months before dialysis therapy initiation, the Medical Evidence Report, and claims during the 3 months after dialysis therapy initiation. None. Comorbid condition prevalence according to claims before dialysis therapy initiation generally exceeded prevalence according to the Medical Evidence Report. The κ statistics for comorbid condition designations other than diabetes ranged from 0.06 to 0.43. Discordance of designations was associated with age, race, sex, and end-stage renal disease Network. During 23,930 patient-years of follow-up from 4 to 12 months after dialysis therapy initiation (8,930 deaths), designations from claims during the 3 months after initiation better discriminated risk of death than designations from the Medical Evidence Report (C statistics of 0.674 vs 0.616). Between the Medical Evidence Report and claims, standardized mortality ratios changed by >10% for more than half the dialysis facilities. Neither the Medical Evidence Report nor diagnosis codes in claims constitute a gold standard of comorbid condition data; results may not apply to nonelderly patients or patients without Medicare coverage. Discordance of comorbid condition designations from the Medical Evidence Report and claims around dialysis therapy initiation was substantial and significantly associated with patient characteristics, including location. These patterns may engender bias in risk-adjusted quality metrics. In lieu of the Medical

  11. How does arm positioning of polytraumatized patients in the initial computed tomography (CT) affect image quality and diagnostic accuracy?

    International Nuclear Information System (INIS)

    Kahn, Johannes; Grupp, Ulrich; Maurer, Martin

    2014-01-01

    Purpose: To evaluate the influence of different arm positions on abdominal image quality during initial whole-body CT (WBCT) in polytraumatized patients and to assess the risk of missing potentially life-threatening injuries due to arm artifacts. Materials and methods: Between July 2011 and February 2013, WBCT scans of 203 patients with arms in the abdominal area during initial WBCT were analyzed. Six different arms-down positions were defined: patients with both (group A)/one arm(s) (group B) down alongside the torso, patients with both (group C)/one arm(s) (group D) crossed in front of the upper abdomen, patients with both (group E)/one arm(s) (group F) crossed in front of the pelvic area. A group of 203 patients with elevated arms beside the head served as a control group. Two observers jointly evaluated image quality of different organ regions using a 4-point scale system. Follow-up examinations (CT scans and/or ultrasound) were analyzed to identify findings missed during initial WBCT due to reduced image quality. Results: Image quality for most of the organ regions analyzed was found to be significantly different among all groups (p < 0.05). Image quality was most severely degraded in group A, followed by groups E and C. Positioning with one arm up resulted in significantly better image quality than both arms down (p < 0.05). Overall, arms-up positioning showed significantly better image quality than arms-down positions (p < 0.05). In one case, liver hemorrhage missed in the initial WBCT because of arm artifacts, was revealed by follow-up CT. Conclusion: In WBCT arms-down positioning significantly degrades abdominal image quality and artifacts might even conceal potentially life-threatening injuries. If the patient's status does not allow elevation of both arms, image quality can benefit from raising at least one arm. Otherwise, arms should be placed in front of the upper abdomen instead of alongside the torso

  12. EVOLUTION AND QUALITY OF FINANCIAL REPORTING IN ROMANIA: AN OVERVIEW FROM 1990 TO PRESENT

    Directory of Open Access Journals (Sweden)

    NICHITA Mirela

    2015-07-01

    Full Text Available The results of a business activity are concentrated in the financial reports; accounting is the instrument that provides these reports to internal and external users in order to help users to make useful economic decisions. At international level, the accounting is standardized by IASB (former IASC which elaborate financial reporting standards (known as IAS / IFRS in order to improve the quality and transparency of reporting. The changes in business environment (globalization, mergers and acquisition transactions, internationalization, corporate social implications requires a continuous updated of financial reporting. The accounting information is useful to their users if comply with quality characteristics, defined through the Conceptual Framework of Financial Reporting issued by IASB (the new form of Conceptual Framework is in place starting 2010. Starting 1990, the researchers (namely academics had to focus on new kind of works about accounting and accounting research; the process was difficult and is not end. Initially, the academics inspired from French accounting books and translated them with some changes/improvements correlated to Romanian economy. Gradually, some journals founded and the academics and practitioners begin to publish their work in a more scientific manner. In this paper, we will try to present an evolution of financial reporting in Romania, to identify if the alignment to international financial reporting standards improved the quality of reporting, and to investigate whether the adoption of the International Financial Reporting Standards for the individual financial statements of Romanian listed entities has improved the value relevance of the accounting numbers. The study uses data of entities listed on the Bucharest Stock Exchange, prior and post the adoption of the International Financial Reporting Standards for the individual financial statements. The year 2012 represents the year in which Romanian entities listed on

  13. A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit.

    Science.gov (United States)

    Pearse, Bronwyn Louise; Rickard, Claire M; Keogh, Samantha; Lin Fung, Yoke

    2018-03-09

    Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost. Given the success of the initiative, we sought to answer the question; "How and why was the process of implementing a bleeding management quality initiative in the cardiac surgery unit successful, and sustainable?" A retrospective explanatory case study design was chosen to explore the quality initiative. Analysis of the evidence was reviewed through phases of the 'Knowledgeto Action' planned change model. Data was derived from: (1) document analysis, (2) direct observation of the local environment, (3) clinical narratives from interviews, and analysed with a triangulation approach. The study period extended from 10/2011 to 6/2013. Results demonstrated the complexity of changing practice, as well as the significant amount of dedicated time and effort required to support individual, department and system wide change. Results suggest that while many clinicians were aware of the potential to apply improved practice, numerous barriers and challenges needed to be overcome to implement change across multiple disciplines and departments. The key successful components of the QI were revealed through the case study analysis as: (1) an appropriately skilled project manager to facilitate the implementation process; (2) tools to support changes in workflow and decision making including a bleeding management treatment algorithm with POCCTs; (3) strong clinical leadership from the multidisciplinary team and; (4) the evolution of the project

  14. Structured reporting of MRI of the shoulder - improvement of report quality?

    Energy Technology Data Exchange (ETDEWEB)

    Gassenmaier, Sebastian; Armbruster, Marco; Sommer, Wieland H.; Sommer, Nora N. [Ludwig-Maximilians-University (LMU), Department of Clinical Radiology, Munich (Germany); Haasters, Florian [Schoen Klinik Muenchen Harlaching, Department of Knee, Hip and Shoulder Surgery, Munich (Germany); Ludwig-Maximilians-University (LMU), Department of General, Trauma and Reconstructive Surgery, Munich (Germany); Helfen, Tobias [Ludwig-Maximilians-University (LMU), Department of General, Trauma and Reconstructive Surgery, Munich (Germany); Henzler, Thomas [University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Heidelberg (Germany); Alibek, Sedat [Ambulatory Health Care Center Radiology and Nuclear Medicine, Fuerth (Germany); Friedrich-Alexander University, Department of Diagnostic Radiology, Erlangen-Nuremberg (Germany); Pfoerringer, Dominik [Klinikum rechts der Isar, Technical University of Munich, Department of Trauma Surgery, Munich (Germany)

    2017-10-15

    To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning. NRs were generated during clinical routine. Corresponding SRs were created using a dedicated template. All 60 reports were evaluated by two experienced orthopaedic shoulder surgeons using a questionnaire that included eight questions. Eighty per cent of the SRs were fully complete without any missing key features whereas only 45% of the NRs were fully complete (p < 0.001). The extraction of information was regarded to be easy in 92% of the SRs and 63% of the NRs. The overall quality of the SRs was rated better than that of the NRs (p < 0.001). Structured reporting of shoulder MRI improves the readability as well as the linguistic quality of radiological reports, and potentially leads to a higher satisfaction of referring physicians. (orig.)

  15. Structured reporting of MRI of the shoulder - improvement of report quality?

    International Nuclear Information System (INIS)

    Gassenmaier, Sebastian; Armbruster, Marco; Sommer, Wieland H.; Sommer, Nora N.; Haasters, Florian; Helfen, Tobias; Henzler, Thomas; Alibek, Sedat; Pfoerringer, Dominik

    2017-01-01

    To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning. NRs were generated during clinical routine. Corresponding SRs were created using a dedicated template. All 60 reports were evaluated by two experienced orthopaedic shoulder surgeons using a questionnaire that included eight questions. Eighty per cent of the SRs were fully complete without any missing key features whereas only 45% of the NRs were fully complete (p < 0.001). The extraction of information was regarded to be easy in 92% of the SRs and 63% of the NRs. The overall quality of the SRs was rated better than that of the NRs (p < 0.001). Structured reporting of shoulder MRI improves the readability as well as the linguistic quality of radiological reports, and potentially leads to a higher satisfaction of referring physicians. (orig.)

  16. THE IMPACT OF CONTROLS ON FINANCIAL REPORTING QUALITY

    Directory of Open Access Journals (Sweden)

    Cecilia (DAMOC NICA

    2015-11-01

    Full Text Available The study identifies the impact of the internal and external control of the quality of financial reporting, considering the professional accountants’ opinions, evaluating the extent to which financial and non-financial information presented annually by companies represent a guarantee of compliance with the ethical principles of professionals, and also a transparency presentation of the economic activity, risk management, at the same time protecting the interests of stakeholders in the company. The quantitative analysis performed is based on a questionnaire applied to the professional accountants being conducted on a sample of companies in Romania, in various sectors and presents a comparative study of the importance of each type of internal and external control in the delivery of financial reports and non- annual companies, real and credible.

  17. Any effects of social orientation priming on object-location memory are smaller than initially reported.

    Science.gov (United States)

    Drouin, Héloïse; Davidson, Patrick S R

    2015-12-01

    It has previously been reported that priming a collectivistic social orientation (compared with an individualistic one) boosts object-location memory (Kühnen & Oyserman, 2002; Oyserman, Sorensen, Reber, & Chen, 2009). We conducted 4 experiments to replicate this reported effect, using the same methods as in those initial reports. In Experiment 1 (n = 145), we found a hint of a priming effect on object-location memory, but also an unanticipated interaction between priming and gender. In Experiment 2 (n = 90), we included gender as a formal factor and doubled the "dosage" of the priming, yet did not see any priming effects on memory. In Experiment 3 (n = 101), we octupled the priming "dosage" and again saw no significant effects on memory. Finally, in Experiment 4 (n = 102), we performed an exact replication of the methods of the original reports and again found no priming effects on memory. Any effects of this type of social orientation priming on object-location memory appear to be smaller and/or less robust than initially thought. (c) 2015 APA, all rights reserved).

  18. The proxy problem: Child report versus parent report in health-related quality of life research

    NARCIS (Netherlands)

    Theunissen, N.C.M.; Vogels, T.G.C.; Koopman, H.M.; Verrips, G.H.W.; Zwinderman, K.A.H.; Verloove-Vanhorick, S.P.; Wit, J.M.

    1998-01-01

    This study evaluates the agreement between child and parent reports on children's health-related quality of life (HRQoL) in a representative sample of 1,105 Dutch children (age 8-11 years old). Both children and their parents completed a 56 item questionnaire (TACQOL). The questionnaire contains

  19. METHODOLOGICAL BACKGROUND OF EXPERT ESTIMATION OF INITIAL DATA COMPLETENESS AND QUALITY ACCORDING TO THE CERTIFIED INFORMATION SECURITY SYSTEM

    Directory of Open Access Journals (Sweden)

    V. K. Fisenko

    2015-01-01

    Full Text Available Problem of information security systems certification is analyzed and the tasks of initial data analysis are carried out. The objectives, indices and decision making criteria, as well as the challenges to be addressed are formulated. It is shown that, in order to improve quality, reduce time and cost of preparation for certification, it is reasonable to use software system for automatization of the process of initial data analysis, presented by the owner of the information system.

  20. Gas Regional Initiative. North West Regional Energy Market. Transmission Transparency Project. First Implementation Report

    International Nuclear Information System (INIS)

    2008-07-01

    The purpose of this report is to comment on the implementation of the TSO Transmission Transparency Project. In December 2007 sixteen TSOs presented a project plan which committed them to publishing information on capacity availability and gas flows at crossborder interconnection points in the North-West gas region. The data types to be published were agreed between TSOs and network users. It was agreed that TSOs would release new information on capacity and actual gas flows at crossborder interconnection points. The TSOs have committed to publishing the agreed information by three project milestones May, September or December 2008. At the end of May 2008 the TSOs submitted initial data to Ofgem (Office of the Gas and Electricity Markets) on implementation. This report presents the data submitted by the TSOs, provides comment on implementation progress and explains the next steps. This report does not approve or guarantee the accuracy of the data submitted by TSOs

  1. Tribal Colleges Initiative project. Quarterly report, April 1--June 30, 1998

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-07-01

    The Tribal Colleges Initiative (TCI) grant is in the second year of funding from the US Department of Energy Environmental Management Program. The project period has been determined to be 7.5 months, April 1 to November 14, 1998 in order to align with the federal fiscal year. This quarterly report includes activities for the first three months (April 1--June 30, 1998) of the Year 2 funding period. The TCI Program office requested each Tribal College to write a quarterly report of activities at their respective institutions. These reported are attached. These institutions are Southwestern Indian Polytechnic Institute (SIPI), Crownpoint Institute of Technology (CIT) and the Dine` College (DC, formerly Navajo Community College).

  2. [Methodological quality and reporting quality evaluation of randomized controlled trials published in China Journal of Chinese Materia Medica].

    Science.gov (United States)

    Yu, Dan-Dan; Xie, Yan-Ming; Liao, Xing; Zhi, Ying-Jie; Jiang, Jun-Jie; Chen, Wei

    2018-02-01

    To evaluate the methodological quality and reporting quality of randomized controlled trials(RCTs) published in China Journal of Chinese Materia Medica, we searched CNKI and China Journal of Chinese Materia webpage to collect RCTs since the establishment of the magazine. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of RCTs. The CONSORT 2010 list was adopted as reporting quality evaluating tool. Finally, 184 RCTs were included and evaluated methodologically, of which 97 RCTs were evaluated with reporting quality. For the methodological evaluating, 62 trials(33.70%) reported the random sequence generation; 9(4.89%) trials reported the allocation concealment; 25(13.59%) trials adopted the method of blinding; 30(16.30%) trials reported the number of patients withdrawing, dropping out and those lost to follow-up;2 trials (1.09%) reported trial registration and none of the trial reported the trial protocol; only 8(4.35%) trials reported the sample size estimation in details. For reporting quality appraising, 3 reporting items of 25 items were evaluated with high-quality,including: abstract, participants qualified criteria, and statistical methods; 4 reporting items with medium-quality, including purpose, intervention, random sequence method, and data collection of sites and locations; 9 items with low-quality reporting items including title, backgrounds, random sequence types, allocation concealment, blindness, recruitment of subjects, baseline data, harms, and funding;the rest of items were of extremely low quality(the compliance rate of reporting item<10%). On the whole, the methodological and reporting quality of RCTs published in the magazine are generally low. Further improvement in both methodological and reporting quality for RCTs of traditional Chinese medicine are warranted. It is recommended that the international standards and procedures for RCT design should be strictly followed to conduct high-quality trials

  3. Preparing for Evaluation: Lessons from the Evaluability Assessment of the Teagle Foundation's College-Community Connections Initiative. Report

    Science.gov (United States)

    Black, Kristin

    2016-01-01

    Funders, policymakers, and program leaders recognize the value of high-quality evidence. To make good use of a program evaluation, initiatives must contend with a set of fundamental questions first. Some of these are about the initiative itself: What outcomes does it seek to affect? Are daily activities in line with long-term goals? Others are…

  4. The effects of temperature, relative humidity, light, and resource quality on flight initiation in the red flour beetle, Tribolium castaneum.

    Science.gov (United States)

    Drury, Douglas W; Whitesell, Matthew E; Wade, Michael J

    2016-03-01

    We investigated the environmental conditions that induce a flight response in the red flour beetle, Tribolium castaneum Herbst (Coleoptera: Tenebrionidae), including resource quality, temperature, relative humidity, and light. Over 72-h trial periods, we observed the proportion of individuals emigrating by flight to range from 0.0 in extreme heat or cold to 0.82 with starvation. Resource quality, presence of a light source, and temperature all directly influenced the initiation of the flight response. We did not detect any effect of relative humidity or sudden change in temperature on the incidence of flight. We discuss our findings in the context of Tribolium ecology and evolution.

  5. E16 Sandvika-Wøyen - Analysis of tunnel excavation, achieved contour quality and influence of applied initiation system.

    OpenAIRE

    Sklodowska, Anna Maria

    2016-01-01

    The drill and blast excavation method is the most commonly used method for tunnel construction in Norway. In D&B the results from blasting can be evaluated through several factors, such as pull percentage, vibration level and contour quality. The main goal of the thesis was to analyze excavation with a special focus on the quality of the achieved contour and the influence of the applied initiation system. The analysis was performed based on results from the Bjørnegård tunnel, which wa...

  6. Effect of electronic report writing on the quality of nursing report recording

    Science.gov (United States)

    Heidarizadeh, Khadijeh; Rassouli, Maryam; Manoochehri, Houman; Tafreshi, Mansoureh Zagheri; Ghorbanpour, Reza Kashef

    2017-01-01

    Background and Aim Recording performed nursery actions is one of the main chores of nurses. The findings have shown that recorded reports are not qualitatively valid. Since electronic reports can be regarded as a base to write reports, this study aims at determining the effect of utilizing electronic nursing reports on the quality of the records. Methods This quasi-experimental study was conducted with the aim of applying an electronic system of nursing recording in the heart department of Shahid Rahimi Medical Center, Lorestan University of Medical Science. The samples were nursing reports on the hospitalized patients in the heart department, the basis of complete enumeration (census) during the fall of 2014. The subjects were sixteen employed nurses. To do the study, the software of nursing records was set based on the Clinical Care Classification system (CCC). The research’s tool was the checklist of the Standards of Nursing Documentation. Results The findings indicated that before and after the intervention, the amount of reports’ adaption with the written standards, respectively, was (21.8%) and (71.3%), and the most complete recording was medicine status (58%) and (100%). The worst complete recording before the intervention, acute changes was (99.1%) and nursing processes was (78%) and after, the medicine status, intake and output status and patient’s education (100%); while the nursing report structure was regarded in all cases (100%). The results showed that there is a significant difference in the quality of reporting before and after using CCC (pnurses are reminded to record the necessary parts and from the other point, the system does not allow the user to shut it down unless the necessary parameters are recorded. For this reason, the quality of recorded reports with electronic reporting improves. PMID:29238481

  7. The Effect of Quantity, Quality and Timing of Headquarters-Initiated Knowledge Flows on Subsidiary Performance

    DEFF Research Database (Denmark)

    Tran, Yen; Mahnke, Volker; Ambos, Björn

    2010-01-01

    quality/performance relationship and a curvilinear quantity/performance relationship, indicating that too much knowledge sharing can be detrimental to the receiving subsidiary. Most importantly, we show that the timing of a knowledge flow significantly affects subsidiary sales performance....

  8. Guidelines Regarding §16 of the German Transplantation Act - Initial Experiences with Structured Reporting.

    Science.gov (United States)

    Pinto Dos Santos, Daniel; Arnhold, Gordon; Mildenberger, Peter; Düber, Christoph; Kloeckner, Roman

    2017-12-01

    the German Transplantation Act - Initial Experiences with Structured Reporting. Fortschr Röntgenstr 2017; 189: 1145 - 1151. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Do quality improvement initiatives for diabetes care address social inequities? Secondary analysis of a systematic review.

    Science.gov (United States)

    Lu, Jacquie Boyang; Danko, Kristin J; Elfassy, Michael D; Welch, Vivian; Grimshaw, Jeremy M; Ivers, Noah M

    2018-02-14

    Socially disadvantaged populations carry a disproportionate burden of diabetes-related morbidity and mortality. There is an emerging interest in quality improvement (QI) strategies in the care of patients with diabetes, however, the effect of these interventions on disadvantaged groups remains unclear. This is a secondary analysis of a systematic review that seeks to examine the extent of equity considerations in diabetes QI studies, specifically quantifying the proportion of studies that target interventions toward disadvantaged populations and conduct analyses on the impact of interventions on disadvantaged groups. Studies were identified using Medline, HealthStar and the Cochrane Effective Practice and Organisation of Care database. Randomised controlled trials assessing 12 QI strategies targeting health systems, healthcare professionals and/or patients for the management of adult outpatients with diabetes were eligible. The place of residence, race/ethnicity/culture/language, occupational status, gender/sexual identity, religious affiliations, education level, socioeconomic status, social capital, plus age, disability, sexual preferences and relationships (PROGRESS-Plus) framework was used to identify trials that focused on disadvantaged patient populations, to examine the types of equity-relevant factors that are being considered and to explore temporal trends in equity-relevant diabetes QI trials. Of the 278 trials that met the inclusion criteria, 95 trials had equity-relevant considerations. These include 64 targeted trials that focused on a disadvantaged population with the aim to improve the health status of that population and 31 general trials that undertook subgroup analyses to assess the extent to which their interventions may have had differential impacts on disadvantaged subgroups. Trials predominantly focused on race/ethnicity, socioeconomic status and place of residence as potential factors for disadvantage in patients receiving diabetes care. Less

  10. Initial investigation of dietitian perception of plant-based protein quality

    OpenAIRE

    Hughes, Glenna J; Kress, Kathleen S; Armbrecht, Eric S; Mukherjea, Ratna; Mattfeldt-Beman, Mildred

    2014-01-01

    Interest in plant-based diets is increasing, evidenced by scientific and regulatory recommendations, including Dietary Guidelines for Americans. Dietitians provide guidance in dietary protein selection but little is known about how familiar dietitians are with the quality of plant versus animal proteins or methods for measuring protein quality. Likewise, there is a need to explore their beliefs related to dietary recommendations. The aim of this study was to assess dietitians' perceptions of ...

  11. Tics as an initial manifestation of juvenile Huntington's disease: case report and literature review.

    Science.gov (United States)

    Cui, Shi-Shuang; Ren, Ru-Jing; Wang, Ying; Wang, Gang; Chen, Sheng-Di

    2017-08-08

    Huntington's disease (HD) is an autosomal dominant disorder, typically characterized by chorea due to a trinucleotide repeat expansion in the HTT gene, although the clinical manifestations of patients with juvenile HD (JHD) are atypical. A 17-year-old boy with initial presentation of tics attended our clinic and his DNA analysis demonstrated mutation in the HTT gene (49 CAG repeats). After treatment, his symptoms improved. Furthermore, we performed literature review through searching the databases and summarized clinical features in 33 JHD patients. The most prevalent symptoms are ataxia, and two cases reported that tics as initial and prominent manifestation in JHD. Among them, 88% patients carried CAG repeats beyond 60 and most of them have family history. This case here illustrates the variable range of clinical symptoms of JHD and the necessity of testing for the HD mutation in young patients with tics with symptoms unable to be explained by Tourette's syndrome (TS).

  12. Megaloblastic anemia with peripheral neuropathy, a misleading initial presentation in POEMS syndrome: A case report

    Directory of Open Access Journals (Sweden)

    Iadarilang Tiewsoh

    2014-01-01

    Full Text Available POEMS (peripheral neuropathy, organomegaly, endocrinopathy, M protein, skin changes syndrome is a rare multisystem paraneoplastic disorder that occurs in the setting of a plasma cell dyscrasia. A 57-year-old male with initial presentation of peripheral neuropathy of lower limbs and a peripheral blood picture of megaloblastic anemia, presented with progressive lower motor neuron weakness over few months; followed by additional features of skin hyperpigmentation, generalized lymphadenopathy, erectile dysfunction, weight loss, and an attack of cerebrovascular accident (stroke infarct which recovered. On further evaluation with time, there were presence of hepatosplenomegaly, Castleman′s disease of the lymph node on biopsy, serum electrophoresis suggestive of monoclonal gammopathy with light band lambda chain, and endocrinopathy (hypothyroidism and hypogonadism. His bone marrow was suggestive of plasmacytosis. This case report describes a patient who presented with initial picture of peripheral neuropathy with megaloblastic anemia, but when followed-up there were diverse clinical manifestations fulfilling the diagnostic clinical criteria of POEMS Syndrome.

  13. Cauda equina syndrome as the initial presenting clinical feature of medulloblastoma: a case report

    Directory of Open Access Journals (Sweden)

    Al-Otaibi Faisal

    2012-05-01

    Full Text Available Abstract Introduction Medulloblastoma is one of the most common pediatric brain malignancies. The usual presenting clinical features are related to posterior fossa syndrome or/and hydrocephalus. Cauda equina syndrome is a very rare presentation for this disease. Case presentation We describe the case of a three-year-old boy with cauda equina syndrome as the initial presenting clinical feature for medulloblastoma. He was initially diagnosed as having a spinal tumor by magnetic resonance imaging scan. Subsequently, a cranial magnetic resonance imaging scan revealed a posterior fossa tumor with features of dissemination. He had substantial improvement after treatment. This case report is complemented by a literature review related to this unusual presentation. Conclusions Medulloblastoma primarily presenting with cauda equina syndrome is very rare. However, spinal drop metastasis should be considered in the pediatric age group to avoid suboptimal management.

  14. Elevating the quality of disability and rehabilitation research: mandatory use of the reporting guidelines.

    Science.gov (United States)

    Chan, Leighton; Heinemann, Allen W; Roberts, Jason

    2014-01-01

    Note from the AJOT Editor-in-Chief: Since 2010, the American Journal of Occupational Therapy (AJOT) has adopted reporting standards based on the Consolidated Standards of Reporting Trials (CONSORT) Statement and American Psychological Association (APA) guidelines in an effort to publish transparent clinical research that can be easily evaluated for methodological and analytical rigor (APA Publications and Communications Board Working Group on Journal Article Reporting Standards, 2008; Moher, Schulz, & Altman, 2001). AJOT has now joined 28 other major rehabilitation and disability journals in a collaborative initiative to enhance clinical research reporting standards through adoption of the EQUATOR Network reporting guidelines, described below. Authors will now be required to use these guidelines in the preparation of manuscripts that will be submitted to AJOT. Reviewers will also use these guidelines to evaluate the quality and rigor of all AJOT submissions. By adopting these standards we hope to further enhance the quality and clinical applicability of articles to our readers. Copyright © 2014 by the American Occupational Therapy Association, Inc.

  15. Self-reported adverse reactions among patients initiating antiretroviral therapy in Brazil

    Directory of Open Access Journals (Sweden)

    Cristiane A. Menezes de Pádua

    Full Text Available A cross-sectional analysis was carried out to describe adverse reactions to antiretroviral therapy (ART reported by HIV-infected patients initiating treatment at two public health AIDS referral centers in Belo Horizonte, Brazil, 2001-2003 and to verify their association with selected variables. Adverse reactions were obtained through interview at the first follow-up visit (first month after the antiretroviral prescription. Socio-demographic and behavioral variables related to ART were obtained from baseline and follow-up interviews and clinical variables from medical charts. Patients with four or more reactions were compared to those with less than four. Odds ratio with 95% confidence interval were estimated using logistic regression model for both univariate and multivariate analyses. At least one adverse reaction was reported by 92.2% of the participants while 56.2% reported four or more different reactions. Antiretroviral regimens including indinavir/ritonavir, irregular use of antiretrovirals and switch in regimens were independently associated with four or more adverse reactions (OR=7.92, 5.73 and 2.03, respectively. The initial period of ARV treatment is crucial and patients´ perception of adverse reactions should be carefully taken into account. Strategies for monitoring and management of adverse reactions including the choice of regimens and the prevention of irregular ART should be developed in AIDS/HIV referral centers in Brazil to promote better adherence to antiretroviral therapy.

  16. Initial investigation of dietitian perception of plant-based protein quality.

    Science.gov (United States)

    Hughes, Glenna J; Kress, Kathleen S; Armbrecht, Eric S; Mukherjea, Ratna; Mattfeldt-Beman, Mildred

    2014-07-01

    Interest in plant-based diets is increasing, evidenced by scientific and regulatory recommendations, including Dietary Guidelines for Americans. Dietitians provide guidance in dietary protein selection but little is known about how familiar dietitians are with the quality of plant versus animal proteins or methods for measuring protein quality. Likewise, there is a need to explore their beliefs related to dietary recommendations. The aim of this study was to assess dietitians' perceptions of plant-based protein quality and to determine if these are affected by demographic factors such as age and dietary practice group (DPG) membership. This was a cross-sectional design using an online survey. The survey was sent to all members of the Missouri Dietetic Association. All completed surveys (136) were analyzed. The main outcome measures were responses to belief and knowledge questions about the protein quality of plant-based diets, along with demographic information including age and DPG membership. Descriptive statistics and frequencies were determined, and chi-square analysis was used to determine the associations between belief and knowledge responses and demographic characteristics. Responses to belief statements suggested a high level of support for plant-based diets. No associations were found between any of the belief questions and demographic factors. A majority of respondents were not familiar with protein quality determination methods that are currently recognized by global regulatory and advisory agencies. Potential barriers identified in shifting to a more plant-based diet were lack of interest and perceived difficulty. Knowledge among dietitians of plant-based protein quality in general, and methods of protein quality measurement more specifically, needs to be addressed to enhance their knowledge base for making dietary protein recommendations. Two potential avenues for training are university curricula and continuing education opportunities provided to

  17. Air quality and emissions reduction initiatives at the City of Calgary

    International Nuclear Information System (INIS)

    Stone, K.

    2001-01-01

    To conserve, protect and improve the environment for the benefits of the citizens living in Calgary, the City of Calgary is committed to environmental leadership, as declared by the author as an opening statement to this Power Point presentation. The author described some of the partnerships and alliances to which the City of Calgary adheres, such as partner for climate protection program, the Federation of Canadian Municipalities and the International Council for Local Environmental Initiatives (ICLEI). The City is aiming at a 20 per cent reduction of 1990 greenhouse gas emission levels within ten years for municipal operations. The Greenhouse Gas Reduction Commitment is divided in three parts: (1) baseline inventory, (2) economic and emissions abatement assessment, and (3) implementation and each phase was explained. Phase 1 relates to an inventory of equivalent carbon dioxide as a standardized measure of greenhouse gases. Both municipal and corporate reduction targets have been identified, as well as targets for buildings. An innovative cooperative partnership with private industry has been initiated, called the energy performance contracting (EPC), where EPC provides upgraded building infrastructure with more energy efficient equipment. The entire concept was detailed. Other initiatives include green power substitutions and street lighting retrofits. The author concluded by providing a greenhouse gas reduction score sheet. Some initiatives at the community level include Web business office/Web initiatives, a public education outreach program and third party agencies. figs

  18. Cross-Cultural Adaptation and Initial Validation of the Stroke-Specific Quality of Life Scale into the Yoruba Language

    Science.gov (United States)

    Akinpelu, Aderonke O.; Odetunde, Marufat O.; Odole, Adesola C.

    2012-01-01

    Stroke-Specific Quality of Life 2.0 (SS-QoL 2.0) scale is used widely and has been cross-culturally adapted to many languages. This study aimed at the cross-cultural adaptation of SS-QoL 2.0 to Yoruba, the indigenous language of south-western Nigeria, and to carry out an initial investigation on its validity. English SS-QoL 2.0 was first adapted…

  19. An initial report of sleep disturbance in inactive inflammatory bowel disease.

    Science.gov (United States)

    Keefer, Laurie; Stepanski, Edward J; Ranjbaran, Ziba; Benson, Laura M; Keshavarzian, Ali

    2006-10-15

    There is an increased prevalence of gastrointestinal symptoms, peptic ulcer disease, and colon cancer in night-shiftworkers, whose sleep is commonly disrupted. Sleep complaints are an extrapyramidal symptom of irritable bowel syndrome (IBS). Sleep disruption may contribute to increased medical morbidity by weakening the ability of the immune system to protect against endotoxins-this pathway could be of potential importance to the pathogenesis and/or clinical course of inflammatory bowel disease (IBD), a chronic immunoinflammatory gastrointestinal disorder associated with marked reductions in quality of life. This is the first study to comprehensively examine sleep concerns in patients with IBD. Sixteen patients with biopsy-proven inactive IBD (8 with Crohn disease and 8 with ulcerative colitis), 9 patients with IBS, and 7 healthy controls completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Inflammatory Bowel Disease Questionnaire, SF-12, and a single overnight polysomnogram. Polysomnography and arousals were scored according to standard criteria. Multivariate analyses were used to compare subjective and objective sleep parameters between groups and to identify associations between sleep complaints and quality of life. Patients with IBD did not seem to significantly differ from patients with IBS, who have established sleep complaints. On polysomnography, total sleep time differentiated the 3 groups well, with the IBS and IBD groups appearing numerically similar. Whereas IBS and IBD groups were similar with respect to observed sleep parameters, IBS patients did report the most concerns, consistent with earlier research suggesting that hyperarousal and perceptual differences may contribute to symptom reporting. Sleep parameters greatly influenced quality of life in both groups and highlight the need to address sleep concerns as part of IBD management.

  20. Experiment data report for Test RIA 1-2 (Reactivity Initiated Accident Test Series)

    International Nuclear Information System (INIS)

    Zimmermann, C.L.; White, C.E.; Evans, R.P.

    1979-06-01

    Recorded test data are presented for the second of six planned tests in the Reactivity Initiated Accident (RIA) Test Series I, Test RIA 1-2. This test, conducted at the Power Burst Facility, had the following objectives: (1) characterize the response of preirradiated fuel rods during an RIA event conducted at boiling water reactor hot-startup conditions; and (2) evaluate the effect of rod internal pressure on preirradiated fuel rod response during an RIA event. The data from Test RIA 1-2 are graphed in engineering units and have been appraised for quality and validity. These uninterpreted data are presented for use in the nuclear fuel behavior research field before detailed analysis and interpretation have been completed

  1. Quality assurance and the World Health Organization initiative of 'Health for All'

    International Nuclear Information System (INIS)

    Hanson, G.P.

    1989-01-01

    Following a workshop held in Neuherberg, FRG, in 1980 a guide for quality assurance in diagnostic radiology was published by WHO in 1982. Quality assurance programmes were recognized as being necessary for three main objectives: first the improvement of medical diagnostic imaging, secondly cost containment, and thirdly the reduction of radiation exposure. Concurrently, because of the paramount importance for basic diagnostic imaging, WHO prepared Technical Specifications for the X-ray Apparatus to be Used in a Basic Radiological System (BRS), governed by the concepts of ''design-out maintenance'' and ''design-in quality assurance''. The outcome of WHO's efforts, in comparison with the recognized quality assurance objectives, indicates that, although it is too early to measure overall improvements in medical diagnostic imaging, the two main aspects, accessibility and image quality, should be improved. Regarding cost containment, elimination of many logistical and support requirements should result in considerable savings. Regarding the reduction of radiation exposure, and using the entrance skin exposure as an indicator, an important finding is that with the WHO-BRS type X-ray equipment, in most cases the patient exposure was less than the average values in the United States. (author)

  2. Biophysical Aspects of Radiation Quality. Second Panel Report

    International Nuclear Information System (INIS)

    1968-01-01

    If a living system is exposed to ionizing radiation a sequence of events follows. It starts with the absorption and dissipation of radiation energy, and continues through various physico-chemical and biochemical reactions up to the final biological end point observed. One of the aims of research in quantitative radiation biology is to understand the mechanism of this sequence of actions and to explore the differences in quality of different kinds of radiations. Because of its complexity, progress in this work requires the combined efforts of physicists, biochemists, biologists and physicians. It should, however, be done in very close collaboration rather than in following isolated lines in any one direction. For this reason, and because of the growing importance of the field for almost all applications of ionizing radiations, it was felt desirable to bring together a group of scientists engaged in research on radiation quality who represented a wide range of interests. The first panel on Biophysical Aspects of Radiation Quality, convened by the International Atomic Energy Agency in Vienna and held from 29 March to 2 April 1965, proved to be a successful beginning, stimulating a useful exchange of ideas and information. By this meeting, and the resulting collection of papers, published in 1966 as No. 58 of the Agency's Technical Reports Series, the importance of research on radiation quality was highlighted and the field itself became more clearly defined. The Agency held a second Panel on the same subject in Vienna from 14 to 18 April 1967. This meeting was attended by 18 experts from 10 countries, and representatives from Euratom and WHO. The Czechoslovak Socialist Republic, France, India and Poland were represented for the first time. Fourteen papers were presented and discussed in some detail. It became evident that much progress had been made since the previous meeting in certain areas such as microdosimetry, the dependence of the oxygen effect on radiation

  3. Development of a quality instrument for assessing the spontaneous reports of ADR/ADE using Delphi method in China.

    Science.gov (United States)

    Chen, Lixun; Jiang, Ling; Shen, Aizong; Wei, Wei

    2016-09-01

    The frequently low quality of submitted spontaneous reports is of an increasing concern; to our knowledge, no validated instrument exists for assessing case reports' quality comprehensively enough. This work was conducted to develop such a quality instrument for assessing the spontaneous reports of adverse drug reaction (ADR)/adverse drug event (ADE) in China. Initial evaluation indicators were generated using systematic and literature data analysis. Final indicators and their weights were identified using Delphi method. The final quality instrument was developed by adopting the synthetic scoring method. A consensus was reached after four rounds of Delphi survey. The developed quality instrument consisted of 6 first-rank indicators, 18 second-rank indicators, and 115 third-rank indicators, and each rank indicator has been weighted. It evaluates the quality of spontaneous reports of ADR/ADE comprehensively and quantitatively on six parameters: authenticity, duplication, regulatory, completeness, vigilance level, and reporting time frame. The developed instrument was tested with good reliability and validity, which can be used to comprehensively and quantitatively assess the submitted spontaneous reports of ADR/ADE in China.

  4. FOCUS: the Society of Cardiovascular Anesthesiologists' initiative to improve quality and safety in the cardiovascular operating room.

    Science.gov (United States)

    Barbeito, Atilio; Lau, William Travis; Weitzel, Nathaen; Abernathy, James H; Wahr, Joyce; Mark, Jonathan B

    2014-10-01

    The Society of Cardiovascular Anesthesiologists (SCA) introduced the FOCUS initiative (Flawless Operative Cardiovascular Unified Systems) in 2005 in response to the need for a rigorous scientific approach to improve quality and safety in the cardiovascular operating room (CVOR). The goal of the project, which is supported by the SCA Foundation, is to identify hazards and develop evidence-based protocols to improve cardiac surgery safety. A hazard is anything that has the potential to cause a preventable adverse event. Specifically, the strategic plan of FOCUS includes 3 goals: (1) identifying hazards in the CVOR, (2) prioritizing hazards and developing risk-reduction interventions, and (3) disseminating these interventions. Collectively, the FOCUS initiative, through the work of several groups composed of members from different disciplines such as clinical medicine, human factors engineering, industrial psychology, and organizational sociology, has identified and documented significant hazards occurring daily in our CVORs. Some examples of frequent occurrences that contribute to reduce the safety and quality of care provided to cardiac surgery patients include deficiencies in teamwork, poor OR design, incompatible technologies, and failure to adhere to best practices. Several projects are currently under way that are aimed at better understanding these hazards and developing interventions to mitigate them. The SCA, through the FOCUS initiative, has begun this journey of science-driven improvement in quality and safety. There is a long and arduous road ahead, but one we need to continue to travel.

  5. Initial report of the cancer Patient-Reported Outcomes Measurement Information System (PROMIS) sexual function committee: review of sexual function measures and domains used in oncology.

    Science.gov (United States)

    Jeffery, Diana D; Tzeng, Janice P; Keefe, Francis J; Porter, Laura S; Hahn, Elizabeth A; Flynn, Kathryn E; Reeve, Bryce B; Weinfurt, Kevin P

    2009-03-15

    For this report, the authors described the initial activities of the Cancer Patient-Reported Outcomes Measurement Information System (PROMIS)-Sexual Function domain group, which is part of the National Institutes of Health Roadmap Initiative to develop brief questionnaires or individually tailored assessments of quality-of-life domains. Presented are a literature review of sexual function measures used in cancer populations and descriptions of the domains found in those measures. By using a consensus-driven approach, an electronic bibliographic search was conducted for articles that were published from 1991 to 2007, and 486 articles were identified for in-depth review. In total, 257 articles reported the administration of a psychometrically evaluated sexual function measure to individuals who were diagnosed with cancer. Apart from the University of California-Los Angeles Prostate Cancer Index, the International Index of Erectile Function, and the Female Sexual Function Index, the 31 identified measures have not been tested widely in cancer populations. Most measures were multidimensional and included domains related to the sexual response cycle and to general sexual satisfaction. The current review supports the need for a flexible, psychometrically robust measure of sexual function for use in oncology settings and strongly justifies the development of the PROMIS-Sexual Function instrument. When the PROMIS-Sexual Function instrument is available publicly, cancer clinicians and researchers will have another measure with which to assess patient-reported sexual function outcomes in addition to the few legacy measures that were identified through this review. Copyright (c) 2009 American Cancer Society.

  6. Initial report of the ITER Council's Ways and Means Working Party

    International Nuclear Information System (INIS)

    1990-01-01

    Under the auspices of the IAEA, the ITER Conceptual Design Activities began in April, 1988, and are scheduled to be completed in December, 1990. As part of the Terms of Reference of the ITER Conceptual Design Activities, the ITER Council chartered a Working Party which plans to define needed elements to conduct an Engineering Design of ITER, should the members wish to go on with such design. This document is an initial report of the Working Party on Ways and Means; it seeks to define the Engineering Design Activities, and to list the practical topics to be considered by the ITER EDA. 2 figs, 4 tabs

  7. DOE Advanced Scientific Computing Advisory Committee (ASCAC) Report: Exascale Computing Initiative Review

    Energy Technology Data Exchange (ETDEWEB)

    Reed, Daniel [University of Iowa; Berzins, Martin [University of Utah; Pennington, Robert; Sarkar, Vivek [Rice University; Taylor, Valerie [Texas A& M University

    2015-08-01

    On November 19, 2014, the Advanced Scientific Computing Advisory Committee (ASCAC) was charged with reviewing the Department of Energy’s conceptual design for the Exascale Computing Initiative (ECI). In particular, this included assessing whether there are significant gaps in the ECI plan or areas that need to be given priority or extra management attention. Given the breadth and depth of previous reviews of the technical challenges inherent in exascale system design and deployment, the subcommittee focused its assessment on organizational and management issues, considering technical issues only as they informed organizational or management priorities and structures. This report presents the observations and recommendations of the subcommittee.

  8. An uncommon initial presentation of snake bite-subarachnoid hemorrhage: A case report with literature review

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Roy

    2015-01-01

    Full Text Available Snake bites are very common in India, particularly in West Bengal. Snake bite can cause various hematological, neuromyopathical complications. It can be very fatal if not detected and treated early. Timely intervention can save the patient. We are reporting a case of hematotoxic Russell viper snake bite presented with subarachnoid hemorrhage. Patient was successfully treated with antivenom serum (AVS along with other conservative management. Subarachnoid hemorrhage as an initial presentation in viper bite is very rare and we discuss the case with proper literature review.

  9. Self-reported sleep quality, strain and health in relation to perceived working conditions in females.

    Science.gov (United States)

    Edéll-Gustafsson, Ulla M; Kritz, Eivor I K; Bogren, I Kristina

    2002-06-01

    Self-reported sleep quality, strain and health in relation to perceived working conditions in females The aims of this study were to examine self-reported sleep quality, perceived strain and health in relation to working conditions; the prevalence and severity of sleep disturbances and daytime distress arising from poor sleep in women on different work shifts. Furthermore, to see whether females with gastrointestinal symptoms, joint-, back- or muscle-pain and who are dissatisfied with working hours differ with regard to the above aspects. Finally, degree of strain-related symptoms and sleep difficulties were tested as predictors of sleep quality and general health outcome. Important research questions are whether registered nurses and those on rotating work shifts have greater sleep problems than others. A total of 156 females, aged 20-59 years, working at three different casualty departments, answered structured questionnaires. The results showed a persistently high rate of psycho-physiological long-term effects of stress related to working conditions. Thirty-four per cent were dissatisfied with their working hours, and exhibited significantly more mental strain, fatigue/excessive tiredness and inability to relax after work because of involuntary thoughts, in relation to working conditions than others did. Sixty-two females (39.7%) complained of insufficient sleep. The sleep quality outcome was significantly predicted by difficulty falling asleep (odds ratio 8.4), difficulty in falling asleep after nocturnal awakening (odds ratio 3.4) and perceived exhaustion (odds ratio 2.6). Females suffering from gastrointestinal symptoms and joint-, back- and muscle symptoms for several days in a week or even everyday were especially sensitive to worse sleep quality. Independent of work shifts, registered nurses exhibited a higher degree of mental strain and prolonged recovery in comparison with others. In conclusions, sleep initiation difficulties, troubled sleep and

  10. Costs associated with data collection and reporting for diabetes quality improvement in primary care practices: a report from SNOCAP-USA.

    Science.gov (United States)

    West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry

    2012-01-01

    Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.

  11. Quality Assurance and Improvement in Head and Neck Cancer Surgery: From Clinical Trials to National Healthcare Initiatives.

    Science.gov (United States)

    Simon, Christian; Caballero, Carmela

    2018-05-24

    It is without question in the best interest of our patients, if we can identify ways to improve the quality of care we deliver to them. Great progress has been made within the last 25 years in terms of development and implementation of quality-assurance (QA) platforms and quality improvement programs for surgery in general, and within this context for head and neck surgery. As of now, we have successfully identified process indicators that impact outcome of our patients and the quality of care we deliver as surgeons. We have developed risk calculators to determine the risk for complications of individual surgical patients. We have created perioperative guidelines for complex head and neck procedures. We have in Europe and North America created audit registries that can gather and analyze data from institutions across the world to better understand which processes need change to obtain good outcomes and improve quality of care. QA platforms can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit directly from such initiatives on a global level.

  12. European specialist porphyria laboratories: diagnostic strategies, analytical quality, clinical interpretation, and reporting as assessed by an external quality assurance program.

    Science.gov (United States)

    Aarsand, Aasne K; Villanger, Jørild H; Støle, Egil; Deybach, Jean-Charles; Marsden, Joanne; To-Figueras, Jordi; Badminton, Mike; Elder, George H; Sandberg, Sverre

    2011-11-01

    The porphyrias are a group of rare metabolic disorders whose diagnosis depends on identification of specific patterns of porphyrin precursor and porphyrin accumulation in urine, blood, and feces. Diagnostic tests for porphyria are performed by specialized laboratories in many countries. Data regarding the analytical and diagnostic performance of these laboratories are scarce. We distributed 5 sets of multispecimen samples from different porphyria patients accompanied by clinical case histories to 18-21 European specialist porphyria laboratories/centers as part of a European Porphyria Network organized external analytical and postanalytical quality assessment (EQA) program. The laboratories stated which analyses they would normally have performed given the case histories and reported results of all porphyria-related analyses available, interpretative comments, and diagnoses. Reported diagnostic strategies initially showed considerable diversity, but the number of laboratories applying adequate diagnostic strategies increased during the study period. We found an average interlaboratory CV of 50% (range 12%-152%) for analytes in absolute concentrations. Result normalization by forming ratios to the upper reference limits did not reduce this variation. Sixty-five percent of reported results were within biological variation-based analytical quality specifications. Clinical interpretation of the obtained analytical results was accurate, and most laboratories established the correct diagnosis in all distributions. Based on a case-based EQA scheme, variations were apparent in analytical and diagnostic performance between European specialist porphyria laboratories. Our findings reinforce the use of EQA schemes as an essential tool to assess both analytical and diagnostic processes and thereby to improve patient care in rare diseases.

  13. Blind CT image quality assessment via deep learning strategy: initial study

    Science.gov (United States)

    Li, Sui; He, Ji; Wang, Yongbo; Liao, Yuting; Zeng, Dong; Bian, Zhaoying; Ma, Jianhua

    2018-03-01

    Computed Tomography (CT) is one of the most important medical imaging modality. CT images can be used to assist in the detection and diagnosis of lesions and to facilitate follow-up treatment. However, CT images are vulnerable to noise. Actually, there are two major source intrinsically causing the CT data noise, i.e., the X-ray photo statistics and the electronic noise background. Therefore, it is necessary to doing image quality assessment (IQA) in CT imaging before diagnosis and treatment. Most of existing CT images IQA methods are based on human observer study. However, these methods are impractical in clinical for their complex and time-consuming. In this paper, we presented a blind CT image quality assessment via deep learning strategy. A database of 1500 CT images is constructed, containing 300 high-quality images and 1200 corresponding noisy images. Specifically, the high-quality images were used to simulate the corresponding noisy images at four different doses. Then, the images are scored by the experienced radiologists by the following attributes: image noise, artifacts, edge and structure, overall image quality, and tumor size and boundary estimation with five-point scale. We trained a network for learning the non-liner map from CT images to subjective evaluation scores. Then, we load the pre-trained model to yield predicted score from the test image. To demonstrate the performance of the deep learning network in IQA, correlation coefficients: Pearson Linear Correlation Coefficient (PLCC) and Spearman Rank Order Correlation Coefficient (SROCC) are utilized. And the experimental result demonstrate that the presented deep learning based IQA strategy can be used in the CT image quality assessment.

  14. An Investigation of Global Reporting Initiative Performance Indicators in Corporate Sustainability Reports: Greek, Italian and Spanish Evidence

    Directory of Open Access Journals (Sweden)

    Lara Tarquinio

    2018-03-01

    Full Text Available This study has two main purposes. First, it explores the performance indicators disclosed in the Global Reporting Initiative (GRI-based Sustainability Reports (SRs produced by the companies of three different countries: Italy, Spain and Greece. Second, it verifies how some corporate variables, country of origin variables and “attributes” of the SRs can explain the disclosure of GRI indicators. To verify the quantity and type of the indicators disclosed, we performed a content analysis of the SRs. We use a regression trees technique to describe how the companies’ variables explain a different use of the indicators. The findings show that Spanish companies, on average, disclose the greatest number of indicators. The social indicators related to Labour are those more frequently reported in the SRs of the three countries. The least reported are social indicators related to Human Rights. The results show the central role that assurance, ROA and sector may have in classifying the disclosure level of indicators. The study contributes both theoretical and empirical literature on sustainability indicators. It also sheds further light on the determinants of the disclosure of indicators.

  15. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative

    International Nuclear Information System (INIS)

    Bossuyt, P.M.; Reitsma, J.B.; Bruns, D.E.; Gatsonis, C.A.; Glasziou, P.P.; Irwig, L.M.; Lijmer, J.G.; Moher, D.; Rennie, D.; Vet, H.C.W. de

    2003-01-01

    AIM: To improve the accuracy and completeness of reporting of studies of diagnostic accuracy in order to allow readers to assess the potential for bias in a study and to evaluate the general isability of its results. METHODS: The standards for reporting of diagnostic accuracy (STARD) steering committee searched the literature to identify publications on the appropriate conduct and reporting of diagnostic studies and extracted potential items into an extensive list. Researchers, editors, and members of professional organisations shortened this list during a 2 day consensus meeting with the goal of developing a checklist and a generic flow diagram for studies of diagnostic accuracy. RESULTS: The search for published guidelines about diagnostic research yielded 33 previously published checklists, from which we extracted a list of 75 potential items. At the consensus meeting, participants shortened the list to a 25-item checklist, by using evidence whenever available. A prototype of a flow diagram provides information about the method of recruitment of patients, the order of test execution and the numbers of patients undergoing the test under evaluation, the reference standard, or both. CONCLUSIONS: Evaluation of research depends on complete and accurate reporting. If medical journals adopt the checklist and the flow diagram, the quality of reporting of studies of diagnostic accuracy should improve to the advantage of clinicians, researchers, reviewers, journals, and the public

  16. The Implementation of Quality Management Initiatives in the Context of Organisational Learning.

    Science.gov (United States)

    Roche, Evelyn

    2002-01-01

    An Irish company embarked on implementing a business excellence model and continuous improvement initiatives. Some employees' reluctance to participate impeded organizational learning, but the creation of a culture that encouraged, facilitated, and rewarded learning enabled movement toward excellence. (Contains 64 references.) (SK)

  17. Flower initiation in Hyoscyamus niger L. as influenced by widely divergent daylengths in different light qualities

    NARCIS (Netherlands)

    Joustra, M.K.

    1970-01-01

    Investigations have been carried out on the photoperiodic control of flower initiation in the annual strain of the long-day plant Hyoscyamus niger L. Plants were grown in soil; precultivation (in short day (SD) fluorescent light) as well as experimental treatments were applied at 20°C.

  18. Exploring the Relevance and Quality of the VaRemba Initiation ...

    African Journals Online (AJOL)

    opportunity to be critical of cultural values and beliefs that 'work against' ESD ..... marriages on the part of girls and negative attitude on the part of boys. .... The Varemba initiation school also compromises the retention of girls in school and this.

  19. A Novel Quality Measure and Correction Procedure for the Annotation of Microbial Translation Initiation Sites

    NARCIS (Netherlands)

    Overmars, L.; Siezen, R.J.; Francke, C.

    2015-01-01

    The identification of translation initiation sites (TISs) constitutes an important aspect of sequence-based genome analysis. An erroneous TIS annotation can impair the identification of regulatory elements and N-terminal signal peptides, and also may flaw the determination of descent, for any

  20. Field Operations For The "Intelligent River" Observation System: A Basin-wide Water Quality Observation System In The Savannah River Basin And Platform Supporting Related Diverse Initiatives.

    Science.gov (United States)

    Sutton, A.; Koons, M.; O'Brien-Gayes, P.; Moorer, R.; Hallstrom, J.; Post, C.; Gayes, P. T.

    2017-12-01

    The Intelligent River (IR) initiative is an NSF sponsored study developing new data management technology for a range of basin-scale applications. The technology developed by Florida Atlantic and Clemson University established a network of real-time reporting water quality sondes; from the mountains to the estuary of the Savannah River basin. Coastal Carolina University led the field operations campaign. Ancillary studies, student projects and initiatives benefitted from the associated instrumentation, infrastructure and operational support of the IR program. This provided a vehicle for students to participate in fieldwork across the watershed and pursue individual interests. Student projects included: 1) a Multibeam sonar survey investigating channel morphology in the area of an IR sensor station and 2) field tests of developing techniques for acquiring and assimilating flood velocity data into model systems associated with a separate NSF Rapid award. The multibeam survey within the lower Savannah basin exhibited a range of complexity in bathymetry, bedforms and bottom habitat in the vicinity of one of the water quality stations. The complex morphology and bottom habitat reflect complex flow patterns, localized areas of depositional and erosive tendencies providing a valuable context for considering point-source water quality time series. Micro- Lagrangian drifters developed by ISENSE at Florida Atlantic University, a sled mounted ADCP, and particle tracking from imagery collected by a photogrammetric drone were tested and used to develop methodology for establishing velocity, direction and discharge levels to validate, initialize and assimilate data into advance models systems during future flood events. The prospect of expanding wide scale observing systems can serve as a platform to integrate small and large-scale cooperative studies across disciplines as well as basic and applied research interests. Such initiatives provide opportunities for embedded education

  1. Spontaneous acute subdural hematoma as an initial presentation of choriocarcinoma: A case report

    Directory of Open Access Journals (Sweden)

    Rocque Brandon G

    2008-06-01

    Full Text Available Abstract Introduction Diverse sequelae of central nervous system metastasis of choriocarcinoma have been reported, including infarction, intra or extra axial hemorrhages, aneurysm formation and carotid-cavernous fistula. Here we report a case of subdural hematoma as the first presentation of choriocarcinoma. Case presentation The patient is a 34-year-old woman whose initial presentation of widely metastatic choriocarcinoma was an acute subdural hematoma, requiring decompressive craniectomy. Histopathologic examination of the tissue showed no evidence of choriocarcinoma, but the patient was found to have diffuse metastatic disease and cerebrospinal fluid indices highly suggestive of intracranial metastasis. Conclusion Choriocarcinoma frequently metastasizes intracranially. We review the diverse possible manifestations of this process. In addition, the cerebrospinal fluid:serum beta-human chorionic gonadotropin ratio is an important factor in diagnosing these cases. Finally, the role of the neurosurgeon is discussed.

  2. Report of Committee for JAEA Internationalization Initiative. Focusing on the activities of local teams

    International Nuclear Information System (INIS)

    2015-10-01

    The 'Committee for JAEA Internationalization Initiative' was established in 2010 with the view to discuss the policy and improvement plans for JAEA's achievement of an international center of excellence (ICOE), which include improving the environment to accept foreign researchers, etc. The existing issues to be solved in the effort for ICOE and recommendations for the solutions, which were discussed in the committee, and challenges in developing human resources with a global mindset were written in the report summarizing the activities conducted in the following two years. This report was compiled focusing on the efforts in respective sites made during a period of two years from 2013 to 2014 by the local teams that were set up in accordance with the situation of the R and D centers hosting a number of foreign researchers, etc. based on the above-mentioned recommendations. (author)

  3. Case report of narcolepsy in a six-year-old child initially misdiagnosed as atypical epilepsy.

    Science.gov (United States)

    Zhou, Jinquan; Zhang, Xi; Dong, Zaiwen

    2014-08-01

    This report describes a case of first-onset narcolepsy in a six-year-old female that was misdiagnosed as atypical epilepsy and other diagnoses at eight different hospitals over a period of 10 months before the correct diagnosis was made. The diagnosis of narcolepsy is more difficult in children because very few of them experience all four cardinal symptoms of narcolepsy - paroxysmal sleep, cataplexy, hypnagogic hallucination, and sleep paralysis - and they often have a more prolonged onset and diverse symptoms. To decrease the time lag between initial presentation and accurate diagnosis, we recommend that in all cases in which children report excessive sleep of unknown etiology - regardless of the associated symptoms - that sleep monitoring and sleep latency tests be conducted to rule out the possibility of narcolepsy. The case highlights the wide variety of presentations of uncommon psychiatric conditions, particularly in children, and the need for clinicians to be aware of the atypical presentations of these conditions when collecting medical histories.

  4. Quality prediction and mistake proofing: An LDRD final report

    Energy Technology Data Exchange (ETDEWEB)

    McDonald, M.J.

    1998-03-01

    Sandia National Laboratories is responsible for assuring that the US nuclear deterrent remains credible and that the one in a billion disaster of unintended nuclear detonation never occurs. Letting mistake-generated defects into the stockpile would undermine its mission. The current era of shrinking stockpiles is shrinking Sandia`s opportunities to discover and correct mistakes and fine tune processes over long production runs. In response, Sandia has chosen to develop and use a science-based, life cycle systems engineering practices that, in part, require understanding the design to manufacturing issues in enough detail to tune processes and eliminate mistakes before ever making a part. Defect prevention is a key area of concern that currently lacks sufficient theoretical understanding. This report is the result of a scoping study in the application of best-practice quality techniques that could address Sandia`s stockpile mission. The study provides detail on sources and control of mistakes, poka-yoke or mistake-proofing techniques, the Toyota Production system, and design theory in relation to manufacturing quality prediction. Scoping experiments are described and areas for future research are identified.

  5. Organising a manuscript reporting quality improvement or patient safety research.

    Science.gov (United States)

    Holzmueller, Christine G; Pronovost, Peter J

    2013-09-01

    Peer-reviewed publication plays important roles in disseminating research findings, developing generalisable knowledge and garnering recognition for authors and institutions. Nonetheless, many bemoan the whole manuscript writing process, intimidated by the arbitrary and somewhat opaque conventions. This paper offers practical advice about organising and writing a manuscript reporting quality improvement or patient safety research for submission to a peer-reviewed journal. Each section of the paper discusses a specific manuscript component-from title, abstract and each section of the manuscript body, through to reference list and tables and figures-explaining key principles, offering content organisation tips and providing an example of how this section may read. The paper also offers a checklist of common mistakes to avoid in a manuscript.

  6. Optimage central organised image quality control including statistics and reporting

    International Nuclear Information System (INIS)

    Jahnen, A.; Schilz, C.; Shannoun, F.; Schreiner, A.; Hermen, J.; Moll, C.

    2008-01-01

    Quality control of medical imaging systems is performed using dedicated phantoms. As the imaging systems are more and more digital, adequate image processing methods might help to save evaluation time and to receive objective results. The developed software package OPTIMAGE is focusing on this with a central approach: On one hand, OPTIMAGE provides a framework, which includes functions like database integration, DICOM data sources, multilingual user interface and image processing functionality. On the other hand, the test methods are implemented using modules which are able to process the images automatically for the common imaging systems. The integration of statistics and reporting into this environment is paramount: This is the only way to provide these functions in an interactive, user-friendly way. These features enable the users to discover degradation in performance quickly and document performed measurements easily. (authors)

  7. 40 CFR Appendix F to Part 132 - Great Lakes Water Quality Initiative Implementation Procedures

    Science.gov (United States)

    2010-07-01

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

  8. Science Teacher Education in Australia: Initiatives and Challenges to Improve the Quality of Teaching

    Science.gov (United States)

    Treagust, David F.; Won, Mihye; Petersen, Jacinta; Wynne, Georgie

    2015-01-01

    In this article, we describe how teachers in the Australian school system are educated to teach science and the different qualifications that teachers need to enter the profession. The latest comparisons of Australian students in international science assessments have brought about various accountability measures to improve the quality of science…

  9. Development and application of an initial quality assurance program for dosimetry at GSI

    Energy Technology Data Exchange (ETDEWEB)

    Heeg, P; Hartmann, G; Jaekel, O; Karger, C; Kriessbach, A [DKFZ Heidelberg (Germany); Schardt, D [GSI Darmstadt (Germany)

    1997-09-01

    c set of test procedures has been developed for dosimetric quality inspections at the heavy ion therapy facility at GSI. In some cases new test principles had to be established to meet the requirements at the heavy ion beam. As a first application the acceptance test has been carried out during the technical commissioning of the facility. (orig.)

  10. The role of territory settlement, individual quality, and nesting initiation on productivity of Bell's vireos

    Science.gov (United States)

    Cara J. Joos; Frank R., III Thompson; John. Faaborg

    2014-01-01

    Variation in habitat quality among territories within a heterogeneous patch should influence reproductive success of territory owners. Further, territory settlement order following an ideal despotic distribution (IDD) should predict the fitness of occupants if territory selection is adaptive. We recorded settlement order and monitored nests in territories occupied by...

  11. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model.

    Science.gov (United States)

    Machado, Celso; César, Robson Danúbio da Silva; Souza, Maria Tereza Saraiva de

    2017-01-01

    To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Documentary research supported by reports that are electronically available on the website of the companies surveyed. The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous field of common indicators between them. There is similarity between the indicators adopted by companies, but one of the hospitals analyzed had a greater number of converging indicators to Global Reporting Initiative.

  12. Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives.

    Science.gov (United States)

    Larkins, Sarah; Woods, Cindy E; Matthews, Veronica; Thompson, Sandra C; Schierhout, Gill; Mitropoulos, Maxwell; Patrao, Tania; Panzera, Annette; Bailie, Ross Stewart

    2015-01-01

    Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care. PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73). Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care. Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care. The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the

  13. Factors Associated with Subjective Quality of Life of Adults with Autism Spectrum Disorder: Self-Report versus Maternal Reports

    Science.gov (United States)

    Hong, Jinkuk; Bishop-Fitzpatrick, Lauren; Smith, Leann E.; Greenberg, Jan S.; Mailick, Marsha R.

    2016-01-01

    We examined factors related to subjective quality of life (QoL) of adults with autism spectrum disorder (ASD) aged 25-55 (n = 60), using the World Health Organization Quality of Life measure (WHOQOL-BREF). We used three different assessment methods: adult self-report, maternal proxy-report, and maternal report. Reliability analysis showed that…

  14. Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report

    Directory of Open Access Journals (Sweden)

    Mohammed A. Soghaier

    2013-10-01

    Full Text Available Summary: Introduction: Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF, which is considered to be a very serious illness. Yellow Fever (YF outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. Objective: To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. Methodology: >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. Results: The field investigation confirmed the outbreak and identified its cause to be YF. Conclusion: National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs are usually very high among the index cases. Keywords: Yellow Fever, Sudan, Darfur, VHFs, Soghaier

  15. Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report.

    Science.gov (United States)

    Soghaier, Mohammed A; Hagar, Ahmed; Abbas, Mohammed A; Elmangory, Mutasim M; Eltahir, Khalid M; Sall, Amadou A

    2013-10-01

    Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. The field investigation confirmed the outbreak and identified its cause to be YF. National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  16. Instructions to "put the phone down" do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation.

    Science.gov (United States)

    Brown, Todd B; Saini, Devashish; Pepper, Tracy; Mirza, Muzna; Nandigam, Hari Krishna; Kaza, Niroop; Cofield, Stacey S

    2008-02-01

    The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR. In a randomized, double-blinded, controlled trial, subjects were randomized to a modified version of the Medical Priority Dispatch System (MPDS) version 11.2 protocol or a simplified protocol, each with or without instruction to "put the phone down" during CPR. Data were recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions. Primary outcome measures included chest compression rate, depth, and the proportion of compressions without error, with correct hand position, adequate depth, and total release. Time was measured in two distinct ways: time required for initiation of CPR and total amount of time hands were off the chest during CPR. Proportions were analyzed by Wilcoxon rank sum tests and time variables with ANOVA. All tests used a two-sided alpha-level of 0.05. Two hundred and fifteen subjects were randomized-107 in the "put the phone down" instruction group and 108 in the group without "put the phone down" instructions. The groups were comparable across demographic and experiential variables. The additional instruction to "put the phone down" had no effect on the proportion of compressions administered without error, with the correct depth, and with the correct hand position. Likewise, "put the phone down" did not affect the average compression depth, the average compression rate, the total hands-off-chest time, or the time to initiate chest compressions. A statistically significant, yet trivial, effect was found in the proportion of compressions with total release of the chest wall. Instructions to "put the phone down" had no effect on the quality of bystander initiated dispatcher-assisted CPR in this trial.

  17. Pittsburgh Regional Healthcare Initiative puts new spin on improving healthcare quality.

    Science.gov (United States)

    2002-11-01

    For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.

  18. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model

    OpenAIRE

    Machado Junior, Celso; César, Robson Danúbio da Silva; Souza, Maria Tereza Saraiva de

    2017-01-01

    ABSTRACT Objective To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Methods Documentary research supported by reports that are electronically available on the website of the companies surveyed. Results The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous fie...

  19. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model

    OpenAIRE

    Machado, Celso; César, Robson Danúbio da Silva; de Souza, Maria Tereza Saraiva

    2017-01-01

    ABSTRACT Objective To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Methods Documentary research supported by reports that are electronically available on the website of the companies surveyed. Results The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous field of ...

  20. Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

    Science.gov (United States)

    Fowler, Terri O; Wise, Holly H; Mauldin, Mary P; Ragucci, Kelly R; Scheurer, Danielle B; Su, Zemin; Mauldin, Patrick D; Bailey, Jennifer R; Borckardt, Jeffrey J

    2018-04-11

    Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their

  1. Product analysis and initial reliability testing of the total mesorectal excision-quality assessment instrument.

    Science.gov (United States)

    Simunovic, Marko R; DeNardi, Franco G; Coates, Angela J; Szalay, David A; Eva, Kevin W

    2014-07-01

    Product analysis of rectal cancer resection specimens before specimen fixation may provide an immediate and relevant evaluation of surgical performance. We tested the interrater reliability (IRR) of a product analysis tool called the Total Mesorectal Excision-Quality Assessment Instrument (TME-QA). Participants included two gold standard raters, five pathology assistants, and eight pathologists. Domains of the TME-QA reflect total mesorectal excision principles including: (1) completeness of mesorectal margin; (2) completeness of mesorectum; (3) coning of distal mesorectum; (4) physical defects; and (5) overall specimen quality. Specimens were scored independently. We used the generalizability theory to assess the tool's internal consistency and IRR. There were 39 specimens and 120 ratings. Mean overall specimen quality scores for the gold standard raters, pathologists, and assistants were 4.43, 4.43, and 4.50, respectively (p > 0.85). IRR for the first nine items was 0.68 for the full sample, 0.62 for assistants alone, 0.63 for pathologists alone, and 0.74 for gold standard raters alone. IRR for the item overall specimen quality was 0.67 for the full sample, 0.45 for assistants, 0.80 for pathologists, and 0.86 for gold standard raters. IRR increased for all groups when scores were averaged across two raters. Assessment of surgical specimens using the TME-QA may provide rapid and relevant feedback to surgeons about their technical performance. Our results show good internal consistency and IRR when the TME-QA is used by pathologists. However, for pathology assistants, multiple ratings with the averaging of scores may be needed.

  2. Quality initiatives: department scorecard: a tool to help drive imaging care delivery performance.

    Science.gov (United States)

    Donnelly, Lane F; Gessner, Kevin E; Dickerson, Julie M; Koch, Bernadette L; Towbin, Alexander J; Lehkamp, Todd W; Moskovitz, Jay; Brody, Alan S; Dumoulin, Charles L; Jones, Blaise V

    2010-11-01

    The radiology department at a midwestern U.S. children's hospital has created a scorecard that is presented quarterly to the institutional leadership and is available to all radiology employees on the institutional intranet. The scorecard currently has 33 measures in six areas: clinical services (safety, quality, timeliness); education; research; professionalism, communication, and user satisfaction; finances and administration; and staffing. For each measure, the goal, current value of the measure, interval at which the measure is updated, date of last update, and previous value of the measure are listed. Each measure was reviewed over time to determine those measures for which target goals were met. Results indicate that a visible and transparent department scorecard is one of the more powerful tools available to the radiology leadership to call attention to and improve performance in specific areas. The use of such a scorecard can help develop a departmental culture of quality improvement, focus healthcare providers on specific quality improvement projects, and drive departmental performance. © RSNA, 2010.

  3. Initial results of the quality control in 11 computed tomography scanners at Curitiba

    International Nuclear Information System (INIS)

    Kodlulovich, S; Oliveira, L.; Jakubiak, R.R.; Miquelin, C.A.

    2008-01-01

    The aim of this study was to evaluate the image quality of 11 scanners installed in public and private centers of Curitiba, Brazil. This sample represents 30% of the CT scanners in the city so far. The ACR CT accreditation phantom was used to verify the accomplishment of the scanners performance to the international quality requirements. The results indicate that efforts should be concentrated in the maintenance of the equipments and specific training of the technicians. Most of the scanners have showed some non-conformity. In 27,5% of the sample the positioning requirement wasn't accomplished. The CT number accuracy evaluation showed that in 72,3 % of the scanners the CT numbers were out of the tolerance range, reaching values 35% greater than the limit. The low contrast resolution criteria weren't accomplished in 9% of the scanners. The main concern is that there isn't a specific program to evaluate the image quality of the CT scanners neither to estimate the CT doses in the procedures. (author)

  4. Quality Assurance of Real-Time Oceanographic Data from the Cabled Array of the Ocean Observatories Initiative

    Science.gov (United States)

    Kawka, O. E.; Nelson, J. S.; Manalang, D.; Kelley, D. S.

    2016-02-01

    The Cabled Array component of the NSF-funded Ocean Observatories Initiative (OOI) provides access to real-time physical, chemical, geological, and biological data from water column and seafloor platforms/instruments at sites spanning the southern half of the Juan de Fuca Plate. The Quality Assurance (QA) program for OOI data is designed to ensure that data products meet OOI science requirements. This overall data QA plan establishes the guidelines for assuring OOI data quality and summarizes Quality Control (QC) protocols and procedures, based on best practices, which can be utilized to ensure the highest quality data across the OOI program. This presentation will highlight, specifically, the QA/QC approach being utilized for the OOI Cabled Array infrastructure and data and will include a summary of both shipboard and shore-based protocols currently in use. Aspects addressed will be pre-deployment instrument testing and calibration checks, post-deployment and pre-recovery field verification of data, and post-recovery "as-found" testing of instruments. Examples of QA/QC data will be presented and specific cases of cabled data will be discussed in the context of quality assessments and adjustment/correction of OOI datasets overall for inherent sensor drift and/or instrument fouling.

  5. A Transplant-Specific Quality Initiative-Introducing TransQIP: A Joint Effort of the ASTS and ACS.

    Science.gov (United States)

    Parekh, J; Ko, C; Lappin, J; Greenstein, S; Hirose, R

    2017-07-01

    In an attempt to improve surgical quality in the field of transplantation, the American College of Surgeons (ACS) and American Society of Transplant Surgeons have initiated a national quality improvement program in transplantation. This transplant-specific quality improvement program, called TransQIP, has been built from the ground up by transplant surgeons and captures detailed information on donor and recipient factors as well as transplant-specific outcomes. It is built upon the existing ACS/National Surgical Quality Improvement Program infrastructure and is designed to capture 100% of liver and kidney transplants performed at participating sites. TransQIP has completed its alpha pilot and will embark upon its beta phase at approximately 30 centers in the spring of 2017. Going forward, we anticipate TransQIP will help satisfy Centers for Medicare and Medicaid Services requirements for a quality improvement program, surgeon requirements for maintenance of certification, and qualify as a clinical practice improvement activity under the Merit-Based Incentive Payment System. Most importantly, we believe TransQIP will provide insight into surgical outcomes in transplantation that will allow the field to provide better care to our patients. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  6. Report on the incentive regulation regarding the service quality of natural gas network operators and ERDF. Summary report 2011

    International Nuclear Information System (INIS)

    2012-05-01

    The tariffs set by the French Energy Regulation Commission (CRE) for natural gas distribution system operators (DSOs), natural gas transmission system operators (TSOs) as well as for the electricity distribution system operator electricite Reseau Distribution France (ERDF) include an incentive regulation regarding the quality of service. The CRE has defined indicators to monitor the performance of operators in several fields considered relevant to assess the quality of service. Some of these indicators, considered to have specific importance in ensuring that the market operates properly, are subject to a system of financial incentives: bonuses or penalties are given to operators depending on the attainment of objectives set by the CRE. Other indicators, which do not carry financial incentives, complete the mechanism and ensure a broader surveillance of the operators' service quality. A financial incentive may be applied to these indicators at a later date if the CRE deems it necessary. The analyses of the service quality monitoring indicators presented in this report cover the period from 1 July 2010 to 30 June 2011. They were used to inform the work conducted to develop the incentive regulation mechanism for service quality in GrDF's ATRD4 tariff (A Third-party access to natural gas distribution networks, scheduled to enter into effect on 1 July 2012). The conclusions of the report will also be used by the CRE for ERDF as part of the work on TURPE 4 tariff (Tariff for the use of public electricity grids, scheduled to enter into effect during the third quarter of 2013), for natural gas local distribution companies (LDCs) to prepare their ATRD4 tariff (Entry into effect scheduled for 1 July 2013), as well as for GRTgaz and TIGF to define the future ATRT5 tariff (Third-party access to natural gas transmission networks, scheduled to enter into effect on 1 April 2013). Implemented in 2009 with an initial annual follow- up report on gas network operators Gr

  7. Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Zaka, Nabila; Alexander, Emma C; Manikam, Logan; Norman, Irena C F; Akhbari, Melika; Moxon, Sarah; Ram, Pavani Kalluri; Murphy, Georgina; English, Mike; Niermeyer, Susan; Pearson, Luwei

    2018-01-25

    An estimated 2.6 million newborns died in 2016; over 98.5% of deaths occurred in low- and middle-income countries (LMICs). Neonates born preterm and small for gestational age are particularly at risk given the high incidence of infectious complications, cardiopulmonary, and neurodevelopmental disorders in this group. Quality improvement (QI) initiatives can reduce the burden of mortality and morbidity for hospitalised newborns in these settings. We undertook a systematic review to synthesise evidence from LMICs on QI approaches used, outcome measures employed to estimate effects, and the nature of implementation challenges. We searched Medline, EMBASE, WHO Global Health Library, Cochrane Library, WHO ICTRP, and ClinicalTrials.gov and scanned the references of identified studies and systematic reviews. Searches covered January 2000 until April 2017. Search terms were "quality improvement", "newborns", "hospitalised", and their derivatives. Studies were excluded if they took place in high-income countries, did not include QI interventions, or did not include small and sick hospitalised newborns. Cochrane Risk of Bias tools were used to quality appraise the studies. From 8110 results, 28 studies were included, covering 23 LMICs and 65,642 participants. Most interventions were meso level (district and clinic level); fewer were micro (patient-provider level) or macro (above district level). In-service training was the most common intervention subtype; service organisation and distribution of referencing materials were also frequently identified. The most commonly assessed outcome was mortality, followed by length of admission, sepsis rates, and infection rates. Key barriers to implementation of quality improvement initiatives included overburdened staff and lack of sufficient equipment. The frequency of meso level, single centre, and educational interventions suggests that these interventions may be easier for programme planners to implement. The success of some

  8. Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

    Science.gov (United States)

    Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

    2018-03-31

    To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

  9. The human milk project: a quality improvement initiative to increase human milk consumption in very low birth weight infants.

    Science.gov (United States)

    Ward, Laura; Auer, Christine; Smith, Carrie; Schoettker, Pamela J; Pruett, Raymond; Shah, Nilesh Y; Kotagal, Uma R

    2012-08-01

    Human milk has well-established health benefits for preterm infants. We conducted a multidisciplinary quality improvement effort aimed at providing at least 500 mL of human milk/kg in the first 14 days of life to very low birth weight (VLBW) (milk program, and twice-daily physician evaluation of infants' ability to tolerate feedings. The number of infants receiving at least 500 mL of human milk/kg in their first 14 days of life increased from 50% to 80% within 11 months of implementation, and this increase has been sustained for 4 years. Infants who met the feeding goal because they received donor milk increased each year. Since September 2007, infants have received, on average, 1,111 mL of human milk/kg. Approximately 4% of infants did not receive any human milk. Respiratory instability was the most frequent physiological reason given by clinicians for not initiating or advancing feedings in the first 14 days of life. Our quality improvement initiative resulted in a higher consumption of human milk in VLBW infants in the first 14 days of life. Other clinicians can use these described quality improvement methods and techniques to improve their VLBW babies' consumption of human milk.

  10. Calculation of intercepted runoff depth based on stormwater quality and environmental capacity of receiving waters for initial stormwater pollution management.

    Science.gov (United States)

    Peng, Hai-Qin; Liu, Yan; Gao, Xue-Long; Wang, Hong-Wu; Chen, Yi; Cai, Hui-Yi

    2017-11-01

    While point source pollutions have gradually been controlled in recent years, the non-point source pollution problem has become increasingly prominent. The receiving waters are frequently polluted by the initial stormwater from the separate stormwater system and the wastewater from sewage pipes through stormwater pipes. Consequently, calculating the intercepted runoff depth has become a problem that must be resolved immediately for initial stormwater pollution management. The accurate calculation of intercepted runoff depth provides a solid foundation for selecting the appropriate size of intercepting facilities in drainage and interception projects. This study establishes a separate stormwater system for the Yishan Building watershed of Fuzhou City using the InfoWorks Integrated Catchment Management (InfoWorks ICM), which can predict the stormwater flow velocity and the flow of discharge outlet after each rainfall. The intercepted runoff depth is calculated from the stormwater quality and environmental capacity of the receiving waters. The average intercepted runoff depth from six rainfall events is calculated as 4.1 mm based on stormwater quality. The average intercepted runoff depth from six rainfall events is calculated as 4.4 mm based on the environmental capacity of the receiving waters. The intercepted runoff depth differs when calculated from various aspects. The selection of the intercepted runoff depth depends on the goal of water quality control, the self-purification capacity of the water bodies, and other factors of the region.

  11. Leveraging the Partnership for Patients' Initiative to Improve Patient Safety and Quality Within the Military Health System.

    Science.gov (United States)

    King, Heidi B; Kesling, Kimberly; Birk, Carmen; Walker, Theodore; Taylor, Heather; Datena, Michael; Burgess, Brittany; Bower, Lyndsay

    2017-03-01

    Partnership for Patients (PfP) was a national initiative sponsored by the Department of Health and Human Services, Centers for Medicare and Medicaid Services, to reduce preventable hospital acquired conditions (HACs) by 40% and readmissions (within 30 days) by 20%, by the end of 2013 (as compared to the baseline of CY2010). Along with partners across the nation, the Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson, pledged to support PfP in June 2011. Participation of the Military Health System (MHS) in PfP marked the implementation of the first enterprise-wide patient safety initiative. Three phases of the MHS initiative were developed to meet the aims of the national PfP initiative: (1) Planning and Design, (2) Implementation, and (3) Monitoring and Sustainment. The Planning and Design phase focused on the identification of evidence-based practices (Table III); the development of implementation guides; the implementation of various communication, education, and improvement strategies; and the development of methods by which to track progress and share successes. The implementation phase focused on identifying roles and responsibilities across all levels of care; creating, disseminating, and implementing evidence-based practices at participating military treatment facilities; and establishing a structured learning action network. Finally, during the monitoring and sustainment phase, per the guidance of the Agency for Healthcare Research and Quality, an overall HAC rate was developed for quarterly analysis. The HAC rate per 1,000 dispositions (i.e., discharges) was an aggregate of all PfP HACs. Using the HAC rate, the improvement rate was calculated by comparing the current quarter's HAC rate to the baseline (CY2010). This allowed the MHS to track the overall progress across the enterprise. The MHS achieved a number of accomplishments, including a 15.8% cumulative reduction in HACs by the end of 2013, an 11.1% reduction in readmissions

  12. Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

    OpenAIRE

    Chalmers, J.R.; Simpson, E.; Apfelbacher, C.J.; Thomas, K.S.; von Kobyletzki, L.; Schmitt, J.; Singh, J.A.; Svensson, Å.; Williams, H.C.; Abuabara, K.; Aoki, V.; Ardeleanu, M.; Awici-Rasmussen, M.; Barbarot, S.; Berents, T.L.

    2016-01-01

    This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmö, Sweden on 23–24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group a...

  13. Evaluation of quality improvement initiative in pediatric oncology: implementation of aggressive hydration protocol.

    Science.gov (United States)

    Fratino, Lisa M; Daniel, Denise A; Cohen, Kenneth J; Chen, Allen R

    2009-01-01

    Our goal was to improve the efficiency of chemotherapy administration for pediatric oncology patients. We identified prechemotherapy hydration as the process that most often delayed chemotherapy administration. An aggressive hydration protocol, supported by fluid order sets, was developed for patients receiving planned chemotherapy. The mean interval from admission to achieving adequate hydration status was reduced significantly from 4.9 to 1.4 hours with a minor reduction in the time to initiate chemotherapy from 9.6 to 8.6 hours. Chemotherapy availability became the new rate-limiting process.

  14. A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome.

    Science.gov (United States)

    Paccione-Dyszlewski, Margaret R; Conelea, Christine A; Heisler, Walter C; Vilardi, Jodie C; Sachs, Henry T

    2012-07-01

    Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.

  15. Instrument translation and initial psychometric evaluation of the Danish Body Image Quality of Life Inventory

    DEFF Research Database (Denmark)

    Rasmussen, Trine Bernholdt; Berg, Selina Kikkenborg; Dixon, Jane

    2016-01-01

    . The purpose of the study was thus to translate and validate a Danish version of the Body Image Quality of Life Inventory (BIQLI), in order to obtain a valid instrument applicable for healthcare research. METHODS: The study consisted of two phases: (i) instrument adaptation, including forward and back...... to be semantically sound, yet concerns about face validity did arise through cognitive interviews. Danish college students (n = 189, 65 men, Mage = 21.1 years) participated in the piloting of the BIQLI-DA. Convergent construct validity was demonstrated through associations to related constructs. Exploratory factor...

  16. Physician Quality Reporting System (PQRS) for Interventional Pain Management Practices: Challenges and Opportunities.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hammer, Marvel; Benyamin, Ramsin M; Hirsch, Joshua A

    2016-01-01

    Basing their rationale on multiple publications from Institute of Medicine (IOM), specifically Crossing the Quality Chasm, policy makers have focused on a broad range of issues, including assessment of the influence of medical practice organization structures on quality performance and development of quality measures. The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System (PQRS), to enable eligible professionals to report health care quality and health outcome information that cannot be obtained from standard Medicare claims. However, the Patient Protection and Affordable Care Act (ACA) of 2010 required the Centers for Medicare and Medicaid Services (CMS) to incorporate a combination of cost and quality into the payment systems for health care as a precursor to value-based payments. The final change to PQRS pending initiation after 2018, is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which has incorporated alternative payment models and merit-based payment systems. Recent publication of quality performance scores by CMS has been less than optimal. When voluntary participation began in July 2007, providers were paid a bonus for reporting quality measures from 2008 through 2014, ranging from 0.5% to 2% of the Medicare Part B allowed charges furnished during the reporting period. Starting in 2015, penalties started for nonparticipation. Eligible professionals and group practices that failed to satisfactorily report data on quality measures during 2014 are subject to a 2% reduction in Medicare fee-for-service amounts for services furnished by the eligible professional or group practice during 2016. The CMS proposed rule for 2016 physician payments contained a number of provisions with proposed updates to the PQRS and Physician Value-Based Payment Modifier among other changes. The proposed rule is the first release since MACRA repealed the sustainable growth rate formula. CMS proposed to continue many

  17. Quality assurance of mammography training courses via questionnaires. Eighth report

    International Nuclear Information System (INIS)

    Kotsuma, Yoshikazu; Endo, Tokiko; Iwase, Takuji

    2007-01-01

    To maintain a sufficient number of qualified reading doctors for breast cancer mammography screening, we have held training courses across the nation. Grade-up examinations have been carried out for doctors who had failed to attain grade A or B at the training courses. We have evaluated the quality assurance of the examinations via questionnaires and reported the results on 7 previous occasions. In the present investigation, we reviewed all answers obtained from questionnaires at the previous 19 examinations, from the first one (November, 2000) until the last one (March, 2007). There were a total of 3,380 applicants, of whom 402 (11.9%) obtained grade A and 2,008 (59.4%) grade B. Thus a total 2,410 applicants (71.3%) obtained either A or B, and this rate was considerably superior to the 56% obtained in the first three examinations, although the former rate included the results of repeated applicants. These good results may have been due to an increase in the quality of the training courses and may have been affected by conducting the examinations not only in Nagoya but also in Tokyo and Osaka. In a period of about 10 months after April, 2004, the certification standard was increased and a system of certification reappraisal every 5 years was adopted. At that time, more than 75% of all applicants were A- or B-certified doctors at the 9th and 10th examinations, and the good results might have reflected the fact that many doctors tried hard to maintain a high reading ability. In February, 2005, the certification standard reverted to the previous one for various reasons, and the rate of A- or B-certified doctors decreased. In October, 2006, the examination changed from 100 questions concerning one-direction mammography to 50 one-direction questions and 50 two-direction questions, because of the adoption of two-direction mammography to age 40 years. Since it was widely recognized that the second reading at breast cancer screening should be done by A-certified doctors

  18. Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network.

    Science.gov (United States)

    Holub, Jennifer L; Morris, Cynthia; Fagnan, Lyle J; Logan, Judith R; Michaels, LeAnn C; Lieberman, David A

    2018-02-01

    Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P 9mm 16.6% vs 18.7% (P = .106). ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings. © 2016 National Rural Health Association.

  19. Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative.

    Science.gov (United States)

    Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

    2016-02-22

    In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

  20. Provider-Initiated Patient Satisfaction Reporting Yields Improved Physician Ratings Relative to Online Rating Websites.

    Science.gov (United States)

    Ricciardi, Benjamin F; Waddell, Brad S; Nodzo, Scott R; Lange, Jeffrey; Nocon, Allina A; Amundsen, Spencer; Tarity, T David; McLawhorn, Alexander S

    2017-09-01

    Recently, providers have begun to publicly report the results of patient satisfaction surveys from their practices. However, these outcomes have never been compared with the findings of commercial online physician rating websites. The goals of the current study were to (1) compare overall patient satisfaction ratings for orthopedic surgeons derived from provider-based third-party surveys with existing commercial physician rating websites and (2) determine the association between patient ratings and provider characteristics. The authors identified 12 institutions that provided publicly available patient satisfaction outcomes derived from third-party surveys for their orthopedic surgeons as of August 2016. Orthopedic surgeons at these institutions were eligible for inclusion (N=340 surgeons). Provider characteristics were recorded from publicly available data. Four high-traffic commercial online physician rating websites were identified: Healthgrades.com, UCompareHealthCare.com, Vitals.com, and RateMDs.com. For each surgeon, overall ratings (on a scale of 1-5), total number of ratings, and percentage of negative ratings were compared between provider-initiated internal ratings and each commercial online website. Associations between baseline factors and overall physician ratings and negative ratings were assessed. Provider-initiated internal patient satisfaction ratings showed a greater number of overall patient ratings, higher overall patient satisfaction ratings, and a lower percentage of negative comments compared with commercial online physician rating websites. A greater number of years in practice had a weak association with lower internal ratings, and an academic practice setting and a location in the Northeast were protective factors for negative physician ratings. Compared with commercial online physician rating websites, provider-initiated patient satisfaction ratings of orthopedic surgeons appear to be more favorable, with greater numbers of responses

  1. 7-GeV advanced photon source beamline initiative: Conceptual design report

    International Nuclear Information System (INIS)

    1993-05-01

    The DOE is building a new generation 6-7 GeV Synchrotron Radiation Source known as the Advanced Photon Source (APS) at Argonne National Laboratory. This facility, to be completed in FY 1996, can provide 70 x-ray sources of unprecedented brightness to meet the research needs of virtually all scientific disciplines and numerous technologies. The technological research capability of the APS in the areas of energy, communications and health will enable a new partnership between the DOE and US industry. Current funding for the APS will complete the current phase of construction so that scientists can begin their applications in FY 1996. Comprehensive utilization of the unique properties of APS beams will enable cutting-edge research not currently possible. It is now appropriate to plan to construct additional radiation sources and beamline standard components to meet the excess demands of the APS users. In this APS Beamline Initiative, 2.5-m-long insertion-device x-ray sources will be built on four straight sections of the APS storage ring, and an additional four bending-magnet sources will also be put in use. The front ends for these eight x-ray sources will be built to contain and safeguard access to these bright x-ray beams. In addition, funds will be provided to build standard beamline components to meet scientific and technological research demands of the Collaborative Access Teams. The Conceptual Design Report (CDR) for the APS Beamline Initiative describes the scope of all the above technical and conventional construction and provides a detailed cost and schedule for these activities. The document also describes the preconstruction R ampersand D plans for the Beamline Initiative activities and provides the cost estimates for the required R ampersand D

  2. Dual energy CT intracranial angiography: image quality, radiation dose and initial application results

    International Nuclear Information System (INIS)

    Chai Xue; Zhang Longjiang; Lu Guangming; Zhou Changsheng

    2009-01-01

    Objective: To assess the clinical value of dual-energy intracranial CT angiography (CTA). Methods: Forty-one patients suspected of intracranial vascular diseases underwent dual-energy intracranial CT angiography, and 41 patients who underwent conventional subtraction CT were enrolled as the control group. Image quality of intracranial and skull base vessels and radiation dose between dual-energy CTA and conventional subtraction CTA were compared using two independent sample nonparametric test and independent-samples t test, respectively. Prevalence and size of lesions detected by dual-energy CTA and digital subtraction CTA were compared using paired-samples t test and Spearman correlative analysis. Results: The percentage of image quality scored 5 was 70.7% (29/41) for dual-energy CTA and 75.6% (31/41) for conventional subtraction CTA. There was no significant difference between the two groups (Z= -0.455, P=0.650). Image quality of vessels at the skull base in conventional subtraction CTA was superior to that in dual-energy CTA, especially for the petrosal and syphon segment (Z=-4.087, P=0.000). Radiation exposure of dual energy CTA and conventional CTA were (396.54±17.43) and (1090.95±114.29) mGy·cm respectively. Radiation exposure was decreased by 64% (t=-38.52, P=0.000) by dual energy CTA compared with conventional subtraction CTA. Out of the 41 patients, 19 patients were diagnosed as intracranial aneurysm, 2 patients as arteriovenous malformation (AVM), 3 patients with Moya-moya's disease, and the remaining 17 patients with negative results. Nine patients with intracranial aneurysm, 2 patients with AVM, 3 patients with Moya-moya's disease, and 2 patients with negative findings underwent DSA or operation, with concordant findings from both techniques. Diameter of aneurysm neck, long axis and minor axis by dual-energy CTA was (2.90±1.61), (5.23±1.68) and (3.83±1.69) mm, respectively; Diameter of aneurysm neck, long axis and minor axis by DSA was (2.95±1

  3. Environmental Quality Laboratory Research Report, 1985-1987

    OpenAIRE

    Brooks, Norman H.

    1988-01-01

    The Environmental Quality Laboratory at Caltech is a center for research on large-scale systems problems of natural resources and environmental quality. The principal areas of investigation at EQL are: 1. Air quality management. 2. Water resources and water quality management. 3. Control of hazardous substances in the environment. 4. Energy policy, including regulation, conservation and energy-environment tradeoffs. 5. Resources policy (other than energy); residuals m...

  4. Recurrent Venous Thromboembolism as the Initial Clinical Presentation of Gastric Cancer: A Case Report

    Directory of Open Access Journals (Sweden)

    Fariba Rezaeetalab

    2017-09-01

    Full Text Available Pulmonary thromboembolism (PTE is a clinically critical disease, misdiagnosis or delayed diagnosis of which can lead to increased rate of mortality. For prevention of recurrence of PTE, recognition of its risk factors or underlying diseases is of great importance. PTE is common in patients with cancer and has high morbidity and mortality rates. Although cancer is a lethal condition, PTE accelerates death in these patients. In the current study, we reported the case of a 50-year-old male presenting with dyspnea, pleuritic chest pain, and non-massive hemoptysis indicating pulmonary embolism. Anticoagulant therapy was initiated, but after 12 days of treatment, new deep vein thromboses in the left upper and right lower limbs were diagnosed. However, no specific risk factors or laboratory abnormalities were detected. History of weight loss during the recent months encouraged further investigation for ruling out malignancy, which led a diagnosis of gastric adenocarcinoma. He did not have any complaints of gastrointestinal disorders.

  5. Conference report: formulating better medicines for children: 4th European Paediatric Formulation Initiative conference.

    Science.gov (United States)

    Walsh, Jennifer; Mills, Simon

    2013-01-01

    The fourth annual European Paediatric Formulation Initiative (EuPFI) conference on Formulating Better Medicines for Children was held on 19-20 September 2012 at the Institute of Molecular Genetics Congress Centre, Prague, Czech Republic. The 2-day conference concentrated on the latest advances, challenges and opportunities for developing medicinal products and administration devices for pediatric use, both from European and US perspectives. It was aimed specifically at providing exposure to emerging practical applications, and for illustrating remedies utilized by pediatric drug-development teams to overcome hurdles faced in developing medicines for pediatric patients. The conference format included plenary talks, focus sessions on each of the EuPFI work streams (extemporaneous preparations, excipients, pediatric administration devices, taste masking and taste assessment, age-appropriate formulations), case studies, soapbox sessions and a parallel poster display. This conference report summarizes the keynote lectures and also gives a flavor of other presentations and posters from the conference.

  6. 2006 B100 Quality Survey Results: Milestone Report

    Energy Technology Data Exchange (ETDEWEB)

    Alleman, T. L.; McCormick, R. L.; Deutch, S.

    2007-05-01

    In 2006, the National Renewable Energy Laboratory conducted a nationwide quality survey of pure biodiesel (B100) intended to be used as a blendstock. The study collected random samples throughout the United States and analyzed them for quality against the current and proposed ASTM D6751 fuel quality specifications.

  7. Advances in public health accreditation readiness and quality improvement: evaluation findings from the National Public Health Improvement Initiative.

    Science.gov (United States)

    McLees, Anita W; Thomas, Craig W; Nawaz, Saira; Young, Andrea C; Rider, Nikki; Davis, Mary

    2014-01-01

    Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). Evaluate the extent to which NPHII awardees have achieved program goals. NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. NPHII performance improvement managers or principal investigators. Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

  8. Initial ORNL site assessment report on the storage of 233U

    International Nuclear Information System (INIS)

    Bereolos, P.J.; Yong, L.K.; Sadlowe, A.R.; Ramey, D.W.; Krichinsky, A.M.

    1998-03-01

    The 233 U storage facility at ORNL is Building 3019. The inventory stored in Building 3019 consists of 426.5 kg of 233 U contained in 1,387.1 kg of total uranium. The inventory is primarily in the form of uranium oxides; however, uranium metal and other compounds are also stored. Over 99% of the inventory is contained in 1,007 packages stored in tube vaults within the facility. A tank of thorium nitrate solution, the P-24 Tank, contains 0.13 kg of 233 U in ∼ 4,000 gal. of solution. The facility is receiving additional 233 U for storage from the remediation of the Molten Salt Reactor Experiment (MSRE) at ORNL. Consolidation of material from sites with small holdings is also adding to the 233 U inventory. Additionally, small quantities ( 233 U are in other research facilities at ORNL. A risk assessment process was chosen to evaluate the stored material and packages based on available package records. The risk scenario was considered the failure of a package (or a group of similar packages) in the Building 3019 inventory. The probability of such a failure depends on packaging factors such as the age and material of construction of the containers. The consequence of such a failure depends on the amount and form of the material within the packages. One thousand seven packages were categorized with this methodology resulting in 859 low-risk packages, 147 medium-risk packages, and 1 high-risk package. This initial assessment also documents the status of the evaluation of the Building 3019 and its systems for safe storage of 233 U. The final assessment report for ORNL storage of 233 U is scheduled for June 1999. The report will document the facility assessments, the specific package inspection plan, and the results of initial package inspections

  9. Lab-Based Measurement of Remediation Techniques for Radiation Portal Monitors (Initial Report)

    International Nuclear Information System (INIS)

    Livesay, Jake

    2012-01-01

    Radiation Portal Monitors (RPM) deployed by the Second Line of Defense (SLD) are known to be sensitive to the natural environmental radioactive background. There are several techniques used to mitigate the effects of background on the monitors, but since the installation environments can vary significantly from one another the need for a standardized, systematic, study of remediation techniques was proposed and carried out. This study is not meant to serve as the absolute last word on the subject. The data collected are, however, intelligible and useful. Some compromises were made, each of which will be described in detail. The hope of this initial report is to familiarize the SLD science teams with ORNL's effort to model the effect of various remediation techniques on simple, static backgrounds. This study provides a good start toward benchmarking the model, and each additional increment of data will serve to make the model more robust. The scope of this initial study is limited to a few basic cases. Its purpose is to prove the utility of lab-based study of remediation techniques and serve as a standard data set for future use. This importance of this first step of standardization will become obvious when science teams are working in parallel on issues of remediation; having a common starting point will do away with one category of difference, thereby making easier the task of determining the sources of disagreement. Further measurements will augment this data set, allowing for further constraint of the universe of possible situations. As will be discussed in the 'Going Forward' section, more data will be included in the final report of this work. Of particular interest will be the data taken with the official TSA lead collimators, which will provide more direct results for comparison with installation data.

  10. Product manufacturing, quality, and reliability initiatives to maintain a competitive advantage and meet customer expectations in the semiconductor industry

    Science.gov (United States)

    Capps, Gregory

    Semiconductor products are manufactured and consumed across the world. The semiconductor industry is constantly striving to manufacture products with greater performance, improved efficiency, less energy consumption, smaller feature sizes, thinner gate oxides, and faster speeds. Customers have pushed towards zero defects and require a more reliable, higher quality product than ever before. Manufacturers are required to improve yields, reduce operating costs, and increase revenue to maintain a competitive advantage. Opportunities exist for integrated circuit (IC) customers and manufacturers to work together and independently to reduce costs, eliminate waste, reduce defects, reduce warranty returns, and improve quality. This project focuses on electrical over-stress (EOS) and re-test okay (RTOK), two top failure return mechanisms, which both make great defect reduction opportunities in customer-manufacturer relationship. Proactive continuous improvement initiatives and methodologies are addressed with emphasis on product life cycle, manufacturing processes, test, statistical process control (SPC), industry best practices, customer education, and customer-manufacturer interaction.

  11. The Relationship of Engagement in Improvement Practices to Outcome Measures in Large-Scale Quality Improvement Initiatives.

    Science.gov (United States)

    Foster, Gregory L; Kenward, Kevin; Hines, Stephen; Joshi, Maulik S

    Hospital engagement networks (HENs) are part of the largest health care improvement initiative ever undertaken. This article explores whether engagement in improvement activities within a HEN affected quality measures. Data were drawn from 1174 acute care hospitals. A composite quality score was created from 10 targeted topic area measures multiplied by the number of qualifying topics. Scores improved from 5.4 (SD = 6.8) at baseline to 4.6 (5.9) at remeasurement; P improvement ( P improvement, whereas hospitals in the West ( P = .0009) did not improve as much as hospitals in other regions. After adjusting for hospital characteristics, hospitals with improvement champions ( P = .008), a higher level of engagement with their state association ( P = .001), and more leadership involvement ( P = .005) in HEN demonstrated greater improvement.

  12. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    Science.gov (United States)

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    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.

  13. Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative.

    Science.gov (United States)

    Gimbel, Sarah; Mwanza, Moses; Nisingizwe, Marie Paul; Michel, Cathy; Hirschhorn, Lisa

    2017-12-21

    High-quality data are critical to inform, monitor and manage health programs. Over the seven-year African Health Initiative of the Doris Duke Charitable Foundation, three of the five Population Health Implementation and Training (PHIT) partnership projects in Mozambique, Rwanda, and Zambia introduced strategies to improve the quality and evaluation of routinely-collected data at the primary health care level, and stimulate its use in evidence-based decision-making. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this paper: 1) describes and categorizes data quality assessment and improvement activities of the projects, and 2) identifies core intervention components and implementation strategy adaptations introduced to improve data quality in each setting. The CFIR was adapted through a qualitative theme reduction process involving discussions with key informants from each project, who identified two domains and ten constructs most relevant to the study aim of describing and comparing each country's data quality assessment approach and implementation process. Data were collected on each project's data quality improvement strategies, activities implemented, and results via a semi-structured questionnaire with closed and open-ended items administered to health management information systems leads in each country, with complementary data abstraction from project reports. Across the three projects, intervention components that aligned with user priorities and government systems were perceived to be relatively advantageous, and more readily adapted and adopted. Activities that both assessed and improved data quality (including data quality assessments, mentorship and supportive supervision, establishment and/or strengthening of electronic medical record systems), received higher ranking scores from respondents. Our findings suggest that, at a minimum, successful data quality improvement efforts should include routine audits linked to

  14. Results of a sector-wide quality improvement initiative for substance-abuse care: an uncontrolled before-after study in Catalonia, Spain.

    Science.gov (United States)

    Hilarion, Pilar; Groene, Oliver; Colom, Joan; Lopez, Rosa M; Suñol, Rosa

    2010-10-23

    The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using one-way ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1%) and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5%) and 'organization and management' (pre: 50.5%; post: 77.2%). We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5%) and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%); however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. The positive results of this quality improvement initiative are possibly associated with the successful involvement of stakeholders, the consciously constructed feedback reports on individual and sector

  15. Improvement of the quality of life after the Fukushima accident: CIPR's dialogue initiative

    International Nuclear Information System (INIS)

    Lochard, J.; Schneider, T.; Charron, S.; Gariel, J.C.; Rollinger, F.

    2016-01-01

    The CIPR (International Commission on Radiological Protection) organized a series of 12 dialogues involving inhabitants of the Fukushima region, representatives of regional authorities, japanese and foreign experts on radiation protection. These dialogues took place between november 2011 to september 2015. The aim was to create a forum for listening, exchange and information on the issues faced by the local population for the improvement of the quality of life. During the debates and discussions the following concerns have emerged: -) an important difficulty for the inhabitants to apprehend the radiological situation in his daily life, -) a big concern for health and particularly for children's health, -) important damage in the family life and in the social and economic life of the affected communities, and -) a feeling of powerlessness and abandon but also of discrimination that may lead to a loss of human dignity. Most inhabitants still face the dilemma to stay or quit the affected areas. (A.C.)

  16. Cairo city air quality research initiative part-i: A meteorological modelling

    International Nuclear Information System (INIS)

    Abdel-AAl, M.M.

    2001-01-01

    The modified meteorological model Hotmac (Higher order turbulence model for atmospheric circulation) is a three-dimensional and finite grid model developed primarily for simospheric motions and based on solving the conservation equations of mass momentum, energy and turbulent kinetic energy. The model is used for studying air quality of cairo cty and its surrounding to treat a domain that includes an urbanized area for understanding problems of air pollution. The acquired terrain (elevation) data for Egypt was obtained. The local and upper level geostrophic data were provided by rawinsonde of wind speed and direction, temperature,relative humidity, water vapour, and pressure The potential temperature was obtained by a computer program. The meteorological data was obtained for helwan site, about 20 kilometer south of cairo city. Three mested grids were used, with grids resolutions of 2 6 and 18 kilometers to cover a domain of approximately 360 km that extended from the red Sea to the mediterranean Sea

  17. The use of economic indicators from the Global Reporting Initiative by Spanish listed companies

    Directory of Open Access Journals (Sweden)

    María José García

    2014-12-01

    Full Text Available Purpose: Corporate Social Responsibility (CSR in companies is widely accepted within today’s business community. However, the intangibility of this concept and the dispersion of related standards and regulations has created a context characterized by lack of homogeneity in the publishing of CSR results. The present study aims to determine the extent to which Global Reporting Initiative (GRI indicators are used by Spanish listed companies. Design/methodology/approach: An empirical analysis has been performed to asses and evaluate the 2011 CSR reports published by the companies listed on the IBEX-35, the Spanish stock exchange index which includes the most important listed companies. The analysis is centered exclusively on the economic indicators established by the GRI. The methodology used to interpret the results is based on the procedures of multivariate analysis, namely principal components analysis, correlation matrix, and hierarchical clustering. Findings: The results of the study show that although the GRI tool is used extensively within the IBEX-35, the level of performance regarding the parameters established by the GRI varies depending on the studied company and indicator. Research limitations: This study focuses on the biggest Spanish listed companies; thus, the conclusions may differ in other geographic locations, as well as for smaller businesses. Practical implications: This line of research helps to know more about the social reporting policies of big Spanish listed companies. Social implications: The evidence provided by this study helps to know more about the Corporate Social Responsibility policies and sustainability reports and declarations of social and environmental values governing their organizations. Originality/value: This study is the first using principal component analysis in Spanish listed companies focusing in the economic indicators of the GRI.

  18. Initial quality performance results using a phantom to simulate chest computed radiography

    Directory of Open Access Journals (Sweden)

    Muhogora Wilbroad

    2011-01-01

    Full Text Available The aim of this study was to develop a homemade phantom for quantitative quality control in chest computed radiography (CR. The phantom was constructed from copper, aluminium, and polymenthylmethacrylate (PMMA plates as well as Styrofoam materials. Depending on combinations, the literature suggests that these materials can simulate the attenuation and scattering characteristics of lung, heart, and mediastinum. The lung, heart, and mediastinum regions were simulated by 10 mm x 10 mm x 0.5 mm, 10 mm x 10 mm x 0.5 mm and 10 mm x 10 mm x 1 mm copper plates, respectively. A test object of 100 mm x 100 mm and 0.2 mm thick copper was positioned to each region for CNR measurements. The phantom was exposed to x-rays generated by different tube potentials that covered settings in clinical use: 110-120 kVp (HVL=4.26-4.66 mm Al at a source image distance (SID of 180 cm. An approach similar to the recommended method in digital mammography was applied to determine the CNR values of phantom images produced by a Kodak CR 850A system with post-processing turned off. Subjective contrast-detail studies were also carried out by using images of Leeds TOR CDR test object acquired under similar exposure conditions as during CNR measurements. For clinical kVp conditions relevant to chest radiography, the CNR was highest over 90-100 kVp range. The CNR data correlated with the results of contrast detail observations. The values of clinical tube potentials at which CNR is the highest are regarded to be optimal kVp settings. The simplicity in phantom construction can offer easy implementation of related quality control program.

  19. Internal Quality Assurance--Enhancing Quality Culture. ENQA Workshop Report 16

    Science.gov (United States)

    ENQA (European Association for Quality Assurance in Higher Education), 2010

    2010-01-01

    The European Association for Quality Assurance in Higher Education (ENQA), in cooperation with the Quality Assurance Agency (QAA, UK), organised a seminar on theme "Internal Quality Assurance--Enhancing quality culture" which was held on 8-9 June, 2010 in London, United Kingdom. The seminar marked the fourth annual meeting of the ENQA…

  20. Deep Vadose Zone-Applied Field Research Initiative Fiscal Year 2011 Annual Report

    International Nuclear Information System (INIS)

    Wellman, Dawn M.; Johnson, Timothy C.; Smith, Ronald M.; Truex, Michael J.; Matthews, Hope E.

    2011-01-01

    This annual report describes the background of the Deep Vadose Zone-Applied Field Research Initiative, and some of the programmatic approaches and transformational technologies in groundwater and deep vadose zone remediation developed during fiscal year 2011. The Department of Energy (DOE) Office of Technology Innovation and Development's (OTID) mission is to transform science into viable solutions for environmental cleanup. In 2010, OTID developed the Impact Plan, Science and Technology to Reduce the Life Cycle Cost of Closure to outline the benefits of research and development of the lifecycle cost of cleanup across the DOE complex. This plan outlines OTID's ability to reduce by $50 billion, the $200 billion life-cycle cost in waste processing, groundwater and soil, nuclear materials, and deactivation and decommissioning. The projected life-cycle costs and return on investment are based on actual savings realized from technology innovation, development, and insertion into remedial strategies and schedules at the Fernald, Mound, and Ashtabula sites. To achieve our goals, OTID developed Applied Field Research Initiatives to facilitate and accelerate collaborative development and implementation of new tools and approaches that reduce risk, cost and time for site closure. The primary mission of the Deep Vadose Zone-Applied Field Research Initiative (DVZ-AFRI) is to protect our nation's water resources, keeping them clean and safe for future generations. The DVZ-AFRI was established for the DOE to develop effective, science-based solutions for remediating, characterizing, monitoring, and predicting the behavior and fate of deep vadose zone contamination. Subsurface contaminants include radionuclides, metals, organics, and liquid waste that originated from various sources, including legacy waste from the nation's nuclear weapons complexes. The DVZ-AFRI project team is translating strategy into action by working to solve these complex challenges in a collaborative