WorldWideScience

Sample records for salm-surv external quality

  1. Results of Use of WHO Global Salm-Surv External Quality Assurance System for Antimicrobial Susceptibility Testing of Salmonella Isolates from 2000 to 2007

    DEFF Research Database (Denmark)

    Hendriksen, Rene S.; Seyfarth, Anne Mette; Jensen, Arne Bent

    2009-01-01

    An international External Quality Assurance System (EQAS) for antimicrobial susceptibility testing of Salmonella was initiated in 2000 by the World Health Organization (WHO) Global Salm-Surv in order to enhance the capacities of national reference laboratories to obtain reliable data for surveill......An international External Quality Assurance System (EQAS) for antimicrobial susceptibility testing of Salmonella was initiated in 2000 by the World Health Organization (WHO) Global Salm-Surv in order to enhance the capacities of national reference laboratories to obtain reliable data...

  2. WHO global salm-surv external quality assurance system (EQAS): an important step toward improving the quality of Salmonella serotyping and antimicrobial susceptibility testing worldwide

    DEFF Research Database (Denmark)

    Petersen, A.; Aarestrup, Frank Møller; Angulo, F. J.

    2002-01-01

    susceptibility testing through international training courses and an External Quality Assurance System (EQAS). In 2000, 44 WHO Global Salm-Surv member laboratories from 35 countries determined the serotype and antimicrobial susceptibility pattern for eight "blinded" Salmonella isolates. For serotyping, 73......% of the results were correct. For susceptibility testing, 92% of the results were in agreement with the expected results. However, only 78% of the performed tests with the E. coli ATCC 25922 reference strain were within the quality control range specified by National Committee for Clinical Laboratory Standards...... (NCCLS) guidelines. These EQAS results demonstrate the need for further training to improve the performance of some of the laboratories. WHO Global Salm-Surv activities, including international training courses and EQAS, represent an important step toward improving the quality of Salmonella serotyping...

  3. External Quality Assurance System (EQAS) of the WHO Global Salmonella Surveillance and Laboratory Support Project (Global Salm-Surv)

    DEFF Research Database (Denmark)

    Petersen, A.; Aarestrup, Frank Møller; Wong, S.

    laboratories in 35 countries participated. For serotyping, 76% of the results were correct. For susceptibility testing, 92% of the results for the eight Salmonella strains were in agreement with the expected results. However, 28% of the performed tests with the E. coli ATCC 25922 reference strain were out......To assure the quality of methods for serotyping and antimicrobial susceptibility testing among laboratories in WHO Global Salm-Surv, an international collaborative study on serotyping and antimicrobial susceptibility testing of eight Salmonella enterica strains was performed. A total of 44...

  4. External Quality Assurance System (EQAS) of the WHO Global Salmonella Surveillance and Laboratory Support Project (Global Salm-Surv) Results from 2001

    DEFF Research Database (Denmark)

    Petersen, A.; Aarestrup, Frank Møller; Evans, M.C.

    susceptibility testing. A total of 103 laboratories in 60 countries participated. For serotyping, 78% of the results were correct. For susceptibility testing, 91% of the results were in agreement with the expected results. However, 17% of the performed tests with the E. coli ATCC 25922 reference strain were out......An international collaborative study on serotyping and antimicrobial susceptibility testing of eight Salmonella enterica strains was performed to enhance the capacity of national and regional reference laboratories in WHO Global Salm-Surv to conduct Salmonella serotyping and antimicrobial...

  5. The External Quality Assurance System of the WHO Global Salm-Surv Year 2008

    DEFF Research Database (Denmark)

    Hendriksen, Rene S.; Karlsmose, Susanne; Jensen, Arne Bent

    to include other foodborne pathogens as well, and the number of participants has increased from 44 laboratories in 2000, to 187 laboratories in 2008. The serotyping results indicate a continuous need for improving skills in Salmonella serotyping. Future training efforts should be aimed at enhancing...... on the ESBL producing strain. It is important to draw attention to this in the future as we have to recognise the increase of resistance to 3rd and 4th generation of cephalosporins. Many of this year’s participants had difficulties identifying Campylobacter lari. These results indicate a need for additional...

  6. Internal versus External Quality Management

    Science.gov (United States)

    Hofman, Roelande H.; Dijkstra, Nynke J.; Hofman, W. H. Adriaan

    2008-01-01

    This article presents the findings of research into quality management in Dutch elementary schools using theories of school accountability and school improvement as fundamentals. The study is based on data gathered from almost 1000 school leaders. It attempts to determine whether different types of quality management exist in primary schools.…

  7. External quality assessment schemes for toxicology.

    Science.gov (United States)

    Wilson, John

    2002-08-14

    A variety of external quality assurance (EQA) schemes monitor quantitative performance for routine biochemical analysis of agents such as paracetamol, salicylate, ethanol and carboxyhaemoglobin. Their usefulness for toxicologists can be lessened where the concentrations monitored do not extend fully into the toxic range or where the matrix is synthetic, of animal origin or serum as opposed to whole human blood. A scheme for quantitative determinations of a wider range of toxicological analytes such as opioids, benzodiazepines and tricyclics in human blood has been piloted by the United Kingdom National External Quality Assessment Scheme (UKNEQAS). Specialist schemes are available for drugs of abuse testing in urine and for hair analysis. Whilst these programmes provide much useful information on the performance of analytical techniques, they fail to monitor the integrated processes that are needed in investigation of toxicological cases. In practice, both qualitative and quantitative tests are used in combination with case information to guide the evaluation of the samples and to develop an interpretation of the analytical findings that is used to provide clinical or forensic advice. EQA programs that combine the analytical and interpretative aspects of case studies are available from EQA providers such as UKNEQAS and the Dutch KKGT program (Stichting Kwaliteitsbewaking Klinische Geneesmiddelanalyse en Toxicologie).

  8. External quality control for embryology laboratories.

    Science.gov (United States)

    Castilla, Jose Antonio; Ruiz de Assín, Rafael; Gonzalvo, Maria Carmen; Clavero, Ana; Ramírez, Juan Pablo; Vergara, Francisco; Martínez, Luis

    2010-01-01

    Participation in external quality control (EQC) programmes is recommended by various scientific societies. Results from an EQC programme for embryology laboratories are presented. This 5-year programme consisted of the annual delivery of (i) materials to test toxicity and (ii) a DVD/CD-ROM with images of zygotes and embryos on days 2 and 3, on the basis of which the participants were asked to judge the embryo quality and to take a clinical decision. A high degree of agreement was considered achieved when over 75% of the laboratories produced similar classifications. With respect to the materials analysed, the specificity was 68% and the sensitivity was 83%. Concerning embryo classification, the proportion of embryos on which a high degree of agreement was achieved increased during this period from 35% to 55%. No improvement was observed in the degree of agreement on the clinical decision to be taken. Day-3 embryos produced a higher degree of agreement (58%) than did day-2 embryos (32%) (Pembryology laboratories. Copyright (c) 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  9. External quality control program: Experience in the department of ...

    African Journals Online (AJOL)

    Objective: To share experiences and lessons learned from 2002 National External Quality Assessment Schemes for Leukocyte Immunophenotyping (UK NEQAS) and College of American Pathologists (CAP) proficiency testing (PT) panels received and tested as part of External Quality Control Program Setting: Department ...

  10. Performance and External Egg Quality of Layers under Varying ...

    African Journals Online (AJOL)

    Performance and External Egg Quality of Layers under Varying Stocking ... Study determined the performance and external egg quality of layers in locally fabricated metal-type battery cage at different stocking density. ... Birds stocked at 2/cell gained 15g/birds in weight while birds stocked 3 and 4 ... OTHER RESOURCES.

  11. Results from EQAS 2002

    DEFF Research Database (Denmark)

    Petersen, A.; Aarestrup, Frank Møller; Jensen, A.B.

    laboratories from 67 countries participated. For serotyping, almost 90 % of the results were correct. For susceptibility testing, 91 % of the results were in agreement with the expected results, and 86 % of the performed tests with the reference strain E. coli ATCC 25922 were inside the quality control range......An international external quality assurance program on serotyping and antimicrobial susceptibility testing of eight Salmonella enterica strains was performed to enhance the capacity of national and regional reference laboratories in WHO Global Salm-Surv (WHO GSS). In 2002 a total of 117...... specified by NCCLS guidelines. Comparing the results of EQAS 2002 to the results from 2000 and 2001 showed a clear improvement in the laboratories capacity to accurately serotype and susceptibility test Salmonella. We attribute this improvement to the training provided by WHO GSS, the EQAS...

  12. An External Quality Assessment Of Haematology Laboratories-A ...

    African Journals Online (AJOL)

    The study has established the need for a continuous internal and external quality assessment in haematology. Such practice together with continuous education of laboratory personnel and the provision of automated instruments will help to achieve optimum laboratory quality needed for proper health care delivery in the

  13. 77 FR 21086 - Patents External Quality Survey (formerly Customer Panel Quality Survey)

    Science.gov (United States)

    2012-04-09

    ... United States Patent and Trademark Office Patents External Quality Survey (formerly Customer Panel Quality Survey) ACTION: Proposed collection; comment request. SUMMARY: The United States Patent [email protected] . Include ``0651- 0057 Patents External Quality Survey comment'' in the subject line of the...

  14. Higher Education Quality: Perception Differences among Internal and External Stakeholders

    Science.gov (United States)

    Abidin, Munirul

    2015-01-01

    Conceptually, education quality of higher education can be determined by evaluation of their stakeholders's satisfaction level. The purpose of this study is to describe how students as external stakeholder and lecturers as internal stakeholder, perceived their satisfaction of learning experience in the university. This study was conducted in…

  15. External quality assessments for microbiologic diagnosis of diphtheria in Europe.

    Science.gov (United States)

    Both, Leonard; Neal, Shona; De Zoysa, Aruni; Mann, Ginder; Czumbel, Ida; Efstratiou, Androulla

    2014-12-01

    The European Diphtheria Surveillance Network (EDSN) ensures the reliable epidemiological and microbiologic assessment of disease prevalence in the European Union. Here, we describe a survey of current diagnostic techniques for diphtheria surveillance conducted across the European Union and report the results from three external quality assessment (EQA) schemes performed between 2010 and 2014. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  16. Quality electricity lines of external power systems electric traction DC

    Directory of Open Access Journals (Sweden)

    A.V. Petrov

    2012-08-01

    Full Text Available The results of studies that compare and analyze the numerical values of some key indicators quality electricity in the lines of the external power supply system the electric traction DC. As a supplement are additional and fundamental values of energy losses in them.

  17. External quality assessment scheme by private laboratories in Turkey.

    Science.gov (United States)

    Laleli, Yahya R; Oktem, Murat

    2005-01-01

    At the end of this presentation the audiences should be able to understand the goal of external quality assessment and definitions used to describe similar functions of terminology. Also they had information about overview of interlaboratory method performance studies in Turkey in Hematology.

  18. External quality assessment of AFB smear microscopy performances ...

    African Journals Online (AJOL)

    External quality assessment of AFB smear microscopy performances and its associated factors in selected private health facilities in Addis Ababa, Ethiopia. ... Data were captured, cleaned, and analyzed using SPSS version 16.0; χ2 tests, kappa statistics were used for comparison purpose. P value < 0.05 considered ...

  19. Stepfamily Relationship Quality and Children's Internalizing and Externalizing Problems.

    Science.gov (United States)

    Jensen, Todd M; Lippold, Melissa A; Mills-Koonce, Roger; Fosco, Gregory M

    2017-03-07

    The stepfamily literature is replete with between-group analyses by which youth residing in stepfamilies are compared to youth in other family structures across indicators of adjustment and well-being. Few longitudinal studies examine variation in stepfamily functioning to identify factors that promote the positive adjustment of stepchildren over time. Using a longitudinal sample of 191 stepchildren (56% female, mean age = 11.3 years), the current study examines the association between the relationship quality of three central stepfamily dyads (stepparent-child, parent-child, and stepcouple) and children's internalizing and externalizing problems concurrently and over time. Results from path analyses indicate that higher levels of parent-child affective quality are associated with lower levels of children's concurrent internalizing and externalizing problems at Wave 1. Higher levels of stepparent-child affective quality are associated with decreases in children's internalizing and externalizing problems at Wave 2 (6 months beyond baseline), even after controlling for children's internalizing and externalizing problems at Wave 1 and other covariates. The stepcouple relationship was not directly linked to youth outcomes. Our findings provide implications for future research and practice. © 2017 Family Process Institute.

  20. Has External Quality Assurance Actually Improved Quality in Higher Education over the Course of 20 Years of the "Quality Revolution"?

    Science.gov (United States)

    Kristensen, Bente

    2010-01-01

    At the beginning of the last 20 years so-called "quality revolution" it was expected from most of the established national quality agencies that internal quality systems and the development of an internal quality culture would emerge automatically in the HEI from the external quality impact. The author argues that a better balance must be found…

  1. Data connectivity: A critical tool for external quality assessment.

    Science.gov (United States)

    Cheng, Ben; Cunningham, Brad; Boeras, Debrah I; Mafaune, Patron; Simbi, Raiva; Peeling, Rosanna W

    2016-01-01

    Point-of-care (POC) tests have been useful in increasing access to testing and treatment monitoring for HIV. Decentralising testing from laboratories to hundreds of sites around a country presents tremendous challenges in training and quality assurance. In order to address these concerns, companies are now either embedding connectivity in their new POC diagnostic instruments or providing some form of channel for electronic result exchange. These will allow automated key performance and operational metrics from devices in the field to a central database. Setting up connectivity between these POC devices and a central database at the Ministries of Health will allow automated data transmission, creating an opportunity for real-time information on diagnostic instrument performance as well as the competency of the operator through external quality assessment. A pilot programme in Zimbabwe shows that connectivity has significantly improve the turn-around time of external quality assessment result submissions and allow corrective actions to be provided in a timely manner. Furthermore, by linking the data to existing supply chain management software, stock-outs can be minimised. As countries are looking forward to achieving the 90-90-90 targets for HIV, such innovative technologies can automate disease surveillance, improve the quality of testing and strengthen the efficiency of health systems.

  2. Data connectivity: A critical tool for external quality assessment

    Directory of Open Access Journals (Sweden)

    Ben Cheng

    2016-10-01

    Full Text Available Point-of-care (POC tests have been useful in increasing access to testing and treatment monitoring for HIV. Decentralising testing from laboratories to hundreds of sites around a country presents tremendous challenges in training and quality assurance. In order to address these concerns, companies are now either embedding connectivity in their new POC diagnostic instruments or providing some form of channel for electronic result exchange. These will allow automated key performance and operational metrics from devices in the field to a central database. Setting up connectivity between these POC devices and a central database at the Ministries of Health will allow automated data transmission, creating an opportunity for real- time information on diagnostic instrument performance as well as the competency of the operator through external quality assessment. A pilot programme in Zimbabwe shows that connectivity has significantly improve the turn-around time of external quality assessment result submissions and allow corrective actions to be provided in a timely manner. Furthermore, by linking the data to existing supply chain management software, stock-outs can be minimised. As countries are looking forward to achieving the 90-90-90 targets for HIV, such innovative technologies can automate disease surveillance, improve the quality of testing and strengthen the efficiency of health systems.

  3. Technical proficiency in cytopathology: assessment through external quality assurance.

    Science.gov (United States)

    Cummings, M C; Greaves, J; Shukor, R A; Perkins, G; Ross, J

    2017-04-01

    To assess both the feasibility and value of conducting an external quality assurance programme concerning technical aspects of cytopathology laboratory practice, and the interest by laboratories in enrolling in such a programme. Six technical surveys, comprising staining exercises and questionnaires relating to laboratory practice, were distributed over a 4-year period to the approximately 220 laboratories enrolled in the RCPAQAP Cytopathology slide survey modules. Staining exercises using the Papanicolaou and Romanowsky techniques, the preparation of urine and body fluid specimens and immunocytochemistry on the cell block material were assessed. Accompanying relevant questionnaires were included, and one survey comprised a questionnaire alone concerning the collection of urinary tract and body fluid samples. Provision of an external cytopathology technical module was feasible for the RCPAQAP and participation rates (maximum of 87% per survey; average 68% for stained slides and 66% for questionnaires) were commendable, particularly considering these were optional undertakings with some exercises not applicable to all laboratories. The great majority of submitted slides were scored as satisfactory, and there was an especially high standard for the immunocytochemical staining exercise with 95% considered satisfactory, including 50.6% with a perfect score. Reasons for suboptimal scores were provided for potential quality improvement for interested laboratories. A wealth of information relating to laboratory practice was provided to the RCPAQAP which was collated and summarised for laboratory use. The provision of a technical module in cytopathology is both a feasible and valuable undertaking of interest to laboratories which should become standard practice for cytopathology external quality assurance providers. © 2016 John Wiley & Sons Ltd.

  4. [Regional external quality control of the analysis of urinary calculi].

    Science.gov (United States)

    Rebentisch, G

    1989-01-01

    Within one year's period a model for external quality control of urolithiasis was tested. This model includes specifications concerning precision as well as accuracy derived from diagnostic and therapeutic considerations. The quality indices obtained for precision QI-P and accuracy QI-R confirm that all analytical centres of urolithiasis in the GDR are to be found under the fixed specifications, partially to a considerable extent. Thus all participants indirectly demonstrated that the state of adjustment of instrumentation and thereby the reference factors remain stable for at least one year. The system being continued the specifications of precision (ST 0%) and accuracy (D0) might even be fixed more exactly from an analytical point of view.

  5. External quality assessment of BRAF molecular analysis in melanoma.

    Science.gov (United States)

    Deans, Zandra C; Wallace, Andrew; O'Sullivan, Brendan; Purvis, Andrew; Camus, Suzanne; Fairley, Jennifer A; Gonzalez, David

    2014-02-01

    The availability of BRAF inhibitors has given metastatic melanoma patients an effective new treatment choice and molecular testing to determine the presence or absence of a BRAF codon 600 mutation is pivotal in the clinical management of these patients. This molecular test must be performed accurately and appropriately to ensure that the patient receives the most suitable treatment in a timely manner. Laboratories have introduced such testing; however, some experience low sample throughput making it critical that an external quality assurance programme is available to help promote a high standard of testing, reporting and provide an educational aspect for BRAF molecular testing. Laboratories took part in three rounds of external quality assessment (EQA) during a 12-month period giving participants a measure of the accuracy of genotyping, clinical interpretation of the result and experience in testing a range of different samples. Formalin fixed paraffin embedded tissue sections from malignant melanoma patients were distributed to participants for BRAF molecular testing. The standard of testing was generally high but distribution of a mutation other than the most common, p.(Val600Glu), highlighted concerns with detection or reporting of the presence of rarer mutations. The main issues raised in the interpretation of the results were the importance of clear unambiguous interpretation of the result tailored to the patient and the understanding that the treatment is different from that given to other stratified medicine programmes. The variability in reporting and wide range of methodologies used indicate a continuing need for EQA in this field.

  6. External quality assessment and the laboratory diagnosis of thrombophilia.

    Science.gov (United States)

    Meijer, Piet; Haverkate, Frits

    2005-02-01

    External quality assessment is a tool to compare the result of a particular laboratory test in relation to those of other laboratories as well as to assess the performance of a laboratory test over a prolonged period of time. We evaluated the relationship between the between-laboratory variation and the sample category (normal, borderline, and abnormal) for antithrombin, protein C, protein S, and the activated protein C resistance test. Only for antithrombin and protein S was a significant relationship (0.004 < p < 0.012) observed. The effect of the between-laboratory variation of the different sample categories on the clinical interpretation was investigated. With the exception of free protein S antigen, all variables showed a significant relationship (0.004 < p < 0.045) between the sample category and the percentage of misclassification. Because in clinical practice a stable test performance over a prolonged period of time is important, we evaluated the quality of test performance using the long-term analytical coefficient of variation (LCVa). A wide range in the LCVa was observed for antithrombin, protein C, and protein S. Less than half of the participants could fulfill the quality specification for diagnostic testing (LCVa < or = 0.58 x total biological variation). This study shows that a more stable performance of laboratory tests involved in the screening of thrombophilia over a prolonged period of time is necessary.

  7. External quality assurance in nongynecologic cytology: The Australasian experience.

    Science.gov (United States)

    Shield, Paul W; Frost, Felicity; Finnimore, Jo L; Wright, R Gordon; Cummings, Margaret C

    2017-05-01

    The Royal College of Pathologists of Australasia Cytopathology Quality Assurance Program has operated an external quality assurance program in nongynecologic cytopathology since 1993. Glass slide preparations of a wide range of nongynecologic cases were circulated to approximately 200 cytopathology laboratories in 16 countries. General nongynecologic cytology cases were manufactured from residual specimens after routine diagnosis. Fine-needle aspiration (FNA) cases were made by sampling fresh tissue and making direct specimens. The majority of cases consisted of both air-dried and fixed preparations. Results returned to laboratories included illustrated case discussions highlighting diagnostic features, key differential diagnoses, and useful adjunctive tests. The current study reviewed >22,000 results for 123 nongynecologic cases. Cases found to cause the most diagnostic difficulties included serous effusion cases with metastatic carcinoma in a dispersed pattern, well-differentiated carcinoma, and cellular reactive cases; urine specimens with sparse malignant cells; reactive pneumocytes in a bronchoalveolar lavage; breast FNA cases with papillary lesions; gestational specimens; and fibroadenoma. FNA specimens from the lung and thyroid, particularly papillary thyroid carcinoma, generally were well reported. The use of multiple preparations of the same specimen has allowed interlaboratory comparison, and the quality assurance program has played an educational role as well as informing the laboratory accreditation process. Cancer Cytopathol 2017;125:349-361. © 2017 American Cancer Society. © 2017 American Cancer Society.

  8. Internal versus external service quality: reflections of employees and customers in the mirror

    OpenAIRE

    Emir Ganic; Vesna Babic-Hodovic; Maja Arslanagic-Kalajdzic

    2017-01-01

    Introduction: The purpose of this study to investigate internal service quality (as perceived by employees) and external (customer) perceptions of quality in the context of service profit chain (SPC). Objective: The objective of the study is to evaluate the impact of internal service quality on students’ perceptions of quality and to test the significance of a direct link between internal and external service quality. Methods: We measured the perceived service quality using a SERVPERF...

  9. International External Quality Assurance for Laboratory Diagnosis of Diphtheria ▿

    Science.gov (United States)

    Neal, S. E.; Efstratiou, A.

    2009-01-01

    The diphtheria surveillance network (DIPNET) encompassing National Diphtheria Reference Centers from 25 European countries is a Dedicated Surveillance Network recognized by the European Commission. A key DIPNET objective is the quality assessment of microbiological procedures for diphtheria across the European Union and beyond. A detailed questionnaire on the level of reference laboratory services and an external quality assessment (EQA) panel comprising six simulated throat specimens were sent to 34 centers. Twenty-three centers are designated National Diphtheria Reference Centers, with the laboratory in the United Kingdom being the only WHO Collaborating Centre. A variety of screening and identification tests were used, including the cysteinase test (20/34 centers), pyrazinamidase test (17/34 centers), and commercial kits (25/34 centers). The classic Elek test for toxigenicity testing is mostly used (28/34 centers), with variations in serum sources and antitoxin concentrations. Many laboratories reported problems obtaining Elek reagents or media. Only six centers produced acceptable results for all six specimens. Overall, 21% of identification and 13% of toxigenicity reports were unacceptable. Many centers could not isolate the target organism, and most found difficulties with the specimens that contained Corynebacterium striatum as a commensal contaminant. Nineteen centers generated either false-positive or negative toxigenic results, which may have caused inappropriate medical management. The discrepancies in this diphtheria diagnostics EQA alarmingly reflect the urgent need to improve laboratory performance in diphtheria diagnostics in Europe, standardize feasible and robust microbiological methods, and build awareness among public health authorities. Therefore, DIPNET recommends that regular workshops and EQA distributions for diphtheria diagnostics should be supported and maintained. PMID:19828749

  10. External Music Examiners: Micro-Macro Tasks in Quality Assurance Practices

    Science.gov (United States)

    Ross, Valerie

    2009-01-01

    External music examiners play a significant role in assessing, verifying and maintaining musical standards. Educational output endorsed by external examiners serves to verify, modify and legitimise internal behaviour. This article examines some of the "inside practices" of external music examiners in the context of quality assurance. It…

  11. [External quality assessment of semen analysis in Poland].

    Science.gov (United States)

    Jedrzejczak, Piotr; Talarczyk, Joanna; Taszarek-Hauke, Grazyna; Berger, Anna; Hauke, Jan; Pawelczyk, Leszek

    2012-11-01

    Semen analysis is an important part of male infertility diagnosis and should be performed according to international recommendations. The reliability of the results depends mainly on the qualifications of the laboratory analysts. External Quality Assessment Programmes (EQAP) are performed in laboratories worldwide in order to standardize the results. The aim of this study was to perform the first in Poland comparison of the results of sperm analysis from different laboratories. Forty two Polish laboratories were invited to participate in the EQAP and eight laboratories agreed to take part in the analysis. They were sent uniform semen samples, prepared in accordance with the WHO standards: one sample for the assessment of concentration, two for motility (on DVD) and two for the morphology of the sperm (Papanicolau staining). The reference group was comprised of three employees of the Andrologic Laboratory of Poznań University of Medical Sciences, who regularly take part in EQAP organized by ESHRE. The reference group analyzed the samples from the participating laboratories. Statistic features such as mean, median, standard deviation, minimal and maximal value, first and third quartile were assessed for every examined parameter Z-score index was used to compare the differences between assessed laboratories and the reference laboratory. The acceptable Z-score range was +/-1. Average concentration in the reference group was 43 mln/ml, while in the assessed laboratories (L) it was between 31 (L4) and 72.5 mln/ml (L1). Z-score for concentration analysis in three laboratories exceeded +/- 1 (2.51 for L1, 1.42 for L2 and -1.02 for L4). In the analysis of the first sample for progressive motility the reference group received 59%, while the values of participating laboratories varied from 42,5% (L1) to 80% (L4). Most of the centers achieved Z-score within the normal range, except for L1 and L4 (-1.48 and 1.88 respectively). The reference value for the second sample for

  12. Experience of Internal and External Education Quality Rate: Esg and the Legislation of the Russian Federation

    Directory of Open Access Journals (Sweden)

    Nikanorov Ivan N.

    2017-01-01

    Full Text Available Overview of regulation of internal and external education quality rate has been presented. The development of regulation an independent assessment of higher education in Russia in the context of ESG has been considered. Authors noticed, that instruments of internal and external quality rate interact in Russian legislation insufficiently.

  13. Internal versus external service quality: reflections of employees and customers in the mirror

    Directory of Open Access Journals (Sweden)

    Emir Ganic

    2017-09-01

    perceptions of the quality of university services. Perceptions of internal service quality are also positively related to students’ perceptions of reliability, responsiveness and quality assurance. Conclusions: The perceptions of internal service quality by faculty members are positively related to students’ perceptions of quality. Comparing the levels of internal and external service quality will help managers define priorities for allocating resources to improve quality.

  14. Endorsing good quality assurance practices in molecular pathology: risks and recommendations for diagnostic laboratories and external quality assessment providers.

    Science.gov (United States)

    Tembuyser, Lien; Dequeker, Elisabeth M C

    2016-01-01

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

  15. Externalizing Behaviors and Callous-Unemotional Traits: Different Associations With Sleep Quality.

    Science.gov (United States)

    Denis, Dan; Akhtar, Reece; Holding, Benjamin C; Murray, Christina; Panatti, Jennifer; Claridge, Gordon; Sadeh, Avi; Barclay, Nicola L; O'Leary, Rachael; Maughan, Barbara; McAdams, Tom A; Rowe, Richard; Eley, Thalia C; Viding, Essi; Gregory, Alice M

    2017-08-01

    Sleep quality is associated with different aspects of psychopathology, but relatively little research has examined links between sleep quality and externalizing behaviors or callous-unemotional traits. We examined: (1) whether an association exists between sleep quality and externalizing behaviors; (2) whether anxiety mediates this association; (3) whether callous-unemotional traits are associated with sleep quality. Data from two studies were used. Study 1 involved 1556 participants of the G1219 study aged 18-27 years (62% female). Questionnaire measures assessed sleep quality, anxiety, externalizing behaviors, and callous-unemotional traits. Study 2 involved 338 participants aged 18-66 years (65% female). Questionnaires measured sleep quality, externalizing behaviors, and callous-unemotional traits. In order to assess objective sleep quality, actigraphic data were also recorded for a week from a subsample of study 2 participants (n = 43). In study 1, poorer sleep quality was associated with greater externalizing behaviors. This association was partially mediated by anxiety and moderated by levels of callous-unemotional traits. There was no significant relationship between sleep quality and callous-unemotional traits. In study 2, poorer sleep quality, as assessed via self-reported but not objective measures, was associated with higher levels of externalizing behaviors. Furthermore, in study 2, better sleep quality (indicated in both questionnaires and actigraphy measures: lower mean activity, and greater sleep efficiency) was associated with higher levels of callous-unemotional traits. Self-reports of poorer sleep quality are associated with externalizing behaviors, and this association is partially mediated by anxiety. Callous-unemotional traits are not associated with poor sleep and may even be related to better sleep quality. This is an exceptional finding given that poor sleep quality appears to be a characteristic of most psychopathology.

  16. [Indication for mitral valve interventions: Development of a quality indicator for external hospital quality assurance].

    Science.gov (United States)

    Köster, Christina; Schorbach, Lena; Wrede, Stephanie; Meyer, Sven; Kazmaier, Tonia; Szecsenyi, Joachim

    2017-11-01

    The indication for a mitral valve intervention is an important patient-relevant parameter for the assessment of process quality and the comparison of healthcare providers. In this article, we describe the development of a corresponding quality indicator for an external hospital quality assurance (QA) procedure in Germany. An expert panel was set up by the aQua Institute to assist with the development of a QA procedure for mitral valve interventions and the associated quality indicators. In a comprehensive, systematic literature and evidence research, the American and European guidelines were identified as the best evidence available. Especially the more current American guideline formed the basis on which a quality indicator dealing with the correct indication for a mitral valve intervention was developed. The developed quality indicator assesses the proportion of patients for whom an indication for a mitral valve intervention was determined in compliance with guideline recommendations. The indicator differentiates between surgical and catheter-based procedures. To determine whether or not the indication was correct, different medical parameters are included, such as, for example, type of mitral valve defect, etiology of the disease, severity of symptoms, valve morphology (e. g., mitral valve area), valve hemodynamics and comorbidity, which healthcare providers have to document. The documentation for the developed quality indicator is considerable. Nonetheless, its relevance is undeniable because it allows the user to determine whether a surgical or catheter-based mitral valve intervention was necessary and performed according to guideline recommendations. In the first year of its implementation, this indicator should be evaluated for further improvement and simplification of assessment. Copyright © 2017. Published by Elsevier GmbH.

  17. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

    Science.gov (United States)

    Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

    2015-01-01

    The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

  18. Effects of growth conditions on external quality of cut chrysanthemum; analysis and simulation

    NARCIS (Netherlands)

    Carvalho, S.M.P.

    2003-01-01

    For many years the emphasis in floricultural research laid with quantity rather than quality. Nowadays, since the prices are often determined on the basis of visual quality aspects, the so-called external quality, chrysanthemum growers aim to provide a high and constant product

  19. AIR QUALITY CRITERIA FOR PARTICULATE MATTER, VOLUMES I-III, (EXTERNAL REVIEW DRAFT, 1995)

    Science.gov (United States)

    There is no abstract available for these documents. If further information is requested, please refer to the bibliographic citation and contact the Technical Information Staff at the number listed above.Air Quality Criteria for Particulate Matter, Volume I, Extern...

  20. Internal and External Dialogue: A Method for Quality Court Management

    Directory of Open Access Journals (Sweden)

    Marie Hagsgård

    2008-10-01

    Full Text Available The aim of quality court work is to maintain or improve public trust in the court as a vital part of a democratic society. Public confidence in the judicial system is affected by a number of factors, including speedy and judicially correct decisions which are generally understandable and a good treatment of parties and witnesses before and during court proceedings. In order to uphold and enhance public trust, courts need to work systematically to improve the quality of court functioning. But questions remain regarding how to institute quality court management, and how to achieve positive results. Although court managers in Sweden have shown an interest in starting systematic quality work, they have found it difficult to find a method for such work and systematically achieving results.

  1. A quality audit program for external beam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, W.F.; Stovall, M. [Univ. of Texas, Houston, TX (United States)

    1993-12-31

    For more than 25 years, the University of Texas M. D. Anderson Cancer Center has had a quality audit program using mailed dosimeters to verify radiation therapy machine output. Two programs, one compulsory and one voluntary, presently monitor therapy beams at more than 1000 megavoltage-therapy facilities. A successful program requires two major components: a high-precision thermoluminescent dosimeter (TLD) system and dedicated staff that interact closely with the users to resolve discrepancies. The TLD system, the logistics used, and the human interaction of these programs are described. Examples show that the programs can identify major discrepancies, exceeding 5 %, as well as discrepancies as small as 3%.

  2. Parenting and Friendship Quality as Predictors of Internalizing and Externalizing Symptoms in Early Adolescence

    Science.gov (United States)

    Gaertner, Alden E.; Fite, Paula J.; Colder, Craig R.

    2010-01-01

    Research indicates both parents and peers influence child and adolescent adjustment outcomes. Moreover, friendship quality has been found to buffer the influence of parenting on adolescent adjustment, particularly externalizing symptoms. Little to no research, however, has longitudinally examined whether friendship quality moderates the relation…

  3. External Quality Metrics for Object-Oriented Software: A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Danilo Santos

    2017-12-01

    Full Text Available Software quality metrics can be categorized into internal quality, external quality, and quality in use metrics. Although exist close relationship between internal and external software quality, there are not explicit evidences in literature that attributes and metrics of internal quality impact external quality. This is essential to know which metric to use according to the software characteristic that you want to improve. Hence, we carried out a systematic literature review for identifying this relationship. After analyzing 664 papers, 12 papers were studied in depth. As result, we found 65 metrics related to maintainability, usability, reliability, and quality characteristics as well as main attributes that impact external metrics (size, coupling, and cohesion. In follow, we filtered some metrics that have clear definitions, are appropriately related to the characteristic that purports to measure, and do not use subjective attributes in their computation. Therefore, these metrics are more robust and reliable to evaluate software characteristics. So, these metrics are better for use in practice by professionals working in the software market.

  4. Effect of Training and Level of External Auditory Feedback on the Singing Voice: Volume and Quality.

    Science.gov (United States)

    Bottalico, Pasquale; Graetzer, Simone; Hunter, Eric J

    2016-07-01

    Previous research suggests that classically trained professional singers rely not only on external auditory feedback but also on proprioceptive feedback associated with internal voice sensitivities. The Lombard effect and the relationship between sound pressure level (SPL) and external auditory feedback were evaluated for professional and nonprofessional singers. Additionally, the relationship between voice quality, evaluated in terms of singing power ratio (SPR), and external auditory feedback, level of accompaniment, voice register, and singer gender was analyzed. The subjects were 10 amateur or beginner singers and 10 classically trained professional or semiprofessional singers (10 men and 10 women). Subjects sang an excerpt from the Star-Spangled Banner with three different levels of the accompaniment, 70, 80, and 90 dBA and with three different levels of external auditory feedback. SPL and SPR were analyzed. The Lombard effect was stronger for nonprofessional singers than professional singers. Higher levels of external auditory feedback were associated with a reduction in SPL. As predicted, the mean SPR was higher for professional singers than nonprofessional singers. Better voice quality was detected in the presence of higher levels of external auditory feedback. With an increase in training, the singer's reliance on external auditory feedback decreases. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  5. Effect of training and level of external auditory feedback on the singing voice: volume and quality

    Science.gov (United States)

    Bottalico, Pasquale; Graetzer, Simone; Hunter, Eric J.

    2015-01-01

    Background Previous research suggests that classically trained professional singers rely not only on external auditory feedback but also on proprioceptive feedback associated with internal voice sensitivities. Objectives The Lombard Effect in singers and the relationship between Sound Pressure Level (SPL) and external auditory feedback was evaluated for professional and non-professional singers. Additionally, the relationship between voice quality, evaluated in terms of Singing Power Ratio (SPR), and external auditory feedback, level of accompaniment, voice register and singer gender was analyzed. Methods The subjects were 10 amateur or beginner singers, and 10 classically-trained professional or semi-professional singers (10 males and 10 females). Subjects sang an excerpt from the Star-spangled Banner with three different levels of the accompaniment, 70, 80 and 90 dBA, and with three different levels of external auditory feedback. SPL and the SPR were analyzed. Results The Lombard Effect was stronger for non-professional singers than professional singers. Higher levels of external auditory feedback were associated with a reduction in SPL. As predicted, the mean SPR was higher for professional than non-professional singers. Better voice quality was detected in the presence of higher levels of external auditory feedback. Conclusions With an increase in training, the singer’s reliance on external auditory feedback decreases. PMID:26186810

  6. [Analysis of the results of the SEIMC External Quality Control Program. Year 2013].

    Science.gov (United States)

    de Gopegui Bordes, Enrique Ruiz; Orta Mira, Nieves; Del Remedio Guna Serrano, M; Medina González, Rafael; Rosario Ovies, María; Poveda, Marta; Gimeno Cardona, Concepción

    2015-07-01

    The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology, molecular microbiology and HIV-1, HCV and HBV viral loads. This manuscript presents the analysis of results obtained of the participants from the 2013 SEIMC External Quality Control Programme, except viral loads controls, that they are summarized in a manuscript abroad. As a whole, the results obtained in 2013 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. Once again, the results of this program highlighted the need to implement both internal and external controls in order to assure the maximal quality of the microbiological tests. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  7. External Quality Assessment for Rubella Virus RNA Detection Using Armored RNA in China.

    Science.gov (United States)

    Zhang, D; Lin, G; Yi, L; Hao, M; Fan, G; Yang, X; Peng, R; Ding, J; Zhang, K; Zhang, R; Li, J

    2017-02-01

    Although tremendous efforts have been made to reduce rubella incidence, there are still 300 new cases of congenital rubella syndrome daily; thus, rubella infections remain one of the leading causes of preventable congenital birth defects. An effective surveillance system, which could be achieved and maintained by using an external quality assessment program, is critical for prevention and control of this disease. Armored RNAs, which are noninfectious and RNase-resistant, were used for encapsulation of the E1 gene of rubella virus and for preparation of a 10-specimen panel for external quality assessment. Thirty-two laboratories across mainland China that used nucleic acid tests for rubella virus RNA detection were included in the external quality assessment program organized by the National Center for Clinical Laboratories of China. Different kinds of commercial kits were used by the laboratories for nucleic acid extraction and TaqMan real-time reverse-transcription PCR for rubella virus RNA detection; 99.2% sensitivity and 100% specificity were achieved in this external quality assessment program. Most of the participating laboratories obtained accurate results for rubella nucleic acid tests, thereby achieving the quality required for regional rubella and congenital rubella syndrome elimination.

  8. Quality of life effects of automatic external defibrillators in the home: results from the Home Automatic External Defibrillator Trial (HAT).

    Science.gov (United States)

    Mark, Daniel B; Anstrom, Kevin J; McNulty, Steven E; Flaker, Greg C; Tonkin, Andrew M; Smith, Warren M; Toff, William D; Dorian, Paul; Clapp-Channing, Nancy E; Anderson, Jill; Johnson, George; Schron, Eleanor B; Poole, Jeanne E; Lee, Kerry L; Bardy, Gust H

    2010-04-01

    Public access automatic external defibrillators (AEDs) can save lives, but most deaths from out-of-hospital sudden cardiac arrest occur at home. The Home Automatic External Defibrillator Trial (HAT) found no survival advantage for adding a home AED to cardiopulmonary resuscitation (CPR) training for 7,001 patients with a prior anterior wall myocardial infarction. Quality of life (QOL) outcomes for both the patient and spouse/companion were secondary end points. A subset of 1,007 study patients and their spouse/companions was randomly selected for ascertainment of QOL by structured interview at baseline and 12 and 24 months after enrollment. The primary QOL measures were the Medical Outcomes Study 36-Item Short-Form psychological well-being (reflecting anxiety and depression) and vitality (reflecting energy and fatigue) subscales. For patients and spouse/companions, the psychological well-being and vitality scales did not differ significantly between those randomly assigned an AED plus CPR training and controls who received CPR training only. None of the other QOL measures collected showed a clinically and statistically significant difference between treatment groups. Patients in the AED group were more likely to report being extremely or quite a bit reassured by their treatment assignment. Spouse/companions in the AED group reported being less often nervous about the possibility of using AED/CPR treatment than those in the CPR group. Adding access to a home AED to CPR training did not affect QOL either for patients with a prior anterior myocardial infarction or their spouse/companion but did provide more reassurance to the patients without increasing anxiety for spouse/companions. Copyright 2010 Mosby, Inc. All rights reserved.

  9. External Quality Assessment Unravels Interlaboratory Differences in Quality of RAS Testing for Anti-EGFR Therapy in Colorectal Cancer

    NARCIS (Netherlands)

    Tack, V.; Ligtenberg, M.J.L.; Tembuyser, L.; Normanno, N.; Borght, S. van der; Krieken, J.H. van; Dequeker, E.M.

    2015-01-01

    BACKGROUND: Regulations for the selection of patients with metastatic colorectal cancer for anti-EGFR treatment changed at the end of 2013. The set of mutations to be tested extended from KRAS codons 12 and 13 to KRAS and NRAS exons 2, 3, and 4. A European external quality assessment scheme

  10. Guideline on the requirements of external quality assessment programs in molecular pathology

    NARCIS (Netherlands)

    van Krieken, J Han; Normanno, Nicola; Blackhall, Fiona; Boone, Elke; Botti, Gerardo; Carneiro, Fatima; Celik, Ilhan; Ciardiello, Fortunato; Cree, Ian A; Deans, Zandra C; Edsjö, Anders; Groenen, Patricia J T A; Kamarainen, Outi; Kreipe, Hans H; Ligtenberg, Marjolijn J L; Marchetti, Antonio; Murray, Samuel; Opdam, Frank J M; Patterson, Scott D; Patton, Simon; Pinto, Carmine; Rouleau, Etienne; Schuuring, Ed; Sterck, Silke; Taron, Miquel; Tejpar, Sabine; Timens, Wim; Thunnissen, Erik; van de Ven, Peter M; Siebers, Albert G; Dequeker, Elisabeth

    Molecular pathology is an integral part of daily diagnostic pathology and used for classification of tumors, for prediction of prognosis and response to therapy, and to support treatment decisions. For these reasons, analyses in molecular pathology must be highly reliable and hence external quality

  11. Pilot Experience with an External Quality Assurance Scheme for Acylcarnitines in Plasma/Serum

    NARCIS (Netherlands)

    Sala, P Ruiz; Ruijter, G; Acquaviva, C; Chabli, A; de Sain-van der Velden, M G M; Garcia-Villoria, J; Heiner-Fokkema, M R; Jeannesson-Thivisol, E; Leckstrom, K; Franzson, L; Lynes, G; Olesen, J; Onkenhout, W; Petrou, P; Drousiotou, A; Ribes, A; Vianey-Saban, C; Merinero, B

    2016-01-01

    The analysis of acylcarnitines (AC) in plasma/serum is established as a useful test for the biochemical diagnosis and the monitoring of treatment of organic acidurias and fatty acid oxidation defects. External quality assurance (EQA) for qualitative and quantitative AC is offered by ERNDIM and CDC

  12. External Quality Arrangements for the Review of Modern Apprenticeship Off-the-Job Training

    Science.gov (United States)

    Education Scotland, 2015

    2015-01-01

    This publication provides a quality framework to provide a structure for external review of Modern Apprenticeship off-the-job training.? The indicators in this framework are arranged under three key principles, addressing five questions which Education Scotland is adopting for evaluation purposes. These are underpinned by a wider principle on the…

  13. The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes.

    Science.gov (United States)

    Boeras, Debrah I; Peeling, Rosanna W; Onyebujoh, Philip; Yahaya, Ali A; Gumede-Moeletsi, Hieronyma N; Ndihokubwayo, Jean B

    2016-01-01

    External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events

  14. [Analysis of the results of the SEIMC External Quality Control Program. Year 2014].

    Science.gov (United States)

    Gopegui Bordes, Enrique Ruiz de; Guna Serrano, M Del Remedio; Orta Mira, Nieves; Medina González, Rafael; Rosario Ovies, María; Poveda, Marta; Gimeno Cardona, Concepción

    2016-07-01

    The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most relevant conclusions and lessons from the 2014 controls. As a whole, the results obtained in 2014 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. Once again, the results of the SEIMC program highlighted the need to implement both internal and external controls in order to assure the maximal quality of the microbiological tests. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  15. [Analysis of the results of the SEIMC External Quality Control Program. Year 2011].

    Science.gov (United States)

    Ruiz de Gopegui Bordes, Enrique; Guna Serrano, M del Remedio; Orta Mira, Nieves; Ovies, María Rosario; Poveda, Marta; Gimeno Cardona, Concepción

    2013-02-01

    The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [SEIMC]) includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology, and molecular microbiology. This article presents the most relevant conclusions and lessons from the 2011 controls. Overall, the results obtained in 2011 confirm the excellent skill and good technical standards found in previous years. Nevertheless, erroneous results can be obtained in any laboratory and in clinically relevant determinations. The results of this program highlight the need to implement both internal and external controls, such as those offered by the SEIMC program, in order to ensure maximal quality of microbiological tests. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  16. [Analysis of the results of the SEIMC External Quality Control Program. Year 2012].

    Science.gov (United States)

    de Gopegui Bordes, Enrique Ruiz; Guna Serrano, M del Remedio; Orta Mira, Nieves; Ovies, María Rosario; Poveda, Marta; Gimeno Cardona, Concepción

    2014-02-01

    The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most relevant conclusions and lessons from the 2012 controls. As a whole, the results obtained in 2012 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. Once again, the results of this program highlighted the need to implement both internal and external controls in order to assure the maximal quality of the microbiological tests. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  17. Necessity of External Quality Control for anti-Mycoplasma pneumoniae IgM antibodies

    Directory of Open Access Journals (Sweden)

    Massimo De Paschale

    2008-06-01

    Full Text Available We evaluated the correlation among four commercial ELISA tests for the presence of anti-Mycoplasma pneumoniae IgM antibodies in 36 samples obtained from patients with respiratory infections.The overall concordance among the four tests was 30%, while the one among single tests varies from 39% to 75%. Given the variability of the results, it is necessary to implement a External Quality Control specific for anti-Mycoplasma pneumoniae IgM antibodies.

  18. [Data from automated external defibrillators provide important information on the quality of in-hospital resuscitation].

    Science.gov (United States)

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

    2014-09-01

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

  19. Performance of semiquantitative and quantitative D-dimer assays in the ECAT external quality assessment program.

    Science.gov (United States)

    de Maat, M P; Meijer, P; Nieuwenhuizen, W; Haverkate, F; Kluft, C

    2000-01-01

    D-dimer levels are used in clinical practice as markers for the presence or exclusion of venous thrombosis. Therefore, it is important that the performance of the D-dimer tests is well controlled. One of the components of a laboratory quality program is external quality assessment (EQA). The main aim of EQA is to identify the degree of agreement among laboratories. In addition to identifying the individual laboratory performance, it also identifies the characteristics of the different reagents and methods that are used in different laboratories. Recently, the D-dimer test was included in the ECAT External Quality Assessment program. Eighty-one laboratories in four rounds applied semiquantitative and quantitative D-dimer assays to three samples (concentrations normal, slightly elevated, and elevated). Although the reported values varied widely, the classification of the samples was mostly correct for the normal and the elevated samples. The slightly elevated sample was classified as normal by all laboratories using semiquantitative methods and by 60% of the laboratories using quantitative methods, and this varied between 45% and 86% for the different methods. In conclusion, D-dimer methods show a large variation, and the quality of the D-dimer assessment could be improved by standardization and by using cut-off ranges.

  20. Acceptable variability in external quality assessment programmes for basic semen analysis.

    Science.gov (United States)

    Palacios, E R; Clavero, A; Gonzalvo, M C; Rosales, A; Mozas, J; Martínez, L; Ramírez, J P; Björndahl, L; Morancho-Zaragoza, J; Fernández-Pardo, E; Castilla, J A

    2012-02-01

    External quality assessment is essential in modern andrology laboratories. To assess the proficiency of laboratories participating in an external quality assessment programme (EQAP), limits for acceptable variability must be determined. Limits currently specified largely depend on criteria set by the organizers of individual EQAP schemes. The objective of this study was to evaluate the different criteria described in ISO 13528: 2005 for calculating acceptable variability in EQAP when applied to basic semen analysis parameters. The data used in this study were the means and standard deviations obtained for independent samples from two EQAPs, one national (Spanish) and one international (European). The acceptable variability according to ISO 13528: 2005 was calculated using four types of criteria: (i) ± 3 standard deviations of the results of all participating laboratories; (ii) ± 3 standard deviations of the results of expert laboratories; (iii) quality specifications based on biological variability, state-of-the-art and clinicians' opinions and (iv) the same quality specifications adjusted for the uncertainty of the assigned value. The first two strategies resulted in very wide ranges of acceptable variability. Conversely, the strategy based only on quality specifications resulted in very narrow ranges. For the fourth strategy, acceptable ranges were intermediate between the results produced with the other strategies. The third and fourth strategies did not produce observable differences in acceptable ranges when the model used for calculating the specifications of analytical quality was changed. It is essential that EQAPs for semen parameters should determine the ranges for acceptable variability in results. Moreover, these ranges must be clinically useful, i.e. the variability should have a minimal negative impact on clinical decisions. The exact definition of 'expert laboratory' is more important than the model chosen for estimating analytical quality

  1. External quality assessment on detection of hepatitis C virus RNA in clinical laboratories of China.

    Science.gov (United States)

    Wang, Lu-nan; Zhang, Rui; Shen, Zi-yu; Chen, Wen-xiang; Li, Jin-ming

    2008-06-05

    As with many studies carried out in European countries, a quality assurance program has been established by the National Center for Clinical Laboratories in China (NCCL). The results showed that the external quality assessment significantly improves laboratory performance for quantitative evaluation of hepatitis C virus (HCV) RNA. Serum panels were delivered twice annually to the clinical laboratories which performed HCV RNA detection in China. Each panel made up of 5 coded samples. All laboratories were requested to carry out the detection within the required time period and report on testing results which contained qualitative and/or quantitative test findings, reagents used and relevant information about apparatus. All the positive samples were calibrated against the first International Standard for HCV RNA in a collaborative study and the range of comparison target value (TG) designated as +/- 0.5 log. The numbers of laboratories reporting on qualitative testing results for the first and second time external quality assessment were 168 and 167 in the year of 2003 and increased to 209 and 233 in 2007; the numbers of laboratories reporting on quantitative testing results were 134 and 147 in 2003 and rose to 340 and 339 in 2007. Deviation between the mean value for quantitative results at home in 2003 and the target value was above 0.5 log, which was comparatively high. By 2007, the target value was close to the national average except for the low concentrated specimens (10(3) IU/ml). The percentage of results within the range of GM +/- 0.5 log(10) varied from 8.2% to 93.5%. Some laboratories had some difficulties in the exact quantification of the lowest (3.00 log IU/ml) as well as of the highest viral levels (6.37 log IU/ml) values, very near to the limits of the dynamic range of the assays. The comparison of these results with the previous study confirms that a regular participation in external quality assessment (EQA) assures the achievement of a high

  2. [External assessment of analytic quality in hematology: a necessity in Latin America].

    Science.gov (United States)

    Fink, N E; Fernández Alberti, A; Mazziotta, D

    1997-09-01

    The assurance of analytical quality in a clinical laboratory is achieved through an internal system of quality control complemented by an external evaluation program. Quality assurance provides a foundation for the confidence that is placed in laboratory results and their use in the diagnosis and treatment of diseases. Many laboratories in Latin American countries do not have appropriate systems in place to evaluate and control quality. Given the importance of diagnoses based on hematologic data, the Pan American Health Organization sponsored a course in quality control in hematology during the XI Latin American Congress of Clinical Biochemistry (Mexico, 1993), in which representatives from Argentina, Chile, Cuba, Mexico, Paraguay, Dominican Republic, and Uruguay participated. As part of the course, the following control materials were produced: secondary standard solution of cyanmethemoglobin, stabilized concentrated hemoglobin solution, and preserved human whole blood with pseudoleukocytes. These materials were sent to laboratories in the seven participating countries for use in analytical procedures, and the results were then subjected to an external evaluation to assess individual performance and the comparability of results among the group. The specific tasks carried out were: (1) determination of values for hemoglobin, hematocrit, and red and white blood cell counts by the procedures normally used in each laboratory; (2) recording of the data on special reporting forms; and (3) transmittal of those forms to the coordinator in each country. The results were analyzed with regard to both the procedure used and the participating country. Reference values were established by consensus following application of a statistical method to eliminate outlying values. Comparative analysis of the results showed the coefficients of variation (CV) of the hematocrit (4.5%), red blood cell count (11.0%), and white blood cell count (22.2%) to be higher than those reported from

  3. Toward a transnational framework: Aligning internal and external quality assurance processes

    Directory of Open Access Journals (Sweden)

    William Plater

    2012-11-01

    Full Text Available This article explores the tensions between internal and external quality assurance processes, making a case for the preeminence of internal actions to ensure the capacity of institutions to respond quickly and effectively to the rapidly evolving global conditions affecting all of higher education. As the forms and means of formal and informal learning evolve more rapidly than quality assurance and accrediting bodies can adapt, institutions themselves will have to take the steps necessary to ensure that students are actually learning at levels represented by a new array of credentials and to offer credible evidence to employers and others that the credentials are indeed accurate reflections of competence. There is a place for quality assurance bodies, but these agencies will find it in their best interest to operate in the areas where they can offer the greatest societal value by articulating the standards that define integrity and quality. Both institutions and quality assurance bodies alike must join forces to recognize that expectations for what actually constitutes quality, competence, and integrity transcend national borders, cultural differences, the ages, occupations or locations of learners, and outmoded notions of prestige. It is a new era where bold ideas and strong ideals can reshape our understanding of what it means to learn throughout life at demonstrable levels of quality and competence. DOI: 10.18870/hlrc.v3i1.90

  4. Evaluation of an External Quality Assessment Program for HIV Testing in Haiti, 2006–2011

    Science.gov (United States)

    Louis, Frantz Jean; Anselme, Renette; Ndongmo, Clement; Buteau, Josiane; Boncy, Jacques; Dahourou, Georges; Vertefeuille, John; Marston, Barbara; Balajee, S. Arunmozhi

    2016-01-01

    Objectives To evaluate an external quality assessment (EQA) program for human immunodeficiency virus (HIV) rapid diagnostics testing by the Haitian National Public Health Laboratory (French acronym: LNSP). Acceptable performance was defined as any proficiency testing (PT) score more than 80%. Methods The PT database was reviewed and analyzed to assess the testing performance of the participating laboratories and the impact of the program over time. A total of 242 laboratories participated in the EQA program from 2006 through 2011; participation increased from 70 laboratories in 2006 to 159 in 2011. Results In 2006, 49 (70%) laboratories had a PT score of 80% or above; by 2011, 145 (97.5%) laboratories were proficient (P quality of testing and allowed the LNSP to document improvements in the quality of HIV rapid testing over time. PMID:24225755

  5. The Benefits of Internalizing Air Quality and Greenhouse Gas Externalities in the US Energy System

    Science.gov (United States)

    Brown, Kristen E.

    The emission of pollutants from energy use has effects on both local air quality and the global climate, but the price of energy does not reflect these externalities. This study aims to analyze the effect that internalizing these externalities in the cost of energy would have on the US energy system, emissions, and human health. In this study, we model different policy scenarios in which fees are added to emissions related to generation and use of energy. The fees are based on values of damages estimated in the literature and are applied to upstream and combustion emissions related to electricity generation, industrial energy use, transportation energy use, residential energy use, and commercial energy use. The energy sources and emissions are modeled through 2055 in five-year time steps. The emissions in 2045 are incorporated into a continental-scale atmospheric chemistry and transport model, CMAQ, to determine the change in air quality due to different emissions reduction scenarios. A benefit analysis tool, BenMAP, is used with the air quality results to determine the monetary benefit of emissions reductions related to the improved air quality. We apply fees to emissions associated with health impacts, climate change, and a combination of both. We find that the fees we consider lead to reductions in targeted emissions as well as co-reducing non-targeted emissions. For fees on the electric sector alone, health impacting pollutant (HIP) emissions reductions are achieved mainly through control devices while Greenhouse Gas (GHG) fees are addressed through changes in generation technologies. When sector specific fees are added, reductions come mainly from the industrial and electricity generation sectors, and are achieved through a mix of energy efficiency, increased use of renewables, and control devices. Air quality is improved in almost all areas of the country with fees, including when only GHG fees are applied. Air quality tends to improve more in regions with

  6. EXTERNAL QUALITY ASSESSMENT OF GENERAL EDUCATION AS A FACTOR OF TEACHERS’ PROFESSIONAL DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    T. V. Potemkinа

    2017-01-01

    Full Text Available Introduction. Nowadays, foreign and Russian researchers state the lack of reliable tools for diagnostics of professional gaps among teachers. It is unjustified to draw conclusions about skill level of teachers, relying only on results which are shown by pupils when holding unified state examinations and monitoring tests. However, information on results of an external assessment of quality of the general education (the USE, OGE, All-Russian test works and national researches of quality of education corresponds to professional development of teachers and more rational organization of this process.The aim of the article is to consider and discuss the relationship between professional development of teachers and external assessment of the quality of general education; the search of opportunities and terms of the results use of external evaluation procedures in teacher training.Methodology and research methods. The authors analyzed the publications (available on the Internet and in periodicals to determine the relevance of the problem and compare approaches to its solution by Russian and foreign researchers. The methods involve content analysis, problem-based and comparative analysis for the diagnosis of the current practices of teachers’ professional development. The purpose of the analysis is the inclusion of education quality assessment and evaluation results in the contents of programs of professional development of teachers.Results. The created request for the profitability analysis results of an external assessment of general education quality of professional development of pedagogical staff is observed. However, the analysis of modern practice of additional professional pedagogical education showed that the preparation to prevails; certification procedure results for improvement of pedagogical activity are rarely used. The main reasons for this situation are found out: lack of the target information products for system of professional

  7. Anatomy and history of an external quality assessment program for interpretative comments in clinical biochemistry.

    Science.gov (United States)

    Vasikaran, Samuel D

    2015-05-01

    The provision of clinical interpretation of results, either verbally or in the printed report, may be considered an integral part of clinical biochemistry diagnostic service. Proficiency testing or external quality assessment (EQA) of such activity may be useful in education, training, continuing professional development and ensuring the quality of such service. Details of the Patient Report Comments Program (RPCProgram) developed by the Royal College of Pathologists of Australasia (RCPA) Chemical Pathology Quality Assurance Programs Pty Ltd (QAP) is described in this review. The program is aimed at pathologists, clinical scientists and trainees. Registered participants are provided a report with case details and a set of clinical biochemistry results at monthly intervals and submit an interpretative comment for the report. Comments received are broken up into components that are translated into common key phrases. An expert panel evaluates the key phrases, classifies them according to appropriateness and drafts a suggested comment, a case summary and a rationale, which are included in a summary report returned to participants. There is considerable diversity in the quality of interpretative comments received from participants of the PRCProgram. The primary purpose of EQA of interpretative commenting is educational self-assessment, and they are recognized as a continuing professional development activity. Whilst there is some evidence for the utility of interpretative comments in improving patient outcomes, evidence for the utility of EQA in improving quality of comments is awaited. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  8. Lack of grading agreement among international hemostasis external quality assessment programs

    Science.gov (United States)

    Olson, John D.; Jennings, Ian; Meijer, Piet; Bon, Chantal; Bonar, Roslyn; Favaloro, Emmanuel J.; Higgins, Russell A.; Keeney, Michael; Mammen, Joy; Marlar, Richard A.; Meley, Roland; Nair, Sukesh C.; Nichols, William L.; Raby, Anne; Reverter, Joan C.; Srivastava, Alok; Walker, Isobel

    2018-01-01

    Laboratory quality programs rely on internal quality control and external quality assessment (EQA). EQA programs provide unknown specimens for the laboratory to test. The laboratory's result is compared with other (peer) laboratories performing the same test. EQA programs assign target values using a variety of methods statistical tools and performance assessment of ‘pass’ or ‘fail’ is made. EQA provider members of the international organization, external quality assurance in thrombosis and hemostasis, took part in a study to compare outcome of performance analysis using the same data set of laboratory results. Eleven EQA organizations using eight different analytical approaches participated. Data for a normal and prolonged activated partial thromboplastin time (aPTT) and a normal and reduced factor VIII (FVIII) from 218 laboratories were sent to the EQA providers who analyzed the data set using their method of evaluation for aPTT and FVIII, determining the performance for each laboratory record in the data set. Providers also summarized their statistical approach to assignment of target values and laboratory performance. Each laboratory record in the data set was graded pass/fail by all EQA providers for each of the four analytes. There was a lack of agreement of pass/fail grading among EQA programs. Discordance in the grading was 17.9 and 11% of normal and prolonged aPTT results, respectively, and 20.2 and 17.4% of normal and reduced FVIII results, respectively. All EQA programs in this study employed statistical methods compliant with the International Standardization Organization (ISO), ISO 13528, yet the evaluation of laboratory results for all four analytes showed remarkable grading discordance. PMID:29232255

  9. The experience of 3 years of external quality assessment of preimplantation genetic diagnosis for cystic fibrosis

    Science.gov (United States)

    Deans, Zandra; Fiorentino, Francesco; Biricik, Anil; Traeger-Synodinos, Joanne; Moutou, Céline; De Rycke, Martine; Renwick, Pamela; SenGupta, Sioban; Goossens, Veerle; Harton, Gary

    2013-01-01

    Preimplantation genetic diagnosis (PGD) was first performed over 20 years ago and has become an accepted part of genetic testing and assisted reproduction worldwide. The techniques and protocols necessary to carry out genetic testing at the single-cell level can be difficult to master and have been developed independently by the laboratories worldwide offering preimplantation testing. These factors indicated the need for an external quality assessment (EQA) scheme for monogenic disease PGD. Toward this end, the European Society for Human Reproduction and Embryology came together with United Kingdom National External Quality Assessment Services for Molecular Genetics, to create a pilot EQA scheme followed by practical EQA schemes for all interested parties. Here, we detail the development of the pilot scheme as well as development and findings from the practical (clinical) schemes that have followed. Results were generally acceptable and there was marked improvement in results and laboratory scores for those labs that participated in multiple schemes. Data from the first three schemes indicate that the EQA scheme is working as planned and has helped laboratories improve their techniques and result reporting. The EQA scheme for monogenic PGD will continue to be developed to offer assessment for other monogenic disorders. PMID:23150080

  10. The experience of 3 years of external quality assessment of preimplantation genetic diagnosis for cystic fibrosis.

    Science.gov (United States)

    Deans, Zandra; Fiorentino, Francesco; Biricik, Anil; Traeger-Synodinos, Joanne; Moutou, Céline; De Rycke, Martine; Renwick, Pamela; Sengupta, Sioban; Goossens, Veerle; Harton, Gary

    2013-08-01

    Preimplantation genetic diagnosis (PGD) was first performed over 20 years ago and has become an accepted part of genetic testing and assisted reproduction worldwide. The techniques and protocols necessary to carry out genetic testing at the single-cell level can be difficult to master and have been developed independently by the laboratories worldwide offering preimplantation testing. These factors indicated the need for an external quality assessment (EQA) scheme for monogenic disease PGD. Toward this end, the European Society for Human Reproduction and Embryology came together with United Kingdom National External Quality Assessment Services for Molecular Genetics, to create a pilot EQA scheme followed by practical EQA schemes for all interested parties. Here, we detail the development of the pilot scheme as well as development and findings from the practical (clinical) schemes that have followed. Results were generally acceptable and there was marked improvement in results and laboratory scores for those labs that participated in multiple schemes. Data from the first three schemes indicate that the EQA scheme is working as planned and has helped laboratories improve their techniques and result reporting. The EQA scheme for monogenic PGD will continue to be developed to offer assessment for other monogenic disorders.

  11. Computation of External Quality Factors for RF Structures by Means of Model Order Reduction and a Perturbation Approach

    CERN Document Server

    Flisgen, Thomas; van Rienen, Ursula

    2016-01-01

    External quality factors are significant quantities to describe losses via waveguide ports in radio frequency resonators. The current contribution presents a novel approach to determine external quality factors by means of a two-step procedure: First, a state-space model for the lossless radio frequency structure is generated and its model order is reduced. Subsequently, a perturbation method is applied on the reduced model so that external losses are accounted for. The advantage of this approach results from the fact that the challenges in dealing with lossy systems are shifted to the reduced order model. This significantly saves computational costs. The present paper provides a short overview on existing methods to compute external quality factors. Then, the novel approach is introduced and validated in terms of accuracy and computational time by means of commercial software.

  12. Chromosome microarray proficiency testing and analysis of quality metric data trends through an external quality assessment program for Australasian laboratories.

    Science.gov (United States)

    Wright, D C; Adayapalam, N; Bain, N; Bain, S M; Brown, A; Buzzacott, N; Carey, L; Cross, J; Dun, K; Joy, C; McCarthy, C; Moore, S; Murch, A R; O'Malley, F; Parker, E; Watt, J; Wilkin, H; Fagan, K; Pertile, M D; Peters, G B

    2016-10-01

    Chromosome microarrays are an essential tool for investigation of copy number changes in children with congenital anomalies and intellectual deficit. Attempts to standardise microarray testing have focused on establishing technical and clinical quality criteria, however external quality assessment programs are still needed. We report on a microarray proficiency testing program for Australasian laboratories. Quality metrics evaluated included analytical accuracy, result interpretation, report completeness, and laboratory performance data: sample numbers, success and abnormality rate and reporting times. Between 2009 and 2014 nine samples were dispatched with variable results for analytical accuracy (30-100%), correct interpretation (32-96%), and report completeness (30-92%). Laboratory performance data (2007-2014) showed an overall mean success rate of 99.2% and abnormality rate of 23.6%. Reporting times decreased from >90 days to 102 days to quality metrics, however only 'report completeness' and reporting times reached statistical significance. Whether the overall improvement in laboratory performance was due to participation in this program, or from accumulated laboratory experience over time, is not clear. Either way, the outcome is likely to assist referring clinicians and improve patient care. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  13. A new way to analyze resuscitation quality by reviewing automatic external defibrillator data.

    Science.gov (United States)

    Lin, Lian-Yu; Lo, Men-Tzung; Chiang, Wen-Chu; Lin, Chen; Ko, Patrick Chow-In; Hsiung, Kuang-Hua; Lin, Jiunn-Lee; Chen, Wen-Jone; Ma, Matthew Huei-Ming

    2012-02-01

    High quality cardiopulmonary resuscitation (CPR) plays an important role in survival of out-of-hospital cardiac arrests (OHCAs). We have developed an algorithm to automatically identify the quality of chest compressions from data retrieved from automatic external defibrillators (AEDs). Electrocardiographic (ECG) signals retrieved from AEDs were analyzed by a newly developed algorithm to identify fluctuations in CPR. The algorithm contained three steps. First, it decomposed the AED signals into several intrinsic mode fluctuations (IMFs) by empirical mode decomposition (EMD). Second, it identified the dominant IMFs that carried the chest compression signals and weighted the IMFs to both enhance the chest compression oscillations and filter the noise. Third, it calculated the autocorrelation function (ACF) of the reconstructed signals and tested their periodicity. Using this algorithm, several CPR quality indicators were automatically calculated minute-by-minute and compared with those derived by audio and visual review of AED data by experienced physicians. A total of 77 (29 women, 48 men) OHCA patients were enrolled, and 351 one-min segments were analyzed. The results showed that the CPR quality parameters calculated from the algorithm were highly correlated with those from the manual review (all Pautomatically determined by analyzing the ECG signals from AEDs using EMD and autocorrelograms. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. INTERNAL AND EXTERNAL QUALITY OF COMMERCIAL LAYING HENS EGGS WITH NORMAL AND VITREOUS EGGSHELL

    Directory of Open Access Journals (Sweden)

    Daniela Reis Vilela

    2016-10-01

    Full Text Available The objective of this study was to evaluate the internal and external quality of eggs classified as eggs with normal eggshell and eggs with vitreous eggshell, produced by hens at three different ages. Forty-five eggs of each eggshell type, normal and vitreous, were sampled at the ages of 30, 50, and 70 weeks. The weight of the egg, in both types of eggshell, increased with the advancing age of the hen. Higher concentration of calcium was found in eggs with normal eggshells comparing to eggs with vitreous eggshells. The eggshell type did not affect phosphorus percentage. The mineral deposition of the eggshell was constant. The skin thickness increased irrespective of the shell along the reproductive life of the chicken and decreased when the bird became older. The percentage of albumen increased, while the percentage of albumen protein and pH decreased throughout the ages. Percentage of egg yolk, humidity, and pH decreased with increase of age of the laying hen, whereas crude protein and lipid increased. Eggs with vitreous eggshell showed eggshell with lower quality compared to those with normal eggshell, without, however, compromising the internal quality of albumen and yolk. Keywords: egg quality; eggshell types; physical analysis.

  15. External quality assurance performance of clinical research laboratories in sub-saharan Africa.

    Science.gov (United States)

    Amukele, Timothy K; Michael, Kurt; Hanes, Mary; Miller, Robert E; Jackson, J Brooks

    2012-11-01

    Patient Safety Monitoring in International Laboratories (JHU-SMILE) is a resource at Johns Hopkins University that supports and monitors laboratories in National Institutes of Health-funded international clinical trials. To determine the impact of the JHU-SMILE quality assurance scheme in sub-Saharan African laboratories, we reviewed 40 to 60 months of external quality assurance (EQA) results of the College of American Pathologists (CAP) in these laboratories. We reviewed the performance of 8 analytes: albumin, alanine aminotransferase, creatinine, sodium, WBC, hemoglobin, hematocrit, and the human immunodeficiency virus antibody rapid test. Over the 40- to 60-month observation period, the sub-Saharan laboratories had a 1.63% failure rate, which was 40% lower than the 2011 CAP-wide rate of 2.8%. Seventy-six percent of the observed EQA failures occurred in 4 of the 21 laboratories. These results demonstrate that a system of remote monitoring, feedback, and audits can support quality in low-resource settings, even in places without strong regulatory support for laboratory quality.

  16. Perceived external prestige as a mediator between quality of work life and organisational commitment of public sector employees in Ghana

    Directory of Open Access Journals (Sweden)

    Oluyinka Ojedokun

    2015-02-01

    Full Text Available Orientation: Research efforts have been directed at understanding the relationship between quality of work life and organisational commitment, but these studies have not elucidated the mediating role of perceived external prestige in this relationship.Research purpose: This research seeks to close a research gap by determining the role of perceived external prestige in the relationship between quality of work life and organisational commitment amongst public sector employees in Ghana.Research approach, design and method: Theoretically guided hypotheses and models were formulated and tested with hierarchical multiple regression statistics using data from a sample of 137 employees from two public sector organisations in Ghana.Main findings: The results support the hypothesis that quality of work life is positively related to both perceived external prestige and organisational commitment. Also, perceived external prestige was found to predict organisational commitment and partially mediate the relationship between quality of work life and organisational commitment.Practical/managerial implications: The findings imply that one sure way to enhance organisational commitment of employees is by improving their quality of work life and boosting their perceptions of external prestige of the organisation. These results will be of particular interest to policymakers, public organisations and stakeholders interested in increasing organisational commitment of their employees.Contribution/value-add: The findings extend previous research by establishing the mediating role of perceived external prestige in the relationship between quality of work life and organisational commitment. If managers of organisations wish to improve organisational commitment, it is wise to institutionalise an organisational culture that promotes good quality of work life and boost the external prestige of the organisation in the employees’ mind.

  17. Determinants of Quality Perception in Educational Administration: Potential Conflict between the Requirements of Internal and External Customers.

    Science.gov (United States)

    Galloway, R. L.; Wearn, Katrina

    1998-01-01

    Attempts to measure perceived quality, based on customers' views within the context of a (British) university faculty office, using a modified SERVQUAL instrument. Internal customers demonstrated that perceived quality is driven by task-focused issues, stressing clarity, accuracy, and reliability. External customers, whose usage is more casual,…

  18. [Quality analysis by external users of the non-medical health transport unit of Alicante].

    Science.gov (United States)

    Soriano Clemor, C; Cano, F Soriano; Gimeno, F Morant

    2011-01-01

    Non-medical health transport has great health, media and social repercussions and requires a very considerable amount of human and economic resources. To describe the quality, evaluated by external users of our Health Department, in order to know what are the most important elements for external users. Cross-sectional, descriptive observational study. Population to study: patients with a social security health card who come to the Hospital of Alicante and are non-medical health transport unit users. Waiting time to be delivered to hospital in 92.7% of the cases was less than an hour, and was between one and two hours for 7.2%. The most frequent destinations were rehabilitation service and outpatient clinics. When users were asked if the would recommend this service, 60.9% said "for sure" and 39.1% said "probably yes". This study allows us to know patient needs and expectations, as well as the factors they value the most and which of our work areas to improve. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

  19. External quality assessment schemes raise standards: evidence from the UKNEQAS parasitology subschemes

    Science.gov (United States)

    Kettelhut, M M; Chiodini, P L; Edwards, H; Moody, A

    2003-01-01

    Background: The burden of parasitic disease imported into the temperate zone is increasing, and in the tropics remains very high. Thus, high quality diagnostic parasitology services are needed, but to implement clinical governance a measure of quality of service is required. Aim: To examine performance in the United Kingdom National External Quality Assessment Scheme for Parasitology for evidence of improved standards in parasite diagnosis in clinical specimens. Methods: Analysis of performance was made for the period 1986 to 2001, to look for trends in performance scores. Results: An overall rise in performance in faecal and blood parasitology schemes was found from 1986 to 2001. This was seen particularly in the identification of ova, cysts, and larvae in the faecal scheme, the detection of Plasmodium ovale and Plasmodium vivax in the blood scheme, and also in the correct identification of non-malarial blood parasites. Despite this improvement, there are still problems. In the faecal scheme, participants still experience difficulty in recognising small protozoan cysts, differentiating vegetable matter from cysts, and detecting ova and cysts when more than one species is present. In the blood scheme, participants have problems in identifying mixed malarial infections, distinguishing between P ovale and P vivax, and estimating the percentage parasitaemia. The reasons underlying these problems have been identified via the educational part of the scheme, and have been dealt with by distributing teaching sheets and undertaking practical sessions. Conclusions: UK NEQAS for Parasitology has helped to raise the standard of diagnostic parasitology in the UK. PMID:14645352

  20. External Quality Assessment Scheme for reference laboratories - review of 8 years' experience.

    Science.gov (United States)

    Kessler, Anja; Siekmann, Lothar; Weykamp, Cas; Geilenkeuser, Wolf Jochen; Dreazen, Orna; Middle, Jonathan; Schumann, Gerhard

    2013-05-01

    We describe an External Quality Assessment Scheme (EQAS) intended for reference (calibration) laboratories in laboratory medicine and supervised by the Scientific Division of the International Federation of Clinical Chemistry and Laboratory Medicine and the responsible Committee on Traceability in Laboratory Medicine. The official EQAS website, RELA (www.dgkl-rfb.de:81), is open to interested parties. Information on all requirements for participation and results of surveys are published annually. As an additional feature, the identity of every participant in relation to the respective results is disclosed. The results of various groups of measurands (metabolites and substrates, enzymes, electrolytes, glycated hemoglobins, proteins, hormones, thyroid hormones, therapeutic drugs) are discussed in detail. The RELA system supports reference measurement laboratories preparing for accreditation according to ISO 17025 and ISO 15195. Participation in a scheme such as RELA is one of the requirements for listing of the services of a calibration laboratory by the Joint Committee on Traceability in Laboratory Medicine.

  1. External quality assurance system (EQAS) for identification of mastitis pathogens in Denmark from 2006 to 2011

    DEFF Research Database (Denmark)

    Karlsmose, Susanne; Kunstmann, L.; Rundsten, Carsten Friis

    2013-01-01

    the capacity to isolate and identify mastitis pathogens at veterinary clinics, an external quality assurance system (EQAS) was annually (from 2006 to 2011) provided for the identification of mastitis pathogens. This study presents the setup of the proficiency test and the obtained results that enabled...... the organizers to pinpoint areas for improvement and thereby to assist veterinary practices at strengthening their mastitis diagnostics.The proficiency test consisted of 15 milk samples spiked with a pure culture of a mastitis pathogen and distributed to veterinary practices for identification. Applying...... pathogens, the results from this study indicate that the practices’ application of basic biochemical analyses in this context could be optimized. In addition, dissemination of information on new methods and updated nomenclature appeared to be an area which future efforts with advantage could aim at....

  2. External and internal environment of higher school: influence on the quality of education

    Directory of Open Access Journals (Sweden)

    Beketova Olga

    2016-01-01

    Full Text Available Education, especially higher education, no doubt, is one of the most important values in the modern world. To imagine the prospects of the nearest and medium-term development of the country, its share in the intellectual world `coin box`, you need to appreciate the state of functioning within it higher education system properly, to assess the impact of external and internal environment on its quality. The existent global changes make it necessary to construct a new model of the learning process, the creation of a qualitatively new education management system, the formation of a new university model that exists in an open information society. Reforming of higher school - is a priority in terms of national interests of Russia, without which it is impossible to create a competitive innovative economy based on knowledge in our country.

  3. The quality and testing PH-SFT infrastructure for the external LHC software packages deployment

    CERN Multimedia

    CERN. Geneva; MENDEZ LORENZO, Patricia; MATO VILA, Pere

    2015-01-01

    The PH-SFT group is responsible for the build, test, and deployment of the set of external software packages used by the LHC experiments. This set includes ca. 170 packages including Grid packages and Montecarlo generators provided for different versions. A complete build structure has been established to guarantee the quality of the packages provided by the group. This structure includes an experimental build and three daily nightly builds, each of them dedicated to a specific ROOT version including v6.02, v6.04, and the master. While the former build is dedicated to the test of new packages, versions and dependencies (basically SFT internal used), the three latter ones are the responsible for the deployment to AFS of the set of stable and well tested packages requested by the LHC experiments so they can apply their own builds on top. In all cases, a c...

  4. [Simultaneous Detection of External and Internal Quality Parameters of Huping Jujube Fruits using Hyperspectral Imaging Technology].

    Science.gov (United States)

    Xue, Jian-xin; Zhang, Shu-juan; Zhang, Jing-jing

    2015-08-01

    Nondestructive detection of external and internal quality parameters of jujube is crucial for improving jujube's shelf life and industry production. Hyperspectral imaging is an emerging technique that integrates conventional imaging and spectroscopy to acquire both spatial and spectral information from a sample. It takes the advantages of the conventional RGB, near-infrared spectroscopy, and multi-spectral imaging. In this work, hyperspectral imaging technology covered the range of 450~1000 nm has been evaluated for nondestructive determination of "natural defects" (shrink, crack, insect damage and peck injury) and soluble solids content (SSC) in Huping jujube fruit. 400 RGB images were acquired through four different defect (50 for each stage) and normal (200) classes of the Huping jujube samples. After acquiring hyperspectral images of Huping jujube fruits, the spectral data were extracted from region of interests (ROIs). Using Kennard-Stone algorithm, all kinds of samples were randomly divided into training set (280) and test set (120) according to the proportion of 3:1. Seven principal components (PCs) were selected based on principal component analysis (PCA), and seven textural feature variables (contrast, correlation, energy, homogeneity, variance, mean and entropy) were extracted by gray level co-occurrence matrix (GLCM). The least squares support vector machine (LS-SVM) models were built based on the PCs spectral, textural, combined PCs and textural features, respectively. The satisfactory results show the correct discrimination rate of 92.5% for the prediction samples, as well as correlation coefficient (Rp) of 0.944 for the prediction set to calculate SSC content based on PCs and textural features. The study demonstrated that hyperspectral image technique can be a reliable tool to simultaneous detection of external ("natural defects") and internal (SSC) quality parameters of Huping jujube fruits, which provided a theoretical reference for nondestructive

  5. Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

    Science.gov (United States)

    Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

    2015-01-01

    Objectives Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. Methods An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. Results How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. Conclusions The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. PMID:26683885

  6. Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries.

    Science.gov (United States)

    Burnett, Susan; Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

    2016-04-01

    Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. The development of hospital leaders' skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. © The Author(s) 2015.

  7. Variation in adherence to external beam radiotherapy quality measures among elderly men with localized prostate cancer.

    Science.gov (United States)

    Bekelman, Justin E; Zelefsky, Michael J; Jang, Thomas L; Basch, Ethan M; Schrag, Deborah

    2007-12-01

    To characterize the variation in adherence to quality measures of external beam radiotherapy (EBRT) for localized prostate cancer and its relation to patient and provider characteristics in a population-based, representative sample of U.S. men. We evaluated EBRT quality measures proposed by a RAND expert panel of physicians among men aged >or=65 years diagnosed between 2000 and 2002 with localized prostate cancer and treated with primary EBRT using data from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare program. We assessed the adherence to five EBRT quality measures that were amenable to analysis using SEER-Medicare data: (1) use of conformal RT planning; (2) use of high-energy (>10-MV) photons; (3) use of custom immobilization; (4) completion of two follow-up visits with a radiation oncologist in the year after therapy; and (5) radiation oncologist board certification. Of the 11,674 patients, 85% had received conformal RT planning, 75% had received high-energy photons, and 97% had received custom immobilization. One-third of patients had completed two follow-up visits with a radiation oncologist, although 91% had at least one visit with a urologist or radiation oncologist. Most patients (85%) had been treated by a board-certified radiation oncologist. The overall high adherence to EBRT quality measures masked substantial variation in geography, socioeconomic status in the area of residence, and teaching affiliation of the RT facility. Future research should examine the reasons for the variations in these measures and whether the variation is associated with important clinical outcomes.

  8. The use of latex beads in external quality assurance and internal quality control for routine semen analysis.

    Science.gov (United States)

    Zuvela, Emily; Junk, Stephen; Moska, Natalie; Matson, Phillip

    2011-11-01

    The usefulness of latex beads of defined concentration was assessed as a substitute for sperm in the performance of External Quality Assurance (EQA) and Internal Quality Control (IQC) of semen analysis. Within the EQA programme, mean±SEM bias (%) was significantly reduced in 2007 compared to 2002 for both specialist (6.0%±5.4% vs. 55.0%±5.9%) and non-specialist (18.4%±5.9% vs. 90.9%±13.4%) laboratories (both p<0.0001), indicating improved accuracy over time. Within the IQC programme, the beads were used in the appraisal of two scientists, one experienced and one inexperienced, against a known standard. Beads were also used to calibrate eleven counting chambers, resulting in one old chamber being discarded due to its poor performance. The present study has shown that the use of a defined concentration of beads is an excellent adjunct to IQC and EQA programmes enabling the performance of both people and equipment to be assessed in an objective manner.

  9. Representation of External Qualities of the Person in the Russian And French Animalistic Phraseological Units

    Directory of Open Access Journals (Sweden)

    Vyacheslav Olegovich Puchkov

    2015-11-01

    Full Text Available Russian and French phraseological units with an animal name are considered with a special focus on their anthropomorphous semantics (external qualities of the person. The relevance of this research is caused by the urgent need of comparative studies of ethnocultural maps of the world that are encoded in phraseological corpus of any ethnos. Universal and ethno-specific features of animalistic phraseology are revealed in the article. The author states that the main function of animalistic phraseological units is not only pointing to some physical qualities of a person but assessing them. In the French map of the world the aesthetic criterion (beauty / ugliness dominates, whereas in the Russian map it is a physiological and social criteria (mainly, health and wellbeing. Superiority of the esthetic criterion in French is hidden in the mentality and is called the hedonism; opposing to it is Russian animalistic phraseology which is said to be originated from country folk traditions and is focused on physiological and social details in assessing the man's appearance. It is stated in the article that the lack of attention to esthetic criterion in the Russian phraseology may be explained by the influence of Orthodoxy on the content of the world map, the corporal beauty is opposed to internal, spiritual beauty. Contrary to it, under the influence of Catholicism an esthetic attitude to church rituals and corporal beauty was forwarded in the French culture. Finally, the author offers anthropological mechanism and an assessment function to be universal features of phraseology.

  10. How to conduct External Quality Assessment Schemes for the pre-analytical phase?

    Science.gov (United States)

    Kristensen, Gunn B.B.; Aakre, Kristin Moberg; Kristoffersen, Ann Helen; Sandberg, Sverre

    2014-01-01

    In laboratory medicine, several studies have described the most frequent errors in the different phases of the total testing process, and a large proportion of these errors occur in the pre-analytical phase. Schemes for registration of errors and subsequent feedback to the participants have been conducted for decades concerning the analytical phase by External Quality Assessment (EQA) organizations operating in most countries. The aim of the paper is to present an overview of different types of EQA schemes for the pre-analytical phase, and give examples of some existing schemes. So far, very few EQA organizations have focused on the pre-analytical phase, and most EQA organizations do not offer pre-analytical EQA schemes (EQAS). It is more difficult to perform and standardize pre-analytical EQAS and also, accreditation bodies do not ask the laboratories for results from such schemes. However, some ongoing EQA programs for the pre-analytical phase do exist, and some examples are given in this paper. The methods used can be divided into three different types; collecting information about pre-analytical laboratory procedures, circulating real samples to collect information about interferences that might affect the measurement procedure, or register actual laboratory errors and relate these to quality indicators. These three types have different focus and different challenges regarding implementation, and a combination of the three is probably necessary to be able to detect and monitor the wide range of errors occurring in the pre-analytical phase. PMID:24627720

  11. External Quality Assessment of Molecular Detection of Ebola Virus in China

    Science.gov (United States)

    Wang, Guojing; Sun, Yu; Zhang, Kuo; Jia, Tingting; Hao, Mingju; Zhang, Dong; Chang, Le; Zhang, Lei; Zhang, Rui; Lin, Guigao; Peng, Rongxue; Li, Jinming

    2015-01-01

    In 2014, Ebola hemorrhagic fever broke out in West Africa. As contact between China and West Africa is frequent, the possibility that Ebola virus would enter China was high. Thus, an external assessment of the quality of Ebola virus detection was organized by the National Center for Clinical Laboratories in China. Virus-like particles encapsulating known sequences of epidemic strains of Ebola virus from 2014 were prepared as positive quality controls. The sample panel, which was composed of seven positive and three negative samples, was dispatched to 19 laboratories participating in this assessment of Ebola virus detection. Accurate detection was reported at 14 of the 19 participating laboratories, with a sensitivity of 91.43% and a specificity of 100%. Four participants (21.05%) reported false-negative results and were classified as “acceptable.” One participant (5.26%) did not detect any positive samples and was thus classified as “improvable.” Based on the results returned, the ability to detect weakly positive Ebola specimens should be improved. Furthermore, commercial assays and the standard primers offered by the Chinese Centers for Disease Control and Prevention were found to be most accurate and dependable for Ebola detection. A two-target detection approach is recommended for Ebola screening; this approach could reduce the probability of false-negative results. Additionally, standardization of operations and punctual adjustment of instruments are necessary for the control and prevention of Ebola virus. PMID:26177537

  12. Results of the National External Quality Assessment for Toxoplasmosis Serological Testing in China

    Science.gov (United States)

    Zhang, Kuo; Wang, Lunan; Lin, Guigao; Sun, Yu; Zhang, Rui; Xie, Jiehong; Li, Jinming

    2015-01-01

    Background Toxoplasmosis is typically diagnosed by serologic testing. External quality assessment (EQA) of clinical laboratories could ensure the accuracy and reliability of serological tests. We assessed the quality of toxoplasma serological assays in Chinese clinical laboratories by an EQA performed between 2004 and 2013 by the National Center for Clinical Laboratories. Methodology and Findings EQA panels were prepared and shipped at room temperature to participating laboratories that employed toxoplasma IgG and IgM serological detection. By 2013, 5,384 EQA test reports for toxoplasma-specific IgM and 2,666 reports for toxoplasma-specific IgG were collected. Enzyme-linked immunosorbent (ELISA) and chemical immunofluorescent assays were the most commonly used detection methods. The overall coincidence rates of negative samples were better than those of positive samples. The overall EQA score for toxoplasma-specific IgM detection ranged between 84.3% and 99.6%. The ratio of laboratories that achieved correct IgG detection ranged from 61.1% to 99.3%. However, the inter- and intra-assay variabilities were found to be considerable. The most common problem was failure to detect low titers of antibody. Conclusion The EQA scheme showed an improvement in toxoplasma serological testing in China. However, further optimization of assay sensitivity to detect challenging samples remains a future challenge. PMID:26066047

  13. Quality of basic life support education and automated external defibrillator setting in schools in Ishikawa, Japan.

    Science.gov (United States)

    Takamura, Akiteru; Ito, Sayori; Maruyama, Kaori; Ryo, Yusuke; Saito, Manami; Fujimura, Shuhei; Ishiura, Yuna; Hori, Ariyuki

    2017-03-01

    Automated external defibrillators (AED) have been installed in schools in Japan since 2004, and the government strongly recommends teaching basic life support (BLS). We therefore examined the quality of BLS education and AED installation in schools. We conducted a prefecture-wide questionnaire survey of all primary and junior high schools in 2016, to assess BLS education and AED installation against the recommendations of the Japan Circulation Society. The results were analyzed using descriptive statistics and chi-squared test. In total, 195 schools out of 315 (62%) responded, of which 38% have introduced BLS education for children. BLS training was held in a smaller proportion of primary schools (18%) than junior high schools (86%). More than 90% of primary school staff had undergone BLS training in the previous 2 years. The most common locations of AED were the gymnasium (32%) followed by entrance hall (28%), staffroom (25%), and infirmary (12%). The reasons given for location were that it was obvious (34%), convenient for staff (32%), could be used out of hours (17%), and the most likely location for a heart attack (15%). Approximately 18% of schools reported that it takes >5 min to reach the AED from the furthest point. BLS training, AED location, and understanding of both are not sufficient to save children's lives efficiently. Authorities should make recommendations about the correct number of AED, and their location, and provide more information to improve the quality of BLS training in schools. © 2016 Japan Pediatric Society.

  14. French external quality assessment schemes for lead in blood and aluminum in plasma and dialysis water.

    Science.gov (United States)

    Guillard, O; Piriou, A; Pineau, A

    1996-01-01

    An external quality assessment scheme (EQAS) for lead in blood was established in France in 1992 at the request of the Ministry of Labour and organised by the Drug Bureau. Participation is mandatory for laboratories wishing to obtain ministerial approval for the determination of blood lead levels. In 1994, two interlaboratory comparative exercises were carried out, each involving the analysis of 3 samples of human blood (2 with and 1 without lead supplementation). Out of 66 enrolled laboratories, 58 and 60 participated in the two exercises, respectively. The scattering of results was quite comparable to that observed in other EQAS. The EQAS for plasma aluminium was established in 1983 at the request of the Commission on Trace Elements of the Société Française de Biologie Clinique. Today, 80 laboratories in 22 countries on 4 continents participate in this scheme. Six exercises are carried out each year, each including 3 plasma samples (2 with and 1 without aluminium supplementation), 2 samples of water supplemented with aluminium and a blank (water). The results obtained in this scheme showed an improvement in the quality of the analyses.

  15. External quality assessment of malaria microscopy in the Democratic Republic of the Congo

    Directory of Open Access Journals (Sweden)

    Lokombe Jean

    2011-10-01

    Full Text Available Abstract Background External quality assessments (EQA are an alternative to cross-checking of blood slides in the quality control of malaria microscopy. This study reports the findings of an EQA of malaria microscopy in the Democratic Republic of the Congo (DRC. Methods After validation, an EQA slide panel and a questionnaire were delivered to diagnostic laboratories in four provinces of DRC. The panel included three samples for diagnosis (sample 1: Plasmodium falciparum, 177,000/μl, sample 2: P. falciparum, 2,500/μl, sample 3: no parasites seen, one didactic sample (Howell-Jolly bodies and one sample for assessing the quality of staining. Participating laboratories were addressed and selected through the network of the National Tuberculosis Control Programme. Participants were asked to return the responses together with a stained thin and thick blood film for evaluation of Giemsa stain quality. Results Among 174 participants (response rate 95.1%, 26.2% scored samples 1, 2 and 3 correctly and 34.3%, 21.5% and 5.8% of participants reported major errors in one, two or three samples respectively. Major errors included reporting "no malaria" or "non-falciparum malaria" for Plasmodium falciparum-positive samples 1 and 2 (16.1% and 34.9% of participants respectively and "P. falciparum" for Plasmodium negative sample 3 (24.0%. Howell-Jolly bodies (didactic sample were not recognized by any of the participants but reported as "P. falciparum" by 16.7% of participants. With parasite density expressed according to the "plus system", 16.1% and 21.5% of participants scored one "+" different from the reference score for samples 1 and 2 respectively and 9.7% and 2.9% participants scored more than two "+" different. When expressed as counts of asexual parasites/μl, more than two-thirds of results were outside the mean ± 2SD reference values. The quality of the Giemsa stain was poor, with less than 20% slides complying with all criteria assessed. Only one

  16. External quality assessment of malaria microscopy in the Democratic Republic of the Congo.

    Science.gov (United States)

    Mukadi, Pierre; Gillet, Philippe; Lukuka, Albert; Atua, Ben; Kahodi, Simelo; Lokombe, Jean; Muyembe, Jean-Jacques; Jacobs, Jan

    2011-10-18

    External quality assessments (EQA) are an alternative to cross-checking of blood slides in the quality control of malaria microscopy. This study reports the findings of an EQA of malaria microscopy in the Democratic Republic of the Congo (DRC). After validation, an EQA slide panel and a questionnaire were delivered to diagnostic laboratories in four provinces of DRC. The panel included three samples for diagnosis (sample 1: Plasmodium falciparum, 177,000/μl, sample 2: P. falciparum, 2,500/μl, sample 3: no parasites seen), one didactic sample (Howell-Jolly bodies) and one sample for assessing the quality of staining. Participating laboratories were addressed and selected through the network of the National Tuberculosis Control Programme. Participants were asked to return the responses together with a stained thin and thick blood film for evaluation of Giemsa stain quality. Among 174 participants (response rate 95.1%), 26.2% scored samples 1, 2 and 3 correctly and 34.3%, 21.5% and 5.8% of participants reported major errors in one, two or three samples respectively. Major errors included reporting "no malaria" or "non-falciparum malaria" for Plasmodium falciparum-positive samples 1 and 2 (16.1% and 34.9% of participants respectively) and "P. falciparum" for Plasmodium negative sample 3 (24.0%). Howell-Jolly bodies (didactic sample) were not recognized by any of the participants but reported as "P. falciparum" by 16.7% of participants. With parasite density expressed according to the "plus system", 16.1% and 21.5% of participants scored one "+" different from the reference score for samples 1 and 2 respectively and 9.7% and 2.9% participants scored more than two "+" different. When expressed as counts of asexual parasites/μl, more than two-thirds of results were outside the mean ± 2SD reference values. The quality of the Giemsa stain was poor, with less than 20% slides complying with all criteria assessed. Only one quarter of participants purchase Giemsa stain from

  17. The development and validation of dried blood spots for external quality assurance of syphilis serology

    Directory of Open Access Journals (Sweden)

    Smit Pieter W

    2013-02-01

    Full Text Available Abstract Background Syphilis causes up to 1,500,000 congenital syphilis cases annually. These could be prevented if all pregnant women were screened, and those with syphilis treated with a single dose of penicillin before 28 weeks gestation. In recent years, rapid point-of-care tests have allowed greater access to syphilis screening, especially in rural or remote areas, but the lack of quality assurance of rapid testing has been a concern. We determined the feasibility of using dried blood spots (DBS as specimens for quality assurance of syphilis serological assays. Methods We developed DBS extraction protocols for use with Treponema pallidum particle agglutination assay (TPPA, Treponema pallidum haemagglutination assay (TPHA and an enzyme immunoassay (EIA and compared the results with those using matching plasma samples from the same patient. Results Since DBS samples showed poor performance with TPHA and EIA (TPHA sensitivity was 50.5% (95% confidence interval: 39.9–61.2% and EIA specificity was 50.4% (95% CI: 43.7–57.1%, only the DBS TPPA was used in the final evaluation. DBS TPPA showed an sensitivity of 95.5% (95% CI: 91.3–98.0% and a specificity of 99.0% (95% CI: 98.1–99.5% compared to TPPA using plasma samples as a reference. Conclusion DBS samples can be recommended for use with TPPA, and may be of value for external quality assurance of point-of-care syphilis testing.

  18. Comparability of antimicrobial susceptibility test results from 22 European countries and Israel : an external quality assurance exercise of the European Antimicrobial Resistance Surveillance System (EARSS) in collaboration with the United Kingdom National External Quality Assurance Scheme (UK NEQAS)

    NARCIS (Netherlands)

    Bronzwaer, S; Buchholz, U; Courvalin, P; Snell, J; Cornaglia, G; de Neeling, A; Aubry-Damon, H; Degener, J

    2002-01-01

    The goal of this exercise was to organize external quality assurance (QA) of antibiotic susceptibility testing for laboratories participating in EARSS and to assess the comparability of susceptibility test results across countries, and guidelines. In September 2000, UK NEQAS distributed a set of

  19. [External quality survey results of newborn deafness gene mutations in China].

    Science.gov (United States)

    Wang, Wei; Zhong, Kun; He, Falin; Zhang, Yan; Zhao, Yan; Wang, Zhiguo

    2015-01-27

    To evaluate the external quality survey results of newborn hereditary deafness gene mutations to improve and enhance the testing quality of hereditary deafness gene mutations. Each of 30 voluntarily participating laboratories testing newborn hereditary deafness gene mutations received 15 lots of quality control blood spots in this survey at May 2013, including mitochondria DNA 12SrRNA 1555A>G (201311-201315), SLC26A4 IVS7-2A>G (201321-201325) and GJB2 235delC (201331-201335). The testing results, methods, equipments and reagent information were submitted for analyses of Clinet EQA, Microsoft Excel 2007 and SPSS 13.0. The rates of correction (number of correct results/total number of submitted results) were used for evaluating the performance of laboratories. Among them, 24 laboratories submitted the testing results of mitochondria DNA 12SrRNA 1555A>G and the rate of submission was 80.0% (24/30). The rates of correction for each lot were 95.8% (23/24), 95.8% (23/24), 100% (24/24), 95.8% (23/24) and 95.8% (23/24) respectively and the overall rate was 96.7% (116/120). And 23 laboratories submitted the other two kinds of genetic test results, the rate of submission was 76.7% (23/30); the rates of correction for each lot of SLC26A4 IVS7-2A>G genetic test were 95.7% (22/23), 95.7% (22/23), 100% (23/23), 95.7% (22/23) and 95.7% (22/23) respectively and the overall rate was 96.5% (111/115); the genetic test results of GJB2 235delC were all correct (23/23). In this survey, 2/3 laboratories employed fluorescent polymerase chain reaction (PCR) and the remainder microarray chips. The survey of newborn deafness gene mutation testing results is generally satisfactory. Only mitochondria DNA 12SrRNA and SLC26A4 have some errors. The laboratories of gene testing should improve their quality control system, correct mistakes during the test period without any delay and boost the rate of correction for newborn hereditary deafness gene testing.

  20. 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.

  1. External quality assessment of medical laboratories in Croatia: preliminary evaluation of post-analytical laboratory testing.

    Science.gov (United States)

    Krleza, Jasna Lenicek; Dorotic, Adrijana; Grzunov, Ana

    2017-02-15

    Proper standardization of laboratory testing requires assessment of performance after the tests are performed, known as the post-analytical phase. A nationwide external quality assessment (EQA) scheme implemented in Croatia in 2014 includes a questionnaire on post-analytical practices, and the present study examined laboratory responses in order to identify current post-analytical phase practices and identify areas for improvement. In four EQA exercises between September 2014 and December 2015, 145-174 medical laboratories across Croatia were surveyed using the Module 11 questionnaire on the post-analytical phase of testing. Based on their responses, the laboratories were evaluated on four quality indicators: turnaround time (TAT), critical values, interpretative comments and procedures in the event of abnormal results. Results were presented as absolute numbers and percentages. Just over half of laboratories (56.3%) monitored TAT. Laboratories varied substantially in how they dealt with critical values. Most laboratories (65-97%) issued interpretative comments with test results. One third of medical laboratories (30.6-33.3%) issued abnormal test results without confirming them in additional testing. Our results suggest that the nationwide post-analytical EQA scheme launched in 2014 in Croatia has yet to be implemented to the full. To close the gaps between existing recommendations and laboratory practice, laboratory professionals should focus on ensuring that TAT is monitored and lists of critical values are established within laboratories. Professional bodies/institutions should focus on clarify and harmonized rules to standardized practices and applied for adding interpretative comments to laboratory test results and for dealing with abnormal test results.

  2. Customer satisfaction survey to improve the European cystic fibrosis external quality assessment scheme.

    Science.gov (United States)

    Berwouts, Sarah; Dequeker, Elisabeth

    2011-08-01

    The Cystic Fibrosis European Network, coordinated from within the Katholieke Universiteit Leuven, is the provider of the European cystic fibrosis external quality assessment (EQA) scheme. The network aimed to seek feedback from laboratories that participated in the cystic fibrosis scheme in order to improve services offered. In this study we analysed responses to an on-line customer satisfaction survey conducted between September and November 2009. The survey was sent to 213 laboratories that participated in the cystic fibrosis EQA scheme of 2008; 69 laboratories (32%) responded. Scores for importance and satisfaction were obtained from a five-point Likert scale for 24 attributes. A score of one corresponded to very dissatisfied/very unimportant and five corresponded to very satisfied/very important. Means were calculated and placed in a two-dimensional grid (importance-satisfaction analysis). Means were subtracted from each other to obtain gap values (gap-analysis). No attribute had a mean score below 3.63. The overall mean of satisfaction was 4.35. Opportunities for improvement enclosed clarity, usefulness and completeness of the general report and individual comments, and user-friendliness of the electronic datasheet. This type of customer satisfaction survey was a valuable instrument to identify opportunities to improve the cystic fibrosis EQA scheme. It should be conducted on a regular basis to reveal new opportunities in the future and to assess effectiveness of actions taken. Moreover, it could be a model for other EQA providers seeking feedback from participants. Overall, the customer satisfaction survey provided a powerful quality of care improvement tool.

  3. Harmonisation of serum dihydrotestosterone analysis: establishment of an external quality assurance program.

    Science.gov (United States)

    Greaves, Ronda F; Jolly, Lisa; Hartmann, Michaela F; Ho, Chung Shun; Kam, Richard K T; Joseph, John; Boyder, Conchita; Wudy, Stefan A

    2017-03-01

    Serum dihydrotestosterone (DHT) is an important analyte for the clinical assessment of disorders of sex development. It is also reportedly a difficult analyte to measure. Currently, there are significant gaps in the standardisation of this analyte, including no external quality assurance (EQA) program available worldwide to allow for peer review performance of DHT. We therefore proposed to establish a pilot EQA program for serum DHT. DHT was assessed in the 2015 Royal College of Pathologists of Australasia Quality Assurance Programs' Endocrine program material. The material's target (i.e. "true") values were established using a measurement procedure based on isotope dilution gas chromatography (GC) tandem mass spectrometry (MS/MS). DHT calibrator values were based on weighed values of pure DHT material (>97.5% purity) from Sigma. The allowable limits of performance (ALP) were established as ±0.1 up to 0.5 nmol/L and ±15% for targets >0.5 nmol/L. Target values for the six levels of RCPAQAP material for DHT ranged from 0.02 to 0.43 nmol/L (0.01-0.12 ng/mL). The material demonstrated linearity across the six levels. There were seven participating laboratories for this pilot study. Results of the liquid chromatography (LC) MS/MS methods were within the ALP; whereas the results from the immunoassay methods were consistently higher than the target values and outside the ALP. This report provides the first peer comparison of serum DHT measured by mass spectrometry (MS) and immunoassay laboratories. Establishment of this program provides one of the pillars to achieve method harmonisation. This supports accurate clinical decisions where DHT measurement is required.

  4. The Italian pilot external quality assessment program for cystic fibrosis sweat test.

    Science.gov (United States)

    Salvatore, Marco; Floridia, Giovanna; Amato, Annalisa; Censi, Federica; Carta, Claudio; de Stefano, Maria Chiara; Ferrari, Gianluca; Tosto, Fabrizio; Capoluongo, Ettore; Caruso, Ubaldo; Castaldo, Giuseppe; Cirilli, Natalia; Corbetta, Carlo; Padoan, Rita; Raia, Valeria; Taruscio, Domenica

    2016-05-01

    Sweat chloride test is the gold standard test for cystic fibrosis (CF) diagnosis. In 2014 the Istituto Superiore di Sanità established the Italian pilot external quality assessment program for CF sweat test (IEQA-ST). Ten laboratories, included among the 33 Italian CF Referral Centers, were selected and enrolled on the basis of their attitude to perform sweat test (ST) analysis by using methods recommended by the Italian Guidelines. They received three different sweat-like samples (normal, borderline and pathologic chloride concentration), with mock clinical indications, for analysis according to routine procedures. Assessment, performed by a panel of experts, covered analytical performance, interpretation and reporting of results; categories of "poor" and "satisfactory" performance were not defined. All data were managed through a web utility. The program identified important areas of interest and, in some case, of concern. It is important to underline that results are referred to a small proportion, i.e. about 30%, of Italian laboratories performing CF ST in the context of the Referral Centers. Data collected highlight the importance of participation in EQA programs as it may improve laboratory/clinical performance; our study represents a model for the setting up of a large-scale EQA scheme for ST. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  5. Ten years' experience with an external quality control program for semen analysis.

    Science.gov (United States)

    Mallidis, Con; Cooper, Trevor G; Hellenkemper, Barbara; Lablans, Martin; Uckert, Frank; Nieschlag, Eberhard

    2012-09-01

    To gauge the performance of laboratories and impact of the German semen analysis external quality control program (QuaDeGA) over its first 10 years. Retrospective analysis of QuaDeGA's twice yearly distribution of fixed semen samples and electronic material documenting sperm motility. Ranking of each participant's responses was determined according to their relation to a "target window." Multicenter. PAITENT(S): Healthy donors. None. Laboratory performance, World Health Organization (WHO) adherence. Over 19 runs, there was a steady increase of participants (280 laboratories), the largest group being private urologic practices. Although use of WHO-recommended Neubauer chamber (from 33% to 55%) and diluent (from 11% to 32%) increased, the opposite occurred with morphology staining protocols (from 41% to 19%). Overall, <8% of laboratories truly followed WHO guidelines. Median-based comparisons, replacing reference laboratories, resulted in a merging of performance rankings regardless of the protocols used. Adherence to WHO recommendations is low, with the majority of laboratories using methods expressly opposed by the guidelines. Participation in QuaDeGA was found to improve the performance of the laboratories involved in the program. However, the use of median-based ranking, while decreasing the extent of variance between laboratories, brings into question the significance of the rankings. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  6. International external quality assessment study for molecular detection of Lassa virus.

    Directory of Open Access Journals (Sweden)

    Sergejs Nikisins

    2015-05-01

    Full Text Available Lassa virus (LASV is a causative agent of hemorrhagic fever in West Africa. In recent years, it has been imported several times to Europe and North America. The method of choice for early detection of LASV in blood is RT-PCR. Therefore, the European Network for Diagnostics of 'Imported' Viral Diseases (ENIVD performed an external quality assessment (EQA study for molecular detection of LASV. A proficiency panel of 13 samples containing various concentrations of inactivated LASV strains Josiah, Lib-1580/121, CSF, or AV was prepared. Samples containing the LASV-related lymphocytic choriomeningitis virus (LCMV and negative sera were included as specificity controls. Twenty-four laboratories from 17 countries (13 European, one African, one Asian, two American countries participated in the study. Thirteen laboratories (54% reported correct results, 4 (17% laboratories reported 1 to 2 false-negative results, and 7 (29% laboratories reported 3 to 5 false-negative results. This EQA study indicates that most participating laboratories have a good or acceptable performance in molecular detection of LASV. However, several laboratories need to review and improve their diagnostic procedures.

  7. Design and implementation of an external quality assessment program for HIV viral load measurements using dried blood spots.

    Science.gov (United States)

    Prach, Lisa M; Puren, Adrian; Lippman, Sheri A; Carmona, Sergio; Stephenson, Sophie; Cutler, Ewalde; Barnhart, Scott; Liegler, Teri

    2015-03-01

    An external quality assurance program was developed for HIV-1 RNA viral load measurements taken from dried blood spots using a reference panel and field-collected specimens. The program demonstrated that accurate and reproducible quantitation can be obtained from field-collected specimens. Residual proviral DNA may confound interpretation in virologically suppressed subjects. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  8. External quality assurance system for antibiotic resistance in bacteria of animal origin in Europe (ARBAO-II), 2003

    NARCIS (Netherlands)

    Fo Wong, Lo D.M.A.; Hendriksen, R.S.; Mevius, D.J.; Veldman, K.T.; Aarestrup, F.M.

    2006-01-01

    Initiated in 2003 by the European Union, ARBAO-II aims to establish a monitoring of antimicrobial susceptibility among the veterinary laboratories in all European countries based on validated methodologies. This includes an external quality control system for the most important bacterial pathogens.

  9. [Increasing quality and safety of external radiation treatments: actions of the French Society of Radiation Oncology (SFRO)].

    Science.gov (United States)

    Mazeron, J-J; Mornex, F; Eschwege, F; Lartigau, E; Bolla, M

    2008-11-01

    Accidents which recently occured in external radiotherapy led the French Ministry of Health to implement a programme aimed at increasing quality and safety of treatments. We report the actions of the French society of radiation oncology in the field of this programme called Feuille de route.

  10. GLYCOHEMOGLOBIN - COMPARISON OF 12 ANALYTICAL METHODS, APPLIED TO LYOPHILIZED HEMOLYSATES BY 101 LABORATORIES IN AN EXTERNAL QUALITY ASSURANCE PROGRAM

    NARCIS (Netherlands)

    WEYKAMP, CW; PENDERS, TJ; MUSKIET, FAJ; VANDERSLIK, W

    Stable lyophilized ethylenediaminetetra-acetic acid (EDTA)-blood haemolysates were applied in an external quality assurance programme (SKZL, The Netherlands) for glycohaemoglobin assays in 101 laboratories using 12 methods. The mean intralaboratory day-to-day coefficient of variation (CV),

  11. [THE VIRTUAL CYTOLOGIC SLIDES FOR EXTERNAL EVALUATION OF QUALITY OF IMPLEMENTATION OF CYTOLOGIC ANALYSES IN CLINICAL DIAGNOSTIC LABORATORIES: POSSIBILITIES AND PERSPECTIVES].

    Science.gov (United States)

    Djangirova, T V; Shabalova, I P; Pronichev, A N; Polyakov, E V

    2015-08-01

    The article considers application of technology of analysis of cytological slides in external quality control of clinical diagnostic laboratories. The advantages of virtual slides are demonstrated against other applied technologies of external evaluation of quality i.e. slide plate and digital micro-photography. The conditions of formation of virtual slides for external evaluation of quality of clinical diagnostic laboratories. The technology of their application is described. The success of practical application of considered technology in the Federal system of external evaluation of quality is emphasized.

  12. Does feather corticosterone reflect individual quality or external stress in arctic-nesting migratory birds?

    Directory of Open Access Journals (Sweden)

    Pierre Legagneux

    Full Text Available The effects of environmental perturbations or stressors on individual states can be carried over to subsequent life stages and ultimately affect survival and reproduction. The concentration of corticosterone (CORT in feathers is an integrated measure of hypothalamic-pituitary-adrenal activity during the molting period, providing information on the total baseline and stress-induced CORT secreted during the period of feather growth. Common eiders and greater snow geese replace all flight feathers once a year during the pre-basic molt, which occurs following breeding. Thus, CORT contained in feathers of pre-breeding individuals sampled in spring reflects the total CORT secreted during the previous molting event, which may provide insight into the magnitude or extent of stress experienced during this time period. We used data from multiple recaptures to disentangle the contribution of individual quality vs. external factors (i.e., breeding investment or environmental conditions on feather CORT in arctic-nesting waterfowl. Our results revealed no repeatability of feather CORT within individuals of either species. In common eiders, feather CORT was not affected by prior reproductive investment, nor by pre-breeding (spring body condition prior to the molting period. Individual feather CORT greatly varied according to the year, and August-September temperatures explained most of the annual variation in feather CORT. Understanding mechanisms that affect energetic costs and stress responses during molting will require further studies either using long-term data or experiments. Although our study period encompassed only five years, it nonetheless provides evidence that CORT measured in feathers likely reflects responses to environmental conditions experienced by birds during molt, and could be used as a metric to study carry-over effects.

  13. Commutability of control materials for external quality assessment of serum apolipoprotein A-I measurement.

    Science.gov (United States)

    Zeng, Jie; Qi, Tianqi; Wang, Shu; Zhang, Tianjiao; Zhou, Weiyan; Zhao, Haijian; Ma, Rong; Zhang, Jiangtao; Yan, Ying; Dong, Jun; Zhang, Chuanbao; Chen, Wenxiang

    2017-12-01

    The aim of the current study was to evaluate the commutability of commercial control materials and human serum pools and to investigate the suitability of the materials for the external quality assessment (EQA) of serum apolipoprotein A-I (apo A-I) measurement. The Clinical and Laboratory Standards Institute (CLSI) EP14-A3 protocol was used for the commutability study. Apo A-I concentrations in two levels of commercial control materials used in EQA program, two fresh-frozen human serum pools (FSPs) and two frozen human serum pools prepared from residual clinical specimens (RSPs) were measured along with 50 individual samples using nine commercial assays. Measurement results of the 50 individual samples obtained with different assays were pairwise analyzed by Deming regression, and 95% prediction intervals (PIs) were calculated. The commutability of the processed materials was evaluated by comparing the measurement results of the materials with the limits of the PIs. The FSP-1 was commutable for all the 36 assay pairs, and FSP-2 was commutable for 30 pairs; RSP-1 and RSP-2 showed commutability for 27/36 and 22/36 assay pairs, respectively, whereas the two EQA materials were commutable only for 4/36 and 5/36 assay pairs, respectively. Non-commutability of the tested EQA materials has been observed among current apo A-I assays. EQA programs need either to take into account the commutability-related biases in the interpretation of the EQA results or to use more commutable materials. Frozen human serum pools were commutable for most of the assays.

  14. External quality assessment of dengue and chikungunya diagnostics in the Asia Pacific region, 2015

    Directory of Open Access Journals (Sweden)

    Li Ting Soh

    2016-04-01

    Full Text Available Objective: To conduct an external quality assessment (EQA of dengue and chikungunya diagnostics among national-level public health laboratories in the Asia Pacific region following the first round of EQA for dengue diagnostics in 2013. Methods: Twenty-four national-level public health laboratories performed routine diagnostic assays on a proficiency testing panel consisting of two modules. Module A contained serum samples spiked with cultured dengue virus (DENV or chikungunya virus (CHIKV for the detection of nucleic acid and DENV non-structural protein 1 (NS1 antigen. Module B contained human serum samples for the detection of anti-DENV antibodies. Results: Among 20 laboratories testing Module A, 17 (85% correctly detected DENV RNA by reverse transcription polymerase chain reaction (RT-PCR, 18 (90% correctly determined serotype and 19 (95% correctly identified CHIKV by RT-PCR. Ten of 15 (66.7% laboratories performing NS1 antigen assays obtained the correct results. In Module B, 18/23 (78.3% and 20/20 (100% of laboratories correctly detected anti-DENV IgM and IgG, respectively. Detection of acute/recent DENV infection by both molecular (RT-PCR and serological methods (IgM was available in 19/24 (79.2% participating laboratories. Discussion: Accurate laboratory testing is a critical component of dengue and chikungunya surveillance and control. This second round of EQA reveals good proficiency in molecular and serological diagnostics of these diseases in the Asia Pacific region. Further comprehensive diagnostic testing, including testing for Zika virus, should comprise future iterations of the EQA.

  15. First international external quality assessment of molecular detection of Crimean-Congo hemorrhagic fever virus.

    Directory of Open Access Journals (Sweden)

    Camille Escadafal

    Full Text Available Crimean-Congo hemorrhagic fever (CCHF is a zoonosis caused by a Nairovirus of the family Bunyaviridae. Infection is transmitted to humans mostly by Hyalomma ticks and also by direct contact with the blood or tissues of infected humans or viremic livestock. Clinical features usually include a rapid progression characterized by hemorrhage, myalgia and fever, with a lethality rate up to 30%. CCHF is one of the most widely distributed viral hemorrhagic fevers and has been reported in Africa, the Middle East and Asia, as well as parts of Europe. There is no approved vaccine or specific treatment against CCHF virus (CCHFV infections. In this context, an accurate diagnosis as well as a reliable surveillance of CCHFV infections is essential. Diagnostic techniques include virus culture, serology and molecular methods, which are now increasingly used. The European Network for the Diagnostics of "Imported" Viral Diseases organized the first international external quality assessment of CCHVF molecular diagnostics in 2011 to assess the efficiency and accurateness of CCHFV molecular methods applied by expert laboratories. A proficiency test panel of 15 samples was distributed to the participants including 10 different CCHFV preparations generated from infected cell cultures, a preparation of plasmid cloned with the nucleoprotein of CCHFV, two CCHFV RNA preparations and two negative controls. Forty-four laboratories worldwide participated in the EQA study and 53 data sets were received. Twenty data sets (38% met all criteria with optimal performance, 10 (19% with acceptable performance, while 23 (43% reported results showing a need for improvement. Differences in performance depended on the method used, the type of strain tested, the concentration of the sample tested and the laboratory performing the test. These results indicate that there is still a need for improving testing conditions and standardizing protocols for the molecular detection of Crimean

  16. First round of external quality assessment of dengue diagnostics in the WHO Western Pacific Region, 2013

    Directory of Open Access Journals (Sweden)

    Kwoon Yong Pok

    2015-06-01

    Full Text Available Objective: Accurate laboratory testing is a critical component of dengue surveillance and control. The objective of this programme was to assess dengue diagnostic proficiency among national-level public health laboratories in the World Health Organization (WHO Western Pacific Region. Methods: Nineteen national-level public health laboratories performed routine dengue diagnostic assays on a proficiency testing panel consisting of two modules: one containing commercial serum samples spiked with cultured dengue viruses for the detection of nucleic acid and non-structural protein 1 (NS1 (Module A and one containing human serum samples for the detection of anti-dengue virus antibodies (Module B. A review of logistics arrangements was also conducted. Results: All 16 laboratories testing Module A performed reverse transcriptase polymerase chain reaction (RT-PCR for both RNA and serotype detection. Of these, 15 had correct results for RNA detection and all 16 correctly serotyped the viruses. All nine laboratories performing NS1 antigen detection obtained the correct results. Sixteen of the 18 laboratories using IgM assays in Module B obtained the correct results as did the 13 laboratories that performed IgG assays. Detection of ongoing/recent dengue virus infection by both molecular (RT-PCR and serological methods (IgM was available in 15/19 participating laboratories. Discussion: This first round of external quality assessment of dengue diagnostics was successfully conducted in national-level public health laboratories in the WHO Western Pacific Region, revealing good proficiency in both molecular and serological testing. Further comprehensive diagnostic testing for dengue virus and other priority pathogens in the Region will be assessed during future rounds.

  17. External quality assessment/proficiency testing and internal quality control for the PFA-100 and PFA-200: an update.

    Science.gov (United States)

    Favaloro, Emmanuel J; Bonar, Roslyn

    2014-03-01

    Platelet function testing is an essential component of comprehensive hemostasis evaluation within the framework of bleeding and/or bruising investigations, and it may also be performed to evaluate antiplatelet medication effects. Globally, the platelet function analyzer (PFA)-100 (Siemens Healthcare, Marburg, Germany) is the most used primary hemostasis-screening instrument and has also been recently remodeled/upgraded to the PFA-200. The PFA-100 is sensitive to a wide range of associated disorders, including platelet function defects and von Willebrand disease (VWD), as well as to various antiplatelet medications. The PFA-100 is also useful in therapy monitoring, especially in VWD. External quality assessment (EQA) (or proficiency testing) and internal quality control (IQC) are critical to ensuring quality of test practice, inclusive of all hemostasis tests. However, both EQA and IQC for platelet function testing, including the PFA-100, is logistically challenging, given theoretical requirements for production, storage, and shipment of large volumes of "stabilized" normal and pathological blood/platelets covering both normal function plus a wide variety of potential defects. We accordingly describe the development and testing of novel feasible approaches to both EQA and IQC of PFA-100/PFA-200 instruments, whereby a range of formulated "platelet function antagonist" materials are utilized. For EQA purposes, these are distributed to participants, and citrated normal whole blood collected on site is then added locally, thereby creating test material that can be locally evaluated. Several exercises have been conducted by the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP) over the past 6 years. A total of 26 challenges, with most designed to mimic moderate to severe primary hemostasis defects, have been tested in 26 to 50 laboratories depending on the year of dispatch. Numerical results for PFA-100/PFA-200 closure times (CTs) and

  18. [Establishment of lymphocyte cell lines with abnormal chromosome karyotypes and its application in external quality assesment for chromosome karyotype analysis].

    Science.gov (United States)

    Weng, Bin-huan; Cai, Jian-ping; Wang, Xu-min; You, Jian-fei; Jin, Yi; Wang, Xiao-hua

    2007-12-01

    To develop chromosome abnormal karyotype quality control cell and to explore the external quality assessment (EQA) method for chromosome karyotype analysis. The chromosome abnormal karyotype quality control cells were prepared by EB virus (EBV) transfection of human B lymphocyte strain establishment and were distributed to participating labs for EQA test of chromosome karyotype analysis project at appointed time. The evaluation results were obtained through 4 grades scoring. Six kinds of chromosome abnormal karyotype quality control cells were initially developed, the karyotypes of which were 46,X, t(Y;5)(q12;q21), 46, XY, 15p +, 46, XX, t(13;18)(q12;q21), 46, X, r(Xp), 46,X,t(Y;Y), 46,XX,t(9;20)(p13;p13) respectively. In the external quality assessment, feedbacks from the participating labs on the sequencing results of the six kinds of quality control cells showed that the wholly overlapping rate were 82.1%, 92.0%, 84.6%, 80.8%, 86.2%, 74.1% and the wholly deviation rate were 10.7%, 8.0%, 11.5%, 19.2%, 13.8%, 18.5%. The overall wholly overlapping rate, partial overlapping rate, partial deviation rate and wholly deviation rate turned out to be 83.2%, 0.6%, 2.5% and 13.7% respectively. The misdiagnose rate of chromosome karyotype analysis is rather high and regular external quality assessment is necessary to achieve dynamic information and improve diagnosis quality.

  19. Competition improves quality-related external stem characteristics of Fagus sylvatica

    National Research Council Canada - National Science Library

    Seidel, Dominik; Ammer, Christian; Höwler, Kirsten; Annighöfer, Peter

    2017-01-01

    .... We investigated how competition intensity affected the metrics of 118 European beech (Fagus sylvatica L.) trees. We found that two newly developed TLS-based measures of external stem characteristics...

  20. EVALUATING THE ROLE OF THE REGULATORS OF THE EXTERNAL AUDIT PROFESSION IN ACHIEVING THE AUDIT QUALITY IN IRAQ

    Directory of Open Access Journals (Sweden)

    Fedaa Abd Almajid Sabbar Alaraji

    2016-12-01

    Full Text Available The profession of quality auditing can have direct or indirect effects on the performance of accountants and auditors. Both particular research and professional recommendations provided evidence on measuring and evaluating service performance of audit profession by taking into account the relationship between quality and accountant performance. Applied research was developed in Republic of Iraq to reveal the function of bodies that regulate external audit for achieving the required level of audit quality and for identifying the obstacles that prevent the compliance with International Auditing Standards. Research focuses on the role of these bodies in order to achieve the quality of audit by implementing a quality control system. Its benefits reduce chances of criticisms and weaknesses, improving the auditing environment in Iraq.

  1. Neoadjuvant hormonal therapy and external-beam radiotherapy versus external-beam irradiation alone for prostate cancer. A quality-of-life analysis

    Energy Technology Data Exchange (ETDEWEB)

    Pinkawa, Michael; Piroth, Marc D.; Asadpour, Branka; Gagel, Bernd; Fischedick, Karin; Siluschek, Jaroslav; Kehl, Mareike; Krenkel, Barbara; Eble, Michael J. [RWTH Aachen (Germany). Dept. of Radiotherapy

    2009-02-15

    To evaluate the impact of neoadjuvant hormonal therapy (NHT) on quality of life after external-beam radiotherapy (EBRT) for prostate cancer. A group of 170 patients (85 with and 85 without NHT) has been surveyed prospectively before EBRT (70.2-72 Gy), at the last day of EBRT, a median time of 2 months and 15 months after EBRT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Pairs with and without NHT (median treatment time of 3.5 months before EBRT) were matched according to the respective planning target volume and prostate volume. Before EBRT, significantly lower urinary function/bother, sexual function and hormonal function/bother scores were found for patients with NHT. More than 1 year after EBRT, only sexual function scores remained lower. In a multivariate analysis, NHT and adjuvant hormonal therapy (HT) versus NHT only (hazard ratio 14; 95% confidence interval 2.7-183; p = 0.02) and luteinizing hormone-releasing hormone (LHRH) agonists versus antiandrogens (hazard ratio 3.6; 95% confidence interval 1.1-12; p = 0.04) proved to be independent risk factors for long-term erectile dysfunction (no or very poor ability to have an erection). With the exception of sexual function (additional adjuvant HT and application of LHRH analog independently adverse), short-term NHT was not found to decrease quality of life after EBRT for prostate cancer. (orig.)

  2. Both Autonomy and Quality Control are Indispensable to make a Success of the Plural External Evaluation System for Japanese Universities

    Science.gov (United States)

    Ohnami, Masateru

    This paper points out the problem of the plural external evaluation system for Japanese universities. Japanese evaluation system is internationally the peculiar case that both of chartering in government and accreditation in government and non-government agencies exist in parallel. It is the biggest problem that the accreditation agencies secure both the autonomy and quality control and the appropriate cooperation with chartering goes well. This paper also reviews, as the experience in the world and Japan, the activity in the INQAAHE and the JUAA 2003 Version, which aims at the quality assurance of internationally viable higher education and foresees the new accreditation system recognized by government after 2004. From these experiences, it is prospected to develop the plural external evaluation system in future.

  3. Internal and External Resources as Determinants of Health and Quality of Life.

    Directory of Open Access Journals (Sweden)

    Elfriede Greimel

    Full Text Available The salutogenic model has been established as a health promoting resource that is related to a strong sense of coherence (SOC, positive subjective health and quality of life (QoL. The aim of the study was to compare internal and external resources, life style factors, perceived health and QoL in Japan and Austria and to determine associations among these factors.A survey was conducted in a Japanese (N = 460 and an Austrian (N = 421 student sample using the following self-report health questionnaires: Sense of Coherence Scale (SOC-13, Social and Gender Role Scale, Multidimensional Scale of Perceived Social Support (MSPSS, Dutch Eating Behaviour Questionnaire (DEBQ, SF-12 Health Survey, and the Cross-cultural Health Survey. Analyses of data showed that age (ß -0.12, and stress (ß -0.21 were negatively related and SOC (ß 0.47, family support are (ß -0.35 positively related to mental QoL. Significant predictors for emotional strain, were female gender (ß -0.24, older age (ß-0.14, lower SOC (ß 0.28, less traditional gender and social role patterns (ß 0.10, more restrained eating (ß -0.20, more alcohol intake (ß -0.16, and more stress (ß -0.25 explaining 42% of the variance in Austrian students. In Japan stress (ß -0.38 was negatively related and SOC (ß 0.37 positively related to mental QoL. Older age (ß -0.20, lower SOC (ß 0.29 and more stress (ß -0.33 were identified as significant predictors explaining 35% of the variance in Japanese students.SOC and stress are strongly associated with QoL and perceived health in Austria as well as in Japan. SOC seems to be a crucial predictor for stress, and emotional health independent of the cultural context. A major challenge of cross-cultural research is to understand perceived health and QoL and the extent in which it is individually, socially, or culturally determined.

  4. Review of the national external quality assessment (EQA) scheme for breast pathology in the UK.

    Science.gov (United States)

    Rakha, Emad A; Bennett, Rachel L; Coleman, Derek; Pinder, Sarah E; Ellis, Ian O

    2017-01-01

    The National Health Service Breast Screening Programme (NHSBSP; pathology) external quality assurance (EQA) scheme aims to provide a mechanism for examination and monitoring of concordance of pathology reporting within the UK. This study aims to review the breast EQA scheme performance data collected over a 24-year period following its introduction. Data on circulations, number of cases and diagnosis were collected. Detailed analyses with and without combinations of certain diagnostic entities, and over different time periods were performed. Overall, of 576 cases (172 benign, 11 atypical hyperplasia, 98 ductal carcinoma in situ/microinvasive and 295 invasive disease), consistency of assessment of diagnostic parameters was very high (overall k=0.80; k for benign diagnosis=0.79; k for invasive disease=0.91). For distinguishing benign versus malignant lesions, no further improvement is considered possible in view of the limitations of the scheme methodology. Although diagnostic consistency of atypical hyperplasia remains at a low level, combining it with the benign category results in a high level of agreement (k=0.93). The level of consistency of reporting prognostic information is variable and some items such as lymphovascular invasion and tumour size measurement may need further intervention to improve their reporting consistency. Although the level of consistency of reporting of histological grade remained at a moderate level overall (k=0.48), it was variable among cases and appears to have levelled off; no further significant improvement is expected and no significant impact of the previous publication of guidelines is observed. These results provide further evidence to indicate the value of the breast EQA scheme in monitoring performance and the identification of specific areas where improvement or new approaches are required. For most parameters, the concordance of reporting reached a plateaux a few years after the introduction of the EQA scheme. It is

  5. Internal and External Resources as Determinants of Health and Quality of Life.

    Science.gov (United States)

    Greimel, Elfriede; Kato, Yoshiko; Müller-Gartner, Maria; Salchinger, Beate; Roth, Roswith; Freidl, Wolfgang

    2016-01-01

    The salutogenic model has been established as a health promoting resource that is related to a strong sense of coherence (SOC), positive subjective health and quality of life (QoL). The aim of the study was to compare internal and external resources, life style factors, perceived health and QoL in Japan and Austria and to determine associations among these factors. A survey was conducted in a Japanese (N = 460) and an Austrian (N = 421) student sample using the following self-report health questionnaires: Sense of Coherence Scale (SOC-13), Social and Gender Role Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Dutch Eating Behaviour Questionnaire (DEBQ), SF-12 Health Survey, and the Cross-cultural Health Survey. Analyses of data showed that age (ß -0.12), and stress (ß -0.21) were negatively related and SOC (ß 0.47), family support are (ß -0.35) positively related to mental QoL. Significant predictors for emotional strain, were female gender (ß -0.24), older age (ß-0.14), lower SOC (ß 0.28), less traditional gender and social role patterns (ß 0.10), more restrained eating (ß -0.20), more alcohol intake (ß -0.16), and more stress (ß -0.25) explaining 42% of the variance in Austrian students. In Japan stress (ß -0.38) was negatively related and SOC (ß 0.37) positively related to mental QoL. Older age (ß -0.20), lower SOC (ß 0.29) and more stress (ß -0.33) were identified as significant predictors explaining 35% of the variance in Japanese students. SOC and stress are strongly associated with QoL and perceived health in Austria as well as in Japan. SOC seems to be a crucial predictor for stress, and emotional health independent of the cultural context. A major challenge of cross-cultural research is to understand perceived health and QoL and the extent in which it is individually, socially, or culturally determined.

  6. Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration.

    Science.gov (United States)

    Bidassie, Balmatee; Williams, Linda S; Woodward-Hagg, Heather; Matthias, Marianne S; Damush, Teresa M

    2015-05-14

    Facilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement. We conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators. The external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach's role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not

  7. Unemployment Benefits and Redistributive Taxes in the Presence of Labor Quality Externalities

    NARCIS (Netherlands)

    Huizinga, H.P.

    1996-01-01

    In this paper, a worker s productivity is assumed to depend on his own quality and on the average quality of other employed workers.In this setting, unemployment benefits that induce low quality workers to leave the labor force have important efficiency as well as equity implications.In addition to

  8. The Effects of Externally Solidified Product on Wave Celerity and Quality of Die Cast Products

    Energy Technology Data Exchange (ETDEWEB)

    Carroll Mobley; Yogeshwar Sahai; Jerry Brevick

    2003-10-10

    The cold chamber die casting process is used to produce essentially all the die cast aluminum products and about 50% of the die cast magnesium products made today. Modeling of the cold chamber die casting process and metallographic observations of cold chamber die cast products indicate that typically 5 to 20% of the shot weight is solidified in the shot sleeve before or during cavity filling. The protion of the resulting die casting which is solidified in the shot sleeve is referred to as externally solidified product, or, when identified as a casting defect, as cold flakes. This project was directed to extending the understanding of the effects of externally solidified product on the cold chamber die casting process and products to enable the production of defect-free die castings and reduce the energy associated with these products. The projected energy savings from controlling the fraction of externally solidified product in die cast components is 40 x 10 Btu through the year 2025.

  9. Application of the characteristic function to evaluate and compare analytical variability in an external quality assessment scheme for serum ethanol.

    Science.gov (United States)

    Coucke, Wim; Charlier, Corine; Lambert, Willy; Martens, Frank; Neels, Hugo; Tytgat, Jan; Van de Walle, Philippe; Vanescote, André; Wallemacq, Pierre; Wille, Sarah; Verstraete, Alain G

    2015-07-01

    As a cornerstone of quality management in the laboratory, External Quality Assessment (EQA) schemes are used to assess laboratory and analytical method performance. The characteristic function is used to describe the relation between the target concentration and the EQA standard deviation, which is an essential part of the evaluation process. The characteristic function is also used to compare the variability of different analytical methods. We fitted the characteristic function to data from the Belgian External Quality Assessment program for serum ethanol. Data included results from headspace gas chromatography and the enzymatic methods of Abbott, Roche, Siemens, and Ortho-Clinical Diagnostics. We estimated the characteristic function with weighted nonlinear regression. By introducing dummy variables, we rewrote the original formula of the characteristic function to assess statistical inference for comparing the variability of the different analytical methods. The characteristic function fitted the data precisely. Comparison between methods showed that there was little difference between the estimated variability for low concentrations, and that the increase in SD with increasing target concentration was slower for Abbott and Roche than for the other methods. The characteristic function can successfully be introduced in clinical schemes, although its applicability to fit the data should always be assessed. Because of its easy parameterization, it can be used to assess differences in performance between analytical methods and to assess laboratory performance. The characteristic function also offers an alternative framework for coefficients of variation to describe variability of analytical methods. © 2015 American Association for Clinical Chemistry.

  10. External Quality Assessment Scheme for Biological Monitoring of Occupational Exposure to Toxic Chemicals

    Directory of Open Access Journals (Sweden)

    Mi-Young Lee

    2011-09-01

    Conclusion: The EQAS has taken a primary role in improving the reliability of analytical data. A total quality assurance scheme is suggested, including the validation of technical documentation for the whole analytical procedure.

  11. Effect of storage at different temperatures on development of external color and quality of pineapple fruits cv. Gold Extra Sweet

    Directory of Open Access Journals (Sweden)

    Luis Ulloa

    2015-11-01

    Full Text Available In order to improve the quality of the fruit, judged at the market as the degree of yellowing of the peel, 2 experiments were performed to evaluate the effect of storage temperature on change in external color of pineapple (Ananas comosus fruit cv. “Gold Extra Sweet”. The temperatures evaluated were 7.5°C; 10.0°C; 12.5°C and 15.0°C, and their effect on the color change and the chlorophyll content in the peel, respiration rate and parameters of external and internal quality were measured. The fruit was stored at different temperatures for 21 days and then transferred to 18.0°C during 4 additional days. At the end of the storage period, pineapples at 7.5°C showed the highest content of chlorophyll a (200 μg.g-1 f.w and the lowest degree of external color (0.32-0.70, fruits stored at 15.0°C had the lowest content of chlorophyll a (40 μg.g-1 f.w and the highest color grade (4.42-5.25. Pineapples stored at 7.5°C showed the lowest respiration rate at 21 days (6.4 ml CO2/kg*h, while fruit stored at 15.0°C had the highest respiration rate (15.8 ml CO2/kg*h. As the storage temperature increased the weight loss and mold growth in the peduncle increased. At the end of storage at 18.0°C, the color advance in the fruits previously stored at 7.5°C was the lowest, while the highest external yellow color developed on the fruits previously kept at 15.0°C. The results suggest that the storage temperature affects chlorophyll degradation and development of external yellow color, which could be useful in the commercial management of pineapple fruit.

  12. Quality of cervical cancer screening in Brazil: external assessment of the PMAQ

    Science.gov (United States)

    Barcelos, Mara Rejane Barroso; Lima, Rita de Cássia Duarte; Tomasi, Elaine; Nunes, Bruno Pereira; Duro, Suele Manjourany Silva; Facchini, Luiz Augusto

    2017-01-01

    ABSTRACT OBJECTIVE To examine whether demographic and socioeconomic variables and the variables of the organization of services are associated with the quality of cervical cancer screening. METHODS This is a survey carried out in the health services of the five Brazilian regions in 2012. The sample consisted of users of basic health units participating in the Program for Improving Access and Quality of the Primary Care. The independent variables analyzed were: socioeconomic characteristics (municipal context), demographic characteristics (user profile), and two domains related to the organization of basic services (work structure and process). The low quality of the screening was assessed from the lack of access, late examination, and lack of guidance. Crude and adjusted analyses by Poisson regression assessed the association between outcomes and independent variables. RESULTS The values of lack of access, late examination, and lack of guidance were 6.7%, 11.2%, and 19.2%, respectively. Problems of quality were lower according to the increase in Municipal Human Development Index and per capita household income, increasing with population size and municipal coverage of the Family Health Strategy. The Midwest region of the country presented the highest occurrences of low quality outcomes. Indigenous and yellow women had the highest prevalence of outcomes. Women with partner, who received the Bolsa Família Program, and who had paid work had less chances of having lack of access, late examination, and lack of guidance. The appropriate work process in health services decreased the likelihood of low quality in all indicators. CONCLUSIONS Investments in the work process of health teams, social cash transfer programs, and social conditions of the population are essential to improve the quality of the program of cervical cancer screening in Brazil. PMID:28746576

  13. External quality assessment in blood group serology in the World Health Organization South-East Asia Region.

    Science.gov (United States)

    Soisangwan, Patravee

    2012-01-01

    The quality of blood transfusion services (BTS) is essential for the treatment of patients who need blood or blood products. BTS involve several steps, including the acquisition of the donor's blood, blood grouping, unexpected antibody screening, blood storage, transfusion, etc. There is a need to check the effectiveness of all elements in the BTS can be assessed and monitored by an external quality assessment. To assess and evaluate the performance of ABO and Rh(D) blood grouping and unexpected antibody screening of the selected World Health Organization (WHO) South-East Asia Region Member country laboratories. WHO Collaborating Centre on Strengthening Quality of Health Laboratories (Thailand) organized a regional external quality assessment scheme for blood group serology (REQAS-BGS) between 2002 and 2008 for laboratories in countries of the WHO South-East Asia Region. Test items for ABO and Rh(D) blood groupings and unexpected antibody screening and identification were distributed three cycles per year to BTS laboratories in Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. By the end of the project, a total of 20 BTS laboratories had participated for differing lengths of time. It was found that 87.5%, 93.3%, 81.3%, 92.3%, 100% and 87.5% of laboratories returned the test results in 2002, 2003, 2004, 2006, 2007 and 2008, respectively. Laboratories with excellent quality or a trend of quality improvement for ABO and Rh(D) blood grouping, unexpected antibody screening and identification during the six years were 60% (12/20), 50% (10/20), 52.9% (9/17) and 81.8% (9/11), respectively. At the initiation of the scheme, most laboratories were using substandard methods for ABO and Rh blood groupings, i.e. performing only direct blood grouping alone but subsequently adopted the standard methods, i.e. performing both direct and reverse blood groupings. REQAS-BGS in South-East Asia countries has been useful for assessing, monitoring and

  14. 42 CFR 438.354 - Qualifications of external quality review organizations.

    Science.gov (United States)

    2010-10-01

    ... minimum the following: (1) Staff with demonstrated experience and knowledge of— (i) Medicaid recipients...; (iii) Quality assessment and improvement methods; and (iv) Research design and methodology, including... or PIHP exerts control over the other (as used in this paragraph, “control” has the meaning given the...

  15. External Quality Assurance in Higher Education: How Can It Address Corruption and Other Malpractices?

    Science.gov (United States)

    Martin, Michaela

    2016-01-01

    Corruption and malpractices in higher education are today a major concern in nearly all higher education systems worldwide. It is a multifaceted phenomenon and has become particularly visible in the academic domain. This paper represents an exploration of the possible role that quality assurance can play in addressing corruption and malpractices.…

  16. External quality assessment for KRAS testing is needed: setup of a European program and report of the first joined regional quality assessment rounds

    DEFF Research Database (Denmark)

    Bellon, Ellen; Ligtenberg, Marjolijn J L; Tejpar, Sabine

    2011-01-01

    . In an effort to ensure optimal, uniform, and reliable community-based KRAS testing throughout Europe, a KRAS external quality assessment (EQA) scheme was set up. The first large assessment round included 59 laboratories from eight different European countries. For each country, one regional scheme organizer...... their own preferred method for histological evaluation, DNA isolation, and mutation analysis. In this study, we analyze the setup of the KRAS scheme. We analyzed the advantages and disadvantages of the regional scheme organization by analyzing the outcome of genotyping results, analysis of tumor percentage...

  17. [External quality assessment in clinical biochemistry laboratories: pilot study in 11 laboratories of Lomé (Togo)].

    Science.gov (United States)

    Kouassi, Kafui; Fétéké, Lochina; Assignon, Selom; Dorkenoo, Ameyo; Napo-Koura, Gado

    2015-01-01

    This study aims to evaluate the performance of a few biochemistry analysis and make recommendations to the place of the stakeholders. It is a cross-sectional study conducted between the October 1(st), 2012 and the July 31, 2013 bearing on the results of 5 common examinations of clinical biochemistry, provided by 11 laboratories volunteers opening in the public and private sectors. These laboratories have analysed during the 3 cycles, 2 levels (medium and high) of serum concentration of urea, glucose, creatinine and serum aminotransferases. The performance of laboratories have been determined from the acceptable limits corresponding to the limits of total errors, defined by the French Society of Clinical Biology (SFBC). A system of internal quality control is implemented by all laboratories and 45% of them participated in international programs of external quality assessment (EQA). The rate of acceptable results for the entire study was of 69%. There was a significant difference (p<0.002) between the performance of the group of laboratories engaged in a quality approach and the group with default implementation of the quality approach. Also a significant difference was observed between the laboratories of the central level and those of the peripheral level of our health system (p<0.047). The performance of the results provided by the laboratories remains relatively unsatisfactory. It is important that the Ministry of Health put in place a national program of EQA with mandatory participation.

  18. Implementation of Good Clinical Laboratory Practice (GCLP) guidelines within the External Quality Assurance Program Oversight Laboratory (EQAPOL).

    Science.gov (United States)

    Todd, Christopher A; Sanchez, Ana M; Garcia, Ambrosia; Denny, Thomas N; Sarzotti-Kelsoe, Marcella

    2014-07-01

    The EQAPOL contract was awarded to Duke University to develop and manage global proficiency testing programs for flow cytometry-, ELISpot-, and Luminex bead-based assays (cytokine analytes), as well as create a genetically diverse panel of HIV-1 viral cultures to be made available to National Institutes of Health (NIH) researchers. As a part of this contract, EQAPOL was required to operate under Good Clinical Laboratory Practices (GCLP) that are traditionally used for laboratories conducting endpoint assays for human clinical trials. EQAPOL adapted these guidelines to the management of proficiency testing programs while simultaneously incorporating aspects of ISO/IEC 17043 which are specifically designed for external proficiency management. Over the first two years of the contract, the EQAPOL Oversight Laboratories received training, developed standard operating procedures and quality management practices, implemented strict quality control procedures for equipment, reagents, and documentation, and received audits from the EQAPOL Central Quality Assurance Unit. GCLP programs, such as EQAPOL, strengthen a laboratory's ability to perform critical assays and provide quality assessments of future potential vaccines. © 2013.

  19. Internal and External Dialogue: a Swedish Approach to Quality Work in Courts

    Directory of Open Access Journals (Sweden)

    Marie B. Hagsgård

    2014-12-01

    Full Text Available When evaluation shows that a court is not delivering justice in the best possible way, change in the way a court operates can be hard to accomplish. One way is to engage all judges and staff in an internal and external dialogue about the way the court is functioning and how to improve it. When judges and staff are actively involved in evaluating the present situation, in analyzing, suggesting and implementing new measures and in evaluating the effects of those measures, improvements can be reached in the way the court operates in a range of areas. The deployment of such approach in a growing number of Swedish courts is an indicator of the success of the method.At present the majority of Swedish courts are involved in a broad external dialogue, where judges and staff attend meetings with prosecutors and lawyers and interview court users. The aim of the dialogue is to evaluate and improve information and treatment of parties and witnesses and the writing of intelligible judgments. Cuando una evaluación muestra que un tribunal no está administrando justicia de la mejor manera posible, puede ser difícil lograr cambiar la forma en que ese tribunal funciona. Una opción es involucrar a todos los jueces y personal en un diálogo interno y externo sobre el funcionamiento del tribunal y cómo se podría mejorar. Cuando los jueces y el personal participan activamente en la evaluación de la situación actual, analizando, sugiriendo y desarrollando nuevas medidas y evaluando los efectos de esas medidas, se pueden conseguir mejoras en la forma en la que el tribunal opera en diferentes áreas. El uso de este enfoque en un número creciente de tribunales suecos es un indicador del éxito del método.En la actualidad la mayoría de los tribunales suecos están involucrados en un amplio diálogo externo, en el que jueces y personal participan en reuniones con fiscales y abogados y se entrevistan con usuarios de los tribunales. El objetivo del diálogo es

  20. External quality assurance programs as a tool for verifying standardization of measurement procedures: Pilot collaboration in Europe.

    Science.gov (United States)

    Perich, C; Ricós, C; Alvarez, V; Biosca, C; Boned, B; Cava, F; Doménech, M V; Fernández-Calle, P; Fernández-Fernández, P; García-Lario, J V; Minchinela, J; Simón, M; Jansen, R

    2014-05-15

    Current external quality assurance schemes have been classified into six categories, according to their ability to verify the degree of standardization of the participating measurement procedures. SKML (Netherlands) is a Category 1 EQA scheme (commutable EQA materials with values assigned by reference methods), whereas SEQC (Spain) is a Category 5 scheme (replicate analyses of non-commutable materials with no values assigned by reference methods). The results obtained by a group of Spanish laboratories participating in a pilot study organized by SKML are examined, with the aim of pointing out the improvements over our current scheme that a Category 1 program could provide. Imprecision and bias are calculated for each analyte and laboratory, and compared with quality specifications derived from biological variation. Of the 26 analytes studied, 9 had results comparable with those from reference methods, and 10 analytes did not have comparable results. The remaining 7 analytes measured did not have available reference method values, and in these cases, comparison with the peer group showed comparable results. The reasons for disagreement in the second group can be summarized as: use of non-standard methods (IFCC without exogenous pyridoxal phosphate for AST and ALT, Jaffé kinetic at low-normal creatinine concentrations and with eGFR); non-commutability of the reference material used to assign values to the routine calibrator (calcium, magnesium and sodium); use of reference materials without established commutability instead of reference methods for AST and GGT, and lack of a systematic effort by manufacturers to harmonize results. Results obtained in this work demonstrate the important role of external quality assurance programs using commutable materials with values assigned by reference methods to correctly monitor the standardization of laboratory tests with consequent minimization of risk to patients. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. Molecular Genetics External Quality Assessment Pilot Scheme for Irinotecan-Related UGT1A1 Genotyping in China

    Science.gov (United States)

    Zhang, Kuo; Wang, Lunan; Zhang, Rui; Xie, Jiehong; Li, Jinming

    2016-01-01

    Irinotecan is widely used in the treatment of solid tumors, especially in colorectal cancer and lung cancer. Molecular testing for UGT1A1 genotyping is increasingly required in China for optimum irinotecan administration. In order to determine the performance of laboratories with regard to the whole testing process for UGT1A1 to ensure the consistency and accuracy of the test results, the National Center for Clinical Laboratories conducted an external quality assessment program for UGT1A1*28 genotyping in 2015. The panel, which comprised of four known mutational samples and six wild-type samples, was distributed to 45 laboratories that test for the presence of UGT1A1*28 polymorphisms. Participating laboratories were allowed to perform polymorphism analysis by using their routine methods. The accuracy of the genotyping and reporting of results was analyzed. Other information from the individual laboratories, including the number of samples tested each month, accreditation/certification status, and test methodology, was reviewed. Forty-four of the 45 participants reported the correct results for all samples. There was only one genotyping error, with a corresponding analytical sensitivity of 99.44% (179/180 challenges; 95% confidence interval: 96.94−99.99%) and an analytical specificity of 100% (270/270 challenges; 95% confidence interval: 98.64−100%). Both commercial kits and laboratory development tests were commonly used by the laboratories, and pyrosequencing was the main methodology used (n = 26, 57.8%). The style of the written reports showed large variation, and many reports showed a shortage of information. In summary, the first UGT1A1 genotyping external quality assessment result demonstrated that UGT1A1 genotype analysis of good quality was performed in the majority of pharmacogenetic testing centers that were investigated. However, greater education on the reporting of UGT1A1 genetic testing results is needed. PMID:26820647

  2. ASVCP quality assurance guidelines: external quality assessment and comparative testing for reference and in-clinic laboratories.

    Science.gov (United States)

    Camus, Melinda S; Flatland, Bente; Freeman, Kathleen P; Cruz Cardona, Janice A

    2015-12-01

    The purpose of this document is to educate providers of veterinary laboratory diagnostic testing in any setting about comparative testing. These guidelines will define, explain, and illustrate the importance of a multi-faceted laboratory quality management program which includes comparative testing. The guidelines will provide suggestions for implementation of such testing, including which samples should be tested, frequency of testing, and recommendations for result interpretation. Examples and a list of vendors and manufacturers supplying control materials and services to veterinary laboratories are also included. © 2015 American Society for Veterinary Clinical Pathology.

  3. Relating Child Care during Infancy to Externalizing and Internalizing Behaviors in Toddlerhood: How Specific Features of Child Care Quality Matter Depending on a Child's Gender and Temperament

    Science.gov (United States)

    Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

    2014-01-01

    This study explored whether the relationships between specific features of child care quality and externalizing and internalizing behaviors in 24-month-old children are moderated by gender and temperament. Questionnaires were used to record children's gender and measure their temperament. Child care quality was observed with the "Échelles…

  4. Impact of physical fitness and biometric data on the quality of external chest compression: a randomised, crossover trial

    Directory of Open Access Journals (Sweden)

    Russo Sebastian G

    2011-11-01

    Full Text Available Abstract Background During circulatory arrest, effective external chest compression (ECC is a key element for patient survival. In 2005, international emergency medical organisations changed their recommended compression-ventilation ratio (CVR from 15:2 to 30:2 to acknowledge the vital importance of ECC. We hypothesised that physical fitness, biometric data and gender can influence the quality of ECC. Furthermore, we aimed to determine objective parameters of physical fitness that can reliably predict the quality of ECC. Methods The physical fitness of 30 male and 10 female healthcare professionals was assessed by cycling and rowing ergometry (focussing on lower and upper body, respectively. During ergometry, continuous breath-by-breath ergospirometric measurements and heart rate (HR were recorded. All participants performed two nine-minute sequences of ECC on a manikin using CVRs of 30:2 and 15:2. We measured the compression and decompression depths, compression rates and assessed the participants' perception of exhaustion and comfort. The median body mass index (BMI; male 25.4 kg/m2 and female 20.4 kg/m2 was used as the threshold for subgroup analyses of participants with higher and lower BMI. Results HR during rowing ergometry at 75 watts (HR75 correlated best with the quality of ECC (r = -0.57, p 75, the compression depth decreased over time, beginning after four minutes for the 15:2 CVR and after three minutes for the 30:2 CVR. Although found to be more exhausting, a CVR of 30:2 was rated as being more comfortable. Conclusion The quality of the ECC and fatigue can both be predicted by BMI and physical fitness. An evaluation focussing on the upper body may be a more valid predictor of ECC quality than cycling based tests. Our data strongly support the recommendation to relieve ECC providers after two minutes.

  5. Implementation of a national external quality assessment program for medical laboratories in Burkina Faso: challenges, lessons learned, and perspectives.

    Science.gov (United States)

    Sakandé, Jean; Nikièma, Abdoulaye; Kabré, Elie; Sawadogo, Charles; Nacoulma, Eric W; Sanou, Mamadou; Sangaré, Lassana; Traoré-Ouédraogo, Rasmata; Sawadogo, Mamadou; Gershy-Damet, Guy Michel

    2014-02-01

    The National External Quality Assessment (NEQA) program of Burkina Faso is a proficiency testing program mandatory for all laboratories in the country since 2006. The program runs two cycles per year and covers all areas of laboratories. All panels were validated by the expert committee before dispatch under optimal storage and transport conditions to participating laboratories along with report forms. Performance in the last 5 years varied by panel, with average annual performance of bacteriology panels for all laboratories rising from 75% in 2006 to 81% in 2010 and with a best average performance of 87% in 2007 and 2008. During the same period, malaria microscopy performance varied from 85% to 94%, with a best average performance of 94% in 2010; chemistry performance increased from 87% to 94%, with a best average annual performance of 97% in 2009. Hematology showed more variation in performance, ranging from 61% to 86%, with a best annual average performance of 90% in 2008. Average annual performance for immunology varied less between 2006 and 2010, recording 97%, 90%, and 95%. Except for malaria microscopy, annual performances for enrolled panels varied substantially from year to year, indicating some difficulty in maintaining consistency in quality. The main challenges of the NEQA program observed between 2006 to 2010 were funding, sourcing, and safe transportation of quality panels to all laboratories countrywide.

  6. Quality of cervical cancer screening in Brazil: external assessment of the PMAQ.

    Science.gov (United States)

    Barcelos, Mara Rejane Barroso; Lima, Rita de Cássia Duarte; Tomasi, Elaine; Nunes, Bruno Pereira; Duro, Suele Manjourany Silva; Facchini, Luiz Augusto

    2017-07-20

    To examine whether demographic and socioeconomic variables and the variables of the organization of services are associated with the quality of cervical cancer screening. This is a survey carried out in the health services of the five Brazilian regions in 2012. The sample consisted of users of basic health units participating in the Program for Improving Access and Quality of the Primary Care. The independent variables analyzed were: socioeconomic characteristics (municipal context), demographic characteristics (user profile), and two domains related to the organization of basic services (work structure and process). The low quality of the screening was assessed from the lack of access, late examination, and lack of guidance. Crude and adjusted analyses by Poisson regression assessed the association between outcomes and independent variables. The values of lack of access, late examination, and lack of guidance were 6.7%, 11.2%, and 19.2%, respectively. Problems of quality were lower according to the increase in Municipal Human Development Index and per capita household income, increasing with population size and municipal coverage of the Family Health Strategy. The Midwest region of the country presented the highest occurrences of low quality outcomes. Indigenous and yellow women had the highest prevalence of outcomes. Women with partner, who received the Bolsa Família Program, and who had paid work had less chances of having lack of access, late examination, and lack of guidance. The appropriate work process in health services decreased the likelihood of low quality in all indicators. Investments in the work process of health teams, social cash transfer programs, and social conditions of the population are essential to improve the quality of the program of cervical cancer screening in Brazil. Analisar se as variáveis demográficas, socioeconômicas e da organização dos serviços estão associadas à qualidade do rastreamento do câncer de colo uterino. Inqu

  7. External Quality Assessment for Detection of Fetal Trisomy 21, 18, and 13 by Massively Parallel Sequencing in Clinical Laboratories.

    Science.gov (United States)

    Zhang, Rui; Zhang, Hongyun; Li, Yulong; Han, Yanxi; Xie, Jiehong; Li, Jinming

    2016-03-01

    An external quality assessment for detection of trisomy 21, 18, and 13 by massively parallel sequencing was implemented by the National Center for Clinical Laboratories of People's Republic of China in 2014. Simulated samples were prepared by mixing fragmented abnormal DNA with plasma from non-pregnant women. The external quality assessment panel, comprising 5 samples from pregnant healthy women, 2 samples with sex chromosome aneuploidies, and 13 samples with different concentrations of fetal fractions positive for trisomy 21, 18, and 13, was then distributed to participating laboratories. In total, 55.6% (47 of 84) of respondents correctly identified each of the samples in the panel. Seventeen false-negative and 87 gray zone results were reported, most [102 of 104 (98.1%)] of which were derived from for trisomy samples with effective fetal fractions laboratories generated false-positive results. In addition, we observed varied diagnostic capabilities of different assays, with the assay on the basis of NextSeq CN500 performing better than others, whereas Z values generated by BGISEQ-100 fluctuated greatly. There were no significant correlations between the numbers of unique sequence reads and Z values from any trisomy sample generated by BGISEQ-100. Overall, most clinical laboratories detected samples containing effective fetal fractions >4%. Our study shows need for further laboratory training in the management of samples with low fetal fractions. For some assays, precision of Z values needs to be improved. Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  8. [National External Quality Assessment for medical biology laboratories in Burkina Faso: an overview of three years of activity].

    Science.gov (United States)

    Sakande, Jean; Nikièma, Abdoulaye; Kabré, Elie; Nacoulma, Eric; Sawadogo, Charles; Lingani, Virginie; Traoré, Lady Kady; Kouanda, Abdoulaye; Kientéga, Youssouf; Somda, Joseph; Kagambéga, Faustin; Sanou, Mahamoudou; Sangaré, Lassana; Traoré-Ouédraogo, Rasmata

    2010-01-01

    We report results of the National External Quality Assessment for (NEQA) laboratories in Burkina Faso, a country with limited resources located in West Africa whose epidemiology is dominated by infectious diseases. The national laboratory network consists of 160 laboratories including 40 private. The Government of Burkina Faso has adopted a national laboratory policy. One of the objectives of this policy is to improve the quality of laboratory results. One of the strategies to achieve this objective is the establishment of a NEQA. The NEQA is a panel testing also called proficiency testing. It is mandatory for all laboratories to participate to the NEQA. The NEQA is organized twice a year and covers all areas of laboratories (bacteriology-virology, biochemistry, hematology, parasitology and immunology). The review of three years of activity (2006-2008) shows the following results: (1) for microscopic examination of bacteria after Gram staining, the error rate decreased from 24.7% in 2006 to 13.1% in 2007 and 13% in 2008; (2) errors rate in reading slides for the microscopic diagnosis of malaria were 23.4%, 14.6% and 10.2% respectively in 2006, 2007 and 2008; (3) for biochemistry, the percentages of unsatisfactory results were respectively 12.5%, 14.8% and 13.8% in 2006, 2007 and 2008 for the overall parameters assessed. The analysis of the results generated by the laboratories during these three years shows a quality improvement. However, the NEQA should be strengthened through ongoing training and quality control of reagents and equipment.

  9. Influence of physical activity, sedentary behavior, and diet quality in childhood on the incidence of internalizing and externalizing disorders during adolescence: a population-based cohort study.

    Science.gov (United States)

    Wu, XiuYun; Bastian, Kerry; Ohinmaa, Arto; Veugelers, Paul

    2018-02-01

    Studies among youth suggest that physical inactivity, sedentary behaviors, and poor diet quality are associated with poor mental health. Few population-based studies have investigated these relationships longitudinally. We examined the association between physical activity, sedentary behaviors, and diet quality in childhood and the incidence of internalizing and externalizing disorders throughout adolescence. We linked health behavior survey data from 2003 among 10- to 11-year-old children across Nova Scotia, Canada, with administrative health care data from 2003 to 2011. Students' diet quality was assessed using the Harvard Food Frequency Questionnaire. Physical activity and sedentary behaviors were self-reported, and internalizing and externalizing disorders were diagnosed by a physician. We applied Cox regression to examine the associations of the health behaviors with the incidence of internalizing and externalizing disorders between 2003 and 2011. Of the 4861 participating students, 23.7% and 9.4% had a diagnosis of internalizing and externalizing disorders, respectively. The incidences of internalizing and externalizing disorders were higher among students who were less physically active and spent more time using computers and video games. These findings suggest that promoting an active lifestyle in childhood may contribute to the prevention of both internalizing and externalizing disorders during adolescence. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. External quality assessment of cytomegalovirus DNA detection on dried blood spots

    Directory of Open Access Journals (Sweden)

    Binda Sandro

    2008-01-01

    Full Text Available Abstract Background Testing for viral DNA in neonatal blood dried on paper (DBS has proved a valid means of diagnosing congenital CMV infection with both clinical and epidemiological relevance. To assess the quality of the detection of CMV-DNA on DBS in laboratories performing this test a proficiency panel consisting of nine samples with two blood spots on each filter paper was produced and distributed. Six samples were derived from whole blood, negative for CMV DNA and antibody, and spiked with cell-grown CMV Towne in various concentrations (7.3 × 102 – 9.6 × 105 copies/ml, one was a CMV positive clinical specimen (3.9 × 106 copies/ml, and two samples were CMV-negative whole blood. Results The 27 responding laboratories from 14 countries submitted 33 datasets obtained by means of conventional PCR (n = 5 or real-time PCR (n = 28 technologies. A correct positive result was reported in at least 91% of datasets in samples with a viral load of 8.8 × 104 copies/ml or higher. However only 59% and 12% identified the 9.4 × 103 and 7.3 × 102 copies/ml samples, respectively, correctly as positive. False positive results were reported by 9% of laboratories and in 11% of datasets. Conclusion These results indicate a clear need for improvement of methods as sensitivity and false-positivity still appear to be a major problem in a considerable number of laboratories.

  11. Intensive educational efforts combined with external quality assessment improve the preanalytical phase in general practitioner offices and nursing homes.

    Science.gov (United States)

    Sølvik, Una Ørvim; Bjelkarøy, Wenche Iren; Berg, Kari van den; Saga, Anne Lise; Hager, Helle Borgstrøm; Sandberg, Sverre

    2017-10-26

    Errors in the preanalytical phase in clinical laboratories affect patient safety. The aim of this study was to evaluate the effect of intensive educational efforts together with external quality assessment (EQA) of the preanalytical phase from 2013 to 2015 to improve patient identification in primary health care in Norway. In addition, routines for venous and capillary blood sampling were investigated. A preanalytical EQA was circulated in 2013 by the Norwegian Quality Improvement of Laboratory Examinations (Noklus) to general practitioner offices and nursing homes (n=2000) to obtain information about important issues to focus on before launching an intensive educational program with courses, posters and visits in 2013-2015. Preanalytical EQA surveys were further circulated in 2014 and 2015. The response rate varied between 42% and 55%. The percentages of participants asking for the patients' name and the Norwegian identification number increased from about 8% in 2013 to about 35% in 2015. The increase was similar for those participating in only one EQA survey and for those who participated in EQA surveys both in 2013 and 2015. Guidelines for venous and capillary blood sampling were not always followed. Educational efforts more than the preanalytical EQA influenced the actions and resulted in an increase in the percentages of participants that followed the guidelines for patient identification. Some aspects of blood sampling routines need improvement.

  12. Improvement in the performance of external quality assessment in Korean HIV clinical laboratories using unrecalcified human plasma.

    Science.gov (United States)

    Wang, Jin-Sook; Kee, Mee-Kyung; Choi, Byeong-Sun; Kim, Chan-Wha; Kim, Hyon-Suk; Kim, Sung Soon

    2012-01-01

    The external quality assessment schemes (EQAS) organizer provides a suitable program to monitor and improve the quality of human immunodeficiency virus (HIV) testing laboratories with EQAS panels prepared under various conditions. The aim of the current study was to investigate the effects of human plasma samples on the EQAS results of HIV obtained from hospital-based clinical laboratories. From 2007 to 2009, HIV EQAS panels consisted of four to six samples that consisted of undiluted positive and negative samples and were provided to laboratories twice per year. Up until the first half EQAS in 2008, EQAS panel materials were obtained by converting acid citrate dextrose treated plasma to serum via chemical treatment with CaCl2. Beginning with the second EQAS in 2008, all materials were prepared without the defibrination process. Approximately 300 HIV clinical laboratories participated in this program. The overall performance of clinical laboratories was shown to be improved when using unrecalcified plasma panels compared with recalcified panels. Significant differences were observed in EIA analyses of plasma for both positive (plaboratories.

  13. [Assessment of the quality of laboratory diagnosis of intestinal parasitic diseases by the laboratories participating in the Federal System of External Quality Assessment of Clinical Laboratory Testing].

    Science.gov (United States)

    Malakhov, V N; Dovgalev, A S; Astanina, S Iu; Serdiuk, A P

    2014-01-01

    In 2010-2013, the quality of microscopic detection of the causative agents ofparasitic diseases in the feces has been assessed by the specialists of the laboratories of the therapeutic-and-prophylactic institutions (TPIs) and Hygiene and Epidemiology Centers, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare, which are participants of the Federal System of External Quality Assessment of Clinical Laboratory Testing. Thirty-two specimens containing 16 species of human helminths and 4 species of enteric protozoa in different combinations were examined. The findings suggest that the quality of microscopic detection of the causative agents of parasitic diseases is low in the laboratories of health care facilities and that the specialists of the laboratories of TPIs and Hygiene and Epidemiology Centers, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare, do not not possess the knowledge and skills necessary to make a laboratory diagnosis of helminths and enteric protozoa. The average detection rates of helminths and protozoa were at a level of 64 and 36%, respectively. The correct results showed that the proportion of helminths and protozoa were 94.5 and 5.5%, respectively. According to the biological and epidemiological classification of helminths, there were higher detection rates for contact group parasites (Enterobius vermicularis and Hymenolepis nana) and geohelminths (Ascaris, Trichuris trichiura, and others). Biohelminths (Opisthorchis, tapeworms, and others) Were detectable slightly worse.

  14. Application of HTB-SiHa cells transfected with a recombinant plasmid for external quality assessment of Chlamydia trachomatis PCR.

    Science.gov (United States)

    Zhang, Kuo; Huo, Hong; Sun, Yu; Wang, Lunan; Zhang, Rui; Lin, Guigao; Xie, Jiehong; Wang, Qingtao; Li, Jinming

    2014-09-01

    The participation of laboratories in external quality assessment (EQA) programs is required for the quality assurance of nucleic acid amplification of Chlamydia trachomatis. This study aimed to construct a new quality control (QC) material applicated in EQA of C. trachomatis PCR. A QC material-HTB-SiHa cells transfected with a recombinant plasmid containing the cryptic plasmid sequence-was constructed for C. trachomatis PCR detection, and four different panels, each consisting of 4 positive samples with serial dilution of the constructed QC material and 1 negative sample, were distributed by the National Center for Clinical Laboratories among four groups of 275, 268, 317, and 304 participants across China from 2011 through 2012. A total of eight commercial kits were used for C. trachomatis PCR detection in participants. Nine laboratories reported false-positive results (0.9%). As the series dilution increased, the correct reporting of the data sets decreased; the lowest correct rate was 96.3% in the weakest positive samples (10(4) copies/mL). Eight laboratories reported false-positive results, and 42 laboratories reported false-negative results in the EQA detection of C. trachomatis. No significant differences were observed in the detection of the constructed C. trachomatis positive samples (97.9%, 98.5%, 100%, 98.5%; P=0.36) and negative samples (100%, 99.0%, 100%, 99.0%; P=0.764) using four commercial kits commonly used in China. The results of the EQA study indicated that the constructed material provides a noninfectious, stable control material with sufficient volume for PCR detection of C. trachomatis.

  15. Regional Externalities

    NARCIS (Netherlands)

    Heijman, W.J.M.

    2007-01-01

    The book offers practical and theoretical insights in regional externalities. Regional externalities are a specific subset of externalities that can be defined as externalities where space plays a dominant role. This class of externalities can be divided into three categories: (1) externalities

  16. A rapid communication from the AAPM Task Group 201: recommendations for the QA of external beam radiotherapy data transfer. AAPM TG 201: quality assurance of external beam radiotherapy data transfer.

    Science.gov (United States)

    Siochi, R Alfredo; Balter, Peter; Bloch, Charles D; Santanam, Lakshmi; Blodgett, Kurt; Curran, Bruce H; Engelsman, Martijn; Feng, Wenzheng; Mechalakos, Jim; Pavord, Dan; Simon, Tom; Sutlieff, Steven; Zhu, X Ronald

    2010-12-04

    The transfer of radiation therapy data among the various subsystems required for external beam treatments is subject to error. Hence, the establishment and management of a data transfer quality assurance program is strongly recommended. It should cover the QA of data transfers of patient specific treatments, imaging data, manually handled data and historical treatment records. QA of the database state (logical consistency and information integrity) is also addressed to ensure that accurate data are transferred.

  17. [Evaluation of external quality assurance in accordance with sect. 137 SGB V at the Carl Gustav Carus university hospital in Dresden].

    Science.gov (United States)

    Petzold, Thomas; Steinwitz, Adrienne; Schmitt, Jochen; Eberlein-Gonska, Maria

    2013-01-01

    Obligatory external quality assurance is an established method used to ensure the quality of inpatient care in Germany. The comprehensive approach is unique in international comparison. In addition to the statutory requirement, the health insurance funds require this form of external quality control in order to foster quality-based competition between hospitals. Ever since its introduction, healthcare providers have scrutinised the effects of the mandatory use of this survey. The study was based on all patients in the University Hospital Dresden, for whom a quality assurance sheet (n = 45,639) had to be recorded between 2003 and 2011. The documentation of these sheets was carried out by specially trained personnel. For each performance area, the duration of the documentation quality sheets was assessed, and a descriptive analysis of all quality assurance sheets was conducted. In the presence of statistical significance the so-called "Structured Dialogues" were analysed. Over the whole period, 167 statistically noticeable problems occurred. Nine of these have been rated as noticeable problems in medical quality by the specialised working groups of the project office quality assurance (PGSQS) at the Saxon State Medical Association (SLÄK). The remaining 158 statistical anomalies included 25 documentation errors; 96 were classified as statistically significant, and only 37 were marked to indicate that re-observation by the PGSQS was required. The total effort estimate for the documentation of quality assurance sheets was approximately 1,420 working days in the observation period. As far as the quality of patient care is concerned, the results can be considered positive because only a small number of quality indicators indicate noticeable qualitative problems. This statement is based primarily on the comparison of the groups of Saxony and Germany, which are included in the quality report of external quality assurance in accordance with sect. 137 SGB V. The majority of

  18. SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, D; Chung, E; Hess, C; Stern, R; Benedict, S [UC Davis Cancer Center, Sacramento, CA (United States)

    2015-06-15

    Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patient treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements upstream

  19. Relationship between external stink bug (Hemiptera: Pentatomidae) boll-feeding symptoms and internal boll damage with respect to cotton lint gin-out and fiber quality.

    Science.gov (United States)

    Blinka, Eric L; Herbert, Ames; Malone, Sean; Van Duyn, John W; Roberts, Phillip; Bradley, J R; Bacheler, Jack S

    2010-12-01

    Cotton, Gossypium hirsutum L., bolls from 17 field locations in northeastern North Carolina and southeastern Virginia, having 20% or greater internal boll damage, were studied to determine the relationship between external feeding symptoms and internal damage caused by stink bug (Hemiptera: Pentatomidae) feeding. In 2006 and 2007, two cohorts of 100 bolls each were sampled at all field locations. The first cohort was removed as bolls reached approximately quarter size in diameter (2.4 cm). External and internal symptoms of stink bug feeding were assessed and tabulated. Concurrent to when the first cohort was collected, a second cohort of quarter-size-diameter bolls was identified, tagged, examined in situ for external feeding symptoms (sunken lesions), and harvested at the black seed coat stage. Harvested bolls were assessed for internal damage and locks were categorized (undamaged, minor damage, or major damage), dried, and ginned. Lint samples from each damage category were submitted for high volume instrument and advanced fiber information system quality analyses. Significant, moderately strong Pearson correlation coefficients existed between number of external stink bug feeding lesions and internal damage. Pearson correlation of total external lesions with total internal damage was stronger than any correlation among the other single components compared. Predictability plots indicated a rapid increase in relationship strength when relating external stink bug lesions to internal damage as the number of external lesions increased. Approximately 90% predictability of internal damage was achieved with four (2006) or six (2007) external lesions per boll. Gin-turnout and fiber quality decreased with increasing intensity of internal stink bug damage.

  20. External quality assessment for arbovirus diagnostics in the World Health Organization Western Pacific Region, 2013–2016: improving laboratory quality over the years

    Directory of Open Access Journals (Sweden)

    Mohammad Yazid Abdad

    2017-09-01

    Full Text Available Arboviruses continue to pose serious public health threats in the World Health Organization (WHO Western Pacific Region. As such, laboratories need to be equipped for their accurate detection. In 2011, to ensure test proficiency, the WHO Regional Office for the Western Pacific piloted an external quality assessment (EQA programme for arbovirus diagnostics. By 2016, it had grown into a global programme with participation of 96 laboratories worldwide, including 25 laboratories from 19 countries, territories and areas in the Region. The test performance of the 25 laboratories in the Region in 2016 was high with 23 (92% reporting correct results in all specimens for dengue and chikungunya viruses. For Zika virus, 18 (72% of the 25 laboratories reported correct results in all specimens, while seven (28% demonstrated at least one error. When comparing iterations of this EQA programme in the Region between 2013 and 2016, the number of participating laboratories increased from 18 to 25. The first round only included dengue virus, while the latest round additionally included chikungunya, Zika and yellow fever viruses. Proficiency for molecular detection of dengue virus remained high (83–94% over the four-year period. The observed proficiency for arbovirus diagnostics between 2013 and 2016 is an indicator of laboratory quality improvement in the Region.

  1. European external quality control study on the competence of laboratories to recognize rare sequence variants resulting in unusual genotyping results.

    Science.gov (United States)

    Márki-Zay, János; Klein, Christoph L; Gancberg, David; Schimmel, Heinz G; Dux, László

    2009-04-01

    Depending on the method used, rare sequence variants adjacent to the single nucleotide polymorphism (SNP) of interest may cause unusual or erroneous genotyping results. Because such rare variants are known for many genes commonly tested in diagnostic laboratories, we organized a proficiency study to assess their influence on the accuracy of reported laboratory results. Four external quality control materials were processed and sent to 283 laboratories through 3 EQA organizers for analysis of the prothrombin 20210G>A mutation. Two of these quality control materials contained sequence variants introduced by site-directed mutagenesis. One hundred eighty-nine laboratories participated in the study. When samples gave a usual result with the method applied, the error rate was 5.1%. Detailed analysis showed that more than 70% of the failures were reported from only 9 laboratories. Allele-specific amplification-based PCR had a much higher error rate than other methods (18.3% vs 2.9%). The variants 20209C>T and [20175T>G; 20179_20180delAC] resulted in unusual genotyping results in 67 and 85 laboratories, respectively. Eighty-three (54.6%) of these unusual results were not recognized, 32 (21.1%) were attributed to technical issues, and only 37 (24.3%) were recognized as another sequence variant. Our findings revealed that some of the participating laboratories were not able to recognize and correctly interpret unusual genotyping results caused by rare SNPs. Our study indicates that the majority of the failures could be avoided by improved training and careful selection and validation of the methods applied.

  2. Investigation of cholesterol bias due to a matrix effect of external quality assurance samples: how true is your cholesterol method?

    Science.gov (United States)

    Pretorius, Carel J; Klingberg, Sandra; Johnson, Leslie; Park, Rodney; Wilgen, Urs; Ungerer, Jacobus P J

    2012-11-01

    Comparability of cholesterol measurement is clinically required and external quality assurance (EQA) programmes are important to verify the trueness of routine methods. We developed a gas chromatography-isotope dilution mass spectrometry (GC-IDMS) total cholesterol assay to investigate the cause of a suspected matrix-related negative bias with the Beckman Coulter enzymatic method discovered in an EQA programme. The GC-IDMS method was calibrated with certified reference material and verified against a secondary reference method. Bias between the GC-IDMS and Beckman Coulter methods was estimated according to Clinical and Laboratory Standards Institute (CLSI) protocol EP9-A2 with 40 clinical samples. At clinically important decision levels, no significant bias was demonstrated on patients' samples (all results within a ±3% limit). A matrix effect confined to the EQA material that affected the Beckman Coulter total cholesterol method was confirmed. The GC-IDMS method is suitable as a higher order total cholesterol method in a routine clinical laboratory. Matrix effects defeat the objectives of EQA schemes by preventing the verification of trueness. Given the importance of obtaining a true cholesterol result without systematic error, we recommend that EQA material without matrix effects should be used.

  3. Routine internal- and external-quality control data in clinical laboratories for estimating measurement and diagnostic uncertainty using GUM principles.

    Science.gov (United States)

    Magnusson, Bertil; Ossowicki, Haakan; Rienitz, Olaf; Theodorsson, Elvar

    2012-05-01

    Healthcare laboratories are increasingly joining into larger laboratory organizations encompassing several physical laboratories. This caters for important new opportunities for re-defining the concept of a 'laboratory' to encompass all laboratories and measurement methods measuring the same measurand for a population of patients. In order to make measurement results, comparable bias should be minimized or eliminated and measurement uncertainty properly evaluated for all methods used for a particular patient population. The measurement as well as diagnostic uncertainty can be evaluated from internal and external quality control results using GUM principles. In this paper the uncertainty evaluations are described in detail using only two main components, within-laboratory reproducibility and uncertainty of the bias component according to a Nordtest guideline. The evaluation is exemplified for the determination of creatinine in serum for a conglomerate of laboratories both expressed in absolute units (μmol/L) and relative (%). An expanded measurement uncertainty of 12 μmol/L associated with concentrations of creatinine below 120 μmol/L and of 10% associated with concentrations above 120 μmol/L was estimated. The diagnostic uncertainty encompasses both measurement uncertainty and biological variation, and can be estimated for a single value and for a difference. This diagnostic uncertainty for the difference for two samples from the same patient was determined to be 14 μmol/L associated with concentrations of creatinine below 100 μmol/L and 14 % associated with concentrations above 100 μmol/L.

  4. External quality assurance as a revalidation method for pathologists in pediatric histopathology: Comparison of four international programs

    Directory of Open Access Journals (Sweden)

    Mikuz Gregor

    2008-11-01

    Full Text Available Abstract Aim External quality assurance (EQA is an extremely valuable resource for clinical pathologists to maintain high standards, improve diagnostic skills, and possibly revalidate medical license. The aim of this study was to participate in and compare four international slide survey programs (UK, IAP-Germany, USA-Canada, Australasia in pediatric histopathology for clinical pathologists with the aim to use it as a revalidation method. Methods The following parameters were evaluated: number of circulations per year, number of slides, membership requirement, proof of significant pediatric pathology work, open to overseas participants, laboratory accreditation, issue of continuing professional development certificates and credits, slides discussion meeting, use of digital images, substandard performance letter, and anonymity of responses. Results The UK scheme, which has sampling procedure over several time frames (2 circulations/year, 30 slides, partial confidentiality, and multiple sources of data and assessors, can be used as a model for revalidation. The US-Canadian and Australasian schemes only partially fulfill the revalidation requirements. The IAP scheme appears to be essentially an educational program and may be unsuitable for revalidation. Conclusion The purposes and programs of EQA schemes vary worldwide. In order for it to be used for revalidation, it is advisable that EQA schemes are immediately unified.

  5. Influence of apixaban on commonly used coagulation assays: results from the Belgian national External Quality Assessment Scheme.

    Science.gov (United States)

    Van Blerk, M; Bailleul, E; Chatelain, B; Demulder, A; Devreese, K; Douxfils, J; Jacquemin, M; Jochmans, K; Mullier, F; Wijns, W; China, B; Vernelen, K; Soumali, M R

    2017-08-01

    The Belgian national External Quality Assessment Scheme performed a survey to assess the effect of the direct oral anticoagulant apixaban on the coagulation assays prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and antithrombin as performed with a large number of reagent/instrument combinations. Four lyophilized plasma samples spiked with apixaban (0, 41, 94 and 225 ng/mL) were sent to the 195 Belgian and Luxembourg clinical laboratories performing coagulation testing. PT and aPTT were barely influenced at the concentrations tested. At 225 ng/mL apixaban, PT and aPTT clotting times were only 1.15 times longer than at 0 ng/mL. Among PT reagents, RecombiPlasTin 2G® showed a slightly higher sensitivity with 225 ng/mL apixaban prolonging the PT clotting time 1.3-fold. Among aPTT reagents, there was no appreciable difference in sensitivity. Fibrinogen results were unaffected by the presence of apixaban, but antithrombin activity was considerably overestimated when measured with a FXa-based assay. At 225 ng/mL apixaban, the median percentage increase in antithrombin level was 31% when measured with the Liquid Antithrombin® reagent and 44% with the Innovance Antithrombin® reagent. Our data provide clinical laboratories with useful information on the impact of apixaban on their routine coagulation assays. © 2017 John Wiley & Sons Ltd.

  6. Isolation and identification of Burkholderia cepacia by participants in an external Quality Assurance Program (QAP) between 1994 and 1999.

    Science.gov (United States)

    Taylor, Peter C; McLaws, Mary-Louise; De Borde, Margot; Pritchard, Robert

    2004-08-01

    External quality assurance programs (QAPs) provide an opportunity to benchmark laboratory performance according to the profile of specimens received. Participant confidentiality is maintained within each group of laboratories whose performance is measured using similar, repetitive exercises. Isolation and identification of Burkholderia cepacia from simulated cystic fibrosis (CF) sputa was a clinically relevant exercise that provided a model for this analytical approach. Between 1994 and 1999, six Royal College of Pathologists of Australasia (RCPA) Microbiology QAPs included four simulated CF sputa and two panels of oxidative Gram-negative bacilli. Laboratories were grouped according to experience with CF sputa disclosed by two questionnaires. Data were analysed by laboratory group for ability to isolate and identify B. cepacia. Three laboratory groups annually received >100 CF sputa (CF>100), 100 CF sputa or fewer, or did not regularly receive CF sputa. CF>100 laboratories inoculated more isolation media, were more likely to use selective media and were less likely to misidentify B. cepacia than the other groups. Improved performance by CF>100 laboratories was marked after the first exercise and remained at a high level compared with the other two groups. This trend in performance was also apparent for Pseudomonas aeruginosa although the numbers of errors were less than for B. cepacia. These exercises demonstrated consistently improved performance only among CF>100 laboratories. The future criteria for laboratory accreditation may include performance as well as participation in QAPs, placing additional burdens on organisers and participants.

  7. The Indirect Effect of Family Cohesion on Children's Weight Status through Maternal Quality of Life and Children's Internalizing and Externalizing Symptoms

    Science.gov (United States)

    Frontini, Roberta; Haycraft, Emma; Canavarro, Maria Cristina; Moreira, Helena

    2017-01-01

    Background: Obesity has serious psychosocial consequences for youth and family members and has reached epidemic levels in Portugal. Objective: This study had two goals: (1) to investigate differences in family cohesion, mothers' quality of life (QoL), and externalizing/internalizing symptoms between children/adolescents with healthy-weight and…

  8. An approach for estimating measurement uncertainty in medical laboratories using data from long-term quality control and external quality assessment schemes.

    Science.gov (United States)

    Padoan, Andrea; Antonelli, Giorgia; Aita, Ada; Sciacovelli, Laura; Plebani, Mario

    2017-10-26

    The present study was prompted by the ISO 15189 requirements that medical laboratories should estimate measurement uncertainty (MU). The method used to estimate MU included the: a) identification of quantitative tests, b) classification of tests in relation to their clinical purpose, and c) identification of criteria to estimate the different MU components. Imprecision was estimated using long-term internal quality control (IQC) results of the year 2016, while external quality assessment schemes (EQAs) results obtained in the period 2015-2016 were used to estimate bias and bias uncertainty. A total of 263 measurement procedures (MPs) were analyzed. On the basis of test purpose, in 51 MPs imprecision only was used to estimate MU; in the remaining MPs, the bias component was not estimable for 22 MPs because EQAs results did not provide reliable statistics. For a total of 28 MPs, two or more MU values were calculated on the basis of analyte concentration levels. Overall, results showed that uncertainty of bias is a minor factor contributing to MU, the bias component being the most relevant contributor to all the studied sample matrices. The model chosen for MU estimation allowed us to derive a standardized approach for bias calculation, with respect to the fitness-for-purpose of test results. Measurement uncertainty estimation could readily be implemented in medical laboratories as a useful tool in monitoring the analytical quality of test results since they are calculated using a combination of both the long-term imprecision IQC results and bias, on the basis of EQAs results.

  9. External quality-assurance results for the National Atmospheric Deposition Program/National Trends Network, 2002-03

    Science.gov (United States)

    Wetherbee, Gregory A.; Latysh, Natalie E.; Burke, Kevin P.

    2005-01-01

    Six external quality-assurance programs were operated by the U.S. Geological Survey (USGS) External Quality-Assurance (QA) Project for the National Atmospheric Deposition Program/National Trends Network (NADP/NTN) from 2002 through 2003. Each program measured specific components of the overall error inherent in NADP/NTN wet-deposition measurements. The intersite-comparison program assessed the variability and bias of pH and specific conductance determinations made by NADP/NTN site operators twice per year with respect to accuracy goals. The percentage of site operators that met the pH accuracy goals decreased from 92.0 percent in spring 2002 to 86.3 percent in spring 2003. In these same four intersite-comparison studies, the percentage of site operators that met the accuracy goals for specific conductance ranged from 94.4 to 97.5 percent. The blind-audit program and the sample-handling evaluation (SHE) program evaluated the effects of routine sample handling, processing, and shipping on the chemistry of weekly NADP/NTN samples. The blind-audit program data indicated that the variability introduced by sample handling might be environmentally significant to data users for sodium, potassium, chloride, and hydrogen ion concentrations during 2002. In 2003, the blind-audit program was modified and replaced by the SHE program. The SHE program was designed to control the effects of laboratory-analysis variability. The 2003 SHE data had less overall variability than the 2002 blind-audit data. The SHE data indicated that sample handling buffers the pH of the precipitation samples and, in turn, results in slightly lower conductivity. Otherwise, the SHE data provided error estimates that were not environmentally significant to data users. The field-audit program was designed to evaluate the effects of onsite exposure, sample handling, and shipping on the chemistry of NADP/NTN precipitation samples. Field-audit results indicated that exposure of NADP/NTN wet-deposition samples

  10. Using additional external inputs to forecast water quality with an artificial neural network for contamination event detection in source water

    Science.gov (United States)

    Schmidt, F.; Liu, S.

    2016-12-01

    Source water quality plays an important role for the safety of drinking water and early detection of its contamination is vital to taking appropriate countermeasures. However, compared to drinking water, it is more difficult to detect contamination events because its environment is less controlled and numerous natural causes contribute to a high variability of the background values. In this project, Artificial Neural Networks (ANNs) and a Contamination Event Detection Process (CED Process) were used to identify events in river water. The ANN models the response of basic water quality sensors obtained in laboratory experiments in an off-line learning stage and continuously forecasts future values of the time line in an on-line forecasting step. During this second stage, the CED Process compares the forecast to the measured value and classifies it as regular background or event value, which modifies the ANN's continuous learning and influences its forecasts. In addition to this basic setup, external information is fed to the CED Process: A so-called Operator Input (OI) is provided to inform about unusual water quality levels that are unrelated to the presence of contamination, for example due to cooling water discharge from a nearby power plant. This study's primary goal is to evaluate how well the OI fits into the design of the combined forecasting ANN and CED Process and to understand its effects on the online forecasting stage. To test this, data from laboratory experiments conducted previously at the School of Environment, Tsinghua University, have been used to perform simulations highlighting features and drawbacks of this method. Applying the OI has been shown to have a positive influence on the ANN's ability to handle a sudden change in background values, which is unrelated to contamination. However, it might also mask the presence of an event, an issue that underlines the necessity to have several instances of the algorithm run in parallel. Other difficulties

  11. Improvement of coagulation laboratory practice in Thailand: the first-year experience of the national external quality assessment scheme for blood coagulation.

    Science.gov (United States)

    Tientadakul, Panutsaya; Opartkiattikul, Nisarat; Wongtiraporn, Wanida

    2009-01-01

    In Thailand until 2005 there had been no external quality assessment scheme at the national level for blood coagulation tests. Only a few laboratories had an external quality assessment for these tests. In the year 2005, the Thailand National External Quality Assessment Scheme for Blood Coagulation was founded. To describe the establishment of the Thailand National External Quality Assessment Scheme for Blood Coagulation (including problems encountered and solutions), its progression and expansion, and the improvement of coagulation laboratory practice in Thailand during 2 trial surveys and 4 formal surveys conducted in the first 1 1/2 years. Between 2005 and 2006, the external quality assessment samples for prothrombin time/international normalized ratio and activated partial thromboplastin time were distributed to the participants as well as the instructions and suggestions for the improvement of laboratory practice. From the data collected, the all-method coefficient of variation of the international normalized ratio and activated partial thromboplastin time was calculated for each survey. The number of participants increased during the first 1 1/2 years that the surveys were conducted, from 109 to 127. Survey data demonstrate an improvement in response rate and an increase in the number of laboratories that determine their own reference ranges and repeat this for every change of reagent lot, using the appropriate anticoagulant. The increased precision of tests is indicated by the decrease of the all-method coefficient of variation of the international normalized ratio and activated partial thromboplastin time. Examples of individual laboratory improvement through feedback are also described. The improvement of coagulation laboratory practice both through the instructions provided and liaison with participants was observed during the course of this scheme.

  12. Minimal requirements for quality controls in radiotherapy with external beams; Controlli di qualita' essenziali in radioterapia con fasci esterni

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-07-01

    Physical dosimetric guidelines have been developed by the Italian National Institute of Health study group on quality assurance in radiotherapy to define protocols for quality controls in external beam radiotherapy. While the document does not determine strict rules or firm recommendations, it suggests minimal requirements for quality controls necessary to guarantee an adequate degree of accuracy in external beam radiotherapy. [Italian] Il gruppo di studio Assicurazione di qualita' in radioterapia dell'Istituto Superiore di Sanita' presenta le linee guida per la stesura dei protocolli di controllo di qualita' essenziali necessari a garantire un adeguato livello di accuratezza del trattamento radiante e rappresenta pertanto una parte essenziale del contributo fisico-dosimetrico globale di assicurazione di qualita' in radioterapia con fasci esterni.

  13. Successes and Short Comings in Four Years of an International External Quality Assurance Program for Animal Influenza Surveillance.

    Directory of Open Access Journals (Sweden)

    Erica Spackman

    Full Text Available The US National institutes of Health-Centers of Excellence for Influenza Research and Surveillance is a research consortium that funds numerous labs worldwide to conduct influenza A surveillance in diverse animal species. There is no harmonization of testing procedures among these labs; therefore an external quality assurance (EQA program was implemented to evaluate testing accuracy among labs in the program in 2012. Accurate detection of novel influenza A variants is crucial because of the broad host range and potentially high virulence of the virus in diverse species. Two molecular detection sample sets and 2 serology sample sets (one with avian origin isolates, and one with mammalian origin isolates each were made available at approximately six month intervals. Participating labs tested the material in accordance with their own protocols. During a five year period a total of 41 labs from 23 countries ordered a total of 132 avian molecular, 121 mammalian molecular and 90 serology sample sets. Testing was completed by 111 individuals. Detection of type A influenza by RT-PCR was reliable with a pass rate (80% or greater agreement with expected results of 86.6% for avian and 86.2% for mammalian origin isolates. However, identification of subtype by RT-PCR was relatively poor with 54.1% and 75.9% accuracy for avian and mammalian influenza isolates respectively. Serological testing had an overall pass rate of 86.9% and 22/23 labs used commercial ELISA kits. Based on the results of this EQA program six labs modified their procedures to improve accuracy and one lab identified an unknown equipment problem. These data represent the successful implementation of an international EQA program for an infectious disease; insights into the logistics and test design are also discussed.

  14. External Quality Assessment for Tuberculosis Diagnosis and Drug Resistance in the European Union: A Five Year Multicentre Implementation Study.

    Science.gov (United States)

    Nikolayevskyy, Vladyslav; Hillemann, Doris; Richter, Elvira; Ahmed, Nada; van der Werf, Marieke J; Kodmon, Csaba; Drobniewski, Francis; Ruesch-Gerdes, Sabine

    2016-01-01

    External quality assurance (EQA) systems are essential to ensure accurate diagnosis of TB and drug-resistant TB. The implementation of EQA through organising regular EQA rounds and identification of training needs is one of the key activities of the European TB reference laboratory network (ERLTB-Net). The aim of this study was to analyse the results of the EQA rounds in a systematic manner and to identify potential benefits as well as common problems encountered by the participants. The ERLTB-Net developed seven EQA modules to test laboratories' proficiency for TB detection and drug susceptibility testing using both conventional and rapid molecular tools. All National TB Reference laboratories in the European Union and European Economic Area (EU/EEA) Member States were invited to participate in the EQA scheme. A total of 32 National TB Reference laboratories participated in six EQA rounds conducted in 2010-2014. The participation rate ranged from 52.9% - 94.1% over different modules and rounds. Overall, laboratories demonstrated very good proficiency proving their ability to diagnose TB and drug-resistant TB with high accuracy in a timely manner. A small number of laboratories encountered problems with identification of specific Non-tuberculous Mycobacteria (NTMs) (N = 5) and drug susceptibility testing to Pyrazinamide, Amikacin, Capreomycin, and Ethambutol (N = 4). The European TB Reference laboratories showed a steady and high level of performance in the six EQA rounds. A network such as ERLTB-Net can be instrumental in developing and implementing EQA and in establishing collaboration between laboratories to improve the diagnosis of TB in the EU/EEA.

  15. Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots.

    Science.gov (United States)

    Nikolac, Nora; Krleza, Jasna Lenicek; Simundic, Ana-Maria

    2017-02-15

    The aim of this paper is to present results of first two years of preanalytical external quality assessment (EQA) in Croatia. This paper summarizes results from 6 rounds of preanalytical EQA during 2014-2016 in 161-175 Croatian laboratories (number ranged between cycles). EQA was designed as an online survey of the compliance with National recommendations for phlebotomy (NRP). Forty-seven questions in 5 categories are analyzed (materials and equipment, patient identification, patient preparation, sampling and storage). Additionally, preanalytical cases are presented. Overall performance scores (Question score (Qscore) for compliance with NRP and Case score (Cscore) for preanalytical cases) are calculated for each question/case as a proportion of laboratories with satisfactory procedure (x 100). Qscores and Cscores ≥ 70 were classified as acceptable (maximal score = 100). In investigation of compliance with NRP, acceptable Qscores were obtained for 34/47 questions. The lowest scores were observed for the availability of sterile disposable tourniquets (Qscore = 15) and safe-sharp needles (Qscore = 34), obtaining patients address as an identifier (Qscore = 21), using glycolysis inhibitor tubes for glucose concentration measurement (Qscore = 21) and verification of manufacturers declarations on temperature and time of storage (Qscore = 31). There was no statistically significant difference in overall Qscore according to different categories of phlebotomy procedures (P = 0.284). The results of preanalytical cases showed acceptable Cscore values for all cases (89-96). First two years of preanalytical EQA showed good compliance with the NRP and excellent expertise in resolving complex preanalytical issues. Major critical spots are lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes.

  16. SU-F-T-232: Monthly Quality Assurance in External Beam Radiation Therapy Using a Single System

    Energy Technology Data Exchange (ETDEWEB)

    Ding, K [Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD (United States); Ji, T [Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD (United States); Department of Radiation Oncology, The First Hospital, China Medical University, Shenyang, Liaoning (China); Iordachita, I [Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD (United States); Velarde, E; Hyatt, J; Wong, J

    2016-06-15

    Purpose: Monthly quality assurance (QA) is time consuming for external beam radiation therapy, taking as long as 6–8 hours for each machine. It is due to the use and setup of multiple devices for different QA procedures. We have developed a single system with rotational capability for the measurement of both optical light and radiation which significantly reduces the time spent on Monthly QA. Methods: A single system using mirrors, a phosphor screen and a CCD camera is housed on a cylindrical motor so that it can rotate 360 degrees. For monthly QA, the system is placed on the patient couch of the medical accelerator with the plane of the phosphor screen at isocenter for all measurements. For optical QA such as optical distance indicator, room laser and light field, the optical image is collected directly with the camera. For radiation QA such as beam profile, MLC speed, picket-fence test, collimator rotation, table rotation and gantry rotation, a brass build-up plate is attached to the top of the phosphor screen. Two brass plates with islands of different thickness were designed for photon energy and electron energy constancy checks. Flex map, distortion map and uniformity map were developed to calibrate the motor bearing, camera/lens distortion, and the phosphor screen’s measured response across the field. Results: Following the TG142 guidelines for monthly QA with our system, the overall run time is reduced from 6–8 hours to 1.5 hours. Our system’s rotating design allows for quick testing of the gantry radiation isocenter test that is also independent of the sag of the gantry and the EPID. Conclusion: Our system significantly shortens the time needed for monthly QA by unifying the tests with a single system. Future work will be focused on extending the technology to Brachytherapy, IMRT and proton therapy QAs. This work is funded in part by a sponsor research grant from JPLC who owns the Raven technology. John Wong is a co-founder of JPLC.

  17. Friendship Quality, Peer Group Affiliation, and Peer Antisocial Behavior as Moderators of the Link Between Negative Parenting and Adolescent Externalizing Behavior

    OpenAIRE

    Lansford, Jennifer E.; Criss, Michael M.; Pettit, Gregory S.; Dodge, Kenneth A.; Bates, John E.

    2003-01-01

    Quality of peer relationships and perceived peer antisocial behavior were examined as moderators of the link between negative parenting and externalizing behavior problems in school from middle childhood to early adolescence. Data on negative parenting (i.e., unilateral parental decision making, low supervision and awareness, and harsh discipline) were collected from 362 parents in the summer preceding the adolescents’ entry into Grade 6. Adolescent reports of positive peer relationships and ...

  18. Checklists for external validity

    DEFF Research Database (Denmark)

    Dyrvig, Anne-Kirstine; Kidholm, Kristian; Gerke, Oke

    2014-01-01

    RATIONALE, AIMS AND OBJECTIVES: The quality of the current literature on external validity varies considerably. An improved checklist with validated items on external validity would aid decision-makers in judging similarities among circumstances when transferring evidence from a study setting to ...

  19. External incontinence devices

    Science.gov (United States)

    ... enable JavaScript. External incontinence devices are products (or appliances). These are worn on the outside of the ... us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for EHRs For Developers U.S. National ...

  20. Looking for a balance between internal and external evaluation of school quality: evaluation of the SVI model.

    NARCIS (Netherlands)

    Blok, H.; Sleegers, P.; Karsten, S.

    2008-01-01

    This article describes the results of a study into the utility of the SVI model, a model in which internal and external evaluation are balanced. The model consists of three phases: school self-evaluation, visitation and inspection. Under the guidance of school consultants, 27 Dutch primary schools

  1. Policy Reforms, Trojan Horses, and Imaginary Friends: The Role of External Stakeholders in Internal Quality Assurance Systems

    Science.gov (United States)

    Rosa, Maria João; Teixeira, Pedro

    2014-01-01

    The governance of higher education has been changing across Europe, most notably in response to the reform agenda that has been pervading many higher education systems. This wave of reforms has given enhanced visibility to external stakeholders, which has been often received with contrasting views. Some regarded it as a factor that would undermine…

  2. External quality-assurance results for the national atmospheric deposition program/national trends network, 2000-2001

    Science.gov (United States)

    Wetherbee, Gregory A.; Latysh, Natalie E.; Gordon, John D.

    2004-01-01

    Five external quality-assurance programs were operated by the U.S. Geological Survey for the National Atmospheric Deposition Program/National Trends Network (NADP/NTN) from 2000 through 2001 (study period): the intersite-comparison program, the blind-audit program, the field-audit program, the interlaboratory-comparison program, and the collocated-sampler program. Each program is designed to measure specific components of the total error inherent in NADP/NTN wet-deposition measurements. The intersite-comparison program assesses the variability and bias of pH and specific-conductance determinations made by NADP/NTN site operators with respect to accuracy goals. The accuracy goals are statistically based using the median of all of the measurements obtained for each of four intersite-comparison studies. The percentage of site operators responding on time that met the pH accuracy goals ranged from 84.2 to 90.5 percent. In these same four intersite-comparison studies, 88.9 to 99.0 percent of the site operators met the accuracy goals for specific conductance. The blind-audit program evaluates the effects of routine sample handling, processing, and shipping on the chemistry of weekly precipitation samples. The blind-audit data for the study period indicate that sample handling introduced a small amount of sulfate contamination and slight changes to hydrogen-ion content of the precipitation samples. The magnitudes of the paired differences are not environmentally significant to NADP/NTN data users. The field-audit program (also known as the 'field-blank program') was designed to measure the effects of field exposure, handling, and processing on the chemistry of NADP/NTN precipitation samples. The results indicate potential low-level contamination of NADP/NTN samples with calcium, ammonium, chloride, and nitrate. Less sodium contamination was detected by the field-audit data than in previous years. Statistical analysis of the paired differences shows that contaminant ions

  3. Friends’ Knowledge of Youth Internalizing and Externalizing Adjustment: Accuracy, Bias, and the Influences of Gender, Grade, Positive Friendship Quality, and Self-Disclosure

    Science.gov (United States)

    Rose, Amanda J.

    2012-01-01

    Some evidence suggests that close friends may be knowledgeable of youth’s psychological adjustment. However, friends are understudied as reporters of adjustment. The current study examines associations between self- and friend-reports of internalizing and externalizing adjustment in a community sample of fifth-, eighth-, and eleventh-grade youth. The study extends prior work by considering the degree to which friends’ reports of youth adjustment are accurate (i.e., predicted by youths’ actual adjustment) versus biased (i.e., predicted by the friend reporters’ own adjustment). Findings indicated stronger bias effects than accuracy effects, but the accuracy effects were significant for both internalizing and externalizing adjustment. Additionally, friends who perceived their relationships as high in positive quality, friends in relationships high in disclosure, and girls perceived youths’ internalizing symptoms most accurately. Knowledge of externalizing adjustment was not influenced by gender, grade, relationship quality, or self-disclosure. Findings suggest that friends could play an important role in prevention efforts. PMID:19377867

  4. Generation of dried tube specimen for HIV-1 viral load proficiency test panels: a cost-effective alternative for external quality assessment programs.

    Science.gov (United States)

    Ramos, Artur; Nguyen, Shon; Garcia, Albert; Subbarao, Shambavi; Nkengasong, John N; Ellenberger, Dennis

    2013-03-01

    Participation in external quality assessment programs is critical to ensure quality clinical laboratory testing. Commercially available proficiency test panels for HIV-1 virus load testing that are used commonly in external quality assessment programs remain a financial obstacle to resource-limited countries. Maintaining cold-chain transportation largely contributes to the cost of traditional liquid proficiency test panels. Therefore, we developed and evaluated a proficiency test panel using dried tube specimens that can be shipped and stored at ambient temperature. This dried tube specimens panel consisted of 20 μl aliquots of a HIV-1 stock that were added to 2 ml tubes and left uncapped for drying, as a preservation method. The stability of dried tube specimens at concentrations ranging from 10² to 10⁶·⁵ RNA copies/ml was tested at different temperatures over time, showing no viral load reduction at 37 °C and a decrease in viral load smaller than 0.5 Log₁₀ at 45 °C for up to eight weeks when compared to initial results. Eight cycles of freezing-thawing had no effect on the stability of the dried tube specimens. Comparable viral load results were observed when dried tube specimen panels were tested on Roche CAPTAQ, Abbott m2000, and Biomerieux easyMAG viral load systems. Preliminary test results of dried proficiency test panels shipped to four African countries at ambient temperature demonstrated a low inter assay variation (SD range: 0.29-0.41 Log₁₀ RNA copies/ml). These results indicated that HIV-1 proficiency test panels generated by this methodology might be an acceptable alternative for laboratories in resource-limited countries to participate in external quality assessment programs. Published by Elsevier B.V.

  5. Adolescents Who are Less Religious than Their Parents are at Risk for Externalizing and Internalizing Symptoms: The Mediating Role of Parent-Adolescent Relationship Quality

    Science.gov (United States)

    Kim-Spoon, Jungmeen; Longo, Gregory S.; McCullough, Michael E.

    2012-01-01

    Parents generally take pains to insure that their children adopt their own religious beliefs and practices, so what happens psychologically to adolescents who find themselves less religious than their parents? We examined the relationships among parents’ and adolescents’ religiousness, adolescents’ ratings of parent-adolescent relationship quality, and adolescents’ psychological adjustment using data from 322 adolescents and their parents. Adolescent boys who had lower organizational and personal religiousness than their parents, and girls who had lower personal religiousness than their parents, had more internalizing and externalizing psychological symptoms than did adolescents whose religiousness better matched their parents’. The apparent effects of sub-parental religiousness on adolescents’ psychological symptoms were mediated by their intermediate effects on adolescents’ ratings of the quality of their relationships with their parents. These findings identify religious discrepancies between parents and their children as an important influence on the quality of parent-adolescent relationships, with important implications for adolescents’ psychological well-being. PMID:22888785

  6. External quality assurance project report for the National Atmospheric Deposition Program’s National Trends Network and Mercury Deposition Network, 2013–14

    Science.gov (United States)

    Wetherbee, Gregory A.; Martin, RoseAnn

    2016-07-05

    The U.S. Geological Survey Branch of Quality Systems operated five distinct programs to provide external quality assurance monitoring for the National Atmospheric Deposition Program’s (NADP) National Trends Network and Mercury Deposition Network during 2013–14. The National Trends Network programs include (1) a field audit program to evaluate sample contamination and stability, (2) an interlaboratory comparison program to evaluate analytical laboratory performance, and (3) a colocated sampler program to evaluate bias from precipitation sampler upgrades. The Mercury Deposition Network programs include the (4) system blank program and (5) an interlaboratory comparison program. The results indicate that NADP data continue to be of sufficient quality for the analysis of spatial distributions and time trends for chemical constituents in wet deposition.

  7. The Operation Mechanisms of External Quality Assurance Frameworks of Foreign Higher Education and Implications for Graduate Education

    Science.gov (United States)

    Lin, Mengquan; Chang, Kai; Gong, Le

    2016-01-01

    The higher education quality evaluation and assurance frameworks and their operating mechanisms of countries such as the United Kingdom, France, and the United States show that higher education systems, traditional culture, and social background all impact quality assurance operating mechanisms. A model analysis of these higher education quality…

  8. Policy Assessment for the Review of the Primary National Ambient Air Quality Standard for Sulfur Oxides, External Review Draft

    Science.gov (United States)

    Sulfur oxides are one of the six major air pollutants for which EPA has issued air quality criteria and established national ambient air quality standards (NAAQS) based on those criteria. The Clear Air Act (CAA) requires EPA to periodically review and revise, as appropriate, exis...

  9. On the relative effect of spawning asynchrony, sperm quantity and sperm quality on paternity under sperm competition in an external fertilizer

    Directory of Open Access Journals (Sweden)

    Torvald Blikra Egeland

    2015-07-01

    Full Text Available How much of a fitness benefit is obtained by dominant males of external fertilizers from releasing ejaculates in synchrony with female egg-release when engaging in sperm competition, and what is the most important sperm trait for paternity in these situations? The Arctic charr (Salvelinus alpinus is an external fertilizer experiencing intense male-male competition over reproductive opportunities including sperm competition. To compensate for their disadvantage the sneaker males, which often spawn out of synchrony with the female, produce more and faster sperm than the guarding males. We used controlled in vitro fertilization trials with experimentally produced dominant and subordinate, sneaker males to test what effect relative synchrony in gamete release, sperm quality (i.e., motility and velocity and sperm quantity have on a male’s fertilization success in pair-wise sperm competitions. When the sneaker males released ejaculates after the guarding male there was no overall difference in fertilization success. The quality (i.e., motility and velocity of a male’s sperm relative to that of the competing male was the best predictor of male fertilization success regardless of their mating tactic and spawning synchrony. The relative number of sperm cells also had an effect on fertilization success, but mainly when the dominant and sneaker male ejaculated synchronously. Our close imitation of natural sperm competition in charr shows that the sneaker males of external fertilizing species may fully compensate for their disadvantaged mating role by producing ejaculates of higher quality - an adjustment strangely not met by dominants.

  10. The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review.

    Science.gov (United States)

    Alagoz, Esra; Chih, Ming-Yuan; Hitchcock, Mary; Brown, Randall; Quanbeck, Andrew

    2018-01-25

    External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings. We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion. Academic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes. Our results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn't find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.

  11. [How effective is the quality assurance as a result of external checking of nursing homes by the public health services].

    Science.gov (United States)

    Martin, U; Behler, R

    2001-12-01

    This is a report on the external checking of nursing homes by the Public Health Services in Duisburg, Germany, focussing on hygienic problems. For a second time in the last three-and-a-half years a total of 41 such homes were inspected and a total of 4150 residents were covered. Data on the intensity of care and on the hygienic standards were evaluated and compared with the results of 1998. 70.73 % of the homes inspected employed a nurse specifically trained in hygiene-management (1998 15 %), 53.66 % used disinfectant textile cleaning and 34.39 % possessed written standards for management of infections relevant for nursing homes. 1.45 % of all residents had pressure sores III degrees and IV degrees classified according to Shea (1998: 3.37 %). In spite of significant improvements, deficits were still registered. To achieve further improvement attention should be focussed on the effectiveness of Public Health Services' activities. Increased co-operation with other institutions engaged in the external checkings as well as a closer focus on specific subjects in hygiene could be appropriate.

  12. [Analysis of the results of the HIV-1, HCV and HBV viral load of SEIMC External Quality Control Program. Year 2012].

    Science.gov (United States)

    Guna Serrano, María del Remedio; Orta Mira, Nieves; Latorre Martínez, José-Carlos; Ovies, María Rosario; Poveda, Marta; Ruiz de Gopegui, Enrique; Gimeno Cardona, Concepción

    2014-02-01

    Human immunodeficiency virus type 1 (HIV-1) and hepatitis B (HBV) and C virus (HCV) viral load determinations are among the most relevant markers for the follow up of patients infected with these viruses. External quality control tools are crucial to ensure the accuracy of results obtained by microbiology laboratories. This article summarized the results obtained from the 2012 SEIMC External Quality Control Programme for HIV-1, HCV, and HBV viral loads. In the HIV-1 program, a total of five standards were sent. One standard consisted in seronegative human plasma, while the remaining four contained plasma from three different viremic patients, in the range of 2-5 log10 copies/mL; two of these standards were identical aiming to determine repeatability. A significant proportion of the laboratories (22.3% on average) obtained values out of the accepted range (mean±0.25 log10 copies/mL), depending on the standard and on the method used for quantification. Repeatability was excellent, with up to 98.9% of laboratories reporting results within the limits (Δ load contents. Most of the participants, 84% in the case of HCV and 88% in the HBV, obtained all the results within the accepted range (mean±1.96 SD log10 UI/mL). Data from this analysis reinforce the utility of proficiency programmes to ensure the quality of the results obtained by a particular laboratory, as well as the importance of the post-analytical phase on the overall quality. Due to the remarkable interlaboratory variability, it is advisable to use the same method and the same laboratory for patient follow up. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  13. [Analysis of the results of the HIV-1, HCV and HBV viral load of SEIMC External Quality Control Program. Year 2013].

    Science.gov (United States)

    Orta Mira, Nieves; Del Remedio Guna Serrano, María; Latorre Martínez, José-Carlos; Medina González, Rafael; Rosario Ovies, María; Poveda, Marta; Ruiz de Gopegui, Enrique; Gimeno Cardona, Concepción

    2015-07-01

    Human immunodeficiency virus type 1 (HIV-1) and hepatitis B (HBV) and C virus (HCV) viral load determinations are among the most relevant markers for the follow up of patients infected with these viruses. External quality control tools are crucial to ensure the accuracy of results obtained by microbiology laboratories. This article summarized the results obtained from the 2013 SEIMC External Quality Control Programme for HIV-1, HCV, and HBV viral loads. In the HIV-1 program, a total of five standards were sent. One standard consisted in seronegative human plasma, while the remaining four contained plasma from three different viremic patients, in the range of 2-5 log10 copies/mL; two of these standards were identical aiming to determine repeatability. A significant proportion of the laboratories (25% on average) obtained values out of the accepted range (mean ± 0.25 log10 copies/mL), depending on the standard and on the method used for quantification. Repeatability was excellent, with up to 98.9% of laboratories reporting results within the limits (D load contents. Most of the participants, 82% in the case of HCV and 78% in the HBV, obtained all the results within the accepted range (mean ± 1.96 SD log10 UI/mL). Data from this analysis reinforce the utility of proficiency programmes to ensure the quality of the results obtained by a particular laboratory, as well as the importance of the post-analytical phase on the overall quality. Due to the remarkable interlaboratory variability, it is advisable to use the same method and the same laboratory for patient follow up. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  14. [Analysis of the results of the HIV-1 and HCV viral load of the SEIMC External Quality Control Program. Year 2009].

    Science.gov (United States)

    Orta Mira, Nieves; del Remedio Guna Serrano, María; Martínez, José-Carlos Latorre; Ovies, María Rosario; Poveda, Marta; de Gopegui, Enrique Ruiz; Pérez, José L; Cardona, Concepción Gimeno

    2011-03-01

    Human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) viral load determinations are among the most important markers in the follow-up of patients infected with these viruses. External quality control tools are crucial to ensure the accuracy of the results obtained by microbiology laboratories. This article summarizes the results obtained from the SEIMC's External Quality Control Program for HIV-1 and HCV viral loads in 2009. In the HIV-1 program, a total of five standards were sent. One standard consisted of seronegative human plasma, while the remaining four contained plasma from three different viremic patients, in the range of 2-5 log(10) copies/mL; two of these standards were identical, aiming to determine repeatability. A significant proportion of the laboratories (21.5% on average) obtained values outside the accepted range (mean ± 0.2 log(10) copies/mL), depending on the standard and on the method used for quantification. Repeatability was very good, with up to 95 % of laboratories reporting results within the accepted limits (Δload contents. Most of the participants (79.7%) obtained results within the accepted range (mean ± 1.96 SD log(10) UI/mL). Data from this analysis reinforce the utility of proficiency programs to ensure the quality of the results obtained by a particular laboratory, as well as the importance of the post-analytical phase in overall quality. Due to marked interlaboratory variability, use of the same method and the same laboratory for patient follow-up is advisable. Copyright © 2011 Elsevier España S.L. All rights reserved.

  15. [Analysis of the results of the HIV-1, HCV and HBV viral load of SEIMC External Quality Control Program. Year 2014].

    Science.gov (United States)

    Medina González, Rafael; Orta Mira, Nieves; Guna Serrano, María Del Remedio; Latorre Martínez, José-Carlos; Gopegui, Enrique Ruiz de; Rosario Ovies, María; Poveda, Marta; Gimeno Cardona, Concepción

    2016-07-01

    Human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) viral load determinations are among the most relevant markers for the follow up of patients infected with these viruses. External quality control tools are crucial to ensure the accuracy of results obtained by microbiology laboratories. This article summarizes the results obtained from the 2014 SEIMC (Spanish Society of Infectious Diseases and Clinical Microbiology) External Quality Control Programme for HIV-1, HCV, and HBV viral loads. In the HIV-1 program, a total of 5 standards were sent. One standard consisted in seronegative human plasma, while the remaining 4 contained plasma from 3 different viremic patients, in the range of 2-5 log10 copies/mL; 2 of these standards were identical aiming to determine repeatability. A significant proportion of the laboratories (30.8% on average) obtained values out of the accepted range (mean ± 0.25 log10 copies/mL), depending on the standard and on the method used for quantification. Repeatability was excellent, with up to 95.8% of laboratories reporting results within the limits (Δ load contents. Most of the participants, 83.7% in the case of HCV and 87.9% in the HBV, obtained all the results within the accepted range (mean ± 1.96 standard deviations log10 IU/mL). Data from this analysis reinforce the utility of proficiency programmes to ensure the quality of the results obtained by a particular laboratory, as well as the importance of the post-analytical phase on the overall quality. Due to the remarkable interlaboratory variability, it is advisable to use the same method and the same laboratory for patient follow up. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  16. [Analysis of the results of the HIV-1, HCV and HBV viral load of the SEIMC External Quality Control Program. Year 2011].

    Science.gov (United States)

    Orta Mira, Nieves; Guna Serrano, María del Remedio; Latorre Martínez, José-Carlos; Ovies, María Rosario; Poveda, Marta; Ruiz de Gopegui, Enrique; Gimeno Cardona, Concepción

    2013-02-01

    Human immunodeficiency virus type 1 (HIV-1) and hepatitis B (HBV) and C virus (HCV) viral load determinations are among the most important markers in the follow-up of patients infected with these viruses. External quality control tools are crucial to ensure the accuracy of the results obtained by microbiology laboratories. This article summarizes the results of the 2011 SEIMC External Quality Control Program for HIV-1, HCV, and HBV viral loads. In the HIV-1 program, a total of five standards were sent. One standard consisted of seronegative human plasma, while the remaining four contained plasma from three different viremic patients in the range of 2-5 log10 copies/mL; to determine repeatability, two of these standards were identical. A significant proportion of the laboratories (52.1% on average) obtained values outside the accepted range (mean ± 0,25 log10 copies/mL), depending on the standard and on the method used for quantification. Repeatability was very good, with up to 94.9% of laboratories reporting results within the accepted range (Δload contents. In most of the participating laboratories (90% in the case of HCV and 86% in that of HBV), all the results were within the accepted range (mean ± 1.96 SD log10UI/mL). Data from this analysis reinforce the utility of proficiency programs to ensure the quality of the results obtained by a particular laboratory, as well as the importance of the post-analytical phase in overall quality. Due to the marked interlaboratory variability found, use of the same method and the same laboratory for patient follow-up is advisable. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  17. A pragmatic proposal for permissible limits in external quality assessment schemes with a compromise between biological variation and the state of the art.

    Science.gov (United States)

    Haeckel, Rainer; Wosniok, Werner; Kratochvila, Josef; Carobene, Anna

    2012-01-25

    Permissible limits for internal and external quality assurance are either based on biological variation or on the state of the art (technical feasibility). The former approach has a scientific basis, but, in some cases, leads to limits which are either not achievable under the present technology, or which are not stringent enough. If proficiency testing is mandatory, stringent limits which cannot be fulfilled by the majority of laboratories could lead to juristic consequences. Therefore, most national guidelines were based on the state of the art, however, without providing the underlying reasoning. A simple algorithm for permissible limits in external quality assessment schemes (EQAS) is proposed based on biological variation, technical feasibility and correlated to the rate of false positive results. The proposed limits are compared with some limits from several EQAS (RiliBÄK, SEKK, RCPA, CLIA, PROLARIT). The suggested limits are slightly more stringent than the German RiliBÄK, less stringent than the Australasian guidelines and agreed best with the Czech SEKK and the Italian PROLARIT scheme. The graphical presentation of permissible limits strictly derived of biological variation with the proposed limits led to straight lines with different slopes and a cross-over at the limits for quantities with a medium biological variation (e.g., trijodthyronine). The greatest discordance between the various recommendations was observed for calcium, chloride, hemoglobin A(1c) and sodium.

  18. Quality assurance program in the External dosimetry laboratory of the CPHR; Programa de aseguramiento de la calidad en el laboratorio de dosimetria externa del CPHR

    Energy Technology Data Exchange (ETDEWEB)

    Molina P, D.; Pernas S, R.; Martinez H, E.; Cardenas H, J. [Centro de Proteccion e Higiene de las Radiaciones, Calle 20 No. 4113 e/41 y 47. Playa, C.P. 11300, A.P. 6195, C.P. 10600 La Habana (Cuba)

    2006-07-01

    From 1999 the Laboratory of External Dosimetry of the Radiation Protection and Hygiene Center comes applying in its service of personal dosimetry a Program of Quality Assurance. This program was designed according to the recommendations of national and international organizations as the National Assuring Office of the Republic of Cuba (ONARC), the International Standards Organization (ISO), the International Electro technique Commission (IEC) and the International Atomic Energy Agency (IAEA). In this work it is presented in a summarized way the operation of this Program of Quality Assurance which includes the administration and conservation of the results and the documentation of the service, the controls that are carried out to the equipment, the acceptance tests that are applied to the equipment and new dosemeters, the shipment and prosecution of the dosemeters, the evaluation, storage and conservation of the doses, the report of the results, the traceability and reproducibility of the measurements, the attention to the reclamations and the clients complaints and the internal and external audits to those that it undergoes periodically the laboratory. (Author)

  19. Improving teacher-child relationship quality and teacher-rated behavioral adjustment amongst externalizing preschoolers: effects of a two-component intervention.

    Science.gov (United States)

    Vancraeyveldt, Caroline; Verschueren, Karine; Wouters, Sofie; Van Craeyevelt, Sanne; Van den Noortgate, Wim; Colpin, Hilde

    2015-02-01

    The school-based Playing-2-gether is a 12-week intervention with two components aimed at decreasing child externalizing behavior through improving teacher-child interactions. The first component is rooted in attachment theory and aimed at enhancing teacher-child relationship quality, and the second is based on learning theory and aimed at improving teachers' behavior management. In this three-wave randomized study, effects of Playing-2-gether on the teacher-child relationship quality and on teacher-rated child behavioral adjustment were investigated. To this aim, 175 dyads consisting of male preschoolers with relatively high levels of externalizing problem behavior and their teachers were randomly assigned to Playing-2-gether (n = 89) or an education-as-usual control condition (n = 86). Teacher-rated questionnaires were collected at pre-test, after the first intervention component, and at post-test. At post-test, the intervention group showed a larger decrease in teacher-child conflict, child conduct problems, and child hyperactivity/inattention. Supplementary analyses showed that all positive effects were already visible after the first intervention component and that teacher-child conflict, child conduct problems and hyperactivity/inattention did not further reduce during the second component. In addition, an increase in closeness was found following the first component, but subsequently disappeared at post-test.

  20. An external dosimetry audit programme to credential static and rotational IMRT delivery for clinical trials quality assurance.

    Science.gov (United States)

    Eaton, David J; Tyler, Justine; Backshall, Alex; Bernstein, David; Carver, Antony; Gasnier, Anne; Henderson, Julia; Lee, Jonathan; Patel, Rushil; Tsang, Yatman; Yang, Huiqi; Zotova, Rada; Wells, Emma

    2017-03-01

    External dosimetry audits give confidence in the safe and accurate delivery of radiotherapy. The RTTQA group have performed an on-site audit programme for trial recruiting centres, who have recently implemented static or rotational IMRT, and those with major changes to planning or delivery systems. Measurements of reference beam output were performed by the host centre, and by the auditor using independent equipment. Verification of clinical plans was performed using the ArcCheck helical diode array. A total of 54 measurement sessions were performed between May 2014 and June 2016 at 28 UK institutions, reflecting the different combinations of planning and delivery systems used at each institution. Average ratio of measured output between auditor and host was 1.002±0.006. Average point dose agreement for clinical plans was -0.3±1.8%. Average (and 95% lower confidence intervals) of gamma pass rates at 2%/2mm, 3%/2mm and 3%/3mm respectively were: 92% (80%), 96% (90%) and 98% (94%). Moderately significant differences were seen between fixed gantry angle and rotational IMRT, and between combination of planning systems and linac manufacturer, but not between anatomical treatment site or beam energy. An external audit programme has been implemented for universal and efficient credentialing of IMRT treatments in clinical trials. Good agreement was found between measured and expected doses, with few outliers, leading to a simple table of optimal and mandatory tolerances for approval of dosimetry audit results. Feedback was given to some centres leading to improved clinical practice. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  1. High-quality patents for emerging science and technology through external actors: Community scientific experts and knowledge societies

    NARCIS (Netherlands)

    Kica, Evisa; Groenendijk, Nico; Rodriguez, V.F.; Bonaccorsi, A.; Borras, S.

    2010-01-01

    This article explores one type of administrative mechanism to achieve high-quality patents: Article 115 of the European Patent Convention, which permits the inclusion of third parties to provide input to the prior art search and to communicate relevant information to the examiner in charge. Our

  2. Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

    NARCIS (Netherlands)

    S. Burnett (Susan); Mendel, P. (Peter); F. Nunes (Francisco); S. Wiig (Siri); van den Bovenkamp, H. (Hester); Karltun, A. (Anette); G. Robert (Glenn); J.E. Anderson (Janet); C. Vincent (Charles); N.J. Fulop (Naomi)

    2016-01-01

    textabstractObjectives: Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending,

  3. Assessing U.S. Public School Quality: The Advantages of Combining Internal "Consumer Ratings" with External NCLB Ratings

    Science.gov (United States)

    Price, Heather E.

    2016-01-01

    The school quality assessment process under No Child Left Behind (NCLB) is criticized for oversimplifying and overemphasizing standardized test results and unfairly targeting diverse, urban schools. There has been much development in alternative test score evaluations, especially value-added models. These developments have tilted the public…

  4. External drift kriging of NOx concentrations with dispersion model output in a reduced air quality monitoring network

    NARCIS (Netherlands)

    Kassteele, van de J.; Stein, A.; Dekkers, A.L.M.; Velders, G.J.M.

    2009-01-01

    In the mid nineteen eighties the Dutch NOx air quality monitoring network was reduced from 73 to 32 rural and city background stations, leading to higher spatial uncertainties. In this study, several other sources of information are being used to help reduce uncertainties in parameter estimation and

  5. The efficacy of computer reminders on external quality assessment for point-of-care testing in Danish general practice

    DEFF Research Database (Denmark)

    Waldorff, Frans B; Siersma, Volkert; Ertmann, Ruth

    2011-01-01

    of the Capital Region in Denmark. Computer reminders embedded in GPs electronic medical records (ComRem) may facilitate improved quality control behaviour, but more research is needed to identify what types of reminders work and when. The overall aim of this study is to evaluate the efficacy of ComRem to improve...... GPs adherence to quality guidelines. This article describes the rationale and methods of the study that constitute this research project. METHODS/DESIGN: The study is conducted as two randomised controlled trials (RCTs) among general practices in two districts of the Capital Region in Denmark...... a qualitative survey focusing on these aspects. TRIAL REGISTRATIONS: Study A: ClinicalTrials.gov identifier: NCT01152151Study B: ClinicalTrials.gov identifier: NCT01152177....

  6. Adolescents who are less religious than their parents are at risk for externalizing and internalizing symptoms: the mediating role of parent-adolescent relationship quality.

    Science.gov (United States)

    Kim-Spoon, Jungmeen; Longo, Gregory S; McCullough, Michael E

    2012-08-01

    Parents generally take pains to insure that their children adopt their own religious beliefs and practices, so what happens psychologically to adolescents who find themselves less religious than their parents? We examined the relationships among parents' and adolescents' religiousness, adolescents' ratings of parent-adolescent relationship quality, and adolescents' psychological adjustment using data from 322 adolescents and their parents. Adolescent boys who had lower organizational and personal religiousness than their parents, and girls who had lower personal religiousness than their parents, had more internalizing and externalizing psychological symptoms than did adolescents whose religiousness better matched their parents'. The apparent effects of subparental religiousness on adolescents' psychological symptoms were mediated by their intermediate effects on adolescents' ratings of the quality of their relationships with their parents. These findings identify religious discrepancies between parents and their children as an important influence on the quality of parent-adolescent relationships, with important implications for adolescents' psychological well-being. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  7. Evolution of an International External Quality Assurance Model To Support Laboratory Investigation of Streptococcus pneumoniae, Developed for the SIREVA Project in Latin America, from 1993 to 2005▿

    Science.gov (United States)

    Lovgren, Marguerite; Talbot, James A.; Brandileone, Maria Cristina; Casagrande, Silvana T.; Agudelo, Clara Inés; Castañeda, Elizabeth; Regueira, Mabel; Corso, Alejandra; Heitmann, Ingrid; Maldonado, Aurora; Echániz-Avilés, Gabriela; Soto-Noguerón, Araceli; Hortal, María; Camou, Teresa; Gabastou, Jean-Marc; Fabio, José Luis Di

    2007-01-01

    In 1993 the Pan American Health Organization initiated a laboratory-based surveillance system, called the SIREVA project, to learn about Streptococcus pneumoniae invasive disease in Latin American children. In 1994, National Laboratories in six countries were trained to perform serotyping and antibiotic susceptibility testing using broth microdilution to determine the MIC for specified antibiotics. An international External Quality Assurance (EQA) program was developed to monitor and support ongoing laboratory performance. The EQA program was coordinated by the National Centre for Streptococcus (NCS), Edmonton, Canada, and included external proficiency testing (EPT) and a validation process requiring regular submission of a sample of isolates from each laboratory to the NCS for verification of the serotype and MIC. In 1999, the EQA program was decentralized to use three of the original laboratories as regional quality control centers to address operational concerns and to accommodate the growth of the laboratory network to more than 20 countries including the Caribbean region. The overall EPT serotyping accuracies for phase I (1993 to 1998) and phase II (1999 to 2005) were 88.0 and 93.8%, respectively; the MIC correlations within ±1 log2 dilution of the expected result were 83.0 and 91.0% and the interpretive category agreements were 89.1 and 95.3%. Overall, the validation process serotyping accuracies for phases I and II were 81.9 and 88.1%, respectively, 80.4 and 90.5% for MIC agreement, and 85.8 and 94.3% for category agreement. These results indicate a high level of testing accuracy in participating National Laboratories and a sustained increase in EQA participation in Latin America and the Caribbean. PMID:17687007

  8. Serum vitamin A and E analysis: comparison of methods between laboratories enrolled in an external quality assurance programme.

    Science.gov (United States)

    Greaves, Ronda; Jolly, Lisa; Woollard, Gerald; Hoad, Kirsten

    2010-01-01

    To survey laboratories enrolled in the Royal College of Pathologists of Australasia (RCPA) Chemical Pathology Quality Assurance Programme (QAP) for vitamin A and E testing to determine differences between methods of analysis. A detailed questionnaire covering the major aspects of serum vitamin A and E analysis was sent to all participating laboratories in 2007. Thirteen out of the 22 laboratories completed the questionnaire. Methods between laboratories showed a great deal of commonality. All respondents performed a liquid extraction step, which included the addition of an internal standard, followed by high-performance liquid chromatography (C18 columns with predominantly methanol-based mobile phases) with spectrophotometric detection. Major inter-laboratory differences were whether the sample was protected from light, the extraction solvents and ratios used, the drying down temperature used post-liquid extraction and choice of calibrator. The questionnaire highlighted discrete methodological differences between laboratories. These findings provide direction to enable the Vitamins Working Party of the Australasian Association of Clinical Biochemists to further investigate the dispersion in results between participants of the RCPA QAP vitamin programme.

  9. [Implementation of quality standard UNE-EN ISO/IEC 17043 in the External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology].

    Science.gov (United States)

    Poveda Gabaldón, Marta; Ovies, María Rosario; Orta Mira, Nieves; Serrano, M del Remedio Guna; Avila, Javier; Giménez, Alicia; Cardona, Concepción Gimeno

    2011-12-01

    The quality standard "UNE-EN-ISO 17043: 2010. Conformity assessment. General requirements for proficiency testing" applies to centers that organize intercomparisons in all areas. In the case of clinical microbiology laboratories, these intercomparisons must meet the management and technical standards required to achieve maximum quality in the performance of microbiological analysis and the preparation of test items (sample, product, data or other information used in the proficiency test) to enable them to be accredited. Once accredited, these laboratories can operate as a tool for quality control laboratories and competency assessment. In Spain, accreditation is granted by the Spanish Accreditation Body [Entidad Nacional de Acreditación (ENAC)]. The objective of this review is to explain how to apply the requirements of the standard to laboratories providing intercomparisons in the field of clinical microbiology (the organization responsible for all the tasks related to the development and operation of a proficiency testing program). This requires defining the scope and specifying the technical requirements (personnel management, control of equipment, facilities and environment, the design of the proficiency testing and data analysis for performance evaluation, communication with participants and confidentiality) and management requirements (document control, purchasing control, monitoring of complaints / claims, non-compliance, internal audits and management reviews). Copyright © 2011 Elsevier España S.L. All rights reserved.

  10. An external quality assessment program for von Willebrand factor laboratory analysis: an overview from the European concerted action on thrombosis and disabilities foundation.

    Science.gov (United States)

    Meijer, Piet; Haverkate, Frits

    2006-07-01

    The laboratory diagnosis of von Willebrand disease (vWD) is complex and requires a panel of different laboratory tests. Because of this complexity, a proper quality control process is necessary. Since 2003, the European Concerted Action on Thrombosis and Disabilities Foundation has provided an external quality control program for several laboratory tests included in the diagnosis of vWD. Currently, ~180 different laboratories participate in this program, of which the vast majority perform both von Willebrand factor (vWF):antigen (Ag) and activity tests. The lowest between-laboratory variation was observed for the vWF antigen assay (10 to 24%), with a better performance for the latex immunoassay (8 to 24%) than the enzyme immunoassay (13 to 25%). Both the ristocetin cofactor activity assay (RCo) and the collagen-binding assay showed a higher between-laboratory variation (20 to 40% and 17 to 29%, respectively). We have observed that the within-laboratory repeatability for normal samples ranged from 0 to 40% for the antigen assay and from 0 to 86% for the ristocetin cofactor activity assay. Normal samples were interpreted correctly by the majority of the participants. However, type 1 vWD samples were wrongly interpreted by 20 to 40% of the participants, which was mainly caused by a discordance in the vWF:RCo/vWF:Ag ratio. It can be concluded that further improvement in the laboratory diagnosis of vWD is necessary.

  11. The reliable assurance of detecting somatic mutations in cancer-related genes by next-generation sequencing: the results of external quality assessment in China

    Science.gov (United States)

    Han, Yanxi; Yi, Lang; Xie, Jiehong; Yang, Xin; Fan, Gaowei; Wang, Guojing; Hao, Mingju; Zhang, Dong; Zhang, Kuo; Lin, Guigao; Li, Jinming

    2016-01-01

    To evaluate the proficiencies of laboratories utilizing next-generation sequencing (NGS) to detect somatic mutations in cancer-related genes, an external quality assessment (EQA) was implemented by the National Center for Clinical Laboratories of China in 2015. We prepared a panel of samples that comprised eight samples made by mixing synthetic mutated DNA fragments with normal human genomic DNA and one reference sample containing only genomic DNA. We validated our sample panel, and then distributed it to laboratories across China. We received complete results from 64 laboratories. The performances of 51.6 % (33/64) respondent labs were acceptable and 26.6 % (17/64) of the labs returned perfect results. In total, 449 mistakes were reported, including 201 false-negatives (201/449, 44.8 %) and 222 false-positives (222/449, 49.4 %) and 26 slightly discordant results (26/449, 5.8 %). We believe these unsatisfactory results and varied performances are mainly due to the enrichment methods used, the diverse sequencing chemistries of the different NGS platforms, and other errors within the sequencing process. The results indicate that our sample panel is suitable for use in EQA studies, and that further laboratory training in targeted NGS testing is urgently required. To address this, we propose a targeted NGS workflow with details on quality assurance procedures according to the current guidelines. PMID:27542269

  12. Evaluating the quality of prehospital cardiopulmonary resuscitation by reviewing automated external defibrillator records and survival for out-of-hospital witnessed arrests.

    Science.gov (United States)

    Ko, Patrick Chow-In; Chen, Wen-Jone; Lin, Chih-Hao; Ma, Matthew Huei-Ming; Lin, Fang-Yue

    2005-02-01

    Without an easy method to monitor the performance of prehospital cardiopulmonary resuscitation (CPR), earlier studies have not been able to assess the quality of CPR. In this study, we have used a new approach to evaluate prehospital CPR performance and the impact on outcome using data retrieved from the automatic external defibrillators (AED). Electrocardiography (ECG) and voice records from AED data cards from 633 out-of-hospital cardiac arrests (OHCA) were reviewed. Fifty-two witnessed cardiac arrests in ventricular fibrillation (VF) requiring post-shock CPR underwent an independent, structured review by two physicians. The adequacy of prehospital CPR was defined on the basis of noticeable deflection of the ECG with chest compressions, the actual number of chest compressions delivered per minute, and the continuity of prehospital CPR at the scene and during transport. Outcome measures included return of spontaneous circulation (ROSC) and survival to hospital admission and discharge. The quality of prehospital CPR was judged as adequate in 15 (29%, 95%; CI: 18-42%) and inadequate in 37 (71%, 95%; CI: 58-82%) of the consensus. Adequate CPR performance resulted in a higher rate of ROSC at the scene (53% versus 8%, 95% CI of the difference 14-76%), and survival to hospital discharge (53% versus 8%, 95% CI of the difference 14-76%). Two reviewers agreed on whether CPR was adequate in 92.3% of cases, with a kappa of 0.82. The quality of prehospital CPR is associated with a greater likelihood of survival in witnessed VF arrests in need of post-shock CPR. The potential of widely available electrocardiography and voice records in AEDs in providing a convenient and real-time evaluation of prehospital CPR should be explored further.

  13. [External otitis].

    Science.gov (United States)

    Olina, Massimo; Cametti, Massimiliano; Guglielmetti, Chiara; Gattoni, Massimo; Leigheb, Giorgio; Pia, Francesco

    2002-02-01

    Otitis externa is one of the most common diseases in ORL practice, during summer; the treatment of otitis externa may be simple and easy or protracted and frustrating, also with fatal outcome. Many local factors may interfere with the normal defences against infections in the external auditory canal. Removing or dissolving the cerumen by water or other instruments eliminates an important barrier to infections: its acids inhibit the growth of bacteria (Staphylococcus aureus and Pseudomonas aeruginosa) and fungi (Aspergillus). Also skin abrasions or irritation, allergic diseases and many systemic condition like anaemia, vitamin deficiency, endocrine disorders (diabetes) and various forms of dermatitis cause a lower resistance to infections in external auditory canal. Even if the prognosis remains benign in the majority of cases, important complications could appear like: malignant otitis externa, facial nerve paralysis, tympanic bone osteomyelitis, pericondrytis. Successful treatment depends on a proper diagnosis and therapy: the most important factor in the treatment is repeated debridement of the external auditory canal by the physician. The use of Castellani' Tintura rubra, hydroalcoholic solution of phenic fuchsin, can be very effective for bacteria and mycotic eradication. Culturing of ear canal infection could be performed on the second or third visit if the otitis externa is not responding to therapy. Complication are not frequent, but malignant otitis externa can be mortal. Dermatological consultation is often necessary for correct diagnosis.

  14. External Beam Radiation Therapy or Brachytherapy With or Without Short-course Neoadjuvant Androgen Deprivation Therapy: Results of a Multicenter, Prospective Study of Quality of Life

    Energy Technology Data Exchange (ETDEWEB)

    Gay, Hiram A., E-mail: hiramgay@wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Sanda, Martin G. [Department of Urology, Emory University School of Medicine, Atlanta, Georgia (United States); Liu, Jingxia; Wu, Ningying [Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri (United States); Hamstra, Daniel A. [Texas Center for Proton Therapy, Irving, Texas (United States); Wei, John T.; Dunn, Rodney L. [Department of Urology, University of Michigan, Ann Arbor, Michigan (United States); Klein, Eric A. [Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (United States); Sandler, Howard M. [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California (United States); Saigal, Christopher S. [Department of Urology, University of California at Los Angeles, Los Angeles, California (United States); Litwin, Mark S. [Department of Urology, University of California at Los Angeles, Los Angeles, California (United States); Health Policy and Management, University of California at Los Angeles, Los Angeles, California (United States); Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hembroff, Larry [Institute for Public Policy and Social Research, Michigan State University, East Lansing, Michigan (United States); Regan, Meredith M. [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States); Chang, Peter [Department of Surgery, Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (United States); Michalski, Jeff M. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Regan, Meredith; Hembroff, Larry; Wei, John T.; Hamstra, Dan; and others

    2017-06-01

    Purpose: The long-term effects of neoadjuvant androgen deprivation therapy (NADT) with radiation therapy on participant-reported health-related quality of life (HRQOL) have not been characterized in prospective multicenter studies. We evaluated HRQOL for 2 years among participants undergoing radiation therapy (RT) with or without NADT for newly diagnosed, early-stage prostate cancer. Methods and Materials: We analyzed longitudinal cohort data from the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium to ascertain the HRQOL trajectory of men receiving NADT with external beam RT (EBRT) or brachytherapy. HRQOL was measured using the expanded prostate cancer index composite 26-item questionnaire at 2, 6, 12, and 24 months after the initiation of NADT. We used the χ{sup 2} or Fisher exact test to compare the shift in percentages between groups that did or did not receive NADT. Analyses were conducted at the 2-sided 5% significance level. Results: For subjects receiving EBRT, questions regarding the ability to have an erection, ability to reach an orgasm, quality of erections, frequency of erections, ability to function sexually, and lack of energy were in a significantly worse dichotomized category for the patients receiving NADT. Comparing the baseline versus 24-month outcomes, 24%, 23%, and 30% of participants receiving EBRT plus NADT shifted to the worse dichotomized category for the ability to reach an orgasm, quality of erections, and ability to function sexually compared with 14%, 13%, and 16% in the EBRT group, respectively. Conclusions: Compared with baseline, at 2 years, participants receiving NADT plus EBRT compared with EBRT alone had worse HRQOL, as measured by the ability to reach orgasm, quality of erections, and ability to function sexually. However, no difference was found in the ability to have an erection, frequency of erections, overall sexual function, hot flashes, breast tenderness/enlargement, depression

  15. Uncertainty in measurement for 43 biochemistry, immunoassay, and hemostasis routine analytes evaluated by a method using only external quality assessment data.

    Science.gov (United States)

    Matar, Gladys; Poggi, Bernard; Meley, Roland; Bon, Chantal; Chardon, Laurence; Chikh, Karim; Renard, Anne-Claude; Sotta, Catherine; Eynard, Jean-Christophe; Cartier, Regine; Cohen, Richard

    2015-10-01

    International organizations require from medical laboratories a quantitative statement of the uncertainty in measurement (UM) to help interpret patient results. The French accreditation body (COFRAC) recommends an approach (SH GTA 14 IQC/EQA method) using both internal quality control (IQC) and external quality assessment (EQA) data. The aim of this work was to validate an alternative way to quantify UM using only EQA results without any need for IQC data. This simple and practical method, which has already been described as the long-term evaluation of the UM (LTUM), is based on linear regression between data obtained by participants in EQA schemes and target values. We used it for 43 routine analytes covering biochemistry, immunoassay, and hemostasis fields. Data from 50 laboratories participating in ProBioQual (PBQ) EQA schemes over 25 months were used to obtain estimates of the median and 90th percentile LTUM and to compare them to the usual analytical goals. Then, the two UM estimation methods were compared using data from 20 laboratories participating in both IQC and EQA schemes. Median LTUMs ranged from 2.9% (sodium) to 16.3% (bicarbonates) for biochemistry analytes, from 12.6% (prothrombin time) to 18.4% (factor V) for hemostasis analytes when using the mean of all participants, and were around 10% for immunoassays when using the peer-group mean. Median LTUMs were, in most cases, slightly lower than those obtained with the SH GTA 14 method, whatever the concentration level. LTUM is a simple and convenient method that gives UM estimates that are reliable and comparable to those of recommended methods. Therefore, proficiency testing (PT) organizers are allowed to provide participants with an additional UM estimate using only EQA data and which could be updated at the end of each survey.

  16. A European multi-centre External Quality Assessment (EQA) study on phenotypic and genotypic methods used for Herpes Simplex Virus (HSV) drug resistance testing.

    Science.gov (United States)

    Afshar, Baharak; Bibby, David F; Piorkowska, Renata; Ohemeng-Kumi, Natasha; Snoeck, Robert; Andrei, Graciela; Gillemot, Sarah; Morfin, Florence; Frobert, Emilie; Burrel, Sonia; Boutolleau, David; Crowley, Brendan; Mbisa, Jean L

    2017-10-06

    Herpes Simplex Virus (HSV) drug resistance is a significant public health concern among immunocompromised individuals. Phenotypic assays are considered the gold standard method for detecting HSV drug resistance. However, plaque reduction assays (PRAs) are technically demanding, often with long turnaround times of up to four weeks. In contrast, genotypic tests can be performed within a few days. The development and coordination of the first European External Quality Assessment (EQA) study to evaluate phenotypic and genotypic methods used for HSV drug resistance testing in specialised reference laboratories. Four HSV-1 or HSV-2 strains with different antiviral susceptibility profiles were isolated from clinical samples. Isolates were quantified by qPCR, and aliquoted in culture medium. One isolate was distributed at two dilutions to help assess assay sensitivity. The panel was distributed to five European centres with a six-week deadline for the return of phenotypic and genotypic results, together with clinical reports. Four out of five participating labs returned results by the deadline. Limited results were later available from the fifth lab. Phenotypic and genotypic data were largely, but not completely, concordant. An unusual resistance profile shown by one of the samples was explained by the detection of a mixed virus population after extensive further investigation by one of the centres. Discordant clinical outputs reflecting the diversity of phenotypic methodologies demonstrated the utility of this exercise. With emerging genotypic technologies looking to supplant phenotyping, there is a need for curated public databases, accessible interpretation tools and standardised control materials for quality management. By establishing a network of testing laboratories, we hope that this EQA scheme will facilitate ongoing progress in this area. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  17. External validation of the SF-36 quality-of-life questionnaire in Italian and Brazilian populations to select patients with colorectal endometriosis for surgery.

    Science.gov (United States)

    Laas, Enora; Zacharopoulou, Chrysoula; Montanari, Giulia; Seracchioli, Renato; Abrão, Mauricio S; Bassi, Marco A; Ballester, Marcos; Daraï, Emile

    2015-01-01

    To evaluate the external validity of the validated French model of the quality-of-life questionnaire (QOL) SF-36 in predicting improvement after colorectal resection for endometriosis. Italian and Brazilian cohort studies (Canadian Task Force classification II-3). Tertiary referral university hospital in Brazil and expert center in endometriosis in Italy. Patients with colorectal endometriosis from an Italian population (n = 63) and a Brazilian population (n = 151). Laparoscopic colorectal resection for treatment of endometriosis. Preoperative and postoperative evaluations of the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the SF-36 were performed. Substantial improvement in PCS and MCS was observed after colorectal resection in both populations. In the Brazilian population, the receiver operating curve (ROC) (area under the curve [AUC]) was 0.83 (95% confidence interval [CI], 0.77-0.89) for MCS and 0.78 (95% CI, 0.71-0.83) for PCS, demonstrating good discrimination performance. The mean difference between the predicted and calibrated probabilities was 19.6% for MCS and 32.8% for PCS. In the Italian population, the ROC curve (AUC) was 0.65 (95% CI, 0.52-0.78) for PCS and 0.67 (95% CI, 0.55-0.78) for MCS. The model demonstrated poor discrimination and calibration performance for PCS (p SF-36, our results underline the limits of this tool in selection of patients for colorectal resection due to underestimation of predicted quality of life, possibly because of variations in epidemiologic characteristics of the populations. Copyright © 2015. Published by Elsevier Inc.

  18. External quality-assurance project report for the National Atmospheric Deposition Program/National Trends Network and Mercury Deposition Network, 2009-2010

    Science.gov (United States)

    Wetherbee, Gregory A.; Martin, RoseAnn; Rhodes, Mark F.; Chesney, Tanya A.

    2014-01-01

    The U.S. Geological Survey operated six distinct programs to provide external quality-assurance monitoring for the National Atmospheric Deposition Program/National Trends Network (NTN) and Mercury Deposition Network (MDN) during 2009–2010. The field-audit program assessed the effects of onsite exposure, sample handling, and shipping on the chemistry of NTN samples; a system-blank program assessed the same effects for MDN. Two interlaboratory-comparison programs assessed the bias and variability of the chemical analysis data from the Central Analytical Laboratory (CAL) and Mercury (Hg) Analytical Laboratory (HAL). The blind-audit program was also implemented for the MDN to evaluate analytical bias in total Hg concentration data produced by the HAL. The co-located-sampler program was used to identify and quantify potential shifts in NADP data resulting from replacement of original network instrumentation with new electronic recording rain gages (E-gages) and precipitation collectors that use optical sensors. The results indicate that NADP data continue to be of sufficient quality for the analysis of spatial distributions and time trends of chemical constituents in wet deposition across the United States. Results also suggest that retrofit of the NADP networks with the new precipitation collectors could cause –8 to +14 percent shifts in NADP annual precipitation-weighted mean concentrations and total deposition values for ammonium, nitrate, sulfate, and hydrogen ion, and larger shifts (+13 to +74 percent) for calcium, magnesium, sodium, potassium, and chloride. The prototype N-CON Systems bucket collector is more efficient in the catch of precipitation in winter than Aerochem Metrics Model 301 collector, especially for light snowfall.

  19. U.S. Geological Survey external quality-assurance project report for the National Atmospheric Deposition Program / National Trends Network and Mercury Deposition Network, 2011-2012

    Science.gov (United States)

    Wetherbee, Gregory A.; Martin, RoseAnn

    2014-01-01

    The U.S. Geological Survey operated six distinct programs to provide external quality-assurance monitoring for the National Atmospheric Deposition Program (NADP) / National Trends Network (NTN) and Mercury Deposition Network (MDN) during 2011–2012. The field-audit program assessed the effects of onsite exposure, sample handling, and shipping on the chemistry of NTN samples; a system-blank program assessed the same effects for MDN. Two interlaboratory-comparison programs assessed the bias and variability of the chemical analysis data from the Central Analytical Laboratory and Mercury Analytical Laboratory (HAL). A blind-audit program was implemented for the MDN during 2011 to evaluate analytical bias in HAL total mercury concentration data. The co-located–sampler program was used to identify and quantify potential shifts in NADP data resulting from the replacement of original network instrumentation with new electronic recording rain gages and precipitation collectors that use optical precipitation sensors. The results indicate that NADP data continue to be of sufficient quality for the analysis of spatial distributions and time trends of chemical constituents in wet deposition across the United States. Co-located rain gage results indicate -3.7 to +6.5 percent bias in NADP precipitation-depth measurements. Co-located collector results suggest that the retrofit of the NADP networks with the new precipitation collectors could cause +10 to +36 percent shifts in NADP annual deposition values for ammonium, nitrate, and sulfate; -7.5 to +41 percent shifts for hydrogen-ion deposition; and larger shifts (-51 to +52 percent) for calcium, magnesium, sodium, potassium, and chloride. The prototype N-CON Systems bucket collector typically catches more precipitation than the NADP-approved Aerochem Metrics Model 301 collector.

  20. SPIDIA-RNA: second external quality assessment for the pre-analytical phase of blood samples used for RNA based analyses.

    Directory of Open Access Journals (Sweden)

    Francesca Malentacchi

    Full Text Available One purpose of the EC funded project, SPIDIA, is to develop evidence-based quality guidelines for the pre-analytical handling of blood samples for RNA molecular testing. To this end, two pan-European External Quality Assessments (EQAs were implemented. Here we report the results of the second SPIDIA-RNA EQA. This second study included modifications in the protocol related to the blood collection process, the shipping conditions and pre-analytical specimen handling for participants. Participating laboratories received two identical proficiency blood specimens collected in tubes with or without an RNA stabilizer. For pre-defined specimen storage times and temperatures, laboratories were asked to perform RNA extraction from whole blood according to their usual procedure and to return extracted RNA to the SPIDIA facility for further analysis. These RNA samples were evaluated for purity, yield, integrity, stability, presence of interfering substances, and gene expression levels for the validated markers of RNA stability: FOS, IL1B, IL8, GAPDH, FOSB and TNFRSF10c. Analysis of the gene expression results of FOS, IL8, FOSB, and TNFRSF10c, however, indicated that the levels of these transcripts were significantly affected by blood collection tube type and storage temperature. These results demonstrated that only blood collection tubes containing a cellular RNA stabilizer allowed reliable gene expression analysis within 48 h from blood collection for all the genes investigated. The results of these two EQAs have been proposed for use in the development of a Technical Specification by the European Committee for Standardization.

  1. STRUCTURE AND VALIDATION OF A CONTEXTUAL QUALITY OF LIFE SCALE FOR PEOPLE WITH INTELLECTUAL DISABILITIES IN SOCIAL SERVICES: AN ORGANIZATION-ORIENTED MEASURE FROM AN EXTERNAL PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Carolina Moliner

    2013-09-01

    Full Text Available The aim of this study is to develop and validate a scale on the Quality of Life (QoL of people with intellectual disabilities as assessed by family members (external perspective. The instrument measures improvement in QoL due to actions by organizations delivering services to individuals with intellectual disabilities (organization-oriented measure. In order to design the items for the scale, focus groups were set up with professionals dedicated to attending to individuals with intellectual disabilities. An initial scale of 20 items was constructed by consensus. A total of 1195 family members answered the questionnaire. In order to assess the structure of the scale, EFA recommended deleting 3 overlapping items. The final scale consisted of 17 items (α=95 and was composed of four main dimensions: self-determination (SD, social inclusion (SI, rights (RI and overall improvement (OI, which explained 74.83% of the variance. Finally, the consistency and validity were assessed. Convergent validity and discriminant validity were satisfactory. Moreover, CFA confirmed the structure of the scale. Main conclusions, limitations and practical implications are discussed.

  2. Cultural distance, political risk, or governance quality? Towards a more accurate conceptualization and measurement of external uncertainty in foreign entry mode research

    NARCIS (Netherlands)

    Slangen, A.H.L.; van Tulder, R.J.M.

    2009-01-01

    It is well accepted that multinational enterprises (MNEs) prefer equity joint ventures (JVs) over wholly owned subsidiaries (WOSs) in foreign countries where the formal and informal external environment is highly uncertain. Many entry mode studies have modeled the external uncertainty faced by MNEs

  3. Influence of storage conditions and extraction methods on the quantity and quality of circulating cell-free DNA (ccfDNA): the SPIDIA-DNAplas External Quality Assessment experience.

    Science.gov (United States)

    Malentacchi, Francesca; Pizzamiglio, Sara; Verderio, Paolo; Pazzagli, Mario; Orlando, Claudio; Ciniselli, Chiara Maura; Günther, Kalle; Gelmini, Stefania

    2015-11-01

    Circulating cell-free DNA (ccfDNA) has been confirmed as a useful biomarker in cancer and pre-natal clinical practice. One of the main critical points in using ccfDNA is a lack of standardisation for sample processing methods, storage conditions, procedures for extraction, and quantification that can affect ccfDNA quality and quantity. We report the results obtained from the SPIDIA-DNAplas, one of the EU SPIDIA (Standardisation and improvement of generic pre-analytical tools and procedures for in vitro diagnostics) subprojects based on the implementation of an External Quality Assessment scheme for the evaluation of the influence of the pre-analytical phase on ccfDNA. This is the first reported quality control scheme targeting ccfDNA for pre-analytical phase studies. Fifty-six laboratories throughout Europe were recruited. The participating laboratories received the same plasma sample and extracted ccfDNA by using their own procedures, at defined plasma storage conditions, and sent the isolated ccfDNA to the SPIDIA facility for analyses. Laboratory performance was evaluated by using specific quality parameters such as ccfDNA integrity (by multiplex PCR) and yield (by qPCR). The analysis of the ccfDNA extracted by the laboratories showed that most of them (53 of 56) were able to recover ccfDNA but only 12.5% recovered non-fragmented ccfDNA. Extraction methods specifically designed for ccfDNA preserved the integrity profile. The evidence-based results of the SPIDIA-DNAplas EQA have been proposed as a basis for the development of a Technical Specification by the European Committee for standardisation (CEN).

  4. Long-term analytical performance of hemostasis field methods as assessed by evaluation of the results of an external quality assessment program for antithrombin.

    Science.gov (United States)

    Meijer, Piet; de Maat, Moniek P M; Kluft, Cornelis; Haverkate, Frits; van Houwelingen, Hans C

    2002-07-01

    It is important for a laboratory to know the stability of performance of laboratory tests over time. The aim of this study was to adapt from the field of clinical chemistry a method to assess the long-term analytical performance of hemostasis field methods. The linear regression model was used to compare the laboratory results with the consensus mean value of a survey. This model was applied to plasma antithrombin activity using the data for 82 laboratories, collected between 1996 and 1999 in the European Concerted Action on Thrombosis (ECAT) external quality assessment program. The long-term total, random, and systematic error were calculated. The variables introduced to define the long-term performance in this model were the long-term analytical CV (LCV(a)) and the analytical critical difference (ACD), which indicates the minimum difference necessary between two samples measured on a long-term time-scale to consider them statistically significantly different. The systematic error (bias) ranged from 4.5 to 103 units/L. The random error ranged from 24.4 to 242 units/L. For the majority of the laboratories, random error was the main component (>75%) of the total error. The LCV(a), after adjustment for the contribution of the bias, ranged from 2.8% to 48%. The ACD ranged from 78 to 1290 units/L with a median value of 190 units/L. No statistically significant differences were observed for either LCV(a) or ACD between the two different measurement principles for antithrombin activity based on the inhibition of either thrombin or factor Xa. This linear regression model is useful for assessing the total error, random error, and bias for hemostasis field methods. The LCV(a) and ACD for measurement on a long-term time-scale appear to be useful for assessing the long-term analytical performance.

  5. Quality control of the treatment planning systems dose calculations in external radiation therapy using the Penelope Monte Carlo code; Controle qualite des systemes de planification dosimetrique des traitements en radiotherapie externe au moyen du code Monte-Carlo Penelope

    Energy Technology Data Exchange (ETDEWEB)

    Blazy-Aubignac, L

    2007-09-15

    The treatment planning systems (T.P.S.) occupy a key position in the radiotherapy service: they realize the projected calculation of the dose distribution and the treatment duration. Traditionally, the quality control of the calculated distribution doses relies on their comparisons with dose distributions measured under the device of treatment. This thesis proposes to substitute these dosimetry measures to the profile of reference dosimetry calculations got by the Penelope Monte-Carlo code. The Monte-Carlo simulations give a broad choice of test configurations and allow to envisage a quality control of dosimetry aspects of T.P.S. without monopolizing the treatment devices. This quality control, based on the Monte-Carlo simulations has been tested on a clinical T.P.S. and has allowed to simplify the quality procedures of the T.P.S.. This quality control, in depth, more precise and simpler to implement could be generalized to every center of radiotherapy. (N.C.)

  6. SMS photograph-based external quality assessment of reading and interpretation of malaria rapid diagnostic tests in the Democratic Republic of the Congo.

    Science.gov (United States)

    Mukadi, Pierre; Gillet, Philippe; Barbé, Barbara; Luamba, Jean; Lukuka, Albert; Likwela, Joris; Mumba, Dieudonné; Muyembe, Jean-Jacques; Lutumba, Pascal; Jacobs, Jan

    2015-01-28

    The present External Quality Assessment (EQA) assessed reading and interpretation of malaria rapid diagnostic tests (RDTs) in the Democratic Republic of the Congo (DRC). The EQA consisted of (i) 10 high-resolution printed photographs displaying cassettes with real-life results and multiple choice questions (MCQ) addressing individual health workers (HW), and (ii) a questionnaire on RDT use addressing the laboratory of health facilities (HF). Answers were transmitted through short message services (SMS). The EQA comprised 2344 HW and 1028 HF covering 10/11 provinces in DRC. Overall, median HW score (sum of correct answers on 10 MCQ photographs for each HW) was 9.0 (interquartile range 7.5 - 10); MCQ scores (the % of correct answers for a particular photograph) ranged from 54.8% to 91.6%. Most common errors were (i) reading or interpreting faint or weak line intensities as negative (3.3%, 7.2%, 24.3% and 29.1% for 4 MCQ photographs), (ii) failure to distinguish the correct Plasmodium species (3.4% to 7.0%), (iii) missing invalid test results (8.4% and 23.6%) and (iv) missing negative test results (10.0% and 12.4%). HW who were trained less than 12 months ago had best MCQ scores for 7/10 photographs as well as a significantly higher proportion of 10/10 scores, but absolute differences in MCQ scores were small. HW who had participated in a previous EQA performed significantly better for 4/10 photographs compared to those who had not. Except for two photographs, MCQ scores were comparable for all levels of the HF hierarchy and non-laboratory staff (HW from health posts) had similar performance as to laboratory staff. Main findings of the questionnaire were (i) use of other RDT products than recommended by the national malaria control programme (nearly 20% of participating HF), (ii) lack of training for a third (33.6%) of HF, (iii) high proportions (two-thirds, 66.5%) of HF reporting stock-outs. The present EQA revealed common errors in RDT reading and interpretation by

  7. Analytical Bias Exceeding Desirable Quality Goal in 4 out of 5 Common Immunoassays: Results of a Native Single Serum Sample External Quality Assessment Program for Cobalamin, Folate, Ferritin, Thyroid-Stimulating Hormone, and Free T4 Analyses.

    Science.gov (United States)

    Kristensen, Gunn B B; Rustad, Pål; Berg, Jens P; Aakre, Kristin M

    2016-09-01

    We undertook this study to evaluate method differences for 5 components analyzed by immunoassays, to explore whether the use of method-dependent reference intervals may compensate for method differences, and to investigate commutability of external quality assessment (EQA) materials. Twenty fresh native single serum samples, a fresh native serum pool, Nordic Federation of Clinical Chemistry Reference Serum X (serum X) (serum pool), and 2 EQA materials were sent to 38 laboratories for measurement of cobalamin, folate, ferritin, free T4, and thyroid-stimulating hormone (TSH) by 5 different measurement procedures [Roche Cobas (n = 15), Roche Modular (n = 4), Abbott Architect (n = 8), Beckman Coulter Unicel (n = 2), and Siemens ADVIA Centaur (n = 9)]. The target value for each component was calculated based on the mean of method means or measured by a reference measurement procedure (free T4). Quality specifications were based on biological variation. Local reference intervals were reported from all laboratories. Method differences that exceeded acceptable bias were found for all components except folate. Free T4 differences from the uncommonly used reference measurement procedure were large. Reference intervals differed between measurement procedures but also within 1 measurement procedure. The serum X material was commutable for all components and measurement procedures, whereas the EQA materials were noncommutable in 13 of 50 occasions (5 components, 5 methods, 2 EQA materials). The bias between the measurement procedures was unacceptably large in 4/5 tested components. Traceability to reference materials as claimed by the manufacturers did not lead to acceptable harmonization. Adjustment of reference intervals in accordance with method differences and use of commutable EQA samples are not implemented commonly. © 2016 American Association for Clinical Chemistry.

  8. [Evidence of improved quality of urinary calculus analysis using results of 7 surveys with external quality controls. Improvement in the quality of urinary calculus analysis by establishment of uniform methodological assumptions in urinary calculus analysis laboratories. 2].

    Science.gov (United States)

    Rebentisch, G; Berg, W

    1983-11-01

    Seven quality control surveys confirmed the usefulness of standardized urolith analysis by X-ray diffraction. A method is suggested for tabulating the results of the surveys, which permits qualitative comparison of participating analysis centres. Quality improved considerably after the introduction of the standardized instructions for analysis. The results of the survey with international participants clearly demonstrated the superiority of X-ray diffractometric urolith analysis over polarization microscopical, infrared spectroscopic, differential thermoanalytical and wet chemical analytical techniques.

  9. Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Watson, Linda C., E-mail: Linda.watson@albertahealthservices.ca [Department of Interdisciplinary Practice, Community Oncology, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Gies, Donna [Department of Radiation Oncology Nursing, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Thompson, Emmanuel [Department of Mathematics and Statistics, University of Calgary Faculty of Science, Calgary, AB (Canada); Thomas, Bejoy [Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Department of Psychosocial Oncology, University of Calgary Faculty of Medicine, Calgary, AB (Canada)

    2012-05-01

    Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from

  10. Randomized control trial: evaluating aluminum-based antiperspirant use, axilla skin toxicity, and reported quality of life in women receiving external beam radiotherapy for treatment of Stage 0, I, and II breast cancer.

    Science.gov (United States)

    Watson, Linda C; Gies, Donna; Thompson, Emmanuel; Thomas, Bejoy

    2012-05-01

    Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from using antiperspirants during their treatment

  11. The influence of external and internal factors on the quality of semen collection and qualitative indicators of semen in the dog (Canis familiaris

    Directory of Open Access Journals (Sweden)

    Marie Vágenknechtová

    2011-01-01

    Full Text Available The influence of external and internal factors on the course of semen collection and quality of ejaculate has been evaluated in this work. This observation included 30 dogs of various breeds, each of which we collected 3 ejaculates from within one week (first, third and fifth day. The internal factors included the weight of the dog, order of semen collection and the age of the dog. The external factors included type of housing, utilization of the dog, point of the collection and type of nutrition. Average length of preparation of a dog for a collection and onset of sexual reflex was 95.7 sec. The observations showed that none of the evaluated internal factors had any influence on the length of preparation for the semen collection. The largest volume of ejaculate was collected from the first collection (10.5cm3, at the second collection it was 8.9 cm3 and the third one the volume was the smallest – with only 6.6 cm3. The average volume of 8.7 cm3 was found in the whole set of observed dogs. No statistically conclusive difference was found among groups. The average activity of sperm in the observed set was 68.8%. Activity declined from the first to the third collection from 73% to 65.5%. The difference in sperm activity was not statistically conclusive in any indicator. Sperm concentration in whole set of dogs was 143.6 103.mm−3 and was not significantly affected by any monitored internal factors.The longest preparation for the collection was found in dogs housed in pens (134.4 sec, dogs living in households (84.7 sec and the shortest preparation was needed in dogs with freedom of movement. The longest onset of sexual reflexes was found in Police forces dogs, then family dogs and sport dogs (130.0 sec, 97.8 sec and 68.3 sec. In dogs collected in laboratory, the emergence of sexual reflex was longer (110.7 sec than in dogs collected in their own natural environment (80.7 sec. The average length of the whole ejaculation was 396.0 sec in

  12. External quality assessment of HbA1c and its effect on comparison between Swedish pediatric diabetes clinics. Experiences from the Swedish pediatric diabetes quality register (Swediabkids) and Equalis.

    Science.gov (United States)

    Lindblad, Bengt; Nordin, Gunnar

    2013-10-01

    To explore to what extent measurement error can explain the variation of mean patient HbA(1c) between clinics. For each year 2005-2010 data from 5380-6985 children, age clinics was analyzed. Each year 13,000-19,000 HbA(1c) analyses were evaluated. Year mean HbA(1c) for each patient was calculated for HbA(1c) values when insulin dose was ≥0.5 U/kg. In Sweden HbA(1c) values were during the study period standardized to the Mono S level, HbA(1c)(Mono S)%, but are given also in the international unit HbA(1c)(IFCC), mmol/mol. Performance of locally measured HbA(1c) is monitored by Equalis through monthly external quality assessment (EQA) schemes. The yearly mean bias term for each clinic varied from -0.54 to 0.41 HbA(1c)(Mono S)%. The bias between clinic HbA(1c) and target value improved during the 6 years and the mean bias was for 79%-88% of clinics within the recommended level ±0.14 HbA(1c)% the last 2 years. Inter-clinic mean HbA(1c) had a wide interquartile range, 0.30-0.43 HbA(1c)(Mono S)% [3.2-4.5 HbA(1c)(IFCC)mmol/mol]. Regular participation in EQA schemes is necessary when comparing HbA(1c) values. The measurement error decreased during the 6-year period and explained from 28% to clinic variation in year mean clinic HbA(1c).

  13. Parent-Child Relationship Quality and Family Transmission of Parent Posttraumatic Stress Disorder Symptoms and Child Externalizing and Internalizing Symptoms Following Fathers’ Combat-Trauma Exposure

    Science.gov (United States)

    Snyder, James; Gewirtz, Abigail; Schrepferman, Lynn; Gird, Suzanne R.; Quattlebaum, Jamie; Pauldine, Michael R.; Elish, Katie; Zamir, Osnat; Hayes, Charles

    2016-01-01

    Transactional cascades among child internalizing and externalizing symptoms, and fathers’ and mothers’ post-traumatic stress disorder symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents’ positive engagement and coercive interaction with their child, and family members’ emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and non-deployed mothers and their 4 to 13 year old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools, or ADAPT) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child’s symptoms. Parents’ observed behavior during interaction with their children was coded using a multi-method approach at each assessment point. Reciprocal cascades among fathers’ and mothers’ PTSD symptoms, and child internalizing and externalizing symptoms were observed. Fathers’ and mothers’ positive engagement during parent-child interaction linked their PTSD symptoms and their child’s internalizing symptoms. Fathers’ and mothers’ coercive behavior toward their child linked their PTSD symptoms and their child’s externalizing symptoms. Each family members’ capacity for emotion regulation was associated with their adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described. PMID:27739388

  14. Parent-child relationship quality and family transmission of parent posttraumatic stress disorder symptoms and child externalizing and internalizing symptoms following fathers' exposure to combat trauma.

    Science.gov (United States)

    Snyder, James; Gewirtz, Abigail; Schrepferman, Lynn; Gird, Suzanne R; Quattlebaum, Jamie; Pauldine, Michael R; Elish, Katie; Zamir, Osnat; Hayes, Charles

    2016-11-01

    Transactional cascades among child internalizing and externalizing symptoms, and fathers' and mothers' posttraumatic stress disorder (PTSD) symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents' positive engagement and coercive interaction with their child, and family members' emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and nondeployed mothers and their 4- to 13-year-old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child's symptoms. Parents' observed behavior during interaction with their children was coded using a multimethod approach at each assessment point. Reciprocal cascades among fathers' and mothers' PTSD symptoms, and child internalizing and externalizing symptoms, were observed. Fathers' and mothers' positive engagement during parent-child interaction linked their PTSD symptoms and their child's internalizing symptoms. Fathers' and mothers' coercive behavior toward their child linked their PTSD symptoms and their child's externalizing symptoms. Each family member's capacity for emotion regulation was associated with his or her adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described.

  15. Web-based surveillance and global Salmonella distribution, 2000-2002

    DEFF Research Database (Denmark)

    Galanis, E.; Wong, Danilo Lo Fo; Patrick, M.E.

    2006-01-01

    serotypes to a Web-based country databank. We describe the global distribution of reported Salmonella serotypes from human and nonhuman sources from 2000 to 2002. Among human isolates, Salmonella enterica serovar Enteritidis was the most common serotype, accounting for 65% of all isolates. Among nonhuman......Salmonellae are a common cause of foodborne disease worldwide. The World Health Organization (WHO) supports international foodborne disease surveillance through WHO Global Salm-Surv and other activities. WHO Global Salm-Surv members annually report the 15 most frequently isolated Salmonella...... professionals to explore hypotheses related to the sources and distribution of salmonellae worldwide....

  16. External Evaluation Measures for Subspace Clustering

    DEFF Research Database (Denmark)

    Günnemann, Stephan; Färber, Ines; Müller, Emmanuel

    2011-01-01

    research area of subspace clustering. We formalize general quality criteria for subspace clustering measures not yet addressed in the literature. We compare the existing external evaluation methods based on these criteria and pinpoint limitations. We propose a novel external evaluation measure which meets...

  17. Regulating multiple externalities

    DEFF Research Database (Denmark)

    Waldo, Staffan; Jensen, Frank; Nielsen, Max

    2016-01-01

    Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory instrume......Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory...

  18. ExternE National Implementation Finland

    Energy Technology Data Exchange (ETDEWEB)

    Pingoud, K.; Maelkki, H.; Wihersaari, M.; Pirilae, P. [VTT Energy, Espoo (Finland); Hongisto, M. [Imatran Voima Oy, Vantaa (Finland); Siitonen, S. [Ekono Energy Ltd, Espoo (Finland); Johansson, M. [Finnish Environment Institute, Helsinki (Finland)

    1999-07-01

    ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

  19. External Evaluation: a Requirement for Accountability and Responsiveness

    Directory of Open Access Journals (Sweden)

    A Hajifathali

    2009-02-01

    Full Text Available Quality assurance as a comprehensive term encompasses all policies, processes and actions maintaining and developing higher education quality. Quality assurance emphasizes on external goals of evaluation, one of which is to assure learners, public and government that each unit,department, program or institution manages its quality. thus quality assurance focuses on accountability.This article first describes importance of external evaluation and necessity to conduct it, then considering the fact that two educational programs leading to bachelor degrees of nursing and obstetrics, which their internal evaluation have already completed, are volunteers to go under external evaluation. Explains steps of external evaluation and focuses on the external aspect of evaluation to assure quality of educational programs following internal evaluation.Key words: QUALITY ASSURANCE, EVALUATION, EXTERNAL EVALUATION  

  20. SPIDIA-RNA: First external quality assessment for the pre-analytical phase of blood samples used for RNA based analyses

    Czech Academy of Sciences Publication Activity Database

    Pazzagli, M.; Malentacchi, F.; Simi, L.; Wyrich, R.; Guenther, K.; Hartmann, C.; Verderio, P.; Pizzamiglio, S.; Ciniselli, C.M.; Tichopád, Aleš; Kubista, Mikael; Gelmini, S.

    2013-01-01

    Roč. 59, č. 1 (2013), s. 20-31 ISSN 1046-2023 Institutional research plan: CEZ:AV0Z50520701 Keywords : Pre-analytical phase * RNA quality * Blood samples Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 3.221, year: 2013

  1. SPIDIA-DNA: An External Quality Assessment for the pre-analytical phase of blood samples used for DNA-based analyses

    Czech Academy of Sciences Publication Activity Database

    Malentacchi, F.; Pazzagli, M.; Simi, L.; Orlando, C.; Wyrich, R.; Hartmann, C.C.; Verderio, P.; Pizzamiglio, S.; Ciniselli, C.M.; Tichopád, Aleš; Kubista, Mikael; Gelmini, S.

    -, č. 424 (2013), s. 274-286 ISSN 0009-8981 Institutional research plan: CEZ:AV0Z50520701 Keywords : Pre-analytical phase * DNA quality * Blood samples Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 2.764, year: 2013

  2. Online fibre optic OSL in vivo dosimetry for quality assurance of external beam radiation therapy treatments: The ANR-TECSAN Codofer Project; Dosimetrie in vivo par OSL, en ligne par fibre optique, pour l'assurance qualite des traitements par radiotherapie externe: le projet ANR-TECSAN Codofer

    Energy Technology Data Exchange (ETDEWEB)

    Magne, S.; Ferdinand, P. [CEA Saclay, Laboratoire de mesures optiques, CEA LIST, 91191 Gif-sur-Yvette (France); De Carlan, L. [CEA Saclay, Laboratoire national Henri-Becquerel, CEA LIST, 91191 Gif-sur-Yvette (France); Bridier, A.; Isambert, A. [Service de physique, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif (France); Hugon, R. [CEA Saclay, Departement capteur, signal et informations, CEA LIST, 91191 Gif-sur-Yvette (France); Guillon, J. [Societe Fimel, 18, rue Marie-et-Pierre-Curie, 92260 Fontenay-aux-Roses (France)

    2010-05-15

    The Codofer Project (2007-2009), led under the ANR-TECSAN Call, was coordinated by CEA LIST, in partnership with IGR and the Fimel company. The aim of the project was to design and test both metrologically and in clinical conditions OSL optical fiber sensors dedicated to in vivo dosimetry during external beam radiation therapy treatment with high-energy electrons. This study, combined with the results of clinical tests obtained within the European Project Maestro, has demonstrated the advantages of OSL/FO dosimetry for providing quality assurance of treatments. However, the French market for dosimetry has greatly changed as a result of the rules decreed by the French government in 2007. The OSL/FO product is now targeted for other treatment modalities lacking suitable dosimeters (ANR-INTRADOSE Project [2009-2011]). (authors)

  3. Use of Six Sigma Worksheets for assessment of internal and external failure costs associated with candidate quality control rules for an ADVIA 120 hematology analyzer.

    Science.gov (United States)

    Cian, Francesco; Villiers, Elisabeth; Archer, Joy; Pitorri, Francesca; Freeman, Kathleen

    2014-06-01

    Quality control (QC) validation is an essential tool in total quality management of a veterinary clinical pathology laboratory. Cost-analysis can be a valuable technique to help identify an appropriate QC procedure for the laboratory, although this has never been reported in veterinary medicine. The aim of this study was to determine the applicability of the Six Sigma Quality Cost Worksheets in the evaluation of possible candidate QC rules identified by QC validation. Three months of internal QC records were analyzed. EZ Rules 3 software was used to evaluate candidate QC procedures, and the costs associated with the application of different QC rules were calculated using the Six Sigma Quality Cost Worksheets. The costs associated with the current and the candidate QC rules were compared, and the amount of cost savings was calculated. There was a significant saving when the candidate 1-2.5s, n = 3 rule was applied instead of the currently utilized 1-2s, n = 3 rule. The savings were 75% per year (£ 8232.5) based on re-evaluating all of the patient samples in addition to the controls, and 72% per year (£ 822.4) based on re-analyzing only the control materials. The savings were also shown to change accordingly with the number of samples analyzed and with the number of daily QC procedures performed. These calculations demonstrated the importance of the selection of an appropriate QC procedure, and the usefulness of the Six Sigma Costs Worksheet in determining the most cost-effective rule(s) when several candidate rules are identified by QC validation. © 2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

  4. Influência de diversos fatores externos sobre a qualidade da semente de soja Influence of several external factors on the quality of soybean seed

    Directory of Open Access Journals (Sweden)

    Jocely A. Maeda

    1977-01-01

    Full Text Available Cinco lotes de sementes de soja foram caracterizados de acordo com as especificações de exportação do CONCEX - Resolução n.° 82, que classifica as sementes em avariadas, rachadas e manchadas. Unica vez que o lote que apresentou o maior índice total de necrose foi o do cultivar viçoja da safra de 1976, dedicou-se a este uma análise detalhada de laboratório. Assim, conforme os tipos de danificações encontradas, elaborou-se um sistema de nove classes, determinando a seguir a porcentagem de cada classe e a porcentagem em relação ao total. A classe de danificação de maior ocorrência foi a mecânica, vindo a seguir a climática. As que proporcionaram maior índice de plântulas normais foram a mancha-café e a mancha-púrpura, ambas não diferindo da classe de sementes boas. A danificação mecânica foi a que proporcionou o menor índice de germinação. Do mesmo modo, foi elevado o índice de necrose nos cotilédones, nas classes de sementes avariadas por percevejos, com depressões e rachaduras devido a danificações mecânicas. Tanto os testes de germinação como os de vigor demonstraram que entre as classes estudadas, aquela cujas sementes eram aparentemente livres de danificações foi superior às demais, enquanto a de sementes atacadas por percevejo foi a que apresentou valores mais baixos.The influence of weathering, mechanical damage and other classes of external depreciations on soybean seeds was studied. Incidence of necrosis of the cotyledons, low germination and vigor are closely related to different forms of depreciations on the surface of the seed. Mechanical damage which was the most common type of depreciation caused the seed to decrease in germination. Necrosis in the cotyledons was found to be very closely related to stink bug attack, depressions and cracked seed. Apparently sound seed and those showing seed coat mottling or purple stain were those that gave the best results in the germination tests.

  5. Goal Management Training Combined With External Cuing as a Means to Improve Emotional Regulation, Psychological Functioning, and Quality of Life in Patients With Acquired Brain Injury: A Randomized Controlled Trial.

    Science.gov (United States)

    Tornås, Sveinung; Løvstad, Marianne; Solbakk, Anne-Kristin; Schanke, Anne-Kristine; Stubberud, Jan

    2016-11-01

    To investigate whether goal management training (GMT) expanded to include external cuing and an emotional regulation module is associated with improved emotional regulation, psychological functioning, and quality of life (QOL) after chronic acquired brain injury (ABI). Randomized controlled trial with blinded outcome assessment at baseline, posttraining, and 6-month follow-up. Outpatient. Persons with ABI and executive dysfunction (N=70; 64% traumatic brain injury; 52% men; mean age ± SD, 43±13y; mean time since injury ± SD, 8.1±9.4y). Eight sessions of GMT in groups, including a new module addressing emotional regulation, and external cuing. A psychoeducative control condition (Brain Health Workshop) was matched on amount of training, therapist contact, and homework. Emotional regulation was assessed with the Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire, the Emotional Control subscale and the Emotion Regulation factor (Behavior Rating Inventory of Executive Function-Adult Version), and the Positive and Negative Affect subscales from the Dysexecutive Questionnaire. Secondary outcome measures included psychological distress (Hopkins Symptom Checklist-25) and QOL (Quality of Life After Brain Injury Scale). Findings indicated beneficial effects of GMT on emotional regulation skills in everyday life and in QOL 6 months posttreatment. No intervention effects on measures of psychological distress were registered. GMT is a promising intervention for improving emotional regulation after ABI, even in the chronic phase. More research using objective measures of emotional regulation is needed to investigate the efficacy of this type of training. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. The long-term within- and between-laboratory variability for assay of antithrombin, and proteins C and S: results derived from the external quality assessment program for thrombophilia screening of the ECAT Foundation.

    Science.gov (United States)

    Meijer, P; Kluft, C; Haverkate, F; De Maat, M P M

    2003-04-01

    A stable laboratory performance is important for comparability and transferability of laboratory data both within and between laboratories. The lack of a reference system within hemostasis hampers laboratories in establishing their laboratory performance over a prolonged period of time. Therefore, based on data from an external quality assessment program, we evaluated the between laboratory variation (CVBETWEEN) and the long-term within-laboratory variation (LCVa) for antithrombin, and proteins C and S. We evaluated the CVBETWEEN for the period 1996-2001, including the results of 64-240 laboratories from 23 different surveys (protein S activity 15 surveys). We observed a quite high CVBETWEEN and a broad range for each analyte. The CVBETWEEN was significantly higher for antithrombin and protein S for samples with low levels similar to heterozygous deficiencies. We also evaluated the LCVa, including the results of 136 laboratories. The lowest LCVa[median and 95% content interval (CI)] was observed for antithrombin (7.6%; 3.6-35.5%), intermediate values for protein C activity and antigen (8.6%; 3.5-25.3% and 10.8%; 4.8-33.1%, respectively) and highest values for the protein S variables (13.4%; 6.4-50.6% for total protein S antigen, 14.1%; 6.5-79.1% for free protein S antigen and 17.2%; 7.2-84.3% for protein S activity). We concluded that the main reason for the high CVBETWEEN is the long-term within-laboratory variability. Application of linear regression on data of an external quality assessment program is a useful model to demonstrate per analyte per laboratory the long-term variability (LCVa). It is concluded that improvement of the long-term within-laboratory test performance is the first priority in hemostasis to yield important improvements in the comparability and transferability of laboratory data.

  7. Accuracy of central axis dose calculations for photon external radiotherapy beams in Finland: the quality of local beam data and the use of averaged data.

    Science.gov (United States)

    Kapanen, Mika; Sipilä, Petri; Bly, Ritva; Järvinen, Hannu; Tenhunen, Mikko

    2008-02-01

    The accuracy of central axis dose calculation was evaluated for 48 photon beams from 28 linear accelerators at nine centres in Finland. In addition, inter-accelerator consistency of beam data was evaluated for Varian Clinac 600 CDs and 2100 CDs, and averaged data sets were generated for output factors (OFs) and percentage depth doses (PDDs). The averaged data sets obtained were used to identify potential dosimetry reasons for local errors. Agreement between measured and calculated doses was determined at isocentre at 10 cm depth in water for nine different sized open square and rectangular fields. Averaged OFs were determined for nominal energies of 4, 6, 10, 15 and 18 MV both at d(max) and at a 10-cm depth. In order to develop a function for the OF data, OFs for square fields were parameterised through empirical model fitting. The feasibility of a simple equivalent square collimator formula was also evaluated for the presentation of OFs for rectangular fields. Averaged PDDs were determined at a 10-cm depth. The difference between measured and calculated doses exceeded +/-3%, +/-2% and +/-1% for 3, 6 and 35 of the investigated 48 beams, respectively. The differences were due to errors observed in both OFs and depth dose data. When the agreement between dose calculation and measurement was within +/-1%, inter-accelerator differences in OFs were within +/-1.0% at both the depth of dose maximum and at 10 cm for Clinac 600 CDs and also for 2100 CDs. Differences in PDDs were within +/-1.2%. The importance of quality control for beam data was demonstrated by showing significant errors in measured data. For Clinac 600 and 2100 CDs, the quality control can be accurately performed by comparing local data to averaged reference data. Robust averaged data sets were obtained for 6, 15 and 18 MV beams of Clinac 2100 CDs.

  8. External validation of Vascular Study Group of New England risk predictive model of mortality after elective abdominal aorta aneurysm repair in the Vascular Quality Initiative and comparison against established models.

    Science.gov (United States)

    Eslami, Mohammad H; Rybin, Denis V; Doros, Gheorghe; Siracuse, Jeffrey J; Farber, Alik

    2017-08-11

    The purpose of this study is to externally validate a recently reported Vascular Study Group of New England (VSGNE) risk predictive model of postoperative mortality after elective abdominal aortic aneurysm (AAA) repair and to compare its predictive ability across different patients' risk categories and against the established risk predictive models using the Vascular Quality Initiative (VQI) AAA sample. The VQI AAA database (2010-2015) was queried for patients who underwent elective AAA repair. The VSGNE cases were excluded from the VQI sample. The external validation of a recently published VSGNE AAA risk predictive model, which includes only preoperative variables (age, gender, history of coronary artery disease, chronic obstructive pulmonary disease, cerebrovascular disease, creatinine levels, and aneurysm size) and planned type of repair, was performed using the VQI elective AAA repair sample. The predictive value of the model was assessed via the C-statistic. Hosmer-Lemeshow method was used to assess calibration and goodness of fit. This model was then compared with the Medicare, Vascular Governance Northwest model, and Glasgow Aneurysm Score for predicting mortality in VQI sample. The Vuong test was performed to compare the model fit between the models. Model discrimination was assessed in different risk group VQI quintiles. Data from 4431 cases from the VSGNE sample with the overall mortality rate of 1.4% was used to develop the model. The internally validated VSGNE model showed a very high discriminating ability in predicting mortality (C = 0.822) and good model fit (Hosmer-Lemeshow P = .309) among the VSGNE elective AAA repair sample. External validation on 16,989 VQI cases with an overall 0.9% mortality rate showed very robust predictive ability of mortality (C = 0.802). Vuong tests yielded a significant fit difference favoring the VSGNE over then Medicare model (C = 0.780), Vascular Governance Northwest (0.774), and Glasgow Aneurysm Score (0

  9. Effects Of On–Line Banking On External Audit And Banks\\' External ...

    African Journals Online (AJOL)

    This paper presents the effect of on-line banking on external audit and external examination of Banks in Nigeria. Although the paper has shown that on-line banking presents such benefits as speedy account balances retrieval, quick funds transfer, rapid transformation of the quality of service delivery in the banking sector ...

  10. External Costs of Transport

    OpenAIRE

    INFRAS, UNIVERSITAT KARLRUHE

    2014-01-01

    This study is an update of a former UIC study on external effects (IFRAS / IWW 2000). It aims at improving the empirical basis of external costs of transport based on the actual state of the art of cost estimation methodologies reflecting also recent studies on external costs of transport on a European level (especially UNITE).The following dimensions are considered:- cost categories- contries- base year- differentiation by means of transport 

  11. External radiation surveillance

    Energy Technology Data Exchange (ETDEWEB)

    Antonio, E.J.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report describes how external radiation was measured, how surveys were performed, and the results of these measurements and surveys. External radiation exposure rates were measured at locations on and off the Hanford Site using thermoluminescent dosimeters (TLD). External radiation and contamination surveys were also performed with portable radiation survey instruments at locations on and around the Hanford Site.

  12. External influences on local institutions: spatial dependence and openness

    NARCIS (Netherlands)

    Faber, G.; Gerritsen, M.J.

    There are both empirical and theoretical arguments for the thesis that external factors have an impact on domestic institutional quality. Consequently, external factors may have large effects on domestic income via local institutions. This paper investigates the role of external factors by

  13. Enhanced External Counterpulsation (EECP)

    Science.gov (United States)

    2006-01-01

    balance between benefits and harms, quality of evidence, applicability, and the certainty of the baseline risks are considered in judgments about the strength of recommendations. Summary of Findings The Cochrane and INAHTA databases yielded 3 HTAs or systematic reviews on EECP treatment (Blue Cross Blue Shield Technology Evaluation Center [BCBS TEC], ECRI, and the Centers for Medicare and Medicaid Services [CMS]). A search of Medline and Embase December 2005 – March 2006 (after the literature search cutoff from the most recent HTA) was conducted using key words enhanced external counterpulsation, EECP, angina, myocardial ischemia, congestive heart failure. This search produced 1 study which met the inclusion criteria. This level 4a study was inferior in quality to the RCT which formed the basis of the 2003 Medical Advisory Secretariat recommendation. BCBS reviewed the evidence through November 2005 to determine if EECP improves health outcomes for refractory chronic stable angina pectoris or chronic stable HF. (12) BCBS concluded that the available evidence is not sufficient to permit conclusions of the effect of EECP on health outcomes. Both controlled trials had methodologic flaws (MUST EECP and MUST EECP quality of life studies). The case series and observational studies for both indications while suggestive of a treatment benefit from EECP have shortcomings as well. On March 20 2006, CMS posted their proposed coverage decision memorandum for external counterpulsation therapy. (13) Overall, CMS stated that the evidence is not adequate to conclude that external counterpulsation therapy is reasonable and necessary for: Canadian Cardiovascular Society Classification (CCSC) II angina Heart failure NYHA class II/III stable HF symptoms with an EF≤35% NYHA class II/III stable HF symptoms with an EF≤40% NYHA class IV HF Acute HF Cardiogenic shock Acute MI In January 2005, ECRI (14) stated that there was insufficient evidence available to draw conclusions about the long

  14. Quality assurance program of a respiratory gating irradiation system based on external and internal fiducial markers; Programa de garantia de calidad de un sistema de irradiacion con control respiratorio basado en marcadores fiduciales externos e internos

    Energy Technology Data Exchange (ETDEWEB)

    Zucca Aparicio, D.; Perez Moreno, J. M.; Fernandez Leton, P.; Garcia Ruiz-Zorrilla, J.; Minambres Moro, A.

    2011-07-01

    Respiratory Gating involves the administration of radiation during treatment delivery within a particular portion of the patients breathing cycle, so the absorbed dose administration with respiratory control techniques requires specific quality control to ensure the correctness of the delivered dose. The establishment of a Quality Control Program (QC) is proposed for the Respiratory Gating based techniques in order to have a better understanding of how this system works and to know its associated dosimetric impact. The influence of the CT acquisition under respiratory motion conditions has been analyzed for the treatment isocenter localization, using internal and external fiducial markers with IGRT techniques that allow the correlation of the isocenter positioning with the phase of the respiratory cycle. Radiation delivery in the presence of intra fraction organ motion causes an averaging or blurring of the static dose distribution over the path of motion increasing the beam penumbra of the radiation field and reducing the therapeutic region when the irradiation is not breath controlled. The feasibility of intensity modulated treatments (IMRT) for both static and dynamic techniques, managed by respiratory control has been tested, demonstrating the possibility of synchronizing the movement of the leaves in the microfluorimeter collimator (mMLC) with the gated beam irradiation. (Author) 45 refs.

  15. Examining social competence, self-perception, quality of life, and internalizing and externalizing symptoms in adolescent females with and without autism spectrum disorder: a quantitative design including between-groups and correlational analyses.

    Science.gov (United States)

    Jamison, T Rene; Schuttler, Jessica Oeth

    2015-01-01

    Adolescent females with an autism spectrum disorder (ASD) are an understudied population, yet are also quite vulnerable, due to the increased complexities of social interaction and increased risk for internalizing symptoms in adolescence. Most research literature currently focuses on males with ASD, limiting our understanding of social experiences for females with ASD, and thus the potential to better inform supports and intervention to promote social-emotional functioning. This study examined similarities and differences in selected indicators of social-emotional health (social competence, self-perception, quality of life) and problematic behaviors such as externalizing and internalizing symptoms for adolescent females with and without ASD. This study employed a quantitative design utilizing correlational analysis as well as t test comparisons to examine selected indicators of social-emotional health and problematic symptoms using the Social Skills Improvement System (SSIS), Youth Quality of Life Instrument (YQOL), and the Self-Perceptions Profile for Adolescents (SPPA) for adolescent females with ASD in relation to their typically developing peers. Significant differences were found between females with and without ASD in terms of their self-ratings of social-emotional health and problematic behaviors. The no-ASD group rated themselves higher across all areas of social-emotional health. Findings also suggest strong relationships between these constructs, especially for females without ASD. Parent reports of autism symptoms and social-emotional health indicated that as symptoms of autism are more severe, so too was the impact on individuals' social competence. Adolescent females with ASD perceive themselves as having lower social competence, self-worth, and quality of life and higher levels of internalizing and externalizing symptoms as compared to their typically developing peers. Parent ratings indicate that higher levels of autism symptoms relate to lower

  16. Social Agglomeration Externalities

    OpenAIRE

    Borck, Rainald

    2005-01-01

    This paper examines social agglomeration externalities. Using survey data from the German Socio-Economic Panel, I examine the link between city size and different measures of consumption, social interaction and social capital. Further, using responses to satisfaction questions, I analyse whether individuals are compensated for diseconomies of agglomeration by positive agglomeration externalities in other areas. This equilibrium hypothesis cannot be rejected.

  17. External approach to rhinoplasty.

    Science.gov (United States)

    Goodman, Wilfred S; Charbonneau, Paul A

    2015-07-01

    The technique of external rhinoplasty is outlined. Having reviewed 74 cases, its advantages and disadvantages are discussed. Reluctance to use this external approach seems to be based on emotional rather than radical grounds, for its seems to be the procedure of choice for many problems.

  18. The External Mind

    DEFF Research Database (Denmark)

    The External Mind: an Introduction by Riccardo Fusaroli, Claudio Paolucci pp. 3-31 The sign of the Hand: Symbolic Practices and the Extended Mind by Massimiliano Cappuccio, Michael Wheeler pp. 33-55 The Overextended Mind by Shaun Gallagher pp. 57-68 The "External Mind": Semiotics, Pragmatism...

  19. Internal and external factors in innovation persistence

    OpenAIRE

    Antonelli, Cristiano; Crespi, Francesco; Scellato, Giuseppe

    2012-01-01

    This paper contributes the analysis of the persistence of innovation activities, as measured by total factor productivity (TFP) and explores its internal and external determinants stressing its path dependent characteristics. The external conditions, namely the quality of local knowledge pools and the strength of the Schumpeterian rivalry, together with the internal conditions, that is the actual levels of dynamic capabilities, as proxied by the levels of wages and the size of firms, exert a ...

  20. High Power Diode Lasers with External Feedback: Overview and Prospects

    DEFF Research Database (Denmark)

    Chi, Mingjun; Petersen, Paul Michael

    2012-01-01

    In summary, different external-cavity feedback techniques to improve the spatial beam quality and narrow the linewidth of the output beam from both BALs and TDLs are presented. Broad-area diode laser system with external-cavity feedback around 800 nm can produce several Watts of output power...... with a good beam quality. Tapered diode laser systems with external-cavity feedback around 800 and 1060 nm can deliver more than 2 W output power with diffraction-limited beam quality and can be operated in single-longitudinal mode. These high-brightness, narrow linewidth, and tunable external-cavity diode...

  1. Multi-institutional Prospective Evaluation of Bowel Quality of Life After Prostate External Beam Radiation Therapy Identifies Patient and Treatment Factors Associated With Patient-Reported Outcomes: The PROSTQA Experience

    Energy Technology Data Exchange (ETDEWEB)

    Hamstra, Daniel A., E-mail: dhamm@med.umich.edu [Department of Radiation Oncology, The University of Michigan Medical Center, Ann Arbor, Michigan (United States); Conlon, Anna S.C.; Daignault, Stephanie [Department of Biostatistics, The University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan (United States); Dunn, Rodney L. [Department of Urology, The University of Michigan Medical Center, Ann Arbor, Michigan (United States); Sandler, Howard M. [Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, California (United States); Hembroff, A. Larry [Office for Survey Research, Michigan State University, East Lansing, Michigan (United States); Zietman, Anthony L. [Department of Radiation Oncology, The Massachusetts General Hospital, Boston, Massachusetts (United States); Kaplan, Irving [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (United States); Ciezki, Jay [Department of Radiation Oncology, The Cleveland Clinic, Cleveland, Ohio (United States); Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, John T. [Department of Urology, The University of Michigan Medical Center, Ann Arbor, Michigan (United States); Sanda, Martin G. [Department of Urology, Emory University Medical Center, Atlanta, Georgia (United States); Michalski, Jeff M. [Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri (United States)

    2013-07-01

    Purpose: To evaluate patients treated with external beam radiation therapy as part of the multicenter Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA), to identify factors associated with posttreatment patient-reported bowel health-related quality of life (HRQOL). Methods and Materials: Pretreatment characteristics and treatment details among 292 men were evaluated using a general linear mixed model for their association with measured HRQOL by the Expanded Prostate Cancer Index Composite instrument through 2 years after enrollment. Results: Bowel HRQOL had a median score of 100 (interquartile range 91.7-100) pretreatment and 95.8 (interquartile range 83.3-100) at 2 years, representing new moderate/big problems in 11% for urgency, 7% for frequency, 4% for bloody stools, and 8% for an overall bowel problems. Baseline bowel score was the strongest predictor for all 2-year endpoints. In multivariable models, a volume of rectum ≥25% treated to 70 Gy (V70) yielded a clinically significant 9.3-point lower bowel score (95% confidence interval [CI] 16.8-1.7, P=.015) and predicted increased risks for moderate to big fecal incontinence (P=.0008). No other radiation therapy treatment-related variables influenced moderate to big changes in rectal HRQOL. However, on multivariate analyses V70 ≥25% was associated with increases in small, moderate, or big problems with the following: incontinence (3.9-fold; 95% CI 1.1-13.4, P=.03), rectal bleeding (3.6-fold; 95% CI 1.3-10.2, P=.018), and bowel urgency (2.9-fold; 95% CI 1.1-7.6, P=.026). Aspirin use correlated with a clinically significant 4.7-point lower bowel summary score (95% CI 9.0-0.4, P=.03) and an increase in small, moderate, or big problems with bloody stools (2.8-fold; 95% CI 1.2-6.4, P=.018). Intensity modulated radiation therapy was associated with higher radiation therapy doses to the prostate and lower doses to the rectum but did not independently correlate with bowel HRQOL

  2. External indebtedness of Croatian banks

    Directory of Open Access Journals (Sweden)

    Antun Jurman

    2005-06-01

    Full Text Available The paper analyses the main characteristics of the foreign assets and foreign liabilities of the banks that to a great extent include credit and deposit activities with non-residents – foreign physical persons and legal entities, mostly with foreign banks. The author in this paper analyses the size and trends of the Republic of Croatia’s external debt with regard to gross domestic product, import, export, international reserve of the Croatian National Bank (HNB, etc. The author also discusses external debt of the banks that have, during the past few years, contributed substantially to the overall external debt of the Republic of Croatia. The autor points out that the banks have used foreign sources mainly for placing citizens’ loans, and less for financing development projects and economy. Thus, the banks have “spent”, i.e. used up their credit capacity as well as the credit capacity of the Republic of Croatia. Regardless of the fact that the banks have improved the quality of their assets, maintained liquidity/solvency and made extremely good profits, there have not been positive effects of the multiplication of credits/loans and deposits nor have there been the awaited effects on the growth of the gross domestic product and employment that otherwise might have been achieved via different foreign resources investment policy

  3. Externally Verifiable Oblivious RAM

    Directory of Open Access Journals (Sweden)

    Gancher Joshua

    2017-04-01

    Full Text Available We present the idea of externally verifiable oblivious RAM (ORAM. Our goal is to allow a client and server carrying out an ORAM protocol to have disputes adjudicated by a third party, allowing for the enforcement of penalties against an unreliable or malicious server. We give a security definition that guarantees protection not only against a malicious server but also against a client making false accusations. We then give modifications of the Path ORAM [15] and Ring ORAM [9] protocols that meet this security definition. These protocols both have the same asymptotic runtimes as the semi-honest original versions and require the external verifier to be involved only when the client or server deviates from the protocol. Finally, we implement externally verified ORAM, along with an automated cryptocurrency contract to use as the external verifier.

  4. The relationship between the biochemical control outcomes and the quality of planning of high-dose rate brachytherapy as a boost to external beam radiotherapy for locally and locally advanced prostate cancer using the RTOG-ASTRO Phoenix definition.

    Science.gov (United States)

    Pellizzon, Antonio Cassio Assis; Salvajoli, João; Novaes, Paulo; Maia, Maria; Fogaroli, Ricardo; Gides, Doglas; Horriot, Rodrigues

    2008-06-04

    To evaluated prognostic factors and impact of the quality of planning of high dose rate brachytherapy (HDR-BT) for patients with local or locally advanced prostate cancer treated with external beam radiotherapy (EBRT) and HDR-BT. Between 1997 and 2005, 209 patients with biopsy proven prostate adenocarcinoma were treated with localized EBRT and HDR-BT at the Department of Radiation-Oncology, Hospital A. C. Camargo, Sao Paulo, Brazil. Patient's age, Gleason score (GS), clinical stage (CS), initial PSA (iPSA), risk group for biochemical failure (GR), doses of EBRT and HDR-BT, use of three-dimensional planning for HDR-BT (3DHDR) and the Biological Effective Dose (BED) were evaluated as prognostic factors for biochemical control (bC). Median age and median follow-up time were 68 and 5.3 years, respectively. Median EBRT and HDR-BT doses were 45 Gy and 20 Gy. The crude bC at 3.3 year was 94.2%. For the Low, intermediate and high risk patients the bC rates at 3.3 years were 91.5%, 90.2% and 88.5%, respectively. Overall survival (OS) and disease specific survival rates at 3.3 years were 97.8% and 98.4%, respectively. On univariate analysis the prognostic factors related bC were GR (p= 0.040), GS or = 20 Gy (p or = 99 Gy(1.5) (p or = 185 (p or = 20 Gy (p=0.008) and 3DHDR (p<0.001). we observed that the bC rates correlates with the generally accepted risk factors described in the literature. Dose escalation, evaluated through the BED, and the quality of planning of HDR-BT are also important predictive factors when treating prostate cancer.

  5. ADE Guide for External Reviewers.

    Science.gov (United States)

    ADE Bulletin, 2002

    2002-01-01

    Helps external reviewers of academic departments draw on the experience of those who have learned by trial and error. Outlines the steps taken by an external reviewer. Considers the particular task for an external reviewer and presents some notes on self-preservation for the external reviewer. Discusses the external reviewer's responsibility of…

  6. External trade development in 2010

    OpenAIRE

    Český statistický úřad

    2011-01-01

    Analysis of the external trade development of the CR in total (turnover, export, import, trade balance). Main factors, which influence the external trade development. Territorial structure (by main blocks and selected countries) and commodity structure (by SITC, rev. 4) of the external trade. Comparisons of the CR external trade development with the external trade development of the other member states of the EU.

  7. [The influence of timing of surgery on mortality and early complications in femoral neck fractures, by surgical procedure: an analysis of 22,566 cases from the German External Quality Assurance Program].

    Science.gov (United States)

    Kostuj, T; Smektala, R; Schulze-Raestrup, U; Müller-Mai, C

    2013-02-01

    The current S2 guideline recommends treatment of a femoral neck fracture within the first 24 h; this becomes evident by the significant rise in general and early surgical complications, when the surgical treatment was delayed for more than 48 h. The influence of different surgical procedures was investigated. PATIENTS UND METHODS: A total of 22,566 records from the external Quality Assurance Program in North Rhine-Westphalia for treatment of femoral neck fractures in 2004/2005 (BQS specification 7.0 and 8.0) were risk-adjusted and evaluated. Surgery was performed within 48 h in 83.9% of the patients. A significant rise in general and early surgical complications was registered when the surgical treatment was delayed for more than 48 h. Mortality and general complications were significantly lower for percutaneous screw fixation. All kinds of joint replacement show significantly higher general and surgical complications. The analyzed data support the rating of femoral neck fracture as requiring the intervention of urgent early surgery, as stated in the guideline. Percutaneous screw fixation can be considered for immobile and multimorbid patients with undislocated fractures. Advantages of total hip replacement compared to hemiarthroplasty cannot be supported by the QS-NRW data.

  8. Ranking schools on external knowledge tests results

    Directory of Open Access Journals (Sweden)

    Gašper Cankar

    2007-01-01

    Full Text Available The paper discusses the use of external knowledge test results for school ranking and the implicit effect of such ranking. A question of validity is raised and a review of research literature and main known problems are presented. In many western countries publication of school results is a common practice and a similar trend can be observed in Slovenia. Experiences of other countries help to predict positive and negative aspects of such publication. Results of external knowledge tests produce very limited information about school quality—if we use other sources of information our ranking of schools can be very different. Nevertheless, external knowledge tests can yield useful information. If we want to improve quality in schools, we must allow schools to use this information themselves and improve from within. Broad public scrutiny is unnecessary and problematic—it moves the focus of school efforts from real improvement of quality to mere improvement of the school public image.

  9. Productivity Change and Externalities

    DEFF Research Database (Denmark)

    Kravtsova, Victoria

    2014-01-01

    on Hungary. While the country leads the group of post-socialist countries in the amount of attracted foreign direct investments (FDI) the effect of this policy on the economy remains unclear. The research finds that different externalities play a different role in productivity, technological and efficiency...... firms and the economy as a whole. The approach used in the current research accounts for different internal as well as external factors that individual firms face and evaluates the effect on changes in productivity, technology as well as the efficiency of domestic firms. The empirical analysis focuses...

  10. Integrating Building Functions into Massive External Walls

    NARCIS (Netherlands)

    Hafez, A.H.

    2016-01-01

    Well into the twentieth century, brick and stone were the materials used in external walls. Bricklaying and stonemasonry were the construction technologies employed for the exterior walls of virtually all major structures. However, with the rise in quality of life, the massive walls alone became

  11. Impact of the target volume (prostate alone vs. prostate with seminal vesicles) and fraction dose (1.8 Gy vs. 2.0 Gy) on quality of life changes after external-beam radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Eble, Michael J. [Dept. of Radiotherapy, RWTH Aachen (Germany); Pinkawa, Michael; Piroth, Marc D.; Fischedick, Karin; Holy, Richard; Klotz, Jens; Nussen, Sandra; Krenkel, Barbara

    2009-11-15

    Purpose: to evaluate the impact of the clinical target volume (CTV) and fraction dose on quality of life (QoL) after external-beam radiotherapy (EBRT) for prostate cancer. Patients and methods: a group of 283 patients has been surveyed prospectively before, at the last day, at a median time of 2 months and 15 months after EBRT (70.2-72 Gy) using a validated questionnaire (Expanded Prostate Cancer Index Composite). FBRT of prostate alone (P, n = 70) versus prostate with seminal vesicles (PS, n = 213) was compared. Differences of fraction doses (1.8 Gy, n = 80, vs. 2.0 Gy, n = 69) have been evaluated in the patient group receiving a total dose of 72 Gy. Results: significantly higher bladder and rectum volumes were found at all dose levels for the patients with PS versus P within the CTV (p < 0.001). Similar volumes resulted in the groups with different fraction doses. Paradoxically, bowel function scores decreased significantly less 2 and 15 months after EBRT of PS versus P. 2 months after EBRT, patients with a fraction dose of 2.0 Gy versus 1.8 Gy reported pain with urination ({>=} once a day in 12% vs. 3%; p = 0.04) and painful bowel movements ({>=} rarely in 46% vs. 29%; p = 0.05) more frequently. No long-term differences were found. Conclusion: the risk of adverse QoL changes after EBRT for prostate cancer cannot be derived from the dose-volume histogram alone. Seminal vesicles can be included in the CTV up to a moderate total dose without adverse effects on QoL. Apart from a longer recovery period, higher fraction doses were not associated with higher toxicity. (orig.)

  12. First external quality assurance program of the Italian HLA-B*57:01 Network assessing the performance of clinical virology laboratories in HLA-B*57:01 testing.

    Science.gov (United States)

    Meini, Genny; Dello Russo, Cinzia; Allice, Tiziano; Barresi, Renata; D'Arrigo, Roberta; Falasca, Francesca; Lipsi, Maria Rosaria; Paolucci, Stefania; Zanussi, Stefania; Antonetti, Raffaele; Baldanti, Fausto; Basaglia, Giancarlo; Bruzzone, Bianca; Polilli, Ennio; Ghisetti, Valeria; Pucillo, Leopoldo Paolo; Turriziani, Ombretta; Pirazzoli, Antonella; Navarra, Pierluigi; Zazzi, Maurizio

    2016-05-01

    Since the HLA-B*57:01 allele is strongly associated with abacavir hypersensitivity reaction, testing for the presence of HLA-B*57:01 is mandatory before administration of abacavir. While HLA-B*57:01 testing is usually provided by pharmacogenetics, genetics or blood transfusion services, clinical virology laboratories can be an optimal opportunity for HLA-B*57:01 testing since they receive blood samples for routine HIV monitoring and have the expertise for convenient and less expensive PCR-based point mutation assays. The Italian HLA-B*57:01 Network gathers accredited clinical virology laboratories offering HLA-B*57:01 testing in Italy with the aim to share protocols, test new methods, develop and maintain external quality assurance (EQA) programs. A panel of 9HLA-B*57:01-positive and 16HLA-B*57:01-negative frozen blood samples were blindly distributed to 10 units including 9 clinical virology laboratories and one reference pharmacology laboratory. Each laboratory was free to use its own routine method for DNA extraction and HLA-B*57:01 testing. DNA was extracted by automated workstations in 6 units and by manual spin columns in 4. Eight units used the Duplicα Real Time HLA-B*57:01 kit by Euroclone and two units used two different PCR homemade protocols. All the 10 units correctly identified all the 25 samples. The first HLA-B*57:01 EQA program run in Italy showed that clinical virology units are equipped and proficient for providing HLA-B*57:01 testing by inexpensive assays easy to integrate into their routine. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Network cities and externalities

    Directory of Open Access Journals (Sweden)

    Rafael Boix Domènech

    2004-01-01

    Full Text Available The concept of «agglomeration economies» explains the existence of advantages derived from the concentration of population and activity. However, it does not explain the existence of spatially dynamic external economies. Network economies generated in networks of cities correspond to this last type, since they are generated from the interaction between urban units, linked by a network relationship. The objective of this research is to advance in the study of the relationship between the networks of cities and the generation of external economies. The research is divided in four parts: first we expose the link between networks of cities and external economies. The second part outlines a model for the combined measuring of the concentration and network economies. The third part explains the results of applying the model to a case of study: the network of cities of Catalonia. The results suggest that there is a causal relationship between the organization of the urban units forming networks of cities and the generation of external economies that affect growth and economic development. Finally, conclusions and policy implications are drawn up.

  14. Stochastic Control - External Models

    DEFF Research Database (Denmark)

    Poulsen, Niels Kjølstad

    2005-01-01

    This note is devoted to control of stochastic systems described in discrete time. We are concerned with external descriptions or transfer function model, where we have a dynamic model for the input output relation only (i.e.. no direct internal information). The methods are based on LTI systems...... a section on that topic can be found in appendix....

  15. On parabolic external maps

    DEFF Research Database (Denmark)

    Lomonaco, Luna; Petersen, Carsten Lunde; Shen, Weixiao

    2017-01-01

    We prove that any C1+BV degree d ≥ 2 circle covering h having all periodic orbits weakly expanding, is conjugate by a C1+BV diffeomorphism to a metrically expanding map. We use this to connect the space of parabolic external maps (coming from the theory of parabolic-like maps) to metrically...

  16. Patient-reported lower urinary tract symptoms, urinary incontinence, and quality of life after external beam radiotherapy for localized prostate cancer - 15 years' follow-up. A comparison with age-matched controls

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, Per (Dept. of Radiation Sciences, Oncology, Umeaa Univ., Umeaa (Sweden))

    2008-06-15

    Background. To prospectively examine the urinary toxicity and quality of life (QOL) in patients 15 years after external beam radiotherapy (EBRT) for localized prostate cancer (LPC) and compare the outcomes with results for age-matched controls. Material and methods. Urinary symptoms were assessed using the symptom-specific Prostate Cancer Symptom Scale (PCSS) questionnaire, and QOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC)'s Quality of Life Questionnaire (QLQ-C30). Both questionnaires were sent to the surviving 41 patients (25%) and the PCSS questionnaire was sent to 69 age-matched controls for comparison. Results. The response rate was 71% in the patient group and 59% in the control group. Two patients and four controls were excluded due to other cancer diagnoses, resulting in a total of 27 patients and 37 controls for inclusion in the analyses. The mean age in both groups was 78 years. In the patient group, incontinence had increased between the 8-year (mean=0.6) and the 15-year follow-up (mean=2.1; p=0.038). No other differences in urinary problems were seen between these two follow-ups. Increased incontinence, stress incontinence, and pain while urinating were reported by the patients in comparison with the controls at 15 years. Role function was worse in the patient group (mean=67.3) compared with the controls (mean=82.4; p=0.046). The patients also reported more appetite loss, diarrhea, nausea/vomiting, and pain than the controls. Conclusion. EBRT for LPC has divergent effects on urinary symptoms and QOL in comparison with age-matched controls. In our patient population, urinary incontinence increased between 8 and 15 years of follow-up. Otherwise, no differences in urinary symptoms were seen between 4 and 15 years. Incontinence, stress incontinence, and pain while urinating were increased after EBRT in comparison with the controls. Conventional EBRT did not result in a major deterioration in QOL 15 years

  17. Future shock: automatic external defibrillators.

    Science.gov (United States)

    Einav, Sharon; Weissman, Charles; Kark, Jeremy; Lotan, Chaim; Matot, Idit

    2005-04-01

    This review provides a practical overview of the performance capabilities of automatic external defibrillators (AEDs), and of advances in technology and dissemination programmes for these devices. Arrhythmia analysis by AEDs is extremely reliable in most settings (sensitivity 81-100%, specificity 99.9-97.6%). Accurate detection of arrhythmias has also been demonstrated in children, leading the US Food and Drug Administration to approve the use of several AEDs in children aged 8 years or younger. Factors that potentially may reduce the quality of arrhythmia detection are the presence of wide complex supraventricular tachycardia and location of an arrythmic event near to high-power lines. AED use by professional basic life support providers resulted in increased survival in the prehospital setting. However, provision of AEDs to nonmedical rescue services did not result in universal improvement in patient outcome. Public access defibrillation programmes have led to higher rates of survival from cardiac arrest. The role of AEDs in hospitals has yet to be elucidated, although in-hospital mortality from ventricular arrhythmias has been shown to decrease following AED deployment. Given the correct setting, AEDs can ensure that defibrillation is not limited by lack of medical knowledge or difficulties in decision making. However, event-related variables and operator-related factors, that are yet to be determined, can significantly affect the efficacy of automatic external defibrillation.

  18. Integrating Building Functions into Massive External Walls

    Directory of Open Access Journals (Sweden)

    Ahmed Hisham Hafez

    2017-11-01

    Full Text Available Well into the twentieth century, brick and stone were the materials used. Bricklaying and stonemasonry were the construction technologies employed for the exterior walls of virtually all major structures. However, with the rise in quality of life, the massive walls alone became incapable of fulfilling all the developed needs. Adjacent systems and layers had then to be attached to the massive layer. Nowadays, the external wall is usually composed of a layered construction. Each external wall function is usually represented by a separate layer or system. The massive layer of the wall is usually responsible for the load-bearing function. Traditional massive external walls vary in terms of their external appearance, their composition and attached layers. However, their design and construction process is usually a repeated process. It is a linear process where each discipline is concerned with a separate layer or system. These disciplines usually take their tasks away and bring them back to be re-integrated in a layered manner. New massive technologies with additional function have recently become available. Such technologies can provide the external wall with other functions in addition to its load-bearing function. The purpose of this research is to map the changes required to the traditional design and construction process when massive technologies with additional function are applied in external walls. Moreover, the research aims at assessing the performance of massive solutions with additional function when compared to traditional solutions in two different contexts, the Netherlands and Egypt. Through the analysis of different additional function technologies in external walls, a guidance scheme for different stakeholders is generated. It shows the expected process changes as related to the product level and customization level. Moreover, the research concludes that the performance of additional insulating technologies, and specifically

  19. ExternE transport methodology for external cost evaluation of air pollution

    DEFF Research Database (Denmark)

    Jensen, S. S.; Berkowicz, R.; Brandt, J.

    The report describes how the human exposure estimates based on NERI's human exposure modelling system (AirGIS) can improve the Danish data used for exposure factors in the ExternE Transport methodology. Initially, a brief description of the ExternE Tranport methodology is given and it is summarised...

  20. [Wearable Automatic External Defibrillators].

    Science.gov (United States)

    Luo, Huajie; Luo, Zhangyuan; Jin, Xun; Zhang, Leilei; Wang, Changjin; Zhang, Wenzan; Tu, Quan

    2015-11-01

    Defibrillation is the most effective method of treating ventricular fibrillation(VF), this paper introduces wearable automatic external defibrillators based on embedded system which includes EGG measurements, bioelectrical impedance measurement, discharge defibrillation module, which can automatic identify VF signal, biphasic exponential waveform defibrillation discharge. After verified by animal tests, the device can realize EGG acquisition and automatic identification. After identifying the ventricular fibrillation signal, it can automatic defibrillate to abort ventricular fibrillation and to realize the cardiac electrical cardioversion.

  1. Externally triggered microcapsules

    Science.gov (United States)

    Morrison, Dennis R. (Inventor); Mosier, Benjamin (Inventor)

    2011-01-01

    Disclosed are microcapsules comprising a polymer shell enclosing one or more immiscible liquid phases in which a drug or drug precursor are contained in a liquid phase. The microparticles also contain magnetic particles that can be heated by application of an external magnetic field and thus heated to a predetermined Curie temperature. Heating of the particles melts the polymer shell and releases the drug without causing heating of surrounding tissues.

  2. Agglomeration Externalities in Germany

    OpenAIRE

    Bode, Eckhardt

    2004-01-01

    Several recent econometric investigations found externalities related to the density of economic activity to account for one fifth to one half of total regional variations in average labor productivity in the U.S. and big European countries, including Germany. The present paper shows for German NUTS 3 regions, first, that this result is not robust against a more extensive control for private returns that may be correlated with economic density. The paper presents, second, evidence of various ...

  3. External Auditors and Corporate Corruption: Implications for External Audit Regulators

    National Research Council Canada - National Science Library

    Kassem, Rasha; Higson, Andrew W

    2016-01-01

      The purpose of the current study is to examine the responsibility of external auditors in relation to corporate corruption and to highlight the implications of this for external audit regulators...

  4. Regularization by External Variables

    DEFF Research Database (Denmark)

    Bossolini, Elena; Edwards, R.; Glendinning, P. A.

    2016-01-01

    Regularization was a big topic at the 2016 CRM Intensive Research Program on Advances in Nonsmooth Dynamics. There are many open questions concerning well known kinds of regularization (e.g., by smoothing or hysteresis). Here, we propose a framework for an alternative and important kind of regula...... of regularization, by external variables that shadow either the state or the switch of the original system. The shadow systems are derived from and inspired by various applications in electronic control, predator-prey preference, time delay, and genetic regulation....

  5. Chronic progressive external ophthalmoplegia.

    Science.gov (United States)

    Lee, Andrew G; Brazis, Paul W

    2002-09-01

    Chronic progressive external ophthalmoplegia (CPEO) is a descriptive term for a heterogenous group of disorders characterized by chronic, progressive, bilateral, and usually symmetric ocular motility deficit and ptosis. Significant pain, proptosis, or pupil involvement are not features of CPEO and should prompt evaluation for alternative etiologies. Mitochondrial DNA mutations are increasingly being recognized as the etiology for CPEO syndromes. Clinicians should recognize the specific syndromes associated with CPEO, characterized by variable systemic, neurologic, or other findings. Treatment is limited, but newer therapies are being investigated.

  6. Control de la calidad del diagnóstico coproparasitológico en la provincia de Ciudad de La Habana, Cuba External quality assessment in coproparasitology in Havana City Province, Cuba

    Directory of Open Access Journals (Sweden)

    Fidel Angel Núñez

    1997-01-01

    Full Text Available Se realizó un estudio sobre la calidad del diagnóstico coproparasitológico en 77 laboratorios de la red de salud pública de la provincia Ciudad de La Habana, Cuba. El procedimiento se basó en la entrega a cada jefe de laboratorio de un modelo de encuesta, y una bolsa de nylon conteniendo 10 viales plásticos con distintos especímenes parasitarios, preservados en formaldehído al 7%. Recogidos los resultados en las primeras 72 horas después de su entrega, se realizó la evaluación mediante una escala de puntuación establecida. La mayoría de los laboratorios aprobaron (70%; sin embargo aún existen centros, sobre todo policlínicas, con calificaciones deficientes. Los municipios con resultados más desfavorables fueron, Lisa, Marianao y Habana del Este, alcanzándose mejores resultados en los hospitales que en las policlínicas. En el análisis de Protozooarios, el mejor diagnosticado fué Giardia lamblia, con solo un centro que erró al identificarlo. Las mayores dificultades se presentaron en Blastocystis hominis con 61% de fallas, Endolimax nana, con 24,6%, y Entamoeba histolytica, con 22%. Entre los helmintos, la mayor aprobación fué en Trichuris trichiura y los errores diagnósticos predominaron con Fasciola hepatica y Taenia sp., ambos con 66,2% de fallas. Dados los resultados obtenidos, hemos organizado una intervención educativa en la red de laboratorios de la provincia.An external quality assessment in coproparasitology was carried out in 77 laboratories from Havana City. A questionnaire and ten plastic vials with different intestinal parasites in a small nylon bag, duly sealed, were sent to each laboratory. Answers were collected during the 72 hours after delivery. Results were analyzed by means of a computer program. The majority of the laboratories (70% passed the test; the municipalities with the worst scores in the province were Lisa, Marianao, and Habana del Este. Better results were obtained among technologists working

  7. Locating Problems with Quality Circles.

    Science.gov (United States)

    White, Donald D.; Bednar, David A.

    1985-01-01

    Five categories of common quality circles problems are identified to help firms anticipate difficulties and avert circle failures. These categories include encountered internal problems, encountered external problems, created internal problems, created external problems, and interface problems. Solutions are suggested. (CT)

  8. Consumption externalities and preference complementarities

    OpenAIRE

    Cleary, Rebecca; Carlson, Andrea

    2014-01-01

    Social interactions can lead to a variety of phenomena including consumption externalities and complementarities. Consumption externalities arise when the choices of others have an effect on the total value of a household's purchases; complementarities arise when the choices of others have an effect on the marginal value of a household's purchases. This paper develops a conceptual model that separately identifies consumption externalities and complementarities and illustrates their significan...

  9. Household External Finance and Consumption

    OpenAIRE

    Besley, Timothy J.; Meads, Neil; Surico, Paolo

    2008-01-01

    This paper uses mortgage data to construct a measure of terms on which households access to external finance, and relates it to consumption at both the aggregate and cohort levels. The Household External Finance (HEF) index is based on the spread paid by risky borrowers in the mortgage market. There is evidence that the terms of access to external finance matter more for the consumption of young cohorts in U.K. data. Results are robust to a wide variety of specifications.

  10. Incumbent's Incentive under Network Externalities

    OpenAIRE

    Kim, Jaehong

    2001-01-01

    This paper shows that an incumbent monopolist's incentive confronting a new entrant depends on the degree of product differentiation and the strength of network externality. If products are homogeneous, the incumbent never wants to invite entry regardless of the degree of network externality. On the other hand, if products are differentiated, duopoly profit is higher than the monopoly profit when products are more differentiated and/or the network externality is weak. Conversely, the incumben...

  11. Evaluating the impact of accreditation and external peer review

    NARCIS (Netherlands)

    Kilsdonk, Melvin; Siesling, Sabine; Otter, Renee; van Harten, Willem H.

    2015-01-01

    Purpose – Accreditation and external peer review play important roles in assessing and improving healthcare quality worldwide. Evidence on the impact on the quality of care remains indecisive because of programme features and methodological research challenges. The purpose of this paper is to create

  12. Monetization of Environmental Externalities (Emissions from Bioenergy

    Directory of Open Access Journals (Sweden)

    Isabelle BROSE

    2008-01-01

    Full Text Available Bioenergy from agriculture is today in the heart of sustainabledevelopment, integrating its key components: environment and climate change,energy economics and energy supply, agriculture, rural and social development.Each bioenergy production route presents externalities that must be assessed inorder to compare one bioenergy route to another (bioenergy route. The lack ofprimary and reliable data on externalities is, nevertheless, an important nontechnologicalbarrier to the implementation of the best (bioenergy routes. In thisarticle, we want to monetize one environmental externality from bioenergy:emissions (GHG: CO2, CH4, N2O, O3; CO, NOx, SO2, metal, and PM. We have tomonetize emissions on the basis of their effects on health, global warming, and soiland water quality. Emissions will be quantified through Life Cycle Analysis (LCAand ECOINVENT database. Impacts on health will be monetized on the basis ofmortality (number of life expectancy years lost multiplied by Value Of Life Year(VOLY and morbidity (number of ill persons multiplied by Cost Of Illness(COI. Impacts on global warming will be monetized by Benefits Transfers fromthe Stern Review and its critics. Finally, impacts on soil and water quality will bemonetized by Averting Behaviour or Defensive Expenses methods. Monetizationresults will be gathered, weighted, and incorporated in states and firms’ decisionmakingtools. They would enhance capacity of policy makers and managers tochose the best (bioenergy routes.

  13. ExternE transport methodology for external cost evaluation of air pollution (DK)

    Energy Technology Data Exchange (ETDEWEB)

    Solvang Jensen, S.; Berkowicz, R.; Brandt, J. [National Environmental Research Inst., Dept. of Atmospheric Environment (Denmark); Willumsen, E.; Kristensen, N.B. [COWI (Denmark)

    2004-07-01

    The report describes how the human exposure estimates based on NERI's human exposure modelling system (AiGIS) can improve the Danish data used for exposure factors in the ExternE Transport methodology. Inititally, a brief description of the ExternE Transport methodology is given and it is summarised how the methodology has been applied so far in a previous Danish study. Finally, results of a case study are reported. Exposure factors have been calculated for various urban categories in the Greater Copenhagen Area. (au)

  14. Retrofitting Systems for External Walls

    DEFF Research Database (Denmark)

    Rose, Jørgen

    1997-01-01

    In this report, 9 different external and internal retrofitting systems are analyzed using numerical calculations. The analysis focuses on the thermal bridge effects in the different systems, and on this basis it is discussed whether internal or external retrofitting has the most advantages....... The different systems are evaluated using 5 different types of existing walls....

  15. External Examining: Fit for Purpose?

    Science.gov (United States)

    Bloxham, Sue; Price, Margaret

    2015-01-01

    In a context of international concern about academic standards, the practice of external examining is widely admired for its role in defending standards. Yet a contradiction exists between this faith in examining and continuing concerns about standards. This article argues that external examining rests on assumptions about standards which are…

  16. External coating of colonic anastomoses

    DEFF Research Database (Denmark)

    Pommergaard, Hans-Christian; Achiam, Michael Patrick; Rosenberg, Jacob

    2012-01-01

    Colon anastomotic leakage remains both a frequent and serious complication in gastrointestinal surgery. External coating of colonic anastomoses has been proposed as a means to lower the rate of this complication. The aim of this review was to evaluate existing studies on external coating of colonic...

  17. Intergenerational Transmission of Externalizing Behavior.

    Science.gov (United States)

    Brook, Judith S; Balka, Elinor B; Zhang, Chenshu; Brook, David W

    2015-10-01

    This prospective longitudinal investigation examined the predictors of generation 2 (G2) parental substance use as related to their generation 3 (G3) offspring's externalizing behavior. The sample comprised 281 mother- or father- child (G2/G3) pairs. The results indicated that the G1/G2 (generations 1 and 2) parent-child relationship during G2's adolescence predicted externalizing behavior in the G2 young adults which correlated with G2 parental substance use. G2 parental substance use was related to subsequent G2 substance use disorders (SUDS), and to the G2/G3 parent-child relationship. The G2/G3 parent-child relationship and G2's SUDS each predicted G3 externalizing behavior. The results highlight the significance of breaking the chain of transmission of externalizing behavior across generations. Implications for policy and programs addressing the etiology of externalizing behavior in the offspring are discussed within a developmental framework.

  18. External costs related to power production technologies. ExternE national implementation for Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Schleisner, L.; Sieverts Nielsen, P.

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results; to aggregate these site- and technology-specific results to more general figures. The current report covers the results of the national implementation for Denmark. Three different fuel cycles have been chosen as case studies. These are fuel cycles for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant based on biogas. The report covers all the details of the application of the methodology to these fuel cycles aggregation to a national level. (au) EU-JOULE 3. 59 tabs., 25 ills., 61 refs.

  19. External costs related to power production technologies. ExternE national implementation for Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Schleisner, L.; Sieverts Nielsen, P. [eds.

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results, to aggregate these site- and technology-specific results to more general figures. The current report covers the detailed information concerning the ExternE methodology. Importance is attached to the computer system used in the project and the assessment of air pollution effects on health, materials and ecological effects. Also the assessment of global warming damages are described. Finally the report covers the detailed information concerning the national implementation for Denmark for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant base on biogas. (au) EU-JOULE 3. 79 tabs., 11 ills., 201 refs.

  20. External Tank - The Structure Backbone

    Science.gov (United States)

    Welzyn, Kenneth; Pilet, Jeffrey C.; Diecidue-Conners, Dawn; Worden, Michelle; Guillot, Michelle

    2011-01-01

    The External Tank forms the structural backbone of the Space Shuttle in the launch configuration. Because the tank flies to orbital velocity with the Space Shuttle Orbiter, minimization of weight is mandatory, to maximize payload performance. Choice of lightweight materials both for structure and thermal conditioning was necessary. The tank is large, and unique manufacturing facilities, tooling, handling, and transportation operations were required. Weld processes and tooling evolved with the design as it matured through several block changes, to reduce weight. Non Destructive Evaluation methods were used to assure integrity of welds and thermal protection system materials. The aluminum-lithium alloy was used near the end of the program and weld processes and weld repair techniques had to be refined. Development and implementation of friction stir welding was a substantial technology development incorporated during the Program. Automated thermal protection system application processes were developed for the majority of the tank surface. Material obsolescence was an issue throughout the 40 year program. The final configuration and tank weight enabled international space station assembly in a high inclination orbit allowing international cooperation with the Russian Federal Space Agency. Numerous process controls were implemented to assure product quality, and innovative proof testing was accomplished prior to delivery. Process controls were implemented to assure cleanliness in the production environment, to control contaminants, and to preclude corrosion. Each tank was accepted via rigorous inspections, including non-destructive evaluation techniques, proof testing, and all systems testing. In the post STS-107 era, the project focused on ascent debris risk reduction. This was accomplished via stringent process controls, post flight assessment using substantially improved imagery, and selective redesigns. These efforts were supported with a number of test programs to

  1. Low-wealth Entrepreneurs and Access to External Financing

    DEFF Research Database (Denmark)

    Frid, Casey J.; Wyman, David M.; Gartner, Bill

    2016-01-01

    demonstrates the importance of personal wealth as a factor in acquiring external startup financing compared to human capital, industry, or personal characteristics. Social implications: -If the ability to acquire external funding is significantly constrained, the quality of the opportunity and the skill......Purpose: -The purpose of this paper is to explore the relationship between low-wealth business founders in the USA and external startup funding. Specifically, the authors test whether a founders’ low personal net worth is correlated with a lower probability of acquiring funding from outside sources...... during the business creation process. Design/methodology/approach: -The authors use a double-hurdle Cragg model to jointly estimate: first, the decision to acquire external financing; and second, the amount received. The sample is the US-based Panel Study of Entrepreneurial Dynamics II (PSED II...

  2. Leveraging External Sources of Innovation

    DEFF Research Database (Denmark)

    West, Joel; Bogers, Marcel

    2014-01-01

    suggests several gaps in prior research. One is a tendency to ignore the importance of business models, despite their central role in distinguishing open innovation from earlier research on interorganizational collaboration in innovation. Another gap is a tendency in open innovation to use “innovation......This paper reviews research on open innovation that considers how and why firms commercialize external sources of innovations. It examines both the “outside-in” and “coupled” modes of open innovation. From an analysis of prior research on how firms leverage external sources of innovation......, it suggests a four-phase model in which a linear process—(1) obtaining, (2) integrating, and (3) commercializing external innovations—is combined with (4) interaction between the firm and its collaborators. This model is used to classify papers taken from the top 25 innovation journals, complemented by highly...

  3. Thermodynamic cost of external control

    Science.gov (United States)

    Barato, Andre C.; Seifert, Udo

    2017-07-01

    Artificial molecular machines are often driven by the periodic variation of an external parameter. This external control exerts work on the system of which a part can be extracted as output if the system runs against an applied load. Usually, the thermodynamic cost of the process that generates the external control is ignored. Here, we derive a refined second law for such small machines that include this cost, which is, for example, generated by free energy consumption of a chemical reaction that modifies the energy landscape for such a machine. In the limit of irreversible control, this refined second law becomes the standard one. Beyond this ideal limiting case, our analysis shows that due to a new entropic term unexpected regimes can occur: the control work can be smaller than the extracted work and the work required to generate the control can be smaller than this control work. Our general inequalities are illustrated by a paradigmatic three-state system.

  4. Conceptual challenges for internalising externalities

    DEFF Research Database (Denmark)

    Miguel, Brandão; Weidema, Bo Pedersen

    2013-01-01

    We analyse a number of different externalities to identify conceptual challenges for the practical implementation of their internalisation. Three issues were identified: i) The balance between compensation and technology change and the respective effects on the nominal and real GDP; ii) The relev......We analyse a number of different externalities to identify conceptual challenges for the practical implementation of their internalisation. Three issues were identified: i) The balance between compensation and technology change and the respective effects on the nominal and real GDP; ii...... geographical and especially temporal distance between the benefitting actor and the victim of the external cost, the involvement of a non-governmental intermediate actor becomes increasingly necessary to provide the short-term capital required to ensure a successful implementation....

  5. 46,XY DSD with Female or Ambiguous External Genitalia at Birth due to Androgen Insensitivity Syndrome, 5-Reductase-2 Deficiency, or 17-Hydroxysteroid Dehydrogenase Deficiency: A Review of Quality of Life Outcomes

    Directory of Open Access Journals (Sweden)

    Mazur Tom

    2009-08-01

    Full Text Available Disorders of sex development refer to a collection of congenital conditions in which atypical development of chromosomal, gonadal, or anatomic sex occurs. Studies of 46,XY DSD have focused largely on gender identity, gender role, and sexual orientation. Few studies have focused on other domains, such as physical and mental health, that may contribute to a person's quality of life. The current review focuses on information published since 1955 pertaining to psychological well-being, cognition, general health, fertility, and sexual function in people affected by androgen insensitivity syndromes, 5- reductase-2 deficiency, or 17-hydroxysteroid dehydrogenase-3 deficiency—reared male or female. The complete form of androgen insensitivity syndrome has been the focus of the largest number of investigations in domains other than gender. Despite this, all of the conditions included in the current review are under-studied. Realms identified for further study include psychological well-being, cognitive abilities, general health, fertility, and sexual function. Such investigations would not only improve the quality of life for those affected by DSD but may also provide information for improving physical and mental health in the general population.

  6. Performance Targets and External Benchmarking

    DEFF Research Database (Denmark)

    Friis, Ivar; Hansen, Allan; Vámosi, Tamás S.

    Research on relative performance measures, transfer pricing, beyond budgeting initiatives, target costing, piece rates systems and value based management has for decades underlined the importance of external benchmarking in performance management. Research conceptualises external benchmarking...... of the ‘inside’ costs of the sub-component, technical specifications of the product, opportunistic behavior from the suppliers and cognitive limitation. These are all aspects that easily can dismantle the market mechanism and make it counter-productive in the organization. Thus, by directing more attention...

  7. QANU - Quality Assurance Netherlands Universities

    DEFF Research Database (Denmark)

    Jensen, Henrik Toft; Maria E., Weber; Vyt, André

    The Quality Assurance Netherlands Universities (QANU) underwent an ENQA-coordinated external review in 2016. The review was chaired by Henrik Toft Jensen, Research fellow at Roskilde University (RUC), Denmark.......The Quality Assurance Netherlands Universities (QANU) underwent an ENQA-coordinated external review in 2016. The review was chaired by Henrik Toft Jensen, Research fellow at Roskilde University (RUC), Denmark....

  8. Matching Games with Additive Externalities

    DEFF Research Database (Denmark)

    Branzei, Simina; Michalak, Tomasz; Rahwan, Talal

    2012-01-01

    Two-sided matchings are an important theoretical tool used to model markets and social interactions. In many real life problems the utility of an agent is influenced not only by their own choices, but also by the choices that other agents make. Such an influence is called an externality. Whereas...

  9. Externalization of the Toxic Introject

    Science.gov (United States)

    Beck, Michael

    1975-01-01

    The therapist encounters patients who have incorporated toxic introjects. Therapy helps them to provide room for incorporation of a healthy object by externalizing the toxic introject. This technique is illustrated with several cases and comparison is made between the use of this technique in the treatment of adults and children. (Author)

  10. Lupus vulgaris of external nose.

    Science.gov (United States)

    Bhandary, Satheesh Kumar; Ranganna, B Usha

    2008-12-01

    Lupus vulgaris is the commonest form of cutaneous tuberculosis which commonly involve trunk and buttocks. Lupus vulgaris affecting nose and face, are rarely reported in India. This study reports an unusual case of lupus vulgaris involving the external nose that showed dramatic outcome after six months of anti- tubercular treatment.

  11. Organizing for External Knowledge Sourcing

    DEFF Research Database (Denmark)

    Rabbiosi, Larissa; Reichstein, Toke

    2011-01-01

    The aim of this article is to provide an introduction to the special issue. We briefly consider the external knowledge sourcing and organizing for innovation literatures, which offer a background for the special issue, and we highlight their mutual dialogue. We then illustrate the main findings...

  12. Environmental external effects from wind power based on the EU ExternE methodology

    DEFF Research Database (Denmark)

    Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

    1998-01-01

    of the Danish part of the project is to implement the framework for externality evaluation, for three different power plants located in Denmark. The paper will focus on the assessment of the impacts of the whole fuel cycles for wind, natural gas and biogas. Priority areas for environmental impact assessment...... are identified, based on results of earlier studies and some identified of specific relevance for Denmark. Importance is attached to the quantification of impacts for each of the three fuel cycles and to monetisation of the externalities....

  13. External noise distinguishes attention mechanisms.

    Science.gov (United States)

    Lu, Z L; Dosher, B A

    1998-05-01

    We developed and tested a powerful method for identifying and characterizing the effect of attention on performance in visual tasks as due to signal enhancement, distractor exclusion, or internal noise suppression. Based on a noisy Perceptual Template Model (PTM) of a human observer, the method adds increasing amounts of external noise (white gaussian random noise) to the visual stimulus and observes the effect on performance of a perceptual task for attended and unattended stimuli. The three mechanisms of attention yield three "signature" patterns of performance. The general framework for characterizing the mechanisms of attention is used here to investigate the attentional mechanisms in a concurrent location-cued orientation discrimination task. Test stimuli--Gabor patches tilted slightly to the right or left--always appeared on both the left and the right of fixation, and varied independently. Observers were cued on each trial to attend to the left, the right, or evenly to both stimuli, and decide the direction of tilt of both test stimuli. For eight levels of added external noise and three attention conditions (attended, unattended, and equal), subjects' contrast threshold levels were determined. At low levels of external noise, attention affected threshold contrast: threshold contrasts for non-attended stimuli were systematically higher than for equal attention stimuli, which were, in turn, higher than for attended stimuli. Specifically, when the rms contrast of the external noise is below 10%, there is a consistent 17% elevation of contrast threshold from attended to unattended condition across all three subjects. For higher levels of external noise, attention conditions did not affect threshold contrast values at all. These strong results are characteristic of a signal enhancement, or equivalently, an internal additive noise reduction mechanism of attention.

  14. 14 CFR 27.865 - External loads.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false External loads. 27.865 Section 27.865... STANDARDS: NORMAL CATEGORY ROTORCRAFT Design and Construction External Loads § 27.865 External loads. (a) It must be shown by analysis, test, or both, that the rotorcraft external load attaching means for...

  15. 14 CFR 29.865 - External loads.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false External loads. 29.865 Section 29.865... STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Design and Construction External Loads § 29.865 External loads. (a) It must be shown by analysis, test, or both, that the rotorcraft external load attaching means for...

  16. External Luminescence and Photon Recycling in Near-Field Thermophotovoltaics

    Science.gov (United States)

    DeSutter, John; Vaillon, Rodolphe; Francoeur, Mathieu

    2017-07-01

    The importance of considering near-field effects on photon recycling and spontaneous emission in a thermophotovoltaic device is investigated. Fluctuational electrodynamics is used to calculate external luminescence from a photovoltaic cell as a function of emitter type, vacuum gap thickness between the emitter and cell, and cell thickness. The observed changes in external luminescence suggest strong modifications of photon recycling caused by the presence of the emitter. Photon recycling for propagating modes is affected by reflection at the vacuum-emitter interface and is substantially decreased by the leakage towards the emitter through the tunneling of frustrated modes. In addition, spontaneous emission by the cell can be strongly enhanced by the presence of an emitter supporting surface-polariton modes. It follows that using a radiative recombination model with a spatially uniform radiative lifetime, even corrected by a photon-recycling factor, is inappropriate. Applying the principles of detailed balance and accounting for nonradiative recombination mechanisms, the impact of external luminescence enhancement in the near field on thermophotovoltaic performance is investigated. It is shown that unlike isolated cells, the external luminescence efficiency is not solely dependent on cell quality but significantly increases as the vacuum gap thickness decreases below 400 nm for the case of an intrinsic silicon emitter. In turn, the open-circuit voltage and power density benefit from this enhanced external luminescence toward the emitter. This benefit is larger as cell quality, characterized by the contribution of nonradiative recombination, decreases.

  17. Building Protection Against External Ionizing Fallout Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Dillon, Michael B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Homann, Steven G. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-12-01

    A nuclear explosion has the potential to injure or kill tens to hundreds of thousands of people through exposure to fallout (external gamma) radiation. Existing buildings can protect their occupants (reducing external radiation exposures) by placing material and distance between fallout particles and indoor individuals. This protection is not well captured in current fallout risk assessment models and so the US Department of Defense is implementing the Regional Shelter Analysis methodology to improve the ability of the Hazard Prediction and Assessment Capability (HPAC) model to account for building protection. This report supports the HPAC improvement effort by identifying a set of building attributes (next page) that, when collectively specified, are sufficient to calculate reasonably accurate, i.e., within a factor of 2, fallout shelter quality estimates for many individual buildings. The set of building attributes were determined by first identifying the key physics controlling building protection from fallout radiation and then assessing which building attributes are relevant to the identified physics. This approach was evaluated by developing a screening model (PFscreen) based on the identified physics and comparing the screening model results against the set of existing independent experimental, theoretical, and modeled building protection estimates. In the interests of transparency, we have developed a benchmark dataset containing (a) most of the relevant primary experimental data published by prior generations of fallout protection scientists as well as (b) the screening model results.

  18. [Introduction of quality circles and a quality management system (QMS) in a centralized clinic].

    Science.gov (United States)

    Isemer, F E; Schmidt, K J; Heuser, U; Kirchgesser, G

    1996-01-01

    At our hospital, a quality management system was developed according to the DIN EN ISO 9001. Additionally, several quality circles and an external quality control system with three tracer diagnoses were carried out and two studies were performed to detect the internal and external acceptance of the hospital. All strategies induce an increase in the quality of management and of the patients' outcome.

  19. ISO 9000 case study: the role of the external consultant.

    Science.gov (United States)

    Nevalainen, D E

    1998-01-01

    Increasingly, blood centers worldwide are turning toward the ISO (International Organization for Standardization) 9000 Quality System Standards to meet regulatory demands of public authorities, competitive demands within their industry, and cost requirements from their customers. The South Texas Blood and Tissue Center is the first blood center in North America to achieve registration to the ISO 9002 Quality System Standards. The role of the external consultant in initiating the process and as a facilitator during the implementation process is examined. To ensure the long-term success and viability of any quality system, it is necessary for an organization to develop and implement its own program. External consultants can assist in many ways, but it is important that their role be a supporting one rather than one of direct implementation.

  20. MGR External Events Hazards Analysis

    Energy Technology Data Exchange (ETDEWEB)

    L. Booth

    1999-11-06

    The purpose and objective of this analysis is to apply an external events Hazards Analysis (HA) to the License Application Design Selection Enhanced Design Alternative 11 [(LADS EDA II design (Reference 8.32))]. The output of the HA is called a Hazards List (HL). This analysis supersedes the external hazards portion of Rev. 00 of the PHA (Reference 8.1). The PHA for internal events will also be updated to the LADS EDA II design but under a separate analysis. Like the PHA methodology, the HA methodology provides a systematic method to identify potential hazards during the 100-year Monitored Geologic Repository (MGR) operating period updated to reflect the EDA II design. The resulting events on the HL are candidates that may have potential radiological consequences as determined during Design Basis Events (DBEs) analyses. Therefore, the HL that results from this analysis will undergo further screening and analysis based on the criteria that apply during the performance of DBE analyses.

  1. Firm Search for External Knowledge

    DEFF Research Database (Denmark)

    Sofka, Wolfgang; Grimpe, Christoph

    2012-01-01

    The innovation performance of modern firms is increasingly determined by their ability to search and absorb external knowledge. However, after a certain threshold firms "oversearch" their environment and innovation performance declines. In this paper, we argue that prior literature has largely...... ignored the institutional context that provides or denies access to external knowledge at the country level. Combining institutional and knowledge search theory, we suggest that the market orientation of the institutional environment and the magnitude of institutional change influence when firms begin...... to experience the negative performance effects of oversearch. Based on a comprehensive sample of almost 8,000 firms from ten European countries, we find that institutions matter considerably for firms' search activity. Higher market orientation of institutions increases the effectiveness of firms' search...

  2. Investigating the effect of externalizing perspectives on cognitives biases

    DEFF Research Database (Denmark)

    Madsen, Fredrik Huitfeldt; Hicks, David L., David

    2007-01-01

    the number of attacks that “get through”. There are many subproblems of this main problem, one of which is that relative quality of the intelligence analysis is too low [39, We observe that the analysts suffer from cognitive biases, and we assume that this is one of the reasons behind “low” quality...... of intelligence analysis. We propose that complexity of maintaining multiple different perspectives the same data is one of the reasons for this. We further propose that a tool that facillitates the externalization multiple perspectives would reduce these biases and hence increase the overall quality...

  3. External tank space debris considerations

    Science.gov (United States)

    Elfer, N.; Baillif, F.; Robinson, J.

    1992-01-01

    Orbital debris issues associated with maintaining a Space Shuttle External Tank (ET) on orbit are presented. The first issue is to ensure that the ET does not become a danger to other spacecraft by generating space debris, and the second is to protect the pressurized ET from penetration by space debris or meteoroids. Tests on shield designs for penetration resistance showed that when utilized with an adequate bumper, thermal protection system foam on the ET is effective in preventing penetration.

  4. Acute incarcerated external abdominal hernia

    OpenAIRE

    Yang, Xue-Fei; Liu, Jia-Lin

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surg...

  5. Individuals' insight into intrapersonal externalities

    Directory of Open Access Journals (Sweden)

    David J. Stillwell

    2012-07-01

    Full Text Available An intrapersonal externality exists when an individual's decisions affect the outcomes of her future decisions. It can result in decreasing or increasing average returns to the rate of consumption, as occurs in addiction or exercise. Experimentation using the Harvard Game, which models intrapersonal externalities, has found differences in decision making between drug users and control subjects, leading to the argument that these externalities influence the course of illicit drug use. Nevertheless, it is unclear how participants who behave optimally conceptualise the problem. We report two experiments using a simplified Harvard Game, which tested the differences in contingency knowledge between participants who chose optimally and participants who did not. Those who demonstrated optimal performance exhibited both a pattern of correct responses and systematic errors to questions about the payoff schedules. The pattern suggested that they learned explicit knowledge of the change in reinforcement on a trail-by-trial basis. They did not have, or need, a full knowledge of the historical interaction leading to each payoff. We also found no evidence of choice differences between participants who were given a guaranteed payment and participants who were paid contingent on their performance, but those given a guaranteed payment were able to report more contingency knowledge as the experiment progressed, suggesting that they explored more rather than settling into a routine. Experiment 2 showed that using a fixed inter-trial interval did not change the results.

  6. Effect of prestorage curing on storage life, internal and external qualities of sweet orange (Citrus sinensis Efeito da cura antes do armazenameto no prazo de conservação, qualidades internas e externas da laranja doce (Citrus sinensis

    Directory of Open Access Journals (Sweden)

    Abiola Titilola Aborisade

    2010-09-01

    Full Text Available Orange fruits from two seasons, in April and August 2006 representing late 2005 and early 2006 harvests respectively were cured in hot air at 36-37(0C to 1%, 3%, 5% and 7% weight loss before storage at 28(0C and 86% relative humidity (RH. The fruits were observed for incidence of decay, further weight loss, juice content, firmness or softening of the peel, total soluble solids (TSS, pH, titratable acidity, and colour during storage. Curing reduced the incidence of decay. All control fruits were rotten by day 21 in August harvest while 22.5% of the control was rotten by day 56 in the April harvest. Storage life was extended beyond 56 days in fruits cured with 1, 3, 5 and 7% in April harvest as there was no decay throughout, while decay incidence in August harvest was 88.9, 61.1, 22.2 and 31.3% in 1, 3, 5 and 7% respectively. Penicillium digitatum, Phytophthora sp., Alternaria citri and Collectotrichum gloeosporioides were among decay causing moulds detected. Control fruits lost more weight during storage than cured fruits did. Fruit rind hardening was more noticed in the control and those cured to 1% weight loss, especially from the April harvest. It was insignificant in other treatments in both trials. Titratable acidity, pH, juice content and TSS were not affected by the treatment. Colour change to yellow was however retarded by curing. Curing to 5% weight loss was best for decay control and quality retention.Frutos de laranjas de duas safras, de Abril e de Agosto de 2006 representando colheitas do final de 2005 e começo de 2006 respectivamente foram curados em ar quente a 36-37(0C até a perda de peso de 1%, 3%, 5% e 7% antes do armazenamento a 28(0C e 86% de umidade relativa (UR. Os frutos foram observados quanto à incidência de apodrecimento, mais tarde perda de peso, conteúdo de suco, firmeza ou amolecimento da casca, sólidos solúveis totais (TSS, pH, acidez titúlavel, e coloração durante o armazenamento. A cura diminuiu a incid

  7. Influence of external actions on the Bragg-Laue diffraction of X-Rays

    CERN Document Server

    Gasparyan, L G; Grigoryan, A G

    2000-01-01

    The Bragg-Laue diffraction in finite size crystals under the influence of external actions (ultrasound, temperature gradient) is investigated experimentally. It is established that external actions ''charge for the worse'' the crystal quality, which leads to the broadening of the rocking curves and to the sharp decrease of intensity in the center of the reflection angular range.

  8. Algorithm of control systems required accuracy providing under the undetermined external disturbances

    OpenAIRE

    Zbrutskyi, O.; Zagirska, I.; Stetsenko, T.

    2011-01-01

    New control algorithm and algorithm for providing required quality are defined. It based on comparison the forecast system condition, allowance conditions value, dynamic system properties and undetermined external disturbances compensation.

  9. Evaluating the impact of accreditation and external peer review.

    Science.gov (United States)

    Kilsdonk, Melvin; Siesling, Sabine; Otter, Renee; Harten, Wim van

    2015-01-01

    Accreditation and external peer review play important roles in assessing and improving healthcare quality worldwide. Evidence on the impact on the quality of care remains indecisive because of programme features and methodological research challenges. The purpose of this paper is to create a general methodological research framework to design future studies in this field. A literature search on effects of external peer review and accreditation was conducted using PubMed/Medline, Embase and Web of Science. Three researchers independently screened the studies. Only original research papers that studied the impact on the quality of care were included. Studies were evaluated by their objectives and outcomes, study size and analysis entity (hospitals vs patients), theoretical framework, focus of the studied programme, heterogeneity of the study population and presence of a control group. After careful selection 50 articles were included out of an initial 2,025 retrieved references. Analysis showed a wide variation in methodological characteristics. Most studies are performed cross-sectionally and results are not linked to the programme by a theoretical framework. Based on the methodological characteristics of previous studies the authors propose a general research framework. This framework is intended to support the design of future research to evaluate the effects of accreditation and external peer review on the quality of care.

  10. Implementation and evaluation of a National External Quality Control Program for Cervical Cytology in Mexico Instrumentación y evaluación de un programa nacional de control de calidad externo para citología cervical en México

    Directory of Open Access Journals (Sweden)

    Ana Flisser

    2002-09-01

    Full Text Available Objective. To evaluate cytology laboratories and the performance of cytotechnologists for establishing efficient external quality control for Mexico's National Program for the Prevention and Control of Cervical Cancer. Material and Methods. During January and February 1998, an on-site evaluation of all cytology laboratories of the Ministry of Health found that only 70% of the microscopes were in adequate working conditions, reagents were out of date, and working conditions were sub-optimal. A program for external quality control based on proficiency testing was established for cytotechnologists. Fifty slide sets with 20 Papanicolaou slides and 10 photographic slides were prepared. The sets were given to the cytotechnologists for evaluation and again one year later by courier. Results. Twenty-one percent of microscopes were repaired and 9% replaced; reagents were distributed and laboratory facilities improved. Only 16% of cytotechnologists passed the initial proficiency test. Cytotechnologists received a refresher training course: one year later 67% of them passed the proficiency test. To ascertain that each slide was correctly diagnosed, 41 sets were rescreened by expert cytopathologists or cytologists and their diagnoses compared to the original ones. Thirty-seven sets had 86% to 96% concordance. Conclusions. This new system for external quality control of cervical cytology allowed the opportune and reliable evaluation of the performance of cytotechnologists.Objetivo. Evaluar los laboratorios de citología y la capacidad de los citotecnólogos para establecer un programa eficiente de control de calidad externo para el Programa Nacional de Prevención y Control de Cáncer Cérvico Uterino de México. Material y métodos. Se realizó una evaluación de todos los laboratorios de citología de la Secretaría de Salud; sólo 70% de los microscopios estaban en buenas condiciones de trabajo, había reactivos caducos y condiciones subóptimas de

  11. Parallel External Memory Graph Algorithms

    DEFF Research Database (Denmark)

    Arge, Lars Allan; Goodrich, Michael T.; Sitchinava, Nodari

    2010-01-01

    In this paper, we study parallel I/O efficient graph algorithms in the Parallel External Memory (PEM) model, one o f the private-cache chip multiprocessor (CMP) models. We study the fundamental problem of list ranking which leads to efficient solutions to problems on trees, such as computing lowest...... common ancestors, tree contraction and expression tree evaluation. We also study the problems of computing the connected and biconnected components of a graph, minimum spanning tree of a connected graph and ear decomposition of a biconnected graph. All our solutions on a P-processor PEM model provide...

  12. Accident externality and vehicle size

    OpenAIRE

    Jonsson, Lina; Lindberg, Gunnar

    2009-01-01

    Vehicle mass is a crucial factor for the distribution of injuries between occupants in involved vehicles in a two-vehicle crash. A larger vehicle mass protects the occupants in the vehicle while on the same time inflicts a higher injury risk on the occupants in the collision partner. This mass externality can be internalized to reach a situation where the drivers choose vehicle mass based on the social optimum instead of a private optimum that ignores the negative effects that a large vehicle...

  13. Matchings with Externalities and Attitudes

    DEFF Research Database (Denmark)

    Branzei, Simina; Michalak, Tomasz; Rahwan, Talal

    2013-01-01

    Two-sided matchings are an important theoretical tool used to model markets and social interactions. In many real-life problems the utility of an agent is influenced not only by their own choices, but also by the choices that other agents make. Such an influence is called an externality. Whereas ...... where agents take different attitudes when reasoning about the actions of others. In particular, we study optimistic, neutral and pessimistic attitudes and provide both computational hardness results and polynomial-time algorithms for computing stable outcomes....

  14. Skepticism, Contextualism, Externalism and Modality

    Directory of Open Access Journals (Sweden)

    Ron Wilburn

    2006-12-01

    Full Text Available In this paper, I argue for the following claims. Contextualist strategies to tame or localize epistemic skepticism are hopeless if contextualist factors are construed internalistically. However, because efforts to contextualize externalism via subjunctive conditional analysis court circularity, it is only on an internalistic interpretation that contextualist strategies can even be motivated. While these claims do not give us an argument for skepticism, they do give us an argument that contextualism, as such, is not likely to provide us with an argument against skepticism.

  15. Acute incarcerated external abdominal hernia.

    Science.gov (United States)

    Yang, Xue-Fei; Liu, Jia-Lin

    2014-11-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required.

  16. External Program Reviews (2012) | IDRC - International ...

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

    2016-06-24

    Jun 24, 2016 ... IDRC commissions external program reviews toward the end of each program cycle. These final evaluations are our primary accountability mechanism in terms of the results, effectiveness, and relevance of program spending. External program reviews aim to:

  17. Environmental externalities related to power production on biogas and natural gas based on the EU ExternE methodology

    DEFF Research Database (Denmark)

    Nielsen, Per Sieverts; Ibsen, Liselotte Schleisner

    1998-01-01

    This paper assesses the environmental impacts and external costs from selected electricity generation systems in Denmark. The assessment is carried out as part of the ExternE National Implementation, which is the second phase of the ExternE project and involves case studies from all Western Europ...... show that estimated damages due to the greenhouse effect are predominant, however, the uncertainty is high. The predominant damage at the local and regional level is related to emission of NOx, which results in effects on public health....

  18. 49 CFR 195.110 - External loads.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false External loads. 195.110 Section 195.110 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PIPELINE Design Requirements § 195.110 External loads. (a) Anticipated external loads (e.g.), earthquakes...

  19. 187 AGRICULTURAL GROWTH AND EXTERNAL DEBT ...

    African Journals Online (AJOL)

    Abstract. Agricultural revenue has not been able to sustain the external debt in. Nigeria despite the effort made by the government in facilitating its projects using the external funds. This study adopted external debt elasticity indices as well as an ordinary least square analysis and error correction mechanism to isolate the ...

  20. European Consensus Conference for external quality assessment in molecular pathology

    NARCIS (Netherlands)

    van Krieken, J. H.; Siebers, A. G.; Normanno, N.; Timens, Wim

    Molecular testing of tumor samples to guide treatment decisions is of increasing importance. Several drugs have been approved for treatment of molecularly defined subgroups of patients, and the number of agents requiring companion diagnostics for their prescription is expected to rapidly increase.

  1. The Spanish external quality assessment scheme for mercury in urine.

    Science.gov (United States)

    Quintana, M J; Mazarrasa, O

    1996-01-01

    In 1986 the Instituto Nacional de Seguridad e Higiene en el Trabajo (INSHT), established the "Programa interlaboratorios de control de calidad de mercurio en orina (PICC-HgU)". The operation of this scheme is explained, criteria for evaluation of laboratory performance are defined and some results obtained are reviewed. Since the scheme started, an improvement in the overall performance of laboratories has been observed. The differences in the analytical methods used by laboratories do not seem to have a clear influence on the results.

  2. The Spanish external quality assessment scheme for lead in blood.

    Science.gov (United States)

    Marcuello, D

    1996-01-01

    In 1985 the Instituto Nacional de Seguridad e Higiene en el Trabajo (INSHT) established the "Programa Interlaboratorios de Control de Calidad de Plomo en Sangre (PICC-PbS)". The operation of this scheme is explained, criteria for evaluation of laboratory performance are defined and some results obtained are reviewed.

  3. Relative Importance of External Quality Attributes of Shell Eggs: A ...

    African Journals Online (AJOL)

    An inferential comparison of the attributes however, showed that size and cleanliness were rated higher (P0.05) sub-class differences. Respondents expected large eggs to have more edible material; clean shells to signify freshness and safety, while dark ...

  4. ASSESSMENT OF EXTERNAL AND INTERNAL QUALITY OF BLUEBERRIES USING IMAGES

    OpenAIRE

    LEIVA VALENZUELA, GABRIEL A.

    2013-01-01

    Durante el almacenamiento y el transporte de los arándanos, algunos defectos de la fruta pueden provocar rechazos en algún momento de su comercialización haciendo valiosos los estudios sobre metodologías no destructivas para su evaluación externa e interna durante su poscosecha. De este modo, al ser implementadas, la calidad podría mejorar. La presente tesis tuvo dos ejes principales: la evaluación externa de la calidad de arándanos poscosecha con técnicas de reconocimiento de pat...

  5. External quality assurance agencies and excellence in higher education

    Directory of Open Access Journals (Sweden)

    Josep Grifoll

    2016-07-01

    Full Text Available The article presents briefly the complexity of the concept of “excellence” in higher education. Taking into account this reality, the fundamental question is how agencies can consider this complexity in building up criteria on excellence and the use of the concept “excellence” in their improvement strategies and accountability processes in the sector of higher education. Public-private nature of higher education and its growing internationalisation have significant impact on how excellence in education is described and promoted as a tool.

  6. European consensus conference for external quality assessment in molecular pathology

    NARCIS (Netherlands)

    Krieken, J.H.J.M. van; Siebers, A.G.; Normanno, N.; Blackhall, F.; Boone, E.; Botti, G.; Carneiro, F.; Celik, I.; Ciardiello, F.; Cree, I.A.; Deans, Z.C.; Dequeker, E.; Edsjo, A.; Groenen, P.J.; Kamarainen, O.; Kreipe, H.H.; Ligtenberg, M.J.; Marchetti, A.; Murray, S.; Opdam, F.J.; Patterson, S.D.; Patton, S.; Pinto, C.; Rouleau, E.; Schuuring, E.; Sterck, S.; Taron, M.; Tejpar, S.; Timens, W.; Thunnissen, E.; Ven, P.M. van de

    2013-01-01

    Molecular testing of tumor samples to guide treatment decisions is of increasing importance. Several drugs have been approved for treatment of molecularly defined subgroups of patients, and the number of agents requiring companion diagnostics for their prescription is expected to rapidly increase.

  7. Life cycle assessment of waste management systems: Assessing technical externalities

    DEFF Research Database (Denmark)

    Brogaard, Line Kai-Sørensen

    of the available inventories, so LCAs would represent the industry better if consensus was found in industry and branch organisations regarding the provision of data for the LCA community or if the ISO standard for producing inventory data were followed, which in turn would help to increase transparency....... A critical lack of background information in external databases was highlighted as well as a lack of transparency. Therefore, the assessment of the quality of data was difficult when no description was available. Some industries and branch organisations provide data for databases, which improves the quality...

  8. Qualidade da informação sobre causas externas no Sistema de Informações Hospitalares Cualidad de la información sobre causas externas en el Sistema de Informaciones Hospitalares Quality of external-cause data in the Hospitalization Information System

    Directory of Open Access Journals (Sweden)

    Maria Fátima Akemi Iwakura Tomimatsu

    2009-06-01

    2004, en dos municipios (Londrina y Maringá, Sur de Brasil, fueron comparadas con aquellas identificadas como consecuencias de causas externas por pesquisa en laudos médicos, complementadas por datos de mortalidad y de servicio pre-hospitalar. Se calcularon indicadores de concordancia bruta, sensibilidad y valor predictivo positivo. Se comparó el perfil de agrupación de causas de las internaciones registradas en el Sistema con el obtenido en la pesquisa. RESULTADOS: Se registraron en el Sistema 3.002 internaciones por causas externas en Londrina y 1.403 en Maringá, mientras que la pesquisa detectó 4.018 y 2.370, respectivamente. El Sistema presentó alto valor predictivo positivo para internaciones por causas externas en ambos municipios (97,7% en Londrina y 98,6% en Maringá. Sin embargo, la sensibilidad fue baja: 57,3% en Maringá y 73% en Londrina, denotando sub-registro de tales causas. La comparación de los perfiles de tipos de causas externas reveló que hay subestimación de algunas causas en el Sistema, especialmente por accidentes por exposición a fuerzas mecánicas inanimadas, agresiones y lesiones autoprovocadas. CONCLUSIONES:Hay sub-registro de internaciones por causas externas y algunas distorsiones en relación a los tipos de causas en el Sistema de Informaciones Hospitalares en los dos municipios estudiados. La detección de esas deficiencias puede contribuir para el proceso de calificación de la información de dicho Sistema.OBJECTIVE: To analyze the coverage and quality of the data on hospitalizations due to external causes in the Hospital Information System of the Brazilian National Health System. METHODS: Hospitalizations recorded in the Hospital Information System of 11 hospitals in two municipalities (Londrina and Maringá, Southern Brazil, in 2004, were compared with hospitalizations identified as consequences of external causes through investigating medical records, complemented with mortality and pre-hospital data. The crude agreement

  9. Students' Evaluation of Teaching Quality

    Science.gov (United States)

    Vevere, Nina; Kozlinskis, Vulfs

    2011-01-01

    Students' evaluations of teaching quality are one of the crucial components of the teaching quality evaluation (along with external evaluation, opinions of colleagues, etc.). According to our research and professional experience, the teaching quality has to be examined in correlation with personality traits of a lecturer. Students' surveys (aiming…

  10. Sleep disturbances in chronic progressive external ophthalmoplegia.

    Science.gov (United States)

    Smits, B W; Westeneng, H J; van Hal, M A; van Engelen, B G; Overeem, S

    2012-01-01

    Chronic progressive external ophthalmoplegia (CPEO) is a relatively common mitochondrial disorder. In addition to extraocular muscle weakness, various other organs can typically be affected, including laryngeal and limb muscles, cerebrum, cerebellum, and peripheral nerves. Given this multi-organ involvement, patients are likely to be prone to sleep disturbances. Here, we determined the nature, prevalence, and determinants of sleep disturbances in CPEO. We used validated questionnaires for various sleep disorders and possible determinants such as mood and anxiety, and we performed ambulant polysomnography (PSG) in 20 patients with genetically confirmed CPEO. Three quarters of patients reported nocturnal sleep dysfunction. Thirty-five percent of patients fulfilled the criteria for restless legs syndrome, 30% excessive daytime sleepiness, and 70% significant periodic limb movements. PSG recordings revealed several indicators of a disrupted sleep architecture. Obstructive sleep disordered breathing was present in only one patient. However, four patients had an increased central sleep apnea index, all of whom had a polymerase gamma-1 mutation and a SANDO phenotype (sensoric atactic neuropathy, dysarthria, ophthalmoplegia). Physical examination and questionnaire outcomes were poor predictors of PSG results. Several specific sleep disturbances are part of the phenotype of CPEO. Given that the disease is otherwise incurable, symptomatic treatment of sleep disturbances may be an important tool to improve quality of life. Therefore, patients with CPEO should be actively screened for sleep disorders, with a low threshold to perform PSG. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

  11. Study on external beam radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Sook; Yoo, Seoung Yul; Yoo, Hyung Jun; Ji, Young Hoon; Lee, Dong Han; Lee, Dong Hoon; Choi, Mun Sik; Yoo, Dae Heon; Lee, Hyo Nam; Kim, Kyeoung Jung

    1999-04-01

    To develop the therapy technique which promote accuracy and convenience in external radiation therapy, to obtain the development of clinical treatment methods for the global competition. The contents of the R and D were 1. structure, process and outcome analysis in radiation therapy department. 2. Development of multimodality treatment in radiation therapy 3. Development of computation using networking techniques 4. Development of quality assurance (QA) system in radiation therapy 5. Development of radiotherapy tools 6. Development of intraoperative radiation therapy (IORT) tools. The results of the R and D were 1. completion of survey and analysis about Korea radiation therapy status 2. Performing QA analysis about ICR on cervix cancer 3. Trial of multicenter randomized study on lung cancers 4. Setting up inter-departmental LAN using MS NT server and Notes program 5. Development of ionization chamber and dose-rate meter for QA in linear accelerator 6. Development on optimized radiation distribution algorithm for multiple slice 7. Implementation on 3 dimensional volume surface algorithm and 8. Implementation on adaptor and cone for IORT.

  12. Externalism, skepticism and epistemic luck

    Directory of Open Access Journals (Sweden)

    Lazović Živan

    2011-01-01

    Full Text Available This paper deals with the concept of epistemic luck and its place within wider philosophical debates on knowledge and skepticism. Philosophers involved in these debates share an intuition that knowledge excludes luck. Starting from Prichard’s modal definition of luck and his distinction between two varieties of epistemic luck, namely veridic and reflective, the paper explores the internalist and externalist prospects for avoiding epistemic luck and skepticism. Externalism seems to be capable of both coping with the Gettier-type cases and eliminating at least veridic epistemic luck by introducing the so-called safety condition for knowledge. As such, it also responds to some versions of skepticism as the safety condition explains how it is possible to acquire knowledge without proving that the well known skeptical alternatives (e.g. a brain-in-a-vat are false. Thus, even though it does not eliminate the reflective epistemic luck or meta-epistemological skeptical challenge, the externalist approach to knowledge looks more plausible than the internalist, especially because it may allow an internalist justification to play its due role in acquiring knowledge.

  13. Early discharge after external anal sphincter repair

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1999-01-01

    PURPOSE: The aim of this study was to describe an accelerated-stay program for repair of the external anal sphincter. METHODS: Twenty consecutive patients undergoing overlapping repair of the external anal sphincter were included in the study. Effect parameters were length of hospitalization....... CONCLUSION: We have described a safe accelerated-stay program (24 to 48 hours) for overlapping repair of external anal sphincter....

  14. Internal and External Readings of Same

    DEFF Research Database (Denmark)

    Hardt, Daniel

    2016-01-01

    is infelicitous in the absence of parallelism. Hardt and Mikkelsen propose an account that applies uniformly to internal and external readings; however, the evidence they present largely targets external readings – they don’t offer empirical evidence that clearly supports the uniform approach. Furthermore, Barker...... (2007) argues that internal readings must be treated differently than external readings. In this paper, I show that the parallelism effects observed by Hardt and Mikkelsen in fact apply to internal readings as well. This provides support for a uniform treatment of internal and external readings of same...

  15. Market Quality of Pacific Northwest Pears

    OpenAIRE

    Gallardo, Rosa Karina; Kupferman, Eugene M.; Beaudry, Randolph M.; Blankenship, Sylvia M.; Mitcham, Elizabeth J; Watkins, Christopher B

    2011-01-01

    This study uses data collected from retail grocery chains during marketing season 2003-2004 to examine the external quality and price variations of Pacific Northwest pears. Quality refers to overall fruit appearance and presence of external disorders. Results from a bivariate probit model show that fruit weight and firmness had a positive effect on overall appearance. Results from a hedonic price model show that the recurrence of external disorders is not necessarily negatively correlated wit...

  16. External inspection of compliance with standards for improved healthcare outcomes.

    Science.gov (United States)

    Flodgren, Gerd; Gonçalves-Bradley, Daniela C; Pomey, Marie-Pascale

    2016-12-02

    Inspection systems are used in healthcare to promote quality improvements (i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes). These systems are based on the assumption that externally promoted adherence to evidence-based standards (through inspection/assessment) will result in higher quality of healthcare. However, the benefits of external inspection in terms of organisational-, provider- and patient-level outcomes are not clear. This is the first update of the original Cochrane review, published in 2011. To evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. We searched the following electronic databases for studies up to 1 June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Database of Abstracts of Reviews of Effectiveness, HMIC, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. There was no language restriction and we included studies regardless of publication status. We also searched the reference lists of included studies and contacted authors of relevant papers, accreditation bodies and the International Organization for Standardization (ISO), regarding any further published or unpublished work. We also searched an online database of systematic reviews (PDQ-evidence.org). We included randomised controlled trials (RCTs), non-randomised trials (NRCTs), interrupted time series (ITSs) and controlled before-after studies (CBAs) evaluating the effect of external inspection against external standards on healthcare organisation change, healthcare professional behaviour or patient outcomes in hospitals, primary healthcare organisations and other community-based healthcare organisations. Two review authors independently applied eligibility criteria, extracted data and assessed the

  17. [Proctectomy with external sphincter preservation: long-term functional results].

    Science.gov (United States)

    Vorob'ev, G I; Shelygin, Iu A; Pikunov, D Iu; Rybakov, E G; Dzhanaev, Iu A; Fomenko, O Iu

    2009-01-01

    52 patients with the lower ampullary rectal cancer with tumor localization on the dentate line level had been operated with the use of the originally developed reconstructive technique, permitting preservation of the external anal sphincter elements and, consequently, partial continence. Colonic rectal pouch and smooth muscle cuff were performed during the neorectum and neoanus plasty. A protective stoma was performed in all cases. Contractive activity of saved elements of EAS improved with a course of time and squeezing anal pressure increased as well. Consequent continence improvement occurred during the first year after the stoma closure, biofeed-back therapy provided faster rehabilitation. The achieved long-term functional results (73,4% actuarial 5-year disease-free survival) prove the oncological efficacy of the method on the strict assumption of indications observance. Thus, proctectomy with partial external anal sphincter preservation allows to avoid permanent colostomy and provides a satisfactory quality of life of the operated patients.

  18. EXTERNAL EVALUATIONS IN LOMCE: TRANSPARENCY IN RURAL EDUCATION?

    Directory of Open Access Journals (Sweden)

    Rogeli Santamaría Luna

    2015-06-01

    Full Text Available This document is intended to reflect on some articles of the Organic Law 2/2006 of 3 May on Education last modified by Organic Law 8/2013, of 9 December, to improve educational quality. We have selected those linked to external evaluation and transparency were discussed. In turn, the publication of Law 19/2013, of December 9, transparency, access to public information and good governance, imposes new obligations on the administrations and should result in the availability and dissemination of reports, as well as results. Both laws can promote knowledge of rural school if current approaches to external evaluation in Spain who do not usually attend rural uniqueness or do so partially. Thus they contribute to hiding the rural school or show a negative image of it because they have poorly contextualized results.

  19. Associations of parenting dimensions and styles with externalizing problems of children and adolescents: An updated meta-analysis.

    Science.gov (United States)

    Pinquart, Martin

    2017-05-01

    The present meta-analysis integrates research from 1,435 studies on associations of parenting dimensions and styles with externalizing symptoms in children and adolescents. Parental warmth, behavioral control, autonomy granting, and an authoritative parenting style showed very small to small negative concurrent and longitudinal associations with externalizing problems. In contrast, harsh control, psychological control, authoritarian, permissive, and neglectful parenting were associated with higher levels of externalizing problems. The strongest associations were observed for harsh control and psychological control. Parental warmth, behavioral control, harsh control, psychological control, autonomy granting, authoritative, and permissive parenting predicted change in externalizing problems over time, with associations of externalizing problems with warmth, behavioral control, harsh control, psychological control, and authoritative parenting being bidirectional. Moderating effects of sampling, child's age, form of externalizing problems, rater of parenting and externalizing problems, quality of measures, and publication status were identified. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Harmonisation of the appearance of digital radiographs from different vendors by means of common external image processing.

    Science.gov (United States)

    Larsson, Lars; Båth, Magnus; Engman, Eva-Lena; Månsson, Lars Gunnar

    2010-01-01

    The aim of the present study was to evaluate the use of common external image processing to compensate for differences in appearance between digital X-ray images from different vendors. Twenty posteroanterior chest radiographs were collected from each of three different modalities from different vendors (GE, Siemens and Canon) with vendor-specific image processing applied. The images were also extracted with neutral process parameters and processed with external image-processing software. Six experienced radiologists rated the quality and the similarity of the images with the original Siemens images. The externally processed GE images were rated of higher quality than the original GE images and more similar to the original Siemens images (p images. The externally processed Siemens images were rated of similar quality as the original images. The present study indicates the possibility of using common external image processing to harmonise the appearance of images from different vendors, although the exposure parameters may need to be adjusted for individual vendors.

  1. Endoscopic versus external approach dacryocystorhinostomy: A ...

    African Journals Online (AJOL)

    The difference was not statistically significant (P = 0.609). Conclusion: Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR. Keywords: Dacryocystorhinostomy, endoscopic, external. Nigerian Medical Journal | Vol. 54 | Issue 3 | May-June ...

  2. External Degree Programme Graduates' Perception of Students ...

    African Journals Online (AJOL)

    External Degree Programme Graduates' Perception of Students' Support Services in the Faculty of External Studies, University of Nairobi. ... These findings may give insight to the FES and other distance teaching institutions with a similar support system into those aspects of students' support services to improve on in order ...

  3. External Program Reviews (2015) | IDRC - International ...

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

    2016-05-04

    May 4, 2016 ... IDRC commissions external program reviews toward the end of each program cycle. These final evaluations are our primary accountability mechanism in terms of the results, effectiveness, and relevance of program spending. External program reviews aim to: account to IDRC's Board of Governors for the ...

  4. reoperation rates following intramedullary nailing versus external

    African Journals Online (AJOL)

    hardware failure or malrotation. Conclusion: Treatment of Gustilo Type 3A open tibia shaft fractures with interlocking intramedullary nailing results in lower reoperation rate in the early stages of treatment compared to uniplanar external fixation. Keywords: Orthopaedic surgery, Tanzania, Intramedullary nail, External fixation, ...

  5. 75 FR 70015 - External Defibrillators; Public Workshop

    Science.gov (United States)

    2010-11-16

    ... HUMAN SERVICES Food and Drug Administration External Defibrillators; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. The Food and Drug Administration (FDA) is announcing the following public workshop: FDA Public Workshop on External Defibrillators. The purpose of the...

  6. Combining Teacher Assessment Scores with External Examination ...

    African Journals Online (AJOL)

    This study investigated four statistical models for combining teacher assessment scores with external examination scores for certifying secondary school graduates in Ghana in terms of validity of the composite scores. The models studied were (1) external examination moderation with nominal weights, (2) reference school ...

  7. 187 AGRICULTURAL GROWTH AND EXTERNAL DEBT ...

    African Journals Online (AJOL)

    increasing external debt volume while real private investment expenditure decreases with increase ... returns were used to service the external debt and foreign investment in agriculture dropped drastically as the ..... Ehirim, N.C., M.A.Y Rhaji and D. P. Nguzet (2007) “Determinants of Groundnut Supply in. Nigeria 1960-2005 ...

  8. Crossing boundaries : Involving external parties in innovation

    NARCIS (Netherlands)

    Slot, J.H.

    2013-01-01

    To improve the return on investments in innovation, firms increasingly open up their new product development (NPD) processes by inviting external parties to participate. This dissertation focuses on the involvement of three different types of external parties in the NPD process: suppliers,

  9. The transactional process between the relationships with caregivers and children's externalizing behavior

    OpenAIRE

    Roskam, Isabelle; Stievenart, Marie; Mol, Jan

    2016-01-01

    Externalizing behavior (EB) has been found to be pervasive in children across different interactional systems. The transactional model is one of the most interesting and plausible mechanisms explaining the development of behavioral problems (Sameroff, 2009). The main goal of the study is to test bidirectional and recursive transactional relations between the quality of the caregiver–child relationship and children's externalizing behavior. The transactional model was tested in three-wave long...

  10. Interaction of Theory and Practice to Assess External Validity.

    Science.gov (United States)

    Leviton, Laura C; Trujillo, Mathew D

    2016-01-18

    Variations in local context bedevil the assessment of external validity: the ability to generalize about effects of treatments. For evaluation, the challenges of assessing external validity are intimately tied to the translation and spread of evidence-based interventions. This makes external validity a question for decision makers, who need to determine whether to endorse, fund, or adopt interventions that were found to be effective and how to ensure high quality once they spread. To present the rationale for using theory to assess external validity and the value of more systematic interaction of theory and practice. We review advances in external validity, program theory, practitioner expertise, and local adaptation. Examples are provided for program theory, its adaptation to diverse contexts, and generalizing to contexts that have not yet been studied. The often critical role of practitioner experience is illustrated in these examples. Work is described that the Robert Wood Johnson Foundation is supporting to study treatment variation and context more systematically. Researchers and developers generally see a limited range of contexts in which the intervention is implemented. Individual practitioners see a different and often a wider range of contexts, albeit not a systematic sample. Organized and taken together, however, practitioner experiences can inform external validity by challenging the developers and researchers to consider a wider range of contexts. Researchers have developed a variety of ways to adapt interventions in light of such challenges. In systematic programs of inquiry, as opposed to individual studies, the problems of context can be better addressed. Evaluators have advocated an interaction of theory and practice for many years, but the process can be made more systematic and useful. Systematic interaction can set priorities for assessment of external validity by examining the prevalence and importance of context features and treatment

  11. Use of Automated External Defibrillators

    Energy Technology Data Exchange (ETDEWEB)

    Gregory K Christensen

    2009-02-01

    In an effort to improve survival from cardiac arrest, the American Heart Association (AHA) has promoted the Chain of Survival concept, describing a sequence of prehospital steps that result in improved survival after sudden cardiac arrest. These interventions include immediate deployment of emergency medical services, prompt cardiopulmonary resuscitation, early defibrillation when indicated, and early initiation of advanced medical care. Early defibrillation has emerged as the most important intervention with survival decreasing by 10% with each minute of delay in defibrillation. Ventricular Fibrillation (VF) is a condition in which there is uncoordinated contraction of the heart cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. VF is a medical emergency and if the arrhythmia continues for more than a few seconds, blood circulation will cease, and death can occur in a matter of minutes. During VF, contractions of the heart are not synchronized, blood flow ceases, organs begin to fail from oxygen deprivation and within 10 minutes, death will occur. When VF occurs, the victim must be defibrillated in order to establish the heart’s normal rhythm. On average, the wait for an ambulance in populated areas of the United States is about 11 minutes. In view of these facts, the EFCOG Electrical Safety Task Group initiated this review to evaluate the potential value of deployment and use of automated external defibrillators (AEDs) for treatment of SCA victims. This evaluation indicates the long term survival benefit to victims of SCA is high if treated with CPR plus defibrillation within the first 3-5 minutes after collapse. According to the American Heart Association (AHA), survival rates as high as 74% are possible if treatment and defibrillation is performed in the first 3 minutes. In contrast survival rates are only 5% where no AED programs have been established to provide prompt CPR and defibrillation. ["CPR statistics

  12. Avaliação do controle externo da qualidade nos laboratórios clínicos do Rio de Janeiro de 2006 a 2008 Evaluation of external quality assessment in clinical laboratories from Rio de Janeiro in the years 2006-2008

    Directory of Open Access Journals (Sweden)

    Josefa Sieira Caamaño Chaves

    2010-10-01

    /2006", e a natureza e a iniciativa desses estabelecimentos: LC intra e extra-hospitalares (hospitais públicos ou privados, próprios ou terceirizados. OBJETIVO: Avaliação percentual do CEQ em LCs no estado do Rio de Janeiro ao longo do período analisado, com relação à natureza desses estabelecimentos.INTRODUCTION: External Quality Control (EQC is an important tool for quality assurance, assisting the laboratory in evaluating the efficiency of the analytical phase of its processes. An erroneous result of an analysis hinders the conclusion of diagnosis and the suitable treatment prescription to be followed. Health inspections in Clinical Laboratories (CL in the State of Rio de Janeiro are made based on a sanitary inspection procedure issued by Directive SES/CVS 743, June 2006, RDC 302/2005 and current Brazilian legislation. EQC results observed from the total of 347 inspections conducted by the Division of Clinical Analysis Laboratories of the Department of Health and Civil Defense (LAC-SESDEC during the period under review are presented below: 44% of 133 inspections performed in Clinical Analysis Laboratories had no contract with a proficiency testing provider in 2006; 38% of 95 inspections conducted in Clinical Analysis Laboratories did not have a contract with any proficiency testing provider in 2007; and 35% of 119 inspections conducted in Clinical Analysis Laboratories had no contract with any proficiency testing provider in 2008. Sixty-two percent (134 laboratories of 214 CL inspected in the years 2007 and 2008 had EQC, however, 65% of them did not record the corrective actions related to the nonconformities identified in a report issued by the proficiency testing provider. METHOD: In this study, we evaluated the percentage distribution of the results of health inspections conducted in CL in the State of Rio de Janeiro from 2006 to 2008, registered at SESDEC, stating the number of CL that did not meet health requirements (item: "External Quality Control -EQC

  13. Cardiorespiratory interactions to external stimuli.

    Science.gov (United States)

    Bernardi, L; Porta, C; Spicuzza, L; Sleight, P

    2005-09-01

    Respiration is a powerful modulator of heart rate variability, and of baro- or chemo-reflex sensitivity. This occurs via a mechanical effect of breathing that synchronizes all cardiovascular variables at the respiratory rhythm, particularly when this occurs at a particular slow rate coincident with the Mayer waves in arterial pressure (approximately 6 cycles/min). Recitation of the rosary prayer (or of most mantras), induces a marked enhancement of these slow rhythms, whereas random verbalization or random breathing does not. This phenomenon in turn increases baroreflex sensitivity and reduces chemoreflex sensitivity, leading to increases in parasympathetic and reductions in sympathetic activity. The opposite can be seen during either verbalization or mental stress tests. Qualitatively similar effects can be obtained even by passive listening to more or less rhythmic auditory stimuli, such as music, and the speed of the rhythm (rather than the style) appears to be one of the main determinants of the cardiovascular and respiratory responses. These findings have clinical relevance. Appropriate modulation of breathing, can improve/restore autonomic control of cardiovascular and respiratory systems in relevant diseases such as hypertension and heart failure, and might therefore help improving exercise tolerance, quality of life, and ultimately, survival.

  14. Environment and externalization; Environnement et externalisation

    Energy Technology Data Exchange (ETDEWEB)

    Kremlis, G.; Renaud, R. [Association francaise des ingenieurs et techniciens de l' environnement, AFITE, 75 - Paris (France); Touron, M. [Veritas, 75 - Paris (France)] [and others

    2001-07-01

    This document presents the discussions of the 16 may 2000, concerning the externalization and the environment and proposes to answer the following questions: is the externalization a new strategy to better perceive, hopeful engineering department, the technological risks problems, the environment or the land pollution? Does the externalization allow a better organization of the enterprise? To analyse the situation, the document presents the white book of the environmental liability, the administration point of view, some enterprises examples and the importance of the environmental management. (A.L.B.)

  15. Concurrent sourcing and external supplier opportunism

    DEFF Research Database (Denmark)

    Mols, Niels Peter

    costs of opportunism are determined as a product of four factors. The four factors are: likelihood of discovering supplier opportunism, buyer’s internalized quantity as reaction to supplier opportunism, asset specificity of external supplier’s investments, and multiplicator effects. Each......When a firm simultaneously makes and buys the same components then the firm uses concurrent sourcing. This paper presents an agency model for explaining how and when concurrent sourcing reduces the likelihood of external supplier opportunism. In the proposed model, the external supplier’s expected...... of these factors are explained and discussed in the paper. The paper ends by offering a number of theoretical and managerial implications....

  16. Airworthiness Qualification Criteria for Rotorcraft with External Sling Loads

    Science.gov (United States)

    Key, David L.

    2002-01-01

    This report presents the results of a study to develop airworthiness requirements for rotorcraft with external sling loads. The report starts with a review of the various phenomena that limit external sling load operations. Specifically discussed are the rotorcraft-load aeroservoelastic stability, load-on handling qualities, effects of automatic flight control system failure, load suspension system failure, and load stability at speed. Based on past experience and treatment of these phenomena, criteria are proposed to form a package for airworthiness qualification. The desired end objective is a set of operational flight envelopes for the rotorcraft with intended loads that can be provided to the user to guide operations in the field. The specific criteria proposed are parts of ADS-33E-PRF; MIL-F-9490D, and MIL-STD-913A all applied in the context of external sling loads. The study was performed for the Directorate of Engineering, U.S. Army Aviation and Missile Command (AMCOM), as part of the contract monitored by the Aerothermodynamics Directorate, U.S. Army AMCOM.

  17. Proceedings: National conference on environmental externalities

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-31

    This report is the proceedings of the National Conference on Environmental Externalities. A environmental externality is the environmental impact of a process or a plant that society must endure. It is a social cost and is paid, but not by the company who produced it or the company`s customers who endure it. The main purpose of this report is to gather the many designs and ideas of how and why to internalize the externalities into the pricing systems of the public utility commissions, especially that of the electric utilities. Economic and sociological aspects of the internalization of these externalities are given in these proceedings. Individual papers are processed separately for databases. (MB)

  18. Sleep disturbances in chronic progressive external ophthalmoplegia.

    NARCIS (Netherlands)

    Smits, B.W.; Westeneng, H.J.; Hal, M.A. van; Engelen, B.G.M. van; Overeem, S.

    2012-01-01

    BACKGROUND: Chronic progressive external ophthalmoplegia (CPEO) is a relatively common mitochondrial disorder. In addition to extraocular muscle weakness, various other organs can typically be affected, including laryngeal and limb muscles, cerebrum, cerebellum, and peripheral nerves. Given this

  19. External balances, trade and financial conditions

    National Research Council Canada - National Science Library

    Evans, Martin D.D

    2017-01-01

    .... The model is based on the present value restriction that links a country's external position to future trade flows and financial conditions in the absence of arbitrage opportunities and Ponzi schemes...

  20. Internal Versus External Knowledge Sourcing Of Subsidiaries

    DEFF Research Database (Denmark)

    Gammelgaard, Jens; Pedersen, Torben

    2003-01-01

    's ability to build on two knowledge networks depends on itsscale of resources, absorptive capacity and the role it plays in the corporation.The relationship between internal and external sourcing is tested using a unique dataset that coversmore than 2,000 subsidiaries located in seven different European...... between the external and internal networks. However, newer organizationalforms, like the concept of the `differentiated MNC', imply a relatively smooth flow of knowledgeinside the MNC, indicating that we should not expect an organizational trade-off between internaland external sources. The subsidiary...... countries (the Centre of ExcellenceProject). In fact, the results show that, to a certain extent, there is no dilemma between asubsidiary's knowledge development based on both internal, and external knowledge sources.However, the results also show a bell-shaped relationship between the use of internal...

  1. Owl Mountain Partnership : An external assessment

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — External review of the Owl Mountain Partnership (OMP) to identify benefits and successes associatedwith collaborative work through the perceptions of participating...

  2. Human Sound Externalization in Reverberant Environments

    DEFF Research Database (Denmark)

    Catic, Jasmina

    In everyday environments, listeners perceive sound sources as externalized. In listening conditions where the spatial cues that are relevant for externalization are not represented correctly, such as when listening through headphones or hearing aids, a degraded perception of externalization may...... occur. In this thesis, the spatial cues that arise from a combined effect of filtering due to the head, torso, and pinna and the acoustic environment were analysed and the impact of such cues for the perception of externalization in different frequency regions was investigated. Distant sound sources......) for noise estimation. Intelligibility weighted improvements in signal-to-noise ratio (SNR) of 6 dB and 18 dB were found for diffuse multi-talker babble noise and speech shaped directional noise, respectively, at input SNRs close to the speech reception threshold (SRT) of hearing impaired listeners. Overall...

  3. The Automatic External Cardioverter-Defibrillator

    OpenAIRE

    Antoni Martínez-Rubio; Gonzalo Barón-Esquivias

    2004-01-01

    In-hospital cardiac arrest remains a major problem but new technologies allowing fully automatic external defibrillation are available. These technologies allow the concept of “external therapeutic monitoring” of lethal arrhythmias. Since early defibrillation improves outcome by decreasing morbidity and mortality, the use of this device should improve the outcome of in-hospital cardiac arrest victims. Furthermore, the use of these devices could allow safe monitoring and treatment of patients ...

  4. Road Damage Externalities and Road User Charges.

    OpenAIRE

    Newbery, David M

    1988-01-01

    Vehicles damage roads and, thus, increase road repair costs and create a road damage externality by raising the operating costs of subsequent vehicles. The main result is that if periodic road maintenance is condition responsive and if all road damage is attributable to traffic, then, in steady state with zero traffic growth, the average road damage externality is zero a nd the appropriate road damage charge is the average maintenance cost. Where weather accounts for some road damage, the roa...

  5. Davidson's Externalism and Swampman's Troublesome Biography

    Directory of Open Access Journals (Sweden)

    André Leclerc

    2005-12-01

    Full Text Available After the seminal works of Putnam (1975, Burge (1979, and Kripke (1982, the next important contribution to externalism is certainly Davidson’s (mainly 1987, 1988, 1989, 2001. By criticizing the posi-tions of these philosophers, Davidson elaborated his own brand of exter-nalism. We shall first present some features of Davidson’s externalism (the importance of historical-causal connections for the foundation of language and thought, for the explanation of how language can be learned, and how attitudes can be identified by the interpreter, and fi-nally how mental content is determined by appealing to the idea of trian-gulation, to prepare the discussion of a few problems. We then discuss two questions in Davidson’s externalism. First, how to reconcile the fact that external factors determine mental content, as Putnam, Burge and Davidson himself argued convincingly, with token-physicalism, the thesis that mental events are identical with physical events occurring “in the head” (or the thesis that mental events supervenes locally on brain ac-tivities? The second main problem is how to reconcile the first person authority with some prima facie consequences of externalism, mainly that we should know the relevant parts of our (natural and social envi-ronment in order to know the content of our own thoughts? We argue that Davidson’s answer to the first question is not successful, while his answer to the second was a breakthrough.

  6. Estimating Fuel Cycle Externalities: Analytical Methods and Issues, Report 2

    Energy Technology Data Exchange (ETDEWEB)

    Barnthouse, L.W.; Cada, G.F.; Cheng, M.-D.; Easterly, C.E.; Kroodsma, R.L.; Lee, R.; Shriner, D.S.; Tolbert, V.R.; Turner, R.S.

    1994-07-01

    of complex issues that also have not been fully addressed. This document contains two types of papers that seek to fill part of this void. Some of the papers describe analytical methods that can be applied to one of the five steps of the damage function approach. The other papers discuss some of the complex issues that arise in trying to estimate externalities. This report, the second in a series of eight reports, is part of a joint study by the U.S. Department of Energy (DOE) and the Commission of the European Communities (EC)* on the externalities of fuel cycles. Most of the papers in this report were originally written as working papers during the initial phases of this study. The papers provide descriptions of the (non-radiological) atmospheric dispersion modeling that the study uses; reviews much of the relevant literature on ecological and health effects, and on the economic valuation of those impacts; contains several papers on some of the more complex and contentious issues in estimating externalities; and describes a method for depicting the quality of scientific information that a study uses. The analytical methods and issues that this report discusses generally pertain to more than one of the fuel cycles, though not necessarily to all of them. The report is divided into six parts, each one focusing on a different subject area.

  7. Agricultural trade liberalization and positive externalities

    Directory of Open Access Journals (Sweden)

    Libor Grega

    2005-01-01

    Full Text Available Changes in the perception of economic growth within the context of sustainable development lead to the broadly defined concept of further development of all industries, while agriculture plays qualitatively new role in this concept. Agriculture is not any more viewed only as an industry ensuring nutrition of population, but also its non-production benefit has growing importance. There is growing importance of the concept of multifunctionality of agriculture both in the Czech Republic and in the whole European Union, where agriculture historically played an important role in landscape formation and determined the development of social structures, while these aspects have growing importance for formulating of agricultural policies. Multifunctionality reflects the fact, that agriculture produces many food and non-food commodities, while some of them have the character of externalities and public goods.One of important conditions of efficient conception of agricultural policy is the answer on the question, what is the impact of growing trade liberalization on social welfare, respectively welfare of producers and consumers, if there are positive agricultural externalities. The analysis brings comparison in welfare development when externalities are internalized and when they are not. There are important consequences for social welfare, if state does not evaluate extra-production benefit of agriculture in a proper way.For the distribution analysis of benefits and costs of agricultural trade liberalization in presence of positive externalities connected with agricultural production, e.g. the analysis of impacts on consumers, producers and social welfare, is used traditional international trade model.Under the present tendency to liberalization of world agricultural markets there should be an effort of policy makers to internalise agricultural externalities. If there are agricultural industries, which are net exporters and at the same time produce

  8. External evaluation in municipal level: The impacts of an experience

    Directory of Open Access Journals (Sweden)

    Luana Ferrarotto

    2015-11-01

    Full Text Available The external evaluation is a consolidated reality in our country. Besides the state and federal ones, there are some municipalities that develop their own evaluation programs. To contribute with the debate about the external evaluations, this article presents data from a research which aim was to identify the actions from the Educational Secretariat from a city in the State of São Paulo, Brazil, opposite to the results of PROMASE (Municipal Assessment of the Educational System and its impact in school’s units. It is still being analyzed the path taken by the program with the aim of explaining its conception of the teaching quality. This way, the qualitative research was chosen based on the interviews with the Educational Secretary, teachers and school’s managers. Accordingly with the Secretary, after PROMASE, actions since improvements in the buildings to curricular restructuring and continuing educational were made. Even without the rankings and performance payments, it is noticeable in schools the built of what is called “hidden” and “adjustment” rankings of the pedagogical and evaluative practices to the matrix and to the evaluative instrument of the program to improve the teaching quality and improve the index. For an evaluative system to bring contributions to the network, it is noticeable that the quality must be anchored to the social quality, which more than the index, establishes its own scale as a protagonist in the process of looking to itself, adverse to the blaming of the teachers for the standards tests results and that, consequently, favors the social, political, cultural and human formation of the students.

  9. The Association of Externalizing Behavior and Parent-Child Relationships: An Intergenerational Study.

    Science.gov (United States)

    Brook, Judith S; Lee, Jung Yeon; Finch, Stephen J; Brown, Elaine N

    2012-06-01

    We investigated the influence of the child's behavior on the quality of the mutual parent-child attachment relationships across three generations. We did so using a prospective longitudinal study which spanned 20 years from adolescence through adulthood. Study participants completed in-class questionnaires as students in the East Harlem area of New York City at the first wave and provided follow-up data at 4 additional points in time. 390 participants were included in these analyses; 59% female, 45% African American, and 55% Puerto Rican. Using structural equation modeling, we determined that externalizing behavior in the child was negatively related to the mutual parent-child attachment relationship for two generations of children. We also found continuity in externalizing behavior for the participant over time and from the participant to his/her child. Additionally, we found continuity in the quality of the mutual attachment relationship from the participant's relationship with his/her parents to the participant's relationship with his/her child. Finally, the mutual attachment relationship of the participant with his/her parents had a negative association with the participant's externalizing behavior in adulthood. Based on these results, we propose that family interventions should focus on the role of the child's externalizing behavior in the context of the parent-child attachment relationship. Furthermore, we suggest that prevention programs should address externalizing behavior as early as possible, as the effects of externalizing behavior in adolescence can persist into adulthood and extend to the next generation.

  10. Quality of Higher Education

    DEFF Research Database (Denmark)

    Zou, Yihuan

    is about constructing a more inclusive understanding of quality in higher education through combining the macro, meso and micro levels, i.e. from the perspectives of national policy, higher education institutions as organizations in society, individual teaching staff and students. It covers both......Quality in higher education was not invented in recent decades – universities have always possessed mechanisms for assuring the quality of their work. The rising concern over quality is closely related to the changes in higher education and its social context. Among others, the most conspicuous...... changes are the massive expansion, diversification and increased cost in higher education, and new mechanisms of accountability initiated by the state. With these changes the traditional internally enacted academic quality-keeping has been given an important external dimension – quality assurance, which...

  11. 5HTTLPR genotype moderates the longitudinal impact of early caregiving on externalizing behavior

    Science.gov (United States)

    Smyke, Anna T.; Gleason, Mary Margaret; Nelson, Charles A.; Zeanah, Charles H.; Fox, Nathan A; Drury, Stacy S.

    2014-01-01

    We examined caregiver report of externalizing behavior from 12 to 54 months of age in 102 children randomized to care as usual in institutions or to newly-created high quality foster care. At baseline no differences by group or genotype in externalizing were found. However, changes in externalizing from baseline to 42 months of age were moderated by 5HTTLPR genotype and intervention group, where the slope for s/s individuals differed as a function of intervention group. The slope for individuals carrying the l allele did not significantly differ between groups. At 54 months of age, s/s children in the foster care group had the lowest levels of externalizing behavior, while children with the s/s genotype in the care as usual group demonstrated the highest rates of externalizing behavior. No intervention group differences were found in externalizing behavior among children who carried the l allele. These findings, within a randomized control trial of foster care compared to continued care as usual, indicate that 5HTTLPR genotype moderates the relation between early caregiving environments to predict externalizing behavior in children exposed to early institutional care in a manner most consistent with differential susceptibility. PMID:25640827

  12. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis.

    Science.gov (United States)

    de Hundt, Marcella; Velzel, Joost; de Groot, Christianne J; Mol, Ben W; Kok, Marjolein

    2014-06-01

    To assess the mode of delivery in women after a successful external cephalic version by performing a systematic review and meta-analysis. We searched MEDLINE, Embase, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library for studies reporting on the mode of delivery in women after successful external cephalic version at term and women with a spontaneous cephalic-presenting fetus. Two reviewers independently selected studies, extracted data, and assessed study quality. The association between mode of delivery and successful external cephalic version was expressed as a common odds ratio with a 95% confidence interval (CI). We identified three cohort studies and eight case-control studies, reporting on 46,641 women. The average cesarean delivery rate for women with a successful external cephalic version was 21%. Women after successful external cephalic version were at increased risk for cesarean delivery for dystocia (odds ratio [OR] 2.2, 95% CI 1.6-3.0), cesarean delivery for fetal distress (OR 2.2, 95% CI 1.6-2.9), and instrumental vaginal delivery (OR 1.4, 95% CI 1.1-1.7). Women who have had a successful external cephalic version for breech presentation are at increased risk for cesarean delivery and instrumental vaginal delivery as compared with women with a spontaneous cephalic presentation. Nevertheless, with a number needed to treat of three, external cephalic version still remains a very efficient procedure to prevent a cesarean delivery.

  13. Internalizing Externalities through Payments for Environmental Services

    Directory of Open Access Journals (Sweden)

    Sudarsono Soedomo

    2012-08-01

    Full Text Available Forest ecosystems, including plantation forests, provide goods and services that are marketable and non-marketable. Positive externalities produced by forest ecosystems are rarely considered in pricing of marketable products that result in economic inefficiencies. Internalizing externalities is required to improve the economic efficiency. The traditional way to internalize an externality is by providing subsidies or imposing taxes. Recently, payments for environmental services  are receiving more attention as an instrument for internalizing externalities provided by forest ecosystems. This promising alternative to improve our environment needs to be studied more extensively. In this paper, it can be indicated theoretically that the Pigovian tax, as a traditional way of addressing environmental problems, is able to mimic the result derived from the employment of environmental services payment. The difference is that environmental services payment improves the welfare of environmental service producers, whereas the Pigovian tax reduces it. A positive Pigovian tax increases the optimal rotation, which is positively associated with environmental improvement, but certainly reduces forest owner's welfare. This difference should be taken into account in the public policymaking so that perverse incentive may be avoided. Payment for environmental services  as an additional income to forest growers, not as alternative source of income, is a potential tool to address simultaneously issues of environment and poverty that are frequently contested.Keywords: externalities, payments for environmental services, tax, perverse incentive, social welfare

  14. External GSM phone calls now made simpler

    CERN Multimedia

    2007-01-01

    On 2 July, the IT/CS Telecom Service introduced a new service making external calls from CERN GSM phones easier. A specific prefix is no longer needed for calls outside CERN. External calls from CERN GSM phones are to be simplified. It is no longer necessary to use a special prefix to call an external number from the CERN GSM network.The Telecom Section of the IT/CS Group is introducing a new system that will make life easier for GSM users. It is no longer necessary to use a special prefix (333) to call an external number from the CERN GSM network. Simply dial the number directly like any other Swiss GSM customer. CERN currently has its own private GSM network with the Swiss mobile operator, Sunrise, covering the whole of Switzerland. This network was initially intended exclusively for calls between CERN numbers (replacing the old beeper system). A special system was later introduced for external calls, allowing them to pass thr...

  15. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction.

    Science.gov (United States)

    Jawaheer, Lona; MacEwen, Caroline J; Anijeet, Deepa

    2017-02-24

    A dacryocystorhinostomy (DCR) procedure aims to restore drainage of tears by bypassing a blockage in the nasolacrimal duct, through the creation of a bony ostium that allows communication between the lacrimal sac and the nasal cavity. It can be performed using endonasal or external approaches. The comparative success rates of these two approaches have not yet been established and this review aims to evaluate the relevant up-to-date research. The primary aim of this review is to compare the success rates of endonasal DCR with that of external DCR. The secondary aim is to compare the complication rates between the two procedures. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2016, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to 22 August 2016), Embase (January 1980 to 22 August 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to 22 August 2016), Web of Science Conference Proceedings Citation Index- Science (CPCI-S) (January 1990 to 22 August 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 22 August 2016. We requested or examined relevant conference proceedings for appropriate trials. We included all randomised controlled trials (RCTs) comparing endonasal and external DCRs. Two review authors independently assessed studies for eligibility and extracted data on reported outcomes. We attempted to contact investigators to clarify the methodological quality of the studies. We graded the certainty of the evidence using GRADE. We included two trials in this review. One trial from Finland

  16. External exposure measurements at Bikini Atoll

    Energy Technology Data Exchange (ETDEWEB)

    Greenhouse, N.A.; Miltenberger, R.P.; Lessard, E.T.

    1979-01-01

    External exposure rate surveys from 1975 to 1977 on the islands Nam, Eneu and Bikini of Bikini Atoll gave average external exposure rates of 24, 5.7, and 32 ..mu..R/hr respectively. The exposure rate on Eneu Island is uniform, whereas those on Bikini and Nam range from 7.0 to 80. ..mu..R/hr. Based on an assumed living pattern at Bikini Island, the adult male Bikinian is estimated to be in the presence of an external radiation field corresponding to 16 ..mu..R/hr due to debris and fallout from the 1954 BRAVO incident. This corresponds to a 30 year dose equivalent of 2.8 rem.

  17. Lymphatic drainage of the external ear.

    Science.gov (United States)

    Pan, Wei-Ren; le Roux, Cara Michelle; Levy, Sidney M; Briggs, Christopher A

    2011-01-01

    Lymphoscintigraphy reveals inconsistencies in our knowledge of the lymphatic anatomy of the external ear. Fifteen external ears from 9 unembalmed human cadavers were studied. Six percent hydrogen peroxide was used to find the lymphatic vessels using a surgical microscope. They were injected with a radio-opaque mixture, dissected, photographed, and radiographed to demonstrate lymphatic vessels in the tissue. Final results were transferred to the computer for analysis. Four groups of lymph collecting vessels were found. The anterior branch, in all specimens, drained directly or indirectly (having merged with a vessel descending from the scalp) into the preauricular lymph nodes. The superior, middle, and inferior (lobule) branches drained to their multiple first tier lymph nodes. An accurate lymphatic map of the external ear is described to upgrade our anatomic knowledge. It will be of benefit for the clinical management of malignancies in this region. © 2010 Wiley Periodicals, Inc. Head Neck, 2011.

  18. External-Memory Algorithms and Data Structures

    DEFF Research Database (Denmark)

    Arge, Lars; Zeh, Norbert

    2010-01-01

    The data sets involved in many modern applications are often too massive to fit in main memory of even the most powerful computers and must therefore reside on disk. Thus communication between internal and external memory, and not actual computation time, becomes the bottleneck in the computation....... This is due to the huge difference in access time of fast internal memory and slower external memory such as disks. The goal of theoretical work in the area of external memory algorithms (also called I/O algorithms or out-of-core algorithms) has been to develop algorithms that minimize the Input....../Output communication (or just I/O) performed when solving a given problem. The area was effectively started in the late eighties by Aggarwal and Vitter and subsequently I/O algorithms have been developed for several problem domain. Also I/O performance can often be improved if many disks can efficiently be used...

  19. External Environment and Upper Echelons Theory

    DEFF Research Database (Denmark)

    Escribá-Esteve, Alejandro; Nielsen, Sabina; Yamak, Sibel

    This work reviews empirical research on TMTs with a specific emphasis on the role of the external environment. We extend the existing research on upper echelons theory, which has largely focused on the team and firm level of analyses of top management teams (TMT). Considering institutional...... and industrial organization theories, we elaborate a cross-level conceptual model outlining the direct, mediating and moderating effects of the external environment on TMTs and their impact. Our review distinguishes between industry and institutional level of analyses and three types of environmental...

  20. Performance Targets and External Market Prices

    DEFF Research Database (Denmark)

    Hansen, Allan; Friis, Ivar; Vámosi, Tamás S.

    In this paper we explore the processes of ‘bringing the market inside the firm’ to set performance targets and benchmark production workers productivity. We analyze attempts to use external suppliers’ bids in target setting in a Danish manufacturing company. The case study illustrates how...... the implementation of external market information in target setting – well known in transfer pricing, relative performance evaluation, beyond budgeting, target costing, piece rates systems and value based management – relate to challenging motivation and information problem. The analysis and discussion of those...

  1. RAM-efficient external memory sorting

    DEFF Research Database (Denmark)

    Arge, Lars; Thorup, Mikkel

    2013-01-01

    In recent years a large number of problems have been considered in external memory models of computation, where the complexity measure is the number of blocks of data that are moved between slow external memory and fast internal memory (also called I/Os). In practice, however, internal memory tim...... often dominates the total running time once I/O-efficiency has been obtained. In this paper we study algorithms for fundamental problems that are simultaneously I/O-efficient and internal memory efficient in the RAM model of computation....

  2. The External Networking Behaviour of Public Managers

    DEFF Research Database (Denmark)

    Hansen, Morten Balle; Villadsen, Anders Ryom

    2017-01-01

    There has been an increasing focus on managerial external networking behaviour within public administration. While most previous quantitative research has analysed such behaviour one-dimensionally, we suggest a two-dimensional conceptualization based on the concepts of weak and strong ties....... Utilizing measures resembling previous research, we explore the utility of the approach in an exploratory study of Danish local government. Our findings suggest that the two dimensions of external networking behaviour are distinct. We discuss our approach compared to previous approaches and argue...

  3. Automatic Planning of External Search Engine Optimization

    Directory of Open Access Journals (Sweden)

    Vita Jasevičiūtė

    2015-07-01

    Full Text Available This paper describes an investigation of the external search engine optimization (SEO action planning tool, dedicated to automatically extract a small set of most important keywords for each month during whole year period. The keywords in the set are extracted accordingly to external measured parameters, such as average number of searches during the year and for every month individually. Additionally the position of the optimized web site for each keyword is taken into account. The generated optimization plan is similar to the optimization plans prepared manually by the SEO professionals and can be successfully used as a support tool for web site search engine optimization.

  4. External Costs Related to Power Production Technologies

    DEFF Research Database (Denmark)

    Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

    1997-01-01

    of the Danish part of the project is to implement the framework for externality evaluation, for three different power plants located in Denmark. The paper will focus on the assessment of the impacts of the whole fuel cycles for wind, natural gas and biogas. Priority areas for environmental impact assessment...... are identified, based on results of earlier studies and some identified of specific relevance for Denmark. Importance is attached to the quantification of impacts for each of the three fuel cycles and to monetisation of the externalities....

  5. An unusual cause of external snapping hip.

    Science.gov (United States)

    Battaglia, Milva; Guaraldi, Federica; Monti, Carlo; Vanel, Daniel; Vannini, Francesca

    2011-01-01

    The external snapping hip syndrome is a condition characterized by palpable or audible snap on the lateral region of the hip occurring during movements and sometimes associated with pain. It is typical of young adults and athletes and can be favored by the abnormal sliding of the iliotibial band or of the gluteus maximus muscle over the greater trochanter. We present a case of external snapping hip syndrome occurring in a young woman secondary to a dysmorphic sickle-shaped myotendinous junction of the gluteus maximus muscle. Diagnosis was allowed by an integrated clinical and radiological approach, based on dynamic ultrasound and magnetic resonance imaging (MRI).

  6. Computing betweenness centrality in external memory

    DEFF Research Database (Denmark)

    Arge, Lars; Goodrich, Michael T.; Walderveen, Freek van

    2013-01-01

    Betweenness centrality is one of the most well-known measures of the importance of nodes in a social-network graph. In this paper we describe the first known external-memory and cache-oblivious algorithms for computing betweenness centrality. We present four different external-memory algorithms...... exhibiting various tradeoffs with respect to performance. Two of the algorithms are cache-oblivious. We describe general algorithms for networks with weighted and unweighted edges and a specialized algorithm for networks with small diameters, as is common in social networks exhibiting the “small worlds...

  7. Externalizing behaviors in preadolescents: familial risk to externalizing behaviors and perceived parenting styles

    NARCIS (Netherlands)

    Buschgens, C.J.M.; van Aken, M.A.G.; Swinkels, S.H.N.; Ormel, J.; Verhulst, F.C.; Buitelaar, J.K.

    2010-01-01

    The aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10-12 years who participated in TRAILS, a large

  8. Externalizing behaviors in preadolescents: Familial risk to externalizing behaviors and perceived parenting styles

    NARCIS (Netherlands)

    C.J.M. Buschgens (Cathelijne); M.A.G. van Aken (Marcel); S.H.N. Swinkels (Sophie); J. Ormel (Johan Hans); F.C. Verhulst (Frank); J.K. Buitelaar (Jan)

    2010-01-01

    textabstractThe aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10-12 years who participated in

  9. Externalizing behaviors in preadolescents: familial risk to externalizing behaviors and perceived parenting styles.

    NARCIS (Netherlands)

    Buschgens, C.J.M.; Aken, M.A.G. van; Swinkels, S.H.N.; Ormel, J.; Verhulst, F.C.; Buitelaar, J.K.

    2010-01-01

    The aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10-12 years who participated in TRAILS, a large

  10. External Validation of a Prediction Model for Successful External Cephalic Version

    NARCIS (Netherlands)

    de Hundt, Marcella; Vlemmix, Floortje; Kok, Marjolein; van der Steeg, Jan W.; Bais, Joke M.; Mol, Ben W.; van der Post, Joris A.

    2012-01-01

    We sought external validation of a prediction model for the probability of a successful external cephalic version (ECV). We evaluated the performance of the prediction model with calibration and discrimination. For clinical practice, we developed a score chart to calculate the probability of a

  11. Externalizing behaviors in preadolescents : familial risk to externalizing behaviors and perceived parenting styles

    NARCIS (Netherlands)

    Buschgens, Cathelijne J. M.; van Aken, Marcel A. G.; Swinkels, Sophie H. N.; Ormel, Johan; Verhulst, Frank C.; Buitelaar, Jan K.

    The aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10-12 years who participated in TRAILS, a large

  12. Evolution of market shares with repeated purchases and heterogeneous network externalities

    NARCIS (Netherlands)

    M.C.W. Janssen (Maarten); E. Mendys

    2007-01-01

    textabstractWe investigate how market shares change when a new, superior technology exhibiting network externalities is introduced in a market initially dominated by an old technology. This is done under the assumption that consumers are heterogeneous in their valuation of technology quality and

  13. Performance of external cavity mode-locked semiconductor lasers employing reverse biased saturable absorbers

    DEFF Research Database (Denmark)

    Yvind, Kresten; Skovgaard, P.M.W.; Mørk, Jesper

    2002-01-01

    We have experimentally investigated the performance of external cavity mode-locked semiconductor lasers employing reverse biased saturable absorbers. We have measured the magnitude of trailing pulses when varying the chip length and studied the pulse quality when changing the driving conditions...

  14. A Closer Look at Co-Rumination: Gender, Coping, Peer Functioning and Internalizing/Externalizing Problems

    Science.gov (United States)

    Tompkins, Tanya L.; Hockett, Ashlee R.; Abraibesh, Nadia; Witt, Jody L.

    2011-01-01

    Co-rumination, defined as repetitive, problem-focused talk explains higher levels of friendship quality in youth (Rose, 2002) and increased levels of anxiety/depression in females. Middle adolescents (N = 146) participated in a study of co-rumination, individual coping, externalizing/internalizing problems, and peer functioning. Consistent with…

  15. Japan seeks targeted science funding and to use external scrutiny to increase competitiveness at universities

    CERN Multimedia

    Saegusa, A

    1999-01-01

    Japan's science policy committee is planning to prioritise research fields in an attempt to better support high-priority research areas such as information sciences and genome research. The Science and Technology Council has also asked for the formation of an independent body to externally evaluate the quality of university research (1 page).

  16. Developing a TQM quality management method model

    NARCIS (Netherlands)

    Zhang, Zhihai

    1997-01-01

    From an extensive review of total quality management literature, the external and internal environment affecting an organization's quality performance and the eleven primary elements of TQM are identified. Based on the primary TQM elements, a TQM quality management method model is developed. This

  17. The External Dimension of EU Migration Policy

    Directory of Open Access Journals (Sweden)

    Dorina Gjipali

    2017-01-01

    Defining the conditions of consistency and flexibility to which the Union’s external action can bring the management of migration - a management which will pursue all objectives of the EU’s migration policy in accordance with the its principles, such as solidarity and the protection of fundamental rights - is the focus of this paper.

  18. Proprioception is Robust under External Forces

    NARCIS (Netherlands)

    Kuling, I.A.; Brenner, E.; Smeets, J.B.J.

    2013-01-01

    Information from cutaneous, muscle and joint receptors is combined with efferent information to create a reliable percept of the configuration of our body (proprioception). We exposed the hand to several horizontal force fields to examine whether external forces influence this percept. In an

  19. Fiscal externalities of becoming a parent.

    Science.gov (United States)

    Wolf, Douglas A; Lee, Ronald D; Miller, Timothy; Donehower, Gretchen; Genest, Alexandre

    2011-01-01

    Theoretical and empirical results suggest that there are externalities to childbearing, but those results usually assume that these externalities accrue uniformly within a homogeneous population. We advance this argument by developing separate estimates of the fiscal externalities associated with parents—those who devote time or material resources to minor children—and nonparents. Our analysis uses data from the US Panel Study of income Dynamics on the age profiles of taxes paid and publicly funded benefits consumed by parents and nonparents, together with a previously developed intertemporal economic-demographic accounting model. The accounting framework takes into account the net fiscal impacts of future generations as well as the present population. Our findings indicate that, with a 3 percent discount rate, parents produce a substantial net fiscal externality, about $217,000 in 2009 dollars. This is equivalent to a lifetime annuity of nearly $8,100 per year beginning at age 18. The results are sensitive to both the discount rate used and the proportion of parents within the cohort.

  20. External Debts and Nigeria's Economic Development | Akujuobi ...

    African Journals Online (AJOL)

    The impact of different types of external debt on economic development of Nigeria was studied using multiple regression technique. It was found that while London Club debts were negatively significant, only past values of gross domestic product ( GDP), taken as independent variable, was found to be positively significant.

  1. Cancer of the external auditory canal

    DEFF Research Database (Denmark)

    Nyrop, Mette; Grøntved, Aksel

    2002-01-01

    OBJECTIVE: To evaluate the outcome of surgery for cancer of the external auditory canal and relate this to the Pittsburgh staging system used both on squamous cell carcinoma and non-squamous cell carcinoma. DESIGN: Retrospective case series of all patients who had surgery between 1979 and 2000. M...

  2. KEUNTUNGAN PENGGUNAAN EXTERNAL FUNCTION PADA DATABASE POSTGRESQL

    Directory of Open Access Journals (Sweden)

    Nahrun Hartono

    2015-02-01

    Full Text Available Database id a central data for an information system, there were many database system applications that revolve both paid and free. PostgreSQL is one of the free database system and it has the powerful feature, one of the feature that make it different with others sysem is a function features, where the users can make their function by them selves by using spesific programming language, then it can be called return for executed. In this research the writer tries for conducting additional data testing by using INSERT Query and External Function Query on the terminal/command prompt and web browser. From the result of the trial, the research found that the average of time in additional data processing on the terminal/command prompt by using INSERT Query was 185.293 ms and the average of time External Function Query proccess was 129.52 ms, while the average of time in additional data processing on web browser by using INSERT Query was 168.363 ms and External Function Query was 145.64 ms. There was a difference both of the query, but the important thing and should be noted that external function is a command was defined by stand alone by the user, this matter lets the user to determine a specify command that they need.

  3. External fixation in HIV-positive

    African Journals Online (AJOL)

    Introduction. Open fractures may be complicated by sepsis and septic non- union. Septic complications markedly increase patient morbidity and treatment costs. Thorough debridement and external fixation to achieve bony stability is an accepted approach to management. Septic outcome in HIV positive patients has been ...

  4. Black holes under external influence £

    Indian Academy of Sciences (India)

    KTF MFF UK

    of the flux of external fields across charged and rotating black holes which are approaching extremal states. Recently this effect has been shown to occur for black hole solutions in string theory. We also discuss black holes surrounded by rings and disks and rotating black holes accelerated by strings. Keywords. Black holes ...

  5. Weld pool visual sensing without external illumination

    DEFF Research Database (Denmark)

    Liu, Jinchao; Fan, Zhun; Olsen, Soren Ingvor

    2011-01-01

    Visual sensing in arc welding has become more and more important, but still remains challenging because of the harsh environment with extremely strong illumination from the arc. This paper presents a low-cost camera-based sensor system, without using external Illumination, but nevertheless able...

  6. Treatment optimisation using external beam radiation in ...

    African Journals Online (AJOL)

    The majority of patients with gynaecological cancers present with advanced stages in which external beam radiation forms a major component of the treatment. These patients undergo simulation for treatment planning prior to radiation. Currently the lower extent of the disease is evaluated by vaginal examination and ...

  7. The External Networking Behaviour of Public Managers

    DEFF Research Database (Denmark)

    Hansen, Morten Balle; Villadsen, Anders Ryom

    2017-01-01

    There has been an increasing focus on managerial external networking behaviour within public administration. While most previous quantitative research has analysed such behaviour one-dimensionally, we suggest a two-dimensional conceptualization based on the concepts of weak and strong ties...

  8. Venom Evolution-Genetic and External Factors

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 18; Issue 3. Venom Evolution - Genetic and External Factors. Ema Fatima. Research News Volume 18 Issue 3 March 2013 pp 287-288. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/018/03/0287-0288 ...

  9. Colonoscopy technique with an external straightener.

    Science.gov (United States)

    Catalano, F; Catanzaro, R; Branciforte, G; Bentivegna, C F; Cipolla, R; Brogna, A; Sala, L O; Migliore, G; Paternuosto, M

    2000-05-01

    An external straightener for colonoscopy which enables proper compression of the abdomen during the entire examination has been developed. Beginning January 1, 1997, patients undergoing outpatient colonoscopy were subjected to either manual abdominal compression or compression with an external straightener. Two hundred patients were divided into two groups of 100 patients each: group A (colonoscopy using traditional methods; 38 men, 62 women, mean age 59.6 years, range 18 to 80) and group B (colonoscopy with the help of the external straightener; 40 men, 60 women, mean age 59.8 years, range 16 to 75). Fifteen minutes after the examination, each patient completed a form that assessed the degree of pain during the procedure (no pain, mild, moderate, severe). The ileocecal valve was reached in 89 cases in group A and 94 cases in group B. The average time required to reach the valve was 9.34+/-4 minutes (range 4 to 25) in group A and 6.97+/-3.37 minutes (range 2 to 21) in group B (p<0.001). With regard to the degree of pain, the results for groups A and B were, respectively: no pain = 25% and 40%, mild = 29% and 34%, moderate = 30% and 20%, severe = 16% and 6% (p< 0.001). The external straightener reduced examination time and decreased the degree of patient pain compared with traditional methods.

  10. Lower Bounds for External Memory Dictionaries

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting; Fagerberg, Rolf

    2003-01-01

    We study trade-offs between the update time and the query time for comparison based external memory dictionaries. The main contributions of this paper are two lower bound trade offs between the I/O complexity of member queries and insertions: If N

  11. External costs of aviation. Background report

    Energy Technology Data Exchange (ETDEWEB)

    Dings, J.M.W.; Wit, R.C.N.; Leurs, B.A.; De Bruyn, S.M.; Davidson, M.D. [CE, Delft (Netherlands); Fransen, W. [INTEGRAL Knowledge Utilization, Landsmeer (Netherlands)

    2002-02-01

    Besides numerous benefits to citizens and companies, air transport also brings undesired side-effects such as emissions and noise nuisance. Most of these negative 'external' effects, as they are called, are currently not priced or only to a limited degree. Consequently, the market place creates insufficient incentives to reduce these external effects. The study, commissioned by the German Umweltbundesamt, aims to contribute to the ongoing international process to create market-based incentives to the aviation industry to reduce the environmental impact of aviation. It does to by assessing, within margins as small as possible, external costs of aviation. The report at hand is a background report to the study 'External costs of aviation'. It contains four technical annexes. The first annex contains an overview of the international literature on the valuation of greenhouse gas emissions. The second annex describes the dependence of climatic impact of aviation on the occurrence of contrails, and the dependence of contrail formation on operational circumstances. The third annex contains an assessment of international literature on the valuation of non-greenhouse gas emissions, such as NOx and SO2. The fourth annex contains a short description of the methodology by which emissions and noise are allocated to passenger and freight transport in this study.

  12. The external sector of the Serbian economy

    Directory of Open Access Journals (Sweden)

    Ristanović Vladimir

    2016-01-01

    Full Text Available The aim of this paper is to show the external sector of the Serbian economy, its features and peculiarities, as well as anomalies that afflicted it for years. In the analysis, data acquired from the Statistical Office of the Republic of Serbia will be used, as well as the official international methodology. The text will include the analysis of the structure of the external sector, market share, competitive position of Serbian economy and export products according to sectors of the economy and factor intensity. Since 2000, the structure of production and exports of the Serbian economy shows low comparative advantages and competitive position throughout the world. Unfavorable structure of the sectors, departments and the product groups affected the deepening of external imbalances and high foreign trade deficit. Exports of technology of predominantly low intensity, resources, and labor-intensive products, common for Serbian economy, represent no guarantee of economic growth in the long term. The causes of external imbalances should be sought in the absence of adequate export strategy, as well as in high speed of liberalization of foreign trade flows and exchange rate policy.

  13. Self and External Monitoring of Reading Comprehension

    Science.gov (United States)

    Shiu, Ling-po; Chen, Qishan

    2013-01-01

    The present study compared the effectiveness of 2 approaches to remedy the inaccuracy of self-monitoring of reading comprehension. The first approach attempts to enhance self-monitoring by strengthening the cues utilized in monitoring. The second approach replaces self-monitoring with external regulation based on objective evaluative information.…

  14. The photoelectric effect in external fields

    OpenAIRE

    Bracher, Christian; Delos, John B.; Kanellopoulos, Vassiliki; Kleber, Manfred; Kramer, Tobias

    2006-01-01

    Atoms and negative ions interacting with laser photons yield a coherent source of photoelectrons. Applying external fields to photoelectrons gives rise to interesting and valuable interference phenomena. We analyze the spatial distribution of the photocurrent using elementary quantum methods. The photoelectric effect is shown to be an interesting example for the use of coherent particle sources in quantum mechanics.

  15. Search Engine Competition with Network Externalities

    NARCIS (Netherlands)

    Argenton, C.; Prüfer, J.

    2011-01-01

    The market for Internet search is not only economically and socially important, it is also highly concentrated. Is this a problem? We study the question whether "competition is only a free click away". We argue that the market for Internet search is characterized by indirect network externalities

  16. Intersection of neighbourhood structure, parenting and externalizing ...

    African Journals Online (AJOL)

    Little is known about parenting practices and how it intersects with neighbourhood structure and externalizing behaviour, in South Africa. This chapter presents the findings of parental reflections on neighbourhood structure and problem behaviours, which is one component of a study, that is situated within a child safety, ...

  17. Phosphorus sorption isotherms and external phosphorus ...

    African Journals Online (AJOL)

    Information on P sorption characteristics of soils is important for making profitable P fertiliser recommendations and designing appropriate P management strategies for improving crop productivity. An experiment was conducted to determine the P sorption capacities and external P requirements (EPR) of some soils of ...

  18. External legitimation in international new ventures

    DEFF Research Database (Denmark)

    Turcan, Romeo V.

    2012-01-01

    This paper explores within the framework of new venture legitimation how and why international new ventures acquire external legitimacy and strive for survival in the face of critical events. Following a longitudinal multiple-case study methodology that was adopted for the purpose of theory...

  19. An indicator for ecosystem externalities in fishing

    DEFF Research Database (Denmark)

    Ravn-Jonsen, Lars; Andersen, Ken Haste; Vestergaard, Niels

    2016-01-01

    a benefit indicator that explicitly divides the consequences of fishing into internal and external benefits. This analysis demonstrates that the forage fish fleet has a notable economic impact on the large fish fleet, but the reverse is not true. The impact can be either negative or positive, which entails...

  20. An Indicator for ecosystem externalities in fishing

    DEFF Research Database (Denmark)

    Ravn-Jonsen, Lars; Andersen, Ken Haste; Vestergaard, Niels

    a benefit indicator that explicitly divides the consequences of fishing into internal and external benefits. This analysis demonstrates that the forage fish fleet has a notable economic impact on the large fish fleet, but the reverse is not true. The impact can be either negative or positive, which entails...

  1. Overview of turbulence models for external aerodynamics

    NARCIS (Netherlands)

    Henkes, R.A.W.M.

    1998-01-01

    An overview is given on the background of different turbulence models that can be used to compute boundary layers in external aerodynamics, such as for aircraft. The overview includes algebraic models (Cebeci-Smith, Baldwin-Lomax), a half-equation model (Johnson-King), two-equation models ( K-E-K-),

  2. External insulation with cellular plastic materials

    DEFF Research Database (Denmark)

    Sørensen, Lars Schiøtt; Nielsen, Anker

    2014-01-01

    External thermal insulation composite systems (ETICS) can be used as extra insulation of existing buildings. The system can be made of cellular plastic materials or mineral wool. There is a European Technical guideline, ETAG 004, that describe the tests that shall be conducted on such systems...

  3. Dyadic Parenting and Children's Externalizing Symptoms

    Science.gov (United States)

    Meteyer, Karen B.; Perry-Jenkins, Maureen

    2009-01-01

    We explore dyadic parenting styles and their association with first-grade children's externalizing behavior symptoms in a sample of 85 working-class, dual-earner families. Cluster analysis is used to create a typology of parenting types, reflecting the parental warmth, overreactivity, and laxness of both mothers and fathers in two-parent families.…

  4. 21 CFR 890.3420 - External limb prosthetic component.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External limb prosthetic component. 890.3420... External limb prosthetic component. (a) Identification. An external limb prosthetic component is a device... total prosthesis. Examples of external limb prosthetic components include the following: Ankle, foot...

  5. External effects and social costs of road transport

    NARCIS (Netherlands)

    Verhoef, E.T.

    1994-01-01

    The article contains a welfare economic analysis of road transport's external effects. First, we discuss the definition of external effects. Applying this definition, it is concluded that road transport activities give rise to a wide range of external costs. However, there are no external benefits

  6. 49 CFR 192.461 - External corrosion control: Protective coating.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false External corrosion control: Protective coating... for Corrosion Control § 192.461 External corrosion control: Protective coating. (a) Each external protective coating, whether conductive or insulating, applied for the purpose of external corrosion control...

  7. External effects related to biogas and wind power

    DEFF Research Database (Denmark)

    Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

    1998-01-01

    will focus on estimates of externalities related to wind and biogas energy supplies using the ExternE methodology developed in a major study launched by the European Comission. External costs are the costs imporsed on society that are not included in the market price (e.g. effects of air pollution on health......, buildings, crops, forests and global warming, emissions of noise etc.)....

  8. External-beam PIGE for fluorine determination in atmospheric aerosol

    Science.gov (United States)

    Calastrini, F.; Del Carmine, P.; Lucarelli, F.; Mandò, P. A.; Prati, P.; Zucchiatti, A.

    1998-03-01

    Air pollution measurements have been performed at Montelupo, a town about 20 km west of Florence, characterised by the presence of a large number of ceramic and glass factories just inside the inhabited area. Both filters collecting aerosols during 24 h and streaker filters with 1-h resolution capability have been analysed, using external Particle Induced X-ray Emission (PIXE) and Proton-Induced Gamma-Ray Emission (PIGE) simultaneously. The best operating conditions for getting quantitative information from the PIGE analysis of fluorine in the external beam set-up have been investigated. The minimum detection limit for the concentration of fluorine in air is in the order of 10 ng/m 3. Some specific results concerning fluorine determination in both the 24 and 1-h resolution measurements are finally presented. While the average detected concentrations in air come out to be well below the air quality limits, time episodes of relatively higher concentration have been detected and thanks to the time correlation with the other elements the origin of these pollution episodes can be hypothesised with a good degree of confidence.

  9. Application of external tracking in ultrasound elasticity imaging

    Science.gov (United States)

    Foroughi, Pezhman; Hager, Gregory D.; Wacker, Frank K.; Boctor, Emad M.

    2010-03-01

    Despite the success of ultrasound elasticity imaging (USEI) in medical applications such as diagnosis and screening of breast lesions and prostate cancer, USEI has not been adopted in routine clinical procedures. This is partly caused by the difficulty in acquiring reliable images and interpreting them, the lack of consistency over time, and the dependency of image quality to the expertise of the user. We previously demonstrated the potential of exploiting an external tracker to partially alleviate these issues and enhance the quality of USEI. The tracking data enabled fast and automatic selection of pairs of RF frames used in strain calculation. Here, we expand this method by including new features. The proposed method employs image content to compensate for the limited accuracy of the tracking device. It also combines multiple strain images to improve the quality of the final image. For this purpose, It normalizes the images and determines which images can be combined relying on the tracking information. We have acquired RF frames synchronized with tracking data from livers of pig containing an ablated region and a breast phantom using two different tracking devices; an optical tracker and a less accurate electromagnetic tracker. We present the promising results of the proposed method and investigate the sensitivity of frame selection technique without using the image content to inaccuracies in tracking information.

  10. Quality function and the quality manager

    Directory of Open Access Journals (Sweden)

    Dr.Sc. Miraç Hani

    2012-12-01

    Full Text Available In many organizations, management systems are viewed in terms of the internal dynamics between marketing, design, production, distribution, and accounting. A change is required from this to a larger system which also encompasses and integrates the business interests of customers and   suppliers. Management needs to develop an in-depth understanding of these relationships and how they may be used to cement the partnership concept. The quality function should be the organization’s focal point in this respect and should be equipped to gauge internal and external customers, expectations and degree of satisfaction. It should also identify quality deficiencies in all business functions and promote improvements. The role of the quality function is to make quality become an inseparable aspect of every employee’s performance and responsibility. The transition in many companies from quality departments with line functions will require careful planning, direction and monitoring. Quality professionals have developed numerous techniques and skills focused on product or service quality.

  11. [Basic resuscitation of adults and automatic external defibrillation].

    Science.gov (United States)

    Berlac, Peter Anthony; Torp-Pedersen, Christian T; Lippert, Freddy K

    2008-11-17

    The new ERC guidelines on resuscitation emphasize the importance of quality CPR. BLS should be started as early as possible. Lay rescuers should not check for a pulse, they should call for help and start chest compressions immediately. Compression depth should be 4-5 cm at a rate of 100 compressions per minute. Chest compressions and ventilation should be performed in a ratio of 30:2. Lay rescuers should continue until professional help arrives. Lay rescuers may use the same procedure for children as recommended for adults. Professionals should, however, initiate CPR in children with 5 ventilations followed by a compression-ventilation ratio of 15:2. Automatic External Defibrillation should be used as early as possible.

  12. Surgical treatment of blepharoptosis caused by chronic progressive external ophthalmoplegia.

    Science.gov (United States)

    Soejima, Kazutaka; Sakurai, Hiroyuki; Nozaki, Motohiro; Fujiwara, Osamu; Masuda, Michiko; Yamada, Hiroki; Shimizu, Jun

    2006-04-01

    Chronic progressive external ophthalmoplegia (CPEO) is a neuromyopathic disorder characterized by progressive weakness of the extraocular and levator muscles, which causes blepharoptosis and impairment of ocular motility. Because of the risk of worsening of lagophthalmos and exposure keratitis due to an associated poor Bell phenomenon or weak orbicularis function, surgical treatment of the blepharoptosis caused by CPEO is problematic. We present our experience with a case of blepharoptosis in CPEO. A 61-year-old woman presented with slowly progressive bilateral blepharoptosis. A muscle biopsy of the rectus femoris revealed mitochondrial abnormalities, which satisfied the definition of the diagnosis of CPEO as mitochondrial encephalomyopathy. The lid opening was 2 mm, with maximal frontalis contraction, the levator function was zero, and the eyeball movement was severely limited. The blow movement was about 6 mm. Combination of modest blepharoplasty and frontalis suspension using a monofilament suture was performed. The postoperative result was satisfactory, and the patient's quality of life was markedly improved.

  13. Externalizing behaviors in preadolescents : familial risk to externalizing behaviors, prenatal and perinatal risks, and their interactions

    NARCIS (Netherlands)

    Buschgens, Cathelijne J. M.; Swinkels, Sophie H. N.; van Aken, Marcel A. G.; Ormel, Johan; Verhulst, Frank C.; Buitelaar, Jan K.

    Background Accumulating evidence indicates that there is a rich and varied interplay between persons and their environments, which strongly suggests that this involves gene-environment correlations and interactions. We investigated whether familial risk (FR) to externalizing behaviors and prenatal

  14. Externalizing behaviors in preadolescents: familial risk to externalizing behaviors, prenatal and perinatal risks, and their interactions.

    NARCIS (Netherlands)

    Buschgens, C.J.M.; Swinkels, S.H.N.; Aken, M.A. van; Ormel, J.; Verhulst, F.C.; Buitelaar, J.K.

    2009-01-01

    BACKGROUND: Accumulating evidence indicates that there is a rich and varied interplay between persons and their environments, which strongly suggests that this involves gene-environment correlations and interactions. We investigated whether familial risk (FR) to externalizing behaviors and prenatal

  15. Externalizing behaviors in preadolescents: familial risk to externalizing behaviors, prenatal and perinatal risks, and their interactions

    NARCIS (Netherlands)

    Buschgens, C.J.M.; Swinkels, S.H.N.; van Aken, M.A.G.; Ormel, J.; Verhulst, F.C.; Buitelaar, J.K.

    2009-01-01

    Background Accumulating evidence indicates that there is a rich and varied interplay between persons and their environments, which strongly suggests that this involves gene-environment correlations and interactions. We investigated whether familial risk (FR) to externalizing behaviors and prenatal

  16. Tunable single and dual mode operation of an external cavity quantum-dot injection laser

    Energy Technology Data Exchange (ETDEWEB)

    Biebersdorf, A [Photonics and Optoelectronics Group, Physics Department and CeNS, Ludwig-Maximilians-Universitaet, Amalienstrasse 54, D-80799 Munich (Germany); Lingk, C [Photonics and Optoelectronics Group, Physics Department and CeNS, Ludwig-Maximilians-Universitaet, Amalienstrasse 54, D-80799 Munich (Germany); De Giorgi, M [Photonics and Optoelectronics Group, Physics Department and CeNS, Ludwig-Maximilians-Universitaet, Amalienstrasse 54, D-80799 Munich (Germany); Feldmann, J [Photonics and Optoelectronics Group, Physics Department and CeNS, Ludwig-Maximilians-Universitaet, Amalienstrasse 54, D-80799 Munich (Germany); Sacher, J [Sacher Lasertechnik GmbH, Hannah Arendt Strasse 3-7, D-35037 Marburg (Germany); Arzberger, M [Walter Schottky Institut, Technische Universitaet Muenchen, Am Coulombwall, D-85748 Garching (Germany); Ulbrich, C [Walter Schottky Institut, Technische Universitaet Muenchen, Am Coulombwall, D-85748 Garching (Germany); Boehm, G [Walter Schottky Institut, Technische Universitaet Muenchen, Am Coulombwall, D-85748 Garching (Germany); Amann, M-C [Walter Schottky Institut, Technische Universitaet Muenchen, Am Coulombwall, D-85748 Garching (Germany); Abstreiter, G [Walter Schottky Institut, Technische Universitaet Muenchen, Am Coulombwall, D-85748 Garching (Germany)

    2003-08-21

    We investigate quantum-dot (QD) lasers in an external cavity using Littrow and Littman configurations. Here, we report on a continuously tunable QD laser with a broad tuning range from 1047 to 1130 nm with high stability and efficient side mode suppression. The full-width at half-maximum of the laser line is 0.85 nm determined mainly by the quality of the external grating. This laser can be operated in a dual-mode modus, where the mode-spacing can be tuned continuously between 1.1 and 34 nm. Simultaneous emission of the two laser modes is shown by sum frequency generation experiments.

  17. Governments’ Social Media Use for External Collaboration

    DEFF Research Database (Denmark)

    Wang, Cancan; Medaglia, Rony

    2017-01-01

    study of a collaborative e-government project showcases how emergent organizing practices through external social media differ from existing ones along the dimensions of time, task, team, and transition. Design/methodology/approach: This paper presents a case study of a collaborative e......Purpose: As social media technologies permeate public life, the current forms of collaboration between government and non-government stakeholders are changing. The purpose of this paper is to investigate how social media use reconfigures the organizing practices around such collaboration. A case......-government project on open data, organized by Shanghai Municipality, local businesses, universities, and NGOs, using an external social media platform, WeChat. Adopting the theoretical lens of temporary organization, the paper identifies the key aspects of change emerged in the organizing practices...

  18. The Automatic External Cardioverter-Defibrillator

    Directory of Open Access Journals (Sweden)

    Antoni Martínez-Rubio

    2004-07-01

    Full Text Available In-hospital cardiac arrest remains a major problem but new technologies allowing fully automatic external defibrillation are available. These technologies allow the concept of “external therapeutic monitoring” of lethal arrhythmias. Since early defibrillation improves outcome by decreasing morbidity and mortality, the use of this device should improve the outcome of in-hospital cardiac arrest victims. Furthermore, the use of these devices could allow safe monitoring and treatment of patients at risk of cardiac arrest who not necessarily must be in conventional monitoring units (Intensive or Coronary Care Units saving costs with a more meaningful use of resources. The capability to provide early defibrillation within any patient-care areas should be considered as an obligation (“standard of care” of the modern hospital.

  19. Video exams and the external examiners

    DEFF Research Database (Denmark)

    Qvist, Palle

    with the exams. Almost all respondents thought that video exams gave the external examiner the possibility to ensure that the demands were in accordance with the defined outcomes and see to that the exams were completed in accordance with the rules. This paper presents results from a questionnaire focusing......The Master’s programme in Problem Based Learning in Engineering and Science, MPBL (www.mpbl.aau.dk), at Aalborg University, is an international programme offering formalized staff development. The programme is online, worldwide and offered on demand. The programme is organized exemplarily...... to the Master’s programme. The programme offers streamed videos in combination with other learning resources. Oral exams have been mediated with the help of Skype and later with Adobe Connect Professional. It has for all participants - students, examiners and external examiners – been both a challenge...

  20. Enlargement of the External Mobility Programme

    CERN Multimedia

    HR Department

    2008-01-01

    The External Mobility Programme was launched at the end of September 2007. Initially, the programme was aimed at staff members on limited-duration contracts, having received formal notification of the termination of their employment contract at CERN, to help them towards their next employment. The programme provides a privileged, fast-track entry into the recruitment process of partner companies. Despite the short time since its inception, the programme has already delivered some encouraging and concrete results in terms of interviews granted to participating staff. The Programme has raised considerable interest from both CERN personnel as well as from several major European companies. CERN Management has decided to broaden the scope of the External Mobility Programme. The Programme is now open to: All staff members whose limited duration contract will end in less than one year, as well as all those with indefinite contracts. All fellows who have been employed by CERN fo...

  1. Enlargement of the External Mobility Programme

    CERN Multimedia

    HR Department

    2008-01-01

    The External Mobility Programme was launched at the end of September 2007. Initially, the programme was aimed at staff members on limited-duration contracts having received formal notification of the termination of their employment contract at CERN, to help them towards their next employment. The programme provides a privileged, fast-track entry into the recruitment process of partner companies. Despite the short time since its inception, the programme has already delivered some encouraging and concrete results in terms of interviews granted to participating staff. The Programme has attracted considerable interest from both CERN personnel as well as from several major European companies. The CERN Management has decided to broaden the scope of the External Mobility Programme. The Programme is now open to: All staff members whose limited duration contract will end in less than one year, as well as all those with indefinite contracts. All fellows who have been employed by CE...

  2. Vertical external cavity surface emitting semiconductor lasers

    CERN Document Server

    Holm, M

    2001-01-01

    Active stabilisation showed a relative locked linewidth of approx 3 kHz. Coarse tuning over 7 nm was achieved using a 3-plate birefingent filter plate while fine-tuning using cavity length change allowed tuning over 250 MHz. Vertical external cavity semiconductor lasers have emerged as an interesting technology based on current vertical cavity semiconductor laser knowledge. High power output into a single transverse mode has attracted companies requiring good fibre coupling for telecommunications systems. The structure comprises of a grown semiconductor Bragg reflector topped with a multiple quantum well gain region. This is then included in an external cavity. This device is then optically pumped to promote laser action. Theoretical modelling of AIGaAs based VECSEL structures was undertaken, showing the effect of device design on laser characteristics. A simple 3-mirror cavity was constructed to assess the static characteristics of the structure. Up to 153 mW of output power was achieved in a single transver...

  3. Dissemination of CERN Technologies Through External Entrepreneurs

    CERN Document Server

    Lande, Bjørnulf Visdal; Huuse, Henning

    2008-01-01

    This study focuses on dissemination of innovations through external entrepreneurs. The innovations studied are developed at the European Organization for Nuclear Research (CERN) and commercialized by entrepreneurs establishing spin-off companies on the outside of the Organization. The objective of this study is to provide knowledge to facilitate future external entrepreneurs to increase dissemination of CERN technologies. The research questions looks at the timeline from preparations for creating the spin-off company, until having a product for commercialization in the market. A qualitative cross case investigation was conducted to assess the experiences of four spin-off companies. A framework was created to structure the discussion by finding and categorizing impeding- and success factors seen from the entrepreneurs point of view. The findings where structured in three phases respectively, the time before starting the company, the beginning of the company and the final development before selling products. Th...

  4. The external microenvironment of healing skin wounds

    DEFF Research Database (Denmark)

    Kruse, Carla R; Nuutila, Kristo; Lee, Cameron Cy

    2015-01-01

    The skin wound microenvironment can be divided into two main components that influence healing: the external wound microenvironment, which is outside the wound surface; and the internal wound microenvironment, underneath the surface, to which the cells within the wound are exposed. Treatment...... and carbon dioxide), pH, and anti-microbial treatment on the wound. These factors are well described in the literature and can be modified with treatment methods available in the clinic. Understanding the roles of these factors in wound pathophysiology is of central importance in wound treatment...... methods that directly alter the features of the external wound microenvironment indirectly affect the internal wound microenvironment due to the exchange between the two compartments. In this review, we focus on the effects of temperature, pressure (positive and negative), hydration, gases (oxygen...

  5. Experiments with Externally Prestressed Continuous Composite Girders

    Directory of Open Access Journals (Sweden)

    M. Safan

    2001-01-01

    Full Text Available Steel-concrete composite girders have attractive potentials when applied in bridge construction. The serviceability performance of continuous composite girders is becoming more and more a deterministic parameter in the design of this type of structures. An effective method for improving this performance is to apply prestressing to control or completely eliminate concrete deck cracking caused by static and time dependent actions. Little literature has been found addressing the experimental analysis of continuous girders prestressed by means of external deviated tendons. The current research aims to investigate the behavior of a double-span steel composite beam externally prestressed by means of continuous tendons in terms of cracking characteristics, load deflection response, and load carrying capacity. The efficiency of prestressing is evaluated by comparing the results to those of a non-prestressed beam with similar cross sections and spans.

  6. Bicondylar tibial fractures: Internal or external fixation?

    Directory of Open Access Journals (Sweden)

    Gunasekaran Kumar

    2011-01-01

    Full Text Available Bicondylar fractures of the tibia, representing the Schatzker V and VI fractures represent a challenging problem. Any treatment protocol should aim at restoring articular congruity and the metaphyseo-diaphsyeal dissociation (MDD-both of these are equally important to long-term outcome. Both internal and external fixations have their proponents, and each method of treatment is associated with its unique features and complications. We review the initial and definitive management of these injuries, and the advantages and disadvantages of each method of definitive fixation. We suggest the use of a protocol for definitive management, using either internal or external fixation as deemed appropriate. This protocol is based on the fracture configuration, local soft tissue status and patient condition. In a nutshell, if the fracture pattern and soft tissue status are amenable plate fixation (single or double is performed, otherwise limited open reduction and articular surface reconstruction with screws and circular frame is performed.

  7. Generational Differences in Children's Externalizing Behavior Problems.

    Science.gov (United States)

    Moon, Ui Jeong; Hofferth, Sandra L

    2015-12-01

    This study examines the effects of time spent with parents and peers on generational differences in children's externalizing behavior problems in immigrant families. Using the Child Development Supplement and Time Diaries from the Panel Study of Income Dynamics, we found that first and second generation children exhibited fewer externalizing behavior problems than did third generation children, despite their lower socioeconomic status. First and second generation children spent more time with either one or both parents, and less time with peers, on the weekend day than did third generation children. We found a marginal but beneficial effect of time spent with fathers on the weekday, but not on the weekend day. The implications are that time spent with fathers on weekdays differs from time spent with fathers on the weekend, and that promoting immigrant father involvement on the weekday through school or community programs could benefit immigrant children.

  8. Externalizing behaviors in preadolescents: Familial risk to externalizing behaviors and perceived parenting styles

    OpenAIRE

    Buschgens, Cathelijne; van Aken, Marcel; Swinkels, Sophie; Ormel, Johan Hans; Verhulst, Frank; Buitelaar, Jan

    2010-01-01

    Abstract The aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10?12 years who participated in TRAILS, a large prospective population-based cohort study in the Netherlands (N = 2,230). Regression analyses were used to determine the relative contribution of FR-EXT and perceived parenting s...

  9. Wavelength beam combining of a 980-nm tapered diode laser bar in an external cavity

    DEFF Research Database (Denmark)

    Vijayakumar, Deepak; Jensen, Ole Bjarlin; Thestrup Nielsen, Birgitte

    2010-01-01

    solution for preserving the beam quality of the bar in the range of that of a single emitter and at the same time, enabling the power scaling. We report spectral beam combining applied to a 12 emitter tapered laser bar at 980 nm. The external cavity has been designed for a wavelength separation of 4.0 nm......High power diode lasers are used in a large number of applications. A limiting factor for more widespread use of broad area lasers is the poor beam quality. Gain guided tapered diode lasers are ideal candidates for industrial applications that demands watt level output power with good beam quality...

  10. Imaging findings in external snapping hip syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Krishnamurthy, Ganesh; Connolly, Bairbre L. [The Hospital for Sick Children, Image Guided Therapy, Diagnostic Imaging, Toronto (Canada); Narayanan, Unni [The Hospital for Sick Children, Pediatric Orthopedic Surgery, Toronto (Canada); Babyn, Paul S. [The Hospital for Sick Children, Diagnostic Imaging, Toronto (Canada)

    2007-12-15

    We describe a case of external snapping hip diagnosed by dynamic sonography. The case prompted us to retrospectively review the imaging findings of children who clinically had presented with snapping hip. From this review we identified the features on MRI and CT of either thickening of the iliotibial band or thickening of the anterior edge of the gluteus maximus muscle as the cause of snapping and atrophy of the bulk of gluteus maximus muscle as an important secondary sign associated with snapping. (orig.)

  11. Search engine competition with network externalities

    OpenAIRE

    Argenton, C.; Prüfer, J.

    2012-01-01

    The market for Internet search is not only economically and socially important, it is also highly concentrated. Is this a problem? We study the question of whether “competition is only a free click away.” We argue that the market for Internet search is characterized by indirect network externalities and construct a simple model of search engine competition, which produces a market share development that fits well the empirically observed developments since 2003. We find that there is a strong...

  12. A Rare Conjunctivitis Case: External Ophthalmomyiasis

    Directory of Open Access Journals (Sweden)

    Murat Köksal

    2014-08-01

    Full Text Available Oestrus ovis is the most common cause of external ophthalmomyiasis. This infection typically occurs in shepherds and farmers in rural areas. Ophthalmomyiasis occurs usually during spring or summer. It is often misdiagnosed as acute viral or allergic conjunctivitis. The definitive diagnosis is based on the detection of oestrus ovis larvae at clinical examination. In our country, this infection should be kept in mind by ophthalmologist in unilateral cases of conjunctivitis. (Turk J Ophthalmol 2014; 44:316-8

  13. Examens externes des programmes (2015) | IDRC - International ...

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

    4 mai 2016 ... Le CRDI commande un examen externe vers la fin du cycle d'exécution de chaque programme. Ces examens constituent le principal outil de reddition de comptes du Centre, car ils permettent de démontrer les résultats obtenus grâce aux dépenses de programme, et donc l'efficacité et la pertinence de ces ...

  14. The MNC as an Externally Embedded Organization

    DEFF Research Database (Denmark)

    Nell, Phillip Christopher; Ambos, Björn; Schlegelmilch, Bodo B.

    2011-01-01

    MNCs have been conceptualized as differentiated networks that, in turn, are embedded in external networks. Previous research has predominantly focused on the embeddedness of established subsidiaries into their local environment, omitting to shed light on the phenomenon of headquarters linkages to...... more overlapping network ties when subsidiaries are high performers, hold important resources, operate in turbulent environments, and are closely connected to multinational actors as opposed to purely domestic firms....

  15. Aggregate savings and external imbalances in China

    OpenAIRE

    Yang, Dennis Tao

    2012-01-01

    Over the last decade, the internal and external macroeconomic imbalances in China have risen to unprecedented levels. In 2008, China's national savings rate soared to over 53 percent of its GDP, whereas its current account surplus exceeded 9 percent of GDP. This paper presents a unified framework for understanding the structural causes of these imbalances. I argue that the imbalances are attributable to a set of policies and institutions embedded in the economy. I propose a unified framework ...

  16. Lesions in the external auditory canal

    Directory of Open Access Journals (Sweden)

    Priyank S Chatra

    2011-01-01

    Full Text Available The external auditory canal is an S- shaped osseo-cartilaginous structure that extends from the auricle to the tympanic membrane. Congenital, inflammatory, neoplastic, and traumatic lesions can affect the EAC. High-resolution CT is well suited for the evaluation of the temporal bone, which has a complex anatomy with multiple small structures. In this study, we describe the various lesions affecting the EAC.

  17. The European Union: internal coherence, external relevance

    Directory of Open Access Journals (Sweden)

    Rodica Milena ZAHARIA

    2014-12-01

    Full Text Available internal one, where the EU has to define the future of its internal construction; and the external arena, where the EU has to establish what role it must play and how to do it with a stronger voice. Both challenges are important and mutually reinforcing. The EU is strong outside as long as it is solid inside; it is a model for others as long as it is attractive for its members

  18. Markets, Herding and Response to External Information.

    Science.gov (United States)

    Carro, Adrián; Toral, Raúl; San Miguel, Maxi

    2015-01-01

    We focus on the influence of external sources of information upon financial markets. In particular, we develop a stochastic agent-based market model characterized by a certain herding behavior as well as allowing traders to be influenced by an external dynamic signal of information. This signal can be interpreted as a time-varying advertising, public perception or rumor, in favor or against one of two possible trading behaviors, thus breaking the symmetry of the system and acting as a continuously varying exogenous shock. As an illustration, we use a well-known German Indicator of Economic Sentiment as information input and compare our results with Germany's leading stock market index, the DAX, in order to calibrate some of the model parameters. We study the conditions for the ensemble of agents to more accurately follow the information input signal. The response of the system to the external information is maximal for an intermediate range of values of a market parameter, suggesting the existence of three different market regimes: amplification, precise assimilation and undervaluation of incoming information.

  19. Carnap and Lewis on the External World

    Directory of Open Access Journals (Sweden)

    Ivan Ferreira da Cunha

    2014-08-01

    Full Text Available This paper compares the claims about our knowledge of the external world presented by Rudolf Carnap, in the book known as the Aufbau, to those of Clarence Irving Lewis, in Mind and the World-Order. This comparison is made in terms of the opposition to Kantian epistemology that both books establish; the Aufbau is regarded as the peak of the logicist tradition and Mind and the World-Order is taken in continuity with pragmatism. It is found that both books present knowledge of the external world as a consequence of a structural organization of human experience. However, there is an important point of divergence: the concept of verification each author adopts is different, such a concept was even a matter of discussion between Lewis and the Vienna Circle. This paper shows this disagreement but also shows how Carnap changed his point of view in the decade after the Aufbau was published, towards a standpoint which is much closer to Lewis’s ideas. In that process, nevertheless, Carnap changed his focus and did not deal with the problem of the external world anymore. This paper also seeks to draw attention to some features of the relation between Carnap and the pragmatist tradition which have only recently started to attract interest.

  20. Unilateral Vestibular Loss Impairs External Space Representation

    Science.gov (United States)

    Borel, Liliane; Redon-Zouiteni, Christine; Cauvin, Pierre; Dumitrescu, Michel; Devèze, Arnaud; Magnan, Jacques; Péruch, Patrick

    2014-01-01

    The vestibular system is responsible for a wide range of postural and oculomotor functions and maintains an internal, updated representation of the position and movement of the head in space. In this study, we assessed whether unilateral vestibular loss affects external space representation. Patients with Menière's disease and healthy participants were instructed to point to memorized targets in near (peripersonal) and far (extrapersonal) spaces in the absence or presence of a visual background. These individuals were also required to estimate their body pointing direction. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (one week and one month after the operation), and healthy participants were tested at similar times. Unilateral vestibular loss impaired the representation of both the external space and the body pointing direction: in the dark, the configuration of perceived targets was shifted toward the lesioned side and compressed toward the contralesioned hemifield, with higher pointing error in the near space. Performance varied according to the time elapsed after neurotomy: deficits were stronger during the early stages, while gradual compensation occurred subsequently. These findings provide the first demonstration of the critical role of vestibular signals in the representation of external space and of body pointing direction in the early stages after unilateral vestibular loss. PMID:24523916

  1. Unilateral vestibular loss impairs external space representation.

    Directory of Open Access Journals (Sweden)

    Liliane Borel

    Full Text Available The vestibular system is responsible for a wide range of postural and oculomotor functions and maintains an internal, updated representation of the position and movement of the head in space. In this study, we assessed whether unilateral vestibular loss affects external space representation. Patients with Menière's disease and healthy participants were instructed to point to memorized targets in near (peripersonal and far (extrapersonal spaces in the absence or presence of a visual background. These individuals were also required to estimate their body pointing direction. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (one week and one month after the operation, and healthy participants were tested at similar times. Unilateral vestibular loss impaired the representation of both the external space and the body pointing direction: in the dark, the configuration of perceived targets was shifted toward the lesioned side and compressed toward the contralesioned hemifield, with higher pointing error in the near space. Performance varied according to the time elapsed after neurotomy: deficits were stronger during the early stages, while gradual compensation occurred subsequently. These findings provide the first demonstration of the critical role of vestibular signals in the representation of external space and of body pointing direction in the early stages after unilateral vestibular loss.

  2. External CSR Communication in a Strategic Approach

    Directory of Open Access Journals (Sweden)

    Diana Corina GLIGOR-CIMPOIERU

    2014-12-01

    Full Text Available As part of a strategic approach, aimed at assuring mutual benefits for the social cause and the business organization, a good CSR - Corporate Social Responsibility communication is vital for the success of a CSR program. We argue that there is not a problem with the legitimacy of the CSR concept, but rather to its implementation. If a business organization implementing socially responsible initiatives is focusing only on reaping the image benefits from a simple public relations perspective, then it loses all the potential business benefits it could gain from a strategic approach focused on long term real results in a win-win perspective. The fact that the image benefit is one of the most important incentives that a business organization could obtain for engaging in CSR activities cannot be ignored, and that is the reason why we have chosen to analyse the topic of CSR communication, mainly external communication, as an important link in the process of implementing a CSR program, that plays an important part for the success of a CSR program. The approach on CSR communication should definitely be a strategic one, and long already common forms of external CSR communication like web pages or CSR annual reports new means of social media networks have an increasing importance. For the practical part of the paper, we were interested in analyzing how much of the external CSR communication in the Romanian business environment is oriented toward a traditional or a strategic approach.

  3. A Methodology Proposal to Calculate the Externalities of Liquid Biofuels

    Energy Technology Data Exchange (ETDEWEB)

    Galan, A.; Gonzalez, R.; Varela, M. [Ciemat. Madrid (Spain)

    1999-05-01

    The aim of the survey is to propose a methodology to calculate the externalities associated with the liquid bio fuels cycle. The report defines the externalities from a theoretical point of view and classifies them. The reasons to value the externalities are explained as well as the existing methods. Furthermore, an evaluation of specific environmental and non-environmental externalities is also presented. The report reviews the current situation of the transport sector, considering its environmental effects and impacts. The progress made by the ExternE and ExternE-transport projects related the externalities of transport sector is assessed. Finally, the report analyses the existence of different economic instruments to internalize the external effects of the transport sector as well as other aspects of this internalization. (Author) 58 refs.

  4. Ship emissions and their externalities for Greece

    Science.gov (United States)

    Tzannatos, Ernestos

    2010-06-01

    The existing and emerging international and European policy framework for the reduction of ship exhaust emissions dictates the need to produce reliable national, regional and global inventories in order to monitor emission trends and consequently provide the necessary support for future policy making. Furthermore, the inventories of ship exhaust emissions constitute the basis upon which their external costs are estimated in an attempt to highlight the economic burden they impose upon the society and facilitate the cost-benefit analysis of the proposed emission abatement technologies, operational measures and market-based instruments prior to their implementation. The case of Greece is of particular interest mainly because the dense ship traffic within the Greek seas directly imposes the impact of its exhaust emission pollutants (NO x, SO 2 and PM) upon the highly populated, physically sensitive and culturally precious Greek coastline, as well as upon the land and seas of Greece in general, whereas the contribution of Greece in the global CO 2 inventory at a time of climatic change awareness cannot be ignored. In this context, this paper presents the contribution of Greece in ship exhaust emissions of CO 2, NO x, SO 2 and PM from domestic and international shipping over the last 25 years (1984-2008), utilizing the fuel-based (fuel sales) emission methodology. Furthermore, the ship exhaust emissions generated within the Greek seas and their externalities are estimated for the year 2008, through utilizing the fuel-based (fuel sales) approach for domestic shipping and the activity-based (ship traffic) approach for international shipping. On this basis, it was found that during the 1984 to 2008 period the fuel-based (fuel sales) ship emission inventory for Greece increased at an average annual rate of 2.85%. In 2008, the CO 2, NO x, SO 2 and PM emissions reached 12.9 million tons (of which 12.4 million tons of CO 2) and their externalities were found to be around 3

  5. IMPORTANCE OF DELIVERY CONDITIONS IN THE EXTERNAL PRICE CALCULATION

    Directory of Open Access Journals (Sweden)

    Violeta ISAI

    2005-01-01

    Full Text Available The delivery conditions of the merchandise at export, established by the rules INCOTERMS2000, influence the external price structure. There are some conditions in which the external priceincludes only the value of the merchandise and other conditions in which, besides the value of themerchandise, the price includes also the external transport and insurance. In the case of the exportson commercial credit, when it appears the notion of external interest, this one may be included in theprice or may be invoiced separately, thus defining gross external prices and net external prices.

  6. [The study of the modification of the natural resonance of the external ear following tympanoplasty].

    Science.gov (United States)

    Balestri, J A; Mazzoni, A; Fornasari, V; Costa, A; Battazzi, P; Danesi, G

    1995-08-01

    The shape, position and amplitude of the natural resonance curve of external ear is related to sensation evoked in a subject by sound coming from the external environment. The involution of this curve varies from individual and is the sum of the effects provoked on the incident sound by the head, auricle and the conformation of canal (EEE = External Ear Effect). Natural amplification supplied by the system allows the individual to distinguish natural sound, whose being natural make them pleasant to hear. Any interventions that modifies the anatomy of the auricle and/or the canal activity alternates the REUR (Real Ear Unaided Response) to some degree. Restoration of basic anatomical conditions are choice of interventions which displace the curve only slightly allows a physiological sensation of sound to be maintained. Surgeon often neglect this little studied aspect preferring to evaluate this work in terms of quantity thus rather ignoring the quality of sound achieved.

  7. [An information system for injuries from external causes (SILEX): a successful project in El Salvador].

    Science.gov (United States)

    Salinas, Oscar; de Cosío, Gerardo; Clavel-Arcas, Carme; Montoya, Jeannette; Serpas, Mario; Morán de García, Silvia; Concha-Eastman, Alberto

    2008-12-01

    This article examines the stages in developing an information system for injuries from external causes (Sistema de Información de Lesiones de Causa Externa-SILEX), as well as its limitations and achievements. SILEX is a Web-based application for collection, quality control, presentation, and analysis of data available from the hospital system for surveillance of injuries from external causes created by Ministry of Health of El Salvador with data from the hospital emergency services. This system maintains comprehensive information on the injured person-type of injury, intention, injury site, activity being performed at the time of injury, risk factors, etc.-in the form of tables, graphs, and maps, which streamlines the development of intervention plans and prevention initiatives for these types of injuries in El Salvador. This experience is an example of what can be done to close the information gap on injuries by external causes in the Region of the Americas.

  8. Early Parenting, Represented Family Relationships, and Externalizing Behavior Problems in Children Born Preterm

    Science.gov (United States)

    Poehlmann, Julie; Burnson, Cynthia; Weymouth, Lindsay A.

    2015-01-01

    Through assessment of 173 preterm infants and their mothers at hospital discharge and at 9, 16, 24, 36, and 72 months, the study examined early parenting, attachment security, effortful control, and children’s representations of family relationships in relation to subsequent externalizing behavior problems. Less intrusive early parenting predicted more secure attachment, better effortful control skills, and fewer early behavior problems, although it did not directly relate to the structural or content characteristics of children’s represented family relationships. Children with higher effortful control scores at 24 months had more coherent family representations at 36 months. Moreover, children who exhibited less avoidance in their family representations at 36 months had fewer mother-reported externalizing behavior problems at 72 months. The study suggests that early parenting quality and avoidance in children’s represented relationships are important for the development of externalizing behavior problems in children born preterm. PMID:24580068

  9. ERRORS AND FRAUD IN ACCOUNTING. THE ROLE OF EXTERNAL AUDIT IN FIGHTING CORRUPTION

    Directory of Open Access Journals (Sweden)

    Luminita Ionescu

    2017-12-01

    Full Text Available Accounting errors and fraud are common in most businesses, but there is a difference between fraud and misinterpretation of communication or accounting regulations. The role of management in preventing fraud becomes important in the last decades and the importance of auditing in curbing corruption is increasingly revealed. There is a strong connection between fraud and corruption, accelerated by electronic systems and modern platforms. The most recent developments tend to confirm that external auditing is curbing corruption, due to international accounting and auditing standards at national and regional levels. Thus, a better implementation of accounting standards and high quality of external control could prevent errors and fraud in accounting, and reduce corruption, as well. The aim of this paper is to present some particular aspects of errors and fraud in accounting, and how external audit could ensure accuracy and accountability in financial reporting.

  10. External Review Teams Training in Central America

    Science.gov (United States)

    Silva-Trivino; Moises; Ramirez-Gatica, Soledad

    2004-01-01

    Many Latin American countries have started actions to promote a higher education quality assurance system. Central America appears as a regional effort that includes universities from all seven countries under the initiative of Central American University Higher Council (CSUCA). After focusing in quality management and self-study processes, CSUCA…

  11. Social-dynamical aspects of quality management in NPD

    NARCIS (Netherlands)

    Fisscher, O.A.M.; de Weerd-Nederhof, Petronella C.

    2000-01-01

    Total quality management (TQM) for new product development (NPD) implies first, external quality (EQ): a focus on market demands and organizational embedding; second, internal quality (IQ): the efficiency of the primary NPD processes, and third, process quality (PQ): an orientation on development of

  12. Measuring health care process quality with software quality measures.

    Science.gov (United States)

    Yildiz, Ozkan; Demirörs, Onur

    2012-01-01

    Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures quality of health care processes comprehensively. In addition, due to the not measured overall process quality, hospitals cannot compare quality of processes internally and externally. To bring a solution to above problems, a new model is developed from software quality measures. We have adopted the ISO/IEC 9126 software quality standard for health care processes. Then, JCIAS (Joint Commission International Accreditation Standards for Hospitals) measurable elements were added to model scope for unifying functional requirements. Assessment (diagnosing) process measurement results are provided in this paper. After the application, it was concluded that the model determines weak and strong aspects of the processes, gives a more detailed picture for the process quality, and provides quantifiable information to hospitals to compare their processes with multiple organizations.

  13. In vitro test of external Qigong

    Directory of Open Access Journals (Sweden)

    Reading Melissa

    2004-03-01

    Full Text Available Abstract Background Practitioners of the alternative medical practice 'external Qigong' generally claim the ability to emit or direct "healing energy" to treat patients. We investigated the ability of experienced Qigong practitioners to enhance the healthy growth of cultured human cells in a series of studies, each following a rigorously designed protocol with randomization, blinding and controls for variability. Methods Qigong practitioners directed healing intentionality toward normal brain cell cultures in a basic science laboratory. Qigong treatments were delivered for 20 minutes from a minimum distance of 10 centimeters. Cell proliferation was measured by a standard colony-forming efficiency (CFE assay and a CFE ratio (CFE for treated samples/CFE for sham samples was the dependent measure for each experiment. Results During a pilot study (8 experiments, a trend of increased cell proliferation in Qigong-treated samples (CFE Qigong/sham ratios > 1.0 was observed (P = 0.162. In a formal study (28 experiments, a similar trend was observed, with Qigong-treated samples showing on average more colony formation than sham samples (P = 0.036. In a replication study (60 experiments, no significant difference between Qigong-treated samples and sham samples was observed (P = 0.465. Conclusion We observed an apparent increase in the proliferation of cultured cells following external Qigong treatment by practitioners under strictly controlled conditions, but we did not observe this effect in a replication study. These results suggest the need for more controlled and thorough investigation of external Qigong before scientific validation is claimed.

  14. The Brazilian external individual monitoring scenario

    Energy Technology Data Exchange (ETDEWEB)

    Mauricio, Claudia L.P.; Silva, Claudio R. da; Cunha, Paulo G. da, E-mail: claudia@ird.gov.br, E-mail: cribeiro@ird.gov.br, E-mail: pcunha@ird.gov.br [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2015-07-01

    In order to improve radiation protection it is necessary to have knowledge of the occupational radiation dose levels in all radiation facilities. This information comes from individual monitoring services, which are responsible for measuring and providing information about workers' radiation exposure. In 1981, the Comissao Nacional de Energia Nuclear (CNEN) of Brazil starts to develop a comprehensive system for regulation and storage of occupational radiation dose. This paper starts with an overview of the evolution of the Brazilian authorization and data storage system for external individual monitoring. It starts with a rule for authorization of all Brazilian photon individual monitoring services and the obligation for them to send the measured dose to CNEN. Up to now there is no regulation for neutron individual monitoring. The aim of this paper is to present the current scenario of the Brazilian external monitoring system, reinforcing its importance and remaining problems. The number of monitored workers greatly increases every year, having surpassed 150,000 people monitored. The stored data show that the mean annual occupational external dose is decreasing from 2.4 mSv in 1987 to about 0.6 mSv, in 2012, but there is still some not realistic very high dose measured (higher than 100 mSv), without investigation. About 80% of the annual dose values are lower than the monthly register level. As expected, the higher real photon doses are found in Nuclear Medicine, Industrial Radiology and Interventional Radiology. All recorded annual neutron dose values are lower than 20 mSv. (author)

  15. Otite externe maligne à Candida Albicans

    Science.gov (United States)

    Elayoubi, Fahd; Lachkar, Azeddine; Aabach, Ahmed; Chouai, Mohamed; Ghailan, Mohamed Rachid

    2016-01-01

    L’otite externe maligne est une ostéomyélite de la base du crane. Le Pseudomonas aeruginosa est le germe le plus incriminé. Cependant l’origine fongique n’est pas rare. Patiente âgée de 80 ans avait présenté une otalgie gauche persistante depuis deux mois malgré un traitement bien conduit. L’examen otologique mettait en évidence des signes inflammatoires au niveau du pavillon, une sténose du conduit avec des granulomes, et otorrhée d’allure purulente. Le scanner montrait un comblement otomastoïdien, un processus inflammatoire extensif des tissus pré et rétro-auriculaire et une lyse du tympanal. Vu l’absence d’amélioration un examen mycologique a été réalisé et qui a révélé la présence de Candida Albicans. Les cas d’otite externe maligne à Candida Albicans sont rarement rapportés. L’origine fongique doit être suspecté devant la négativité des prélèvements bactériologiques et la non amélioration malgré un traitement antibiotique bien conduit, et confirmée par des prélèvements mycologiques parfois multiples. L’otite externe maligne à Candida Albicans est une infection rare potentiellement mortelle. PMID:28154677

  16. [Improvement of Hoffmann external fixation apparatus].

    Science.gov (United States)

    Niimura, T

    1984-05-01

    The resurgence of external fixators for the management of skeletal and joint injuries has generated an increasing number of reports. In addition, many types of fixators have been developed in the last ten years. Of these, the Hoffmann external fixator is the most popular one. Is it possible for the patient with a tibial comminuted fracture to walk with the fixator? This study has been pursued to investigate this question and to improve on the fixator. Bone models were made from tubed polyester resin strengthened by glass fiber (elastic module: 9.46 kg/mm2, outside diameter: 35 mm, inside diameter: 30 mm). Each bone model was transfixed by two Steinmann pins (phi: 4.5 mm) with 43 mm between, and a pair of models was framed with two straight bars, with 30 mm from model to bar. The Steinmann pins and straight bars were connected to each attachment. The experiment focused on four main studies: Measurement of the Young's modulus of the Steinmann pin. Compression load test and bending load test framed bone models with each attachment. Observation and measurement of the ground reaction force of ambulation on stilt framed with experimental external fixator. Determination of S-N curve of the Steinmann pin. Results were as follows: The Young's modulus of the Steinmann pin were 1.8 X 10(4) kg/mm2. 0.2% proof of the pin was 110 kg/mm2. The bone models framed with the conventional method were destructed at the universal ball joint at 68 kgf in the compression load test, and 6.8 kgf in the bending load test. The models framed with the conventional method fitted with spring washers at ball joints were not destructed until 203 kgf in compression load, but after several trials the spring washers were crushed. The models fabricated by using a vice with rods and articulation coupling were not damaged until 210 kgf in compression load and were not damaged until 15 kgf in bending load even after several trials. The displacement between the models were 2.8 mm at 80 kgf and 8.5 mm at 210

  17. Entrepreneurship and the Discipline of External Finance

    DEFF Research Database (Denmark)

    Nanda, Ramana

    I confirm the finding that the propensity to start a new firm rises sharply among those in the top five per­centiles of personal wealth. This pattern is more pronounced for entrants in less capital intensive sectors. Prior to entry, founders in this group earn about 6% less compared to those who ......, these findings suggest that the spike in entry at the top end of the wealth distribution is driven by low-ability individuals who can afford to start (and sometimes continue running) weaker firms because they do not face the discipline of external finance....

  18. Cardiac abnormalities in chronic progressive external ophthalmoplegia.

    Science.gov (United States)

    McComish, M; Compston, A; Jewitt, D

    1976-01-01

    This report describes heart disease in a 32-year-old man with the syndrome of chronic progressive external ophthalmoplegia (CPEO). The surface electrocardiogram showed first degree AV block and left bundle-branch block and there was HV prolongation on the His bundle electrogram. Endomyocardial biopsy showed the changes of hypertrophy on light microscopy, and on electron microscopy there were increased numbers of mitochondria which appeared structurally normal. A permanent demand pacemaker was inserted because these patients are prone to develop complete heart block. Images PMID:131570

  19. Pembuatan Knowledge Management pada External Cylindrical Grinding

    Directory of Open Access Journals (Sweden)

    Ikhwan Arief

    2016-04-01

    The design began by analyzing the external cylindrical grinding systems and translate them into Unified Modelling Language (UML which was followed by the design of database and computer software, and test the software. The application software is web-based and can be accessed by multiple users. The application will help the operator in determining parameters with given option of parameter recommendation. The system gives recommendations based on the tacit knowledge that has been gathered into explicit knowledge. The output of the application is a list of selected parameters and report cases. Report data in the case will be used to set up the machine.

  20. Optimal External-Memory Planar Point Enclosure

    DEFF Research Database (Denmark)

    Arge, Lars; Samoladas, Vasilis; Yi, Ke

    2007-01-01

    In this paper we study the external memory planar point enclosure problem: Given N axis-parallel rectangles in the plane, construct a data structure on disk (an index) such that all K rectangles containing a query point can be reported I/O-efficiently. This problem has important applications in e...... term O(K/B) is desired. To show this we prove a general lower bound on the tradeoff between the size of the data structure and its query cost. We also develop a family of structures with matching space and query bounds....