Thoughts on Internal and External Quality Assurance

Science.gov (United States)

Zhang, Jianxin

2012-01-01

Quality assurance of higher education is made up of two parts: internal quality assurance (IQA) and external quality assurance (EQA). Both belong to a union of the coexistence and balance of yin and yang. But in reality there exists a paradox of "confusion of quality assurance (QA) subject consciousness, singularity of social QA and lack of QA…

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. © Sleep Research

[Standardization in laboratory hematology by participating in external quality assurance programs].

Science.gov (United States)

Nazor, Aida; Siftar, Zoran; Flegar-Mestrić, Zlata

2011-09-01

Since 1985, Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zagreb, has been participating in the International External Quality Assessment Scheme for Hematology (IEQAS-H) organized by the World Health Organization (WHO). Owing to very good results, in 1987 the Department received a certificate of participation in this control scheme. Department has been cooperating in the external quality assessment program in laboratory hematology which has been continuously performed in Croatia since 1986 by the Committee for External Quality Assessment Schemes under the auspices of the Croatian Society of Medical Biochemists and School of Pharmacy and Biochemistry, University of Zagreb. Nowadays, 186 medical biochemical laboratories are included in the National External Quality Assessment program, which is performed three times per year. Our Department has participated in the international projects of the European Committee for External Quality Assurance Programs in Laboratory Medicine (EQALM).

Minimal requirements for quality controls in radiotherapy with external beams

International Nuclear Information System (INIS)

1999-01-01

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 [it

[Quality in Revision Arthroplasty: A Comparison between Claims Data Analysis and External Quality Assurance].

Science.gov (United States)

Wessling, M; Gravius, S; Gebert, C; Smektala, R; Günster, C; Hardes, J; Rhomberg, I; Koller, D

2016-02-01

External quality assurance for revisions of total knee arthroplasty (TKA) and total hip arthroplasty (THA) are carried out through the AQUA institute in Germany. Data are collected by the providers and are analyzed based on predefined quality indicators from the hospital stay in which the revision was performed. The present study explores the possibility to add routine data analysis to the existing external quality assurance (EQS). Differences between methods are displayed. The study aims to quantify the benefit of an additional analysis that allows patients to be followed up beyond the hospitalization itself. All persons insured in an AOK sickness fund formed the population for analysis. Revisions were identified using the same algorithm as the existing external quality assurance. Adverse events were defined according to the AQUA indicators for the years 2008 to 2011.The hospital stay in which the revision took place and a follow-up of 30 days were included. For re-operation and dislocation we also defined a 365 days interval for additional follow-up. The results were compared to the external quality control reports. Almost all indicators showed higher events in claims data analysis than in external quality control. Major differences are seen for dislocation (EQS SD: 1.87 vs. claims data [cd] SD: 2.06 %, cd+30 d: 2.91 %, cd+365 d: 7.27 %) and reoperation (hip revision: EQS SD: 5.88 % vs. claims data SD: 8.79 % cd+30 d: 9.82 %, cd+365 d: 15.0 %/knee revision: EQS SD: 3.21 % vs. claims data SD: 4.07 %, cd+30 d: 4.6 %, cd+365 d: 15.43 %). Claims data could show additional adverse events for all indicators after the initial hospital stay, rising to 77 % of all events. The number of adverse events differs between the existing external quality control and our claims data analysis. Claims data give the opportunity to complement existing methods of quality control though a longer follow-up, when many complications become evident. Georg

Lack of grading agreement among international hemostasis external quality assessment programs

OpenAIRE

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.

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 h...

Ten Years of External Quality Audit in Australia: Evaluating Its Effectiveness and Success

Science.gov (United States)

Shah, Mahsood

2012-01-01

External quality audits are now being used in universities across the world to improve quality assurance, accountability for quality education and transparency of public funding of higher education. Some countries such as Australia, New Zealand, United Kingdom, Sweden and Denmark have had external quality audits for more than a decade but there…

Laboratory diagnosis of the rare anaemias: external quality assessment benefits patient care

OpenAIRE

Barbara De La Salle; Andrea Mosca; Renata Paleari; Vasileios Rapanakis; Keith Hyde

2013-01-01

Since its introduction in the 1960s, external quality assessment has developed to become an essential component of the quality management system of the diagnostic laboratory. External quality assessment provides a long term, retrospective view of laboratory performance, demonstrating the competence of the laboratory to others. The ENERCA project (the European Network for Rare and Congenital Anaemias) has established a list of core laboratory tests that are used in the diagnosis of rare and co...

External quality audit programmes for radiotherapy dosimetry and equipment

International Nuclear Information System (INIS)

Thwaites, D.I.

1997-01-01

It is widely accepted that individual radiotherapy centres should have in place a comprehensive quality assurance programme on all the necessary steps for the delivery of safe accurate treatment. As regards the performance of radiotherapy equipment and dosimetry, the most widely used process of external checking has been dosimetry intercomparison, comparing independently measured doses to locally stated doses in a variety of conditions. These have been at a number of different levels: from basic beam calibration; up to and including exercises employing anatomic or pseudo-anatomic phantoms and incorporating tests of treatment planning equipment and procedures. Some of these have been one-off exercises, whilst others are continuing, or have given rise to on-going quality audit programmes on a national (or wider) basis. A number of these have evolved, or are evolving, into audits which include external checking of the achievement of standards in performance of treatment equipment, as well as in the dosimetry in each institution involved. The principles and methodologies of the various types of external checking programmes for treatment equipment and dosimetry are reviewed, covering the experimental approaches and the tolerances applied. What is included in a given programme will, of necessity, depend on the resources available and the purpose of the exercise. Methods and tolerances must be matched to endpoint. Tolerance levels must take into account the experimental uncertainties of the measurement methods employed. Finally, external audit can only be used to complement, and in conjunction with, institutional quality assurance programmes and not as a substitute for them

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

Science.gov (United States)

2012-04-09

... corporations (including those with 500+ employees), small and medium-size businesses, and universities and... DEPARTMENT OF COMMERCE United States Patent and Trademark Office Patents External Quality Survey... their name, address, or Social Security Number. In order to access and complete the online survey...

Migration and income transfers in the presence of labor quality externalities

NARCIS (Netherlands)

Huizinga, H.P.

1994-01-01

In this paper, a worker's productivity is assumed to depend on his own quality and on the average quality of other workers in the same country. The external effects associated with worker quality give rise to increasing returns to average worker quality. As a result, free migration generally reduces

Comparison and Sensitivity Investigations of a CALM and SALM Type Mooring System for Wave Energy Converters

Directory of Open Access Journals (Sweden)

Arthur Pecher

2014-02-01

Full Text Available A quasi-static analysis and sensitivity investigation of two different mooring configurations—a single anchor leg mooring (SALM and a three-legged catenary anchor leg system (CALM—is presented. The analysis aims to indicate what can be expected in terms of requirements for the mooring system size and stiffness. The two mooring systems were designed for the same reference load case, corresponding to a horizontal design load at the wave energy converter (WEC of 2000 kN and a water depth of 30 m. This reference scenario seems to be representative for large WECs operating in intermediate water depths, such as Weptos, Wave Dragon and many others, including reasonable design safety factors. Around this reference scenario, the main influential parameters were modified in order to investigate their impact on the specifications of the mooring system, e.g. the water depth, the horizontal design load, and a mooring design parameter.

[The external evaluation of study quality: the role in maintaining the reliability of laboratory information].

Science.gov (United States)

Men'shikov, V V

2013-08-01

The external evaluation of quality of clinical laboratory examinations was gradually introduced in USSR medical laboratories since 1970s. In Russia, in the middle of 1990 a unified all-national system of external evaluation quality was organized known as the Federal center of external evaluation of quality at the basis of laboratory of the state research center of preventive medicine. The main positions of policy in this area were neatly formulated in the guidance documents of ministry of Health. Nowadays, the center of external evaluation of quality proposes 100 and more types of control studies and permanently extends their specter starting from interests of different disciplines of clinical medicine. The consistent participation of laboratories in the cycles of external evaluation of quality intrinsically promotes improvement of indicators of properness and precision of analysis results and increases reliability of laboratory information. However, a significant percentage of laboratories does not participate at all in external evaluation of quality or takes part in control process irregularly and in limited number of tests. The managers of a number of medical organizations disregard the application of the proposed possibilities to increase reliability of laboratory information and limit financing of studies in the field of quality control. The article proposes to adopt the national standard on the basis of ISO 17043 "Evaluation of compliance. The common requirements of professional competence testing".

Trance, Transparency and Transformation: The Impact of External Quality Monitoring on Higher Education.

Science.gov (United States)

Stensaker, Bjorn

2003-01-01

Discusses the impact of external quality monitoring (EQM) on higher education and identifies areas in which changes have taken place as a result of such external initiatives. Suggests that the lack of effects related directly to quality improvement should not be conceived as an EQM design error, but rather as a misconception of how organizational…

Quality control in the histopathology laboratory: An overview with stress on the need for a structured national external quality assessment scheme

Directory of Open Access Journals (Sweden)

Iyengar Jayaram

2009-01-01

Full Text Available The concept of quality control in histopathology is relatively young and less well understood. Like in other disciplines of laboratory medicine, the concept of quality and its control is applicable to pre analytical, analytical and post analytical activities. Assessment of both precision and accuracy performances is possible by appropriate internal and external quality control and assessment schemes. This article is a review of all processes that achieve quality reporting in histopathology. There is a special focus on external quality assessment - a scheme that lacks organization on a national level in our country. Statistical data derived from a small scale external quality assurance program is also analyzed along with recommendations to organize an effective national scheme with the participation of authorized zonal centers.

Tuberculosis among people living with HIV/AIDS in the German ClinSurv HIV Cohort: long-term incidence and risk factors.

Science.gov (United States)

Karo, Basel; Haas, Walter; Kollan, Christian; Gunsenheimer-Bartmeyer, Barbara; Hamouda, Osamah; Fiebig, Lena

2014-03-19

Tuberculosis (TB) still presents a leading cause of morbidity and mortality among people living with HIV/AIDS (PLWHA), including those on antiretroviral therapy. In this study, we aimed to determine the long-term incidence density rate (IDR) of TB and risk factors among PLWHA in relation to combination antiretroviral therapy (cART)-status. Data of PLWHA enrolled from 2001 through 2011 in the German ClinSurv HIV Cohort were investigated using survival analysis and Cox regression. TB was diagnosed in 233/11,693 PLWHA either at enrollment (N = 62) or during follow-up (N = 171). The TB IDR during follow-up was 0.37 cases per 100 person-years (PY) overall [95% CI, 0.32-0.43], and was higher among patients who never started cART and among patients originating from Sub-Saharan Africa (1.23 and 1.20 per 100PY, respectively). In two multivariable analyses, both patients (I) who never started cART and (II) those on cART shared the same risk factors for TB, namely: originating from Sub-Saharan Africa compared to Germany (I, hazard ratio (HR); [95% CI]) 4.05; [1.87-8.78] and II, HR 5.15 [2.76-9.60], CD4+ cell count 5 log10 copies/ml (I, HR 2.51 [1.33-4.75] and II, HR 1.77 [1.11-2.82]). Gender, age or HIV-transmission risk group were not independently associated with TB. In the German ClinSurv HIV cohort, patients originating from Sub-Saharan Africa, with low CD4+ cell count or high viral load at enrollment were at increased risk of TB even after cART initiation. As patients might be latently infected with Mycobacterium tuberculosis complex, early screening for latent TB infection and implementing isoniazid preventive therapy in line with available recommendations is crucial.

Propagación in vitro de Heliconia bihai (L. cv. Lobster Salmón a partir de meristemos florales In vitro propagation of Heliconia bihai (L. cv. Lobster Salmón from flowering buds

Directory of Open Access Journals (Sweden)

Marta Leonor Marulanda-ángel

2011-04-01

Full Text Available Se desarrolló un protocolo de propagación in vitro a partir de meristemos florales para Heliconia bihai cv. Lobster Salmón. Para el efecto se establecieron 250 yemas florales en diferentes tiempos utilizando NaClO al 1% durante 20 min. El medio de establecimiento Murashige y Skoog con mejores resultados fue BAP (2 mg/lt, AIA (1 mg/lt y 0.1 g/lt de L-cisteína. La mayor produccion de brotes en multiplicación se obtuvo con 6 mg/lt de BAP y con un subcultivo posterior en medio con 2 mg/lt de BAP y 0.5 mg/lt de AIA, alcanzando una tasa de multiplicación de tres nuevas yemas. El enraizamiento de las plántulas in vitro se logró con 1.3 mg/lt de AIA. La aclimatación en vivero fue 92% de supervivencia. Se realizó un análisis de varianza (Anova y un test de Tukey para las variables evaluadas las cuales mostraron diferencias estadísticas en cada fase. La propagación in vitro de heliconias a partir de yemas florales requiere mayor tiempo en la fase de establecimiento y multiplicación, no obstante permite mayores porcentajes de supervivencia y una menor contaminación, ofreciendo material de siembra de diferentes especies de esta planta de interés comercial.A protocol for in vitro propagation of Heliconia bihai cv. Lobster Salmón was developed using flowering buds as initial explants. 250 flowering buds were established in different assays with NaClO at 1% during 20 minutes. The establishment in Murashige & Skoog's medium with BAP (2mg/L, AIA (1 mg/L and L-cystein (0.1 g/L showed the best results. Shoot multiplication was obtained with BAP (6 mg/L with a subsequent subculture in a medium with BAP (2 mg/L and AIA (0.5 mg/L, reaching multiplication rates of 3.0 new shoots. Rooting was achieved with AIA 1.3 mg/L. The survival rate during greenhouse acclimatization was 92%. Analysis of variance (ANOVA and Turkey's test were realized for each of the variables evaluated that showed statistical differences in all stages. The in vitro propagation of

Migration and income transfers in the presence of labor quality externalities

OpenAIRE

Huizinga, H.P.

1994-01-01

In this paper, a worker's productivity is assumed to depend on his own quality and on the average quality of other workers in the same country. The external effects associated with worker quality give rise to increasing returns to average worker quality. As a result, free migration generally reduces world output. Within each country, social benefits that induce low quality workers to leave the labor force can increase national income. Moreover, the operation of such a benefit scheme financed ...

Influence of greenhouse climate and plant density on external quality of chrysanthemum (Dendranthema grandiflorum (Ramat.)Kitamura) : First steps towards a quality model

NARCIS (Netherlands)

Carvalho, S.M.P.; Heuvelink, E.

2001-01-01

The effects of greenhouse climate and plant density on external quality of chrysanthemum (Dendranthema grandiflorum syn. Chrysanthemum morifolium) are reviewed. The external quality aspects analysed in this paper are stem morphology (length, diameter and "strength"), leaf morphology (number and

[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.

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 quality throughout

Child diurnal cortisol rhythms, parenting quality, and externalizing behaviors in preadolescence.

Science.gov (United States)

Martin, Christina Gamache; Kim, Hyoun K; Bruce, Jacqueline; Fisher, Philip A

2014-02-01

This study examined a neurobiologically informed model of the emergence of child externalizing behaviors in an ethnically diverse community sample of 232 9-12 year old children. Replicating extensive prior research, our analyses revealed that parents' inconsistent discipline and poor quality monitoring were predictive of child externalizing behavior. In addition, poor parental monitoring, but not inconsistent discipline, was associated with children having a significantly flatter morning-to-evening cortisol slope, which was in turn, related to higher levels of externalizing behaviors. An indirect effect of parental monitoring on externalizing behaviors, through child diurnal cortisol rhythms, was also supported. These findings highlight the role of the hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end product, cortisol, in the relationship between the caregiving environment and the development of externalizing behaviors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.

Directory of Open Access Journals (Sweden)

Matthias Stoll

Full Text Available UNLABELLED: BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. METHODS: Antiretroviral regimens (ART from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. RESULTS: During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70. Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively. Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. CONCLUSIONS: Analysis of the data of this nationwide study reflects disease-specific health services research

Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.

Science.gov (United States)

Stoll, Matthias; Kollan, Christian; Bergmann, Frank; Bogner, Johannes; Faetkenheuer, Gerd; Fritzsche, Carlos; Hoeper, Kirsten; Horst, Heinz-August; van Lunzen, Jan; Plettenberg, Andreas; Reuter, Stefan; Rockstroh, Jürgen; Stellbrink, Hans-Jürgen; Hamouda, Osamah; Bartmeyer, Barbara

2011-01-01

BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. Antiretroviral regimens (ART) from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC)-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70). Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively). Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. Analysis of the data of this nationwide study reflects disease-specific health services research and will give insights into the cost impacts of

Reconciling Organisational Culture and External Quality Assurance in Higher Education

Science.gov (United States)

Naidoo, Dhaya

2013-01-01

Organisational culture and external quality assurance have both been presented as significant drivers of effectiveness, efficiency and excellence in higher education institutions. However, these assumptions have not been critically examined given the philosophical, conceptual and methodological contestations surrounding both constructs. A…

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…

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.

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…

Can a combination of average of normals and "real time" External Quality Assurance replace Internal Quality Control?

Science.gov (United States)

Badrick, Tony; Graham, Peter

2018-03-28

Internal Quality Control and External Quality Assurance are separate but related processes that have developed independently in laboratory medicine over many years. They have different sample frequencies, statistical interpretations and immediacy. Both processes have evolved absorbing new understandings of the concept of laboratory error, sample material matrix and assay capability. However, we do not believe at the coalface that either process has led to much improvement in patient outcomes recently. It is the increasing reliability and automation of analytical platforms along with improved stability of reagents that has reduced systematic and random error, which in turn has minimised the risk of running less frequent IQC. We suggest that it is time to rethink the role of both these processes and unite them into a single approach using an Average of Normals model supported by more frequent External Quality Assurance samples. This new paradigm may lead to less confusion for laboratory staff and quicker responses to and identification of out of control situations.

External quality audits in radiotherapy in Poland

International Nuclear Information System (INIS)

Bulski, W.; Rostkowska, J.; Kania, M.; Gwiazdowska, B.

2002-01-01

The Secondary Standard Dosimetry Laboratory (SSDL) of the Medical Physics Department of the Centre of Oncology in Warsaw is a continuation of the Radiation Measurements Laboratory created in 1937, following the suggestions of Marie Curie, the founder of the Institute. The present SSDL is a member of the WHO/IAEA international network and is periodically audited by the International Atomic Energy Agency. The SSDL is in charge of the calibration of all radiotherapy dosimeters in Poland, and it also co-ordinates all activities carried out in radiotherapy quality assurance programmes nation-wide. The External Audit Group (EAG) was set-up according to the recommendations of the IAEA, as a part of the SSDL. The EAG is in charge of the management of the project and organization of the TLD measurements. The SSDL takes the responsibilities of the metrological aspects of the programme. The results of the efforts, aimed at the development of a quality audit programme and methodology in radiotherapy, are presented

[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.

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

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.

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

Directory of Open Access Journals (Sweden)

Debrah I. Boeras

2016-10-01

Full Text Available External Quality Assessment (EQA surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO revealed the need for the strengthening of publichealth microbiology laboratories, particularly for testing of epidemic-prone diseases in theAfrican Region. These surveys revealed common issues such as supply chain managementskilled personnel, logistical support and overall lack of quality standards. For sustainableimprovements to health systems as well as global health security, deficiencies identified needto be actively corrected through robust quality assurance programmes and implementation oflaboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programmewith a focus on vaccine-preventable diseases and emerging and re-emerging dangerouspathogens is important, and should not be stand-alone, but integrated within laboratorynetworks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Preventionthe London School of Hygiene & Tropical Medicine and partners in a series of consultationswith countries and national and regional EQA providers for the development of qualityassurance models to support HIV point-of-care testing and monitoring. These consultationsrevealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forthits experience in implementing quality standards for health programmes, and also openeddiscussions on how lessons learned through such established programmes can be utilised tosupporting and strengthening the introduction of early infant diagnosis of HIV and viralload point-of-care testing. An optimised external quality assessment programme will impact the ability of countries tomeet core capacities, providing improved quality management systems, improving theconfidence of diagnostic network services in Africa, and including capacities to detect eventsof

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

[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.

[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.

[Analysis of the results of the SEIMC External Quality Control Program. Year 2008].

Science.gov (United States)

Serrano, María del Remedio Guna; Mira, Nieves Orta; de Gopegui, Enrique Ruiz; Ovies, María Rosario; Cardona, Concepción Gimeno; Pérez, José L

2010-01-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria and virology. This article present the most relevant conclusions and lessons from the 2008 controls. As a whole, the results obtained in 2008 confirm the excellent skill and good technical standards of the microbiology laboratories in Spain found in previous editions. However, a few deviations can be obtained in any laboratory, even in clinically relevant determinations. Once again, the results of this program highlighted the need to implement both internal an external controls in order to assure the maximal quality of the microbiological tests. 2010 Elsevier España S.L. All rights reserved.

[Analysis of the results of the SEIMC External Quality Control Program. Year 2009].

Science.gov (United States)

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

2011-03-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. In this article, the most important conclusions and lessons from the 2009 controls are presented. As a whole, the results obtained in 2009 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. The results of this program highlight the need to implement both internal and external controls in order to ensure maximal quality of microbiological tests. Copyright © 2011 Elsevier España S.L. All rights reserved.

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.

Internal quality control indicators of cervical cytopathology exams performed in laboratories monitored by the External Quality Control Laboratory.

Science.gov (United States)

Ázara, Cinara Zago Silveira; Manrique, Edna Joana Cláudio; Tavares, Suelene Brito do Nascimento; de Souza, Nadja Lindany Alves; Amaral, Rita Goreti

2014-09-01

To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams. The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service. Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated. An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills in detecting cervical cancer precursor lesions.

Analytical performance specifications for external quality assessment - definitions and descriptions.

Science.gov (United States)

Jones, Graham R D; Albarede, Stephanie; Kesseler, Dagmar; MacKenzie, Finlay; Mammen, Joy; Pedersen, Morten; Stavelin, Anne; Thelen, Marc; Thomas, Annette; Twomey, Patrick J; Ventura, Emma; Panteghini, Mauro

2017-06-27

External Quality Assurance (EQA) is vital to ensure acceptable analytical quality in medical laboratories. A key component of an EQA scheme is an analytical performance specification (APS) for each measurand that a laboratory can use to assess the extent of deviation of the obtained results from the target value. A consensus conference held in Milan in 2014 has proposed three models to set APS and these can be applied to setting APS for EQA. A goal arising from this conference is the harmonisation of EQA APS between different schemes to deliver consistent quality messages to laboratories irrespective of location and the choice of EQA provider. At this time there are wide differences in the APS used in different EQA schemes for the same measurands. Contributing factors to this variation are that the APS in different schemes are established using different criteria, applied to different types of data (e.g. single data points, multiple data points), used for different goals (e.g. improvement of analytical quality; licensing), and with the aim of eliciting different responses from participants. This paper provides recommendations from the European Federation of Laboratory Medicine (EFLM) Task and Finish Group on Performance Specifications for External Quality Assurance Schemes (TFG-APSEQA) and on clear terminology for EQA APS. The recommended terminology covers six elements required to understand APS: 1) a statement on the EQA material matrix and its commutability; 2) the method used to assign the target value; 3) the data set to which APS are applied; 4) the applicable analytical property being assessed (i.e. total error, bias, imprecision, uncertainty); 5) the rationale for the selection of the APS; and 6) the type of the Milan model(s) used to set the APS. The terminology is required for EQA participants and other interested parties to understand the meaning of meeting or not meeting APS.

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.

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

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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

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

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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…

Decreased sexual capacity after external radiation therapy for prostate cancer impairs quality of life

International Nuclear Information System (INIS)

Helgason, Asgeir R.; Fredrikson, Mats; Adolfsson, Jan; Steineck, Gunnar

1995-01-01

Purpose: The aim of this study was to assess to what extent patients treated with radiation therapy for prostate cancer experience change in sexual functioning and to what extent this effects quality of life. Methods and Materials: Information was provided by 53 men treated with radiation therapy for localized prostate cancer. Assessment was made with the ''Radiumhemmets Scale of Sexual Functioning,'' which measures sexual desire, erectile capacity, orgasm, and to what extent a decrease in any of these aspects of sexual functioning affects quality of life. Function before treatment was assessed retrospectively. Results: Sexual desire diminished among 77% after treatment. The erection stiffness decreased in 77%. Before external radiation therapy, 66% had an erection usually sufficient for intercourse. Half of the men lost this ability after treatment. Of those retaining orgasm after treatment, 47% reported a decreased orgasmic pleasure and 91% a reduced ejaculation volume. Of all men, 50% reported that quality of life had decreased much or very much due to a decline in the erectile capacity following external radiation therapy. Conclusion: The results of the present study indicate that external radiation therapy for prostate cancer is associated with a reduction in sexual desire, erectile capacity, and orgasm functions. In a majority of patients this reduces quality of life. Previously, we may have underestimated the importance an intact sexual function has for the quality of life in this patient category of elderly men

MCNP simulation of the influence of the external moisture on low calorific value in the coal quality analysis by neutron

International Nuclear Information System (INIS)

Liu Dekun; Zhang Hongyu; Zhang Lihong; Dong Huan; Gu Deshan

2012-01-01

An important index in assessment of coal quality is low calorific value. Using neutron to analysis coal quality, the more the coal moisture content, especially the increasing of external moisture will reduce the low calorific value. The principle of coal quality analysis by neutron prompt Gamma-ray is introduced. The influence of the gamma count of the carbon element peak with increasing external moisture in coal samples was simulated using MCNP code. And discussed the reasons how external moisture content influence the calorific value. Simulation results indicate that with the increasing of external moisture in the coal samples, the gamma count of the carbon element peak dwindling, and the low calorific value reducing. The conclusion is : using neutrons method to analysis coal quality, the more external moisture content, the larger error of the measurement results of the carbon element, and will influence the calculation accuracy of the low calorific value. (authors)

Quality assurance of external exposure measurement for national survey of environmental natural radioactive level

International Nuclear Information System (INIS)

Yue Qingyu

1995-01-01

This paper summarizes the quality assurance work of external exposure measurement for national survey of environmental natural radioactive level. It mainly introduces instrumentation used in external exposure measurement and its properties, the measurement results of three times of national in-site intercomparison, and in-site sample check results of measurement results from 29 provinces, cities and autonomous regions and Wuhan, Baotou cities

External quality assessment programs in the context of ISO 15189 accreditation.

Science.gov (United States)

Sciacovelli, Laura; Secchiero, Sandra; Padoan, Andrea; Plebani, Mario

2018-05-23

Effective management of clinical laboratories participating in external quality assessment schemes (EQAS) is of fundamental importance in ensuring reliable analytical results. The International Standard ISO 15189:2012 requires participation in interlaboratory comparison [e.g. external quality assessment (EQA)] for all tests provided by an individual laboratory. If EQAS is not commercially available, alternative approaches should be identified, although clinical laboratories may find it challenging to choose the EQAS that comply with the international standards and approved guidelines. Great competence is therefore required, as well as knowledge of the characteristics and key elements affecting the reliability of an EQAS, and the analytical quality specifications stated in approved documents. Another skill of fundamental importance is the ability to identify an alternative approach when the available EQAS are inadequate or missing. Yet the choice of the right EQA program alone does not guarantee its effectiveness. In fact, the fundamental steps of analysis of the information provided in EQA reports and the ability to identify improvement actions to be undertaken call for the involvement of all laboratory staff playing a role in the specific activity. The aim of this paper was to describe the critical aspects that EQA providers and laboratory professionals should control in order to guarantee effective EQAS management and compliance with ISO 15189 accreditation requirements.

Guidelines for the preparation of a quality manual for external audit groups on dosimetry in radiotherapy

International Nuclear Information System (INIS)

Izewska, Joanna; Arib, M.; Saravi, M.

2002-01-01

This document has been prepared within the framework of a Co-ordinated Research Programme (CRP) on Development of Quality Assurance Programme for Radiation Therapy Dosimetry in Developing Countries, during two Meetings at the IAEA Headquarters in Vienna (11-14 November 1996 and 6-10 October 1997). It is based on the recommendations of ISO 9000 series and ISO/IEC guide No. 25. The document can be used as a guide on how to prepare a quality manual for national External Audit Groups (EAG), i.e., a nationally recognised group in charge of operating external quality audits for radiotherapy dosimetry. The EAG of a given country includes the SSDL, a Measuring Group and a Medical Physics Group, who work in close co-operation at all steps of the audit. The content herein should be considered as a suggestion and additions or deletions can be made in accordance with the specific conditions in each country. It is preferable that the manual itself be as concise as possible, limiting it to the core scope. Detailed working sheets describing the procedures should be included in Appendices together with data sheets, questionnaires and reporting forms. The quality manual of each country should be carefully reviewed by all members of the EAG and, as far as possible, should be approved by relevant professional bodies and supported by health authorities. It has long been recognised that accurate knowledge of the dose in radiotherapy is vital to ensure safe and effective radiation treatments. To achieve this goal, comprehensive quality assurance programmes should be established to cover all steps from dose prescription to dose delivery. These programmes should include internal checks performed by the radiotherapy centres and external audits made by independent external bodies. It is estimated that not more than 50% of radiotherapy facilities world-wide have participated in some level of dose quality audit by an independent expert. Genuine concern exists that some, or even many

Suggested recommendations for a minimal programme of quality assurance in external radiotherapy

International Nuclear Information System (INIS)

Aletti, P.; Bey, P.; Brossens, M.; Chauvel, P.; Chavaudra, J.; Cohen-Solal, C.; Costa, A.; Desprez, P.; Donnarieix, D.; Gaboriaud, G.; Kinany, R.; Lagrange, J.L.; Manny, C.; Pontvert, D.; Rozan, R.; Valinta, D.; Van Dam, J.

1991-01-01

This article gives the suggested recommendations for a minimal programme of quality assurance in external radiotherapy made by a study group of the French Society of hospital physicists and the French Society of oncological radiation therapy with belgian physicists and radiotherapists [fr

Laboratory diagnosis of the rare anaemias: external quality assessment benefits patient care

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Barbara De La Salle

2013-03-01

Full Text Available Since its introduction in the 1960s, external quality assessment has developed to become an essential component of the quality management system of the diagnostic laboratory. External quality assessment provides a long term, retrospective view of laboratory performance, demonstrating the competence of the laboratory to others. The ENERCA project (the European Network for Rare and Congenital Anaemias has established a list of core laboratory tests that are used in the diagnosis of rare and congenital anaemias, which has been used as the basis for questionnaires to laboratories, to establish the use and quality assurance of diagnostic testing in the congenital and rare anaemias, and to European EQA providers for services in this key area. In general, the provision of EQA for rare and congenital anaemias is widely variable with little provision for the very rare disorders. For the more common congenital anaemias, such as the haemoglobinopathies and thalassaemias, provision is better but there is variation in aspects of the scheme design, especially the frequency of distribution. Where laboratories did not take part in EQA for individual tests, or there was no EQA available, a desire to participate was expressed in 66% (102/154 of cases. The provision of external quality assessment (EQA services for rare disorders is a challenge. For many of these conditions, the number of patients in any one member state is very small with only a few laboratories providing diagnostic testing. In these cases, the development of pan-European or cross-border EQA may be the only means by which standardisation of methods and results can be achieved. An EQA survey of 243 laboratories for performance in Hb A2 quantification showed encouraging results in that there was a clear differentiation in the results from a beta Thalassaemia carrier and an individual with no evidence of Thalassaemia; however, a bias was observed between different methods of measurement.

External quality assurance for image grading in the Scottish Diabetic Retinopathy Screening Programme.

Science.gov (United States)

Goatman, K A; Philip, S; Fleming, A D; Harvey, R D; Swa, K K; Styles, C; Black, M; Sell, G; Lee, N; Sharp, P F; Olson, J A

2012-06-01

To develop and evaluate an image grading external quality assurance system for the Scottish Diabetic Retinopathy Screening Programme. A web-based image grading system was developed which closely matches the current Scottish national screening software. Two rounds of external quality assurance were run in autumn 2008 and spring 2010, each time using the same 100 images. Graders were compared with a consensus standard derived from the top-level graders' results. After the first round, the centre lead clinicians and top-level graders reviewed the results and drew up guidance notes for the second round. Grader sensitivities ranged from 60.0 to 100% (median 92.5%) in 2008, and from 62.5 to 100% (median 92.5%) in 2010. Specificities ranged from 34.0 to 98.0% (median 86%) in 2008, and 54.0 to 100% (median 88%) in 2010. There was no difference in sensitivity between grader levels, but first-level graders had a significantly lower specificity than level-two and level-three graders. In 2008, one centre had a lower sensitivity but higher specificity than the majority of centres. Following the feedback from the first round, overall agreement improved in 2010 and there were no longer any significant differences between centres. A useful educational tool has been developed for image grading external quality assurance. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Quality assurance program in the External dosimetry laboratory of the CPHR

International Nuclear Information System (INIS)

Molina P, D.; Pernas S, R.; Martinez H, E.; Cardenas H, J.

2006-01-01

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)

The external quality assessment scheme: Five years experience as a participating laboratory

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Chaudhary Rajendra

2010-01-01

Full Text Available Background and Aim : Quality assurance in blood banking includes active participation in the external quality program. Such a program offers valuable benefits to patient care, their safety, and an overall quality of laboratory practices. In the year 2002, we participated in the External Quality Assessment Scheme (EQAS under the World Health Organization (WHO, Bureau of Laboratory Quality Standards, Thailand. Materials and Methods: In the current study we evaluated our EQAS test result of the past five years, from 2003 to 2007. Test results of all blood samples such as ABO grouping, D typing, antibody screening, antibody identification, and transfusion transmitted infection (TTI testing were analyzed and documented. Results: Discordant results in one or more instances were observed with antibody identification, weak D testing, and tests for anti-HIV1/2 and HBsAg. Twice we failed to detect the ′anti-Mia′ antibody in the issued sample and that could be attributed to the absence of the corresponding antigen in the used cell panel. HBsAg was missed due to its critically low titer in the serum and the comparatively low sensitivity of our Enzyme-Linked Immunosorbent Assay (ELISA test kit. Conclusion: All these failures in the last five years have helped us to significantly improve our transfusion service in terms of performance evaluation, patient care and safety issues, and the overall quality of laboratory practices. We therefore recommend all laboratories and hospitals to participate in the EQAS program, which will definitely help them to improve from what they learn.

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

[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.

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

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Oluyinka Ojedokun

2015-04-01

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.

Implementation of External Quality Assurance Trials for Immunohistochemically Determined Breast Cancer Biomarkers in Germany.

Science.gov (United States)

von Wasielewski, Reinhard; Krusche, Claudia A; Rüschoff, Joseph; Fisseler-Eckhoff, Anette; Kreipe, Hans

2008-01-01

Besides typing and grading of breast cancer, Pathologists are involved in the determination of biomarkers, such as steroid hormone receptors and HER2, which are of utmost importance in adjuvant therapy. There have been concerns with regard to security and reproducibility of the biomarker assays done on tissue sections applying either immunohistochemistry or in-situ hybridisation. In order to assure the quality of these biomarker assays, a number of measures are required, among them external proficiency testing. Therefore, external quality assurance trials have been implemented in Germany. In the period of 2002-2007, 5 consecutive trials were conducted with up to 180 participating laboratories. Tissue microarrays with 20-24 different breast cancer samples including cell lines enabled that a huge number of pathologists were challenged with identical samples which provides the prerequisite for comparability. Because there is no legal duress to undergo external proficiency testing in histopathology, all laboratories that took part volunteered to do so. These innovative quality assurance trials (Qualitätsinitiative Pathologie, QuIP) will be continued in the future on an annual or bi-annual basis. Participation is recommended for pathology departments involved in the service for breast units. The organisational frame work of the trials is described here.

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.

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

Associations of Perceived Sibling and Parent-Child Relationship Quality with Internalizing and Externalizing Problems: Comparing Indian and Dutch Early Adolescents

Science.gov (United States)

Buist, Kirsten L.; Verhoeven, Marjolein; Hoksbergen, René; ter Laak, Jan; Watve, Sujala; Paranjpe, Analpa

2017-01-01

The aims of the present study were (a) to examine whether Dutch and Indian early adolescents differ concerning sibling and parent-child relationship quality and externalizing and internalizing problems, and (b) to compare the associations between sibling and parent-child relationship quality and externalizing and internalizing problems for Indian…

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

Regional programme on quality control of radioimmunoassay: Development of human resources and external quality assessments

International Nuclear Information System (INIS)

Quiroga, S.; Torres, M.; Mendizabal, A.F.; Farinati, Z.; Galanternik, A.

1986-01-01

Since 1978 the authors have been concerned with helping to standardize radioimmunoassay (RIA) methodology in Argentina and other Latin American countries by: (1) developing human resources through courses on quality control of RIA and training of fellows, and (2) developing four external quality assessment (EQA) schemes to evaluate the performance of laboratories in determining several analytes by RIA. The number of collaborating laboratories increased between the first and fourth schemes. The average analytical performance achieved by the participants in each scheme was estimated by the average between-laboratory variation. Thyroxine, cortisol and tri-iodothyronine were measured the most accurately. Different problems were evident in the RIAs of thyrotrophin, luteinizing hormone, follicle stimulating hormone, prolactin, testosterone, progesterone, cortisol, immunoglobulin E and human growth hormone. RIA of oestradiol showed the worst accuracy. Analysis of the results showed an increasing interest in RIA quality control as it was found to improve the reliability of RIA. (author)

[Analysis of the results of the SEIMC External Quality Control Program, 2007].

Science.gov (United States)

Guna Serrano, María del Remedio; Orta Mira, Nieves; Ovies, María; Gimeno Cardona, Concepción; Pérez, José L

2008-11-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most important conclusions and lessons drawn from the 2007 controls. As a whole, the results obtained in 2007 confirm the excellent skill and good technical standards found in previous years. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. A few deviations were observed in some controls, calling for critical reflection. Once again, the results of this program highlighted the need to complement internal with external controls, such as those offered by the SEIMC program.

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

External quality assurance programme for enzymatic analysis of lysosomal storage diseases : A pilot study

NARCIS (Netherlands)

Ruijter, G.J.G.; Boer, M.; Weykamp, C. W.; de Vries, R.; van den Berg, I.; Janssens-Puister, J.; Niezen-Koning, K.; Wevers, R. A.; Poorthuis, B. J. H. M.; van Diggelen, O. P.

2005-01-01

Inborn errors of metabolism are rare and laboratories performing diagnostic tests in this field must participate in external quality assurance (EQA) schemes to demonstrate their competence and also to maintain sufficient experience with patient material. EQA schemes for metabolite analyses are

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…

External Validation of the Acoustic Voice Quality Index Version 03.01 With Extended Representativity.

Science.gov (United States)

Barsties, Ben; Maryn, Youri

2016-07-01

The Acoustic Voice Quality Index (AVQI) is an objective method to quantify the severity of overall voice quality in concatenated continuous speech and sustained phonation segments. Recently, AVQI was successfully modified to be more representative and ecologically valid because the internal consistency of AVQI was balanced out through equal proportion of the 2 speech types. The present investigation aims to explore its external validation in a large data set. An expert panel of 12 speech-language therapists rated the voice quality of 1058 concatenated voice samples varying from normophonia to severe dysphonia. The Spearman rank-order correlation coefficients (r) were used to measure concurrent validity. The AVQI's diagnostic accuracy was evaluated with several estimates of its receiver operating characteristics (ROC). Finally, 8 of the 12 experts were chosen because of reliability criteria. A strong correlation was identified between AVQI and auditoryperceptual rating (r = 0.815, P = .000). It indicated that 66.4% of the auditory-perceptual rating's variation was explained by AVQI. Additionally, the ROC results showed again the best diagnostic outcome at a threshold of AVQI = 2.43. This study highlights external validation and diagnostic precision of the AVQI version 03.01 as a robust and ecologically valid measurement to objectify voice quality. © The Author(s) 2016.

External bone marrow cytological examination quality assurance (EQAhem)--summary after 6 years in Poland.

Science.gov (United States)

Lewandowski, Krzysztof; Kurpierz, Katarzyna; Sledzinska, Anna

2015-10-01

Bone marrow macroscopic examination remains one of the most difficult and subjective laboratory assessments in hematology. Only a few external quality assurance programs in the field are present worldwide. We have developed an external quality assurance program EQAhem that allows assessment of the whole process of bone marrow examination. The program participants assess blood and bone marrow smears from the patient, identify selected cells from photographs provided to them, and interpret the microscopic results. In this article, the results of the EQAhem program in Poland from 6 years are summarized. During this time, 62 labs were assessed in total, and positive results were achieved by 89.25 % labs, taking into account all tests. Correct responses with respect to the percentage of cell count were provided by ca. 77.5 % labs. Slightly worse results were obtained when megakaryocyte count and cell identification from photographs were tested. The worst results were obtained in case of dysplasia assessment and clinical interpretation of microscopic examination (54.1 and 58.6 % correct responses, respectively). EQAhem delivers precise information about the quality of bone marrow examinations performed in Poland and has a substantial educational value. We believe that after 6 years, EQAhem has significantly improved the quality of bone marrow microscopic examinations performed in Poland.

Higher quality of molecular testing, an unfulfilled priority: Results from external quality assessment for KRAS mutation testing in colorectal cancer.

Science.gov (United States)

Tembuyser, Lien; Ligtenberg, Marjolijn J L; Normanno, Nicola; Delen, Sofie; van Krieken, J Han; Dequeker, Elisabeth M C

2014-05-01

Precision medicine is now a key element in clinical oncology. RAS mutational status is a crucial predictor of responsiveness to anti-epidermal growth factor receptor agents in metastatic colorectal cancer. In an effort to guarantee high-quality testing services in molecular pathology, the European Society of Pathology has been organizing an annual KRAS external quality assessment program since 2009. In 2012, 10 formalin-fixed, paraffin-embedded samples, of which 8 from invasive metastatic colorectal cancer tissue and 2 artificial samples of cell line material, were sent to more than 100 laboratories from 26 countries with a request for routine KRAS testing. Both genotyping and clinical reports were assessed independently. Twenty-seven percent of the participants genotyped at least 1 of 10 samples incorrectly. In total, less than 5% of the distributed specimens were genotyped incorrectly. Genotyping errors consisted of false negatives, false positives, and incorrectly genotyped mutations. Twenty percent of the laboratories reported a technical error for one or more samples. A review of the written reports showed that several essential elements were missing, most notably a clinical interpretation of the test result, the method sensitivity, and the use of a reference sequence. External quality assessment serves as a valuable educational tool in assessing and improving molecular testing quality and is an important asset for monitoring quality assurance upon incorporation of new biomarkers in diagnostic services. Copyright © 2014 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

Toward development of a comprehensive external quality assurance program for polyfunctional intracellular cytokine staining assays.

Science.gov (United States)

Staats, Janet S; Enzor, Jennifer H; Sanchez, Ana M; Rountree, Wes; Chan, Cliburn; Jaimes, Maria; Chan, Ray Chun-Fai; Gaur, Amitabh; Denny, Thomas N; Weinhold, Kent J

2014-07-01

The External Quality Assurance Program Oversight Laboratory (EQAPOL) Flow Cytometry Program assesses the proficiency of NIH/NIAID/DAIDS-supported and potentially other interested research laboratories in performing Intracellular Cytokine Staining (ICS) assays. The goal of the EQAPOL Flow Cytometry External Quality Assurance Program (EQAP) is to provide proficiency testing and remediation for participating sites. The program is not punitive; rather, EQAPOL aims to help sites identify areas for improvement. EQAPOL utilizes a highly standardized ICS assay to minimize variability and readily identify those sites experiencing technical difficulties with their assays. Here, we report the results of External Proficiency 3 (EP3) where participating sites performed a 7-color ICS assay. On average, sites perform well in the Flow Cytometry EQAP (median score is "Good"). The most common technical issues identified by the program involve protocol adherence and data analysis; these areas have been the focus of site remediation. The EQAPOL Flow Cytometry team is now in the process of expanding the program to 8-color ICS assays. Evaluating polyfunctional ICS responses would align the program with assays currently being performed in support of HIV immune monitoring assays. Copyright © 2014 Elsevier B.V. All rights reserved.

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.

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

OpenAIRE

Ojedokun, Oluyinka; Idemudia, Erhabor S.; Desouza, Mercy

2015-01-01

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. ...

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,…

Assessing the Organisational Impact of External Quality Assurance: Hypothesising Key Dimensions and Mechanisms

Science.gov (United States)

Stensaker, Bjørn; Leiber, Theodor

2015-01-01

The aim of the article is to provide a framework in which the organisational impact of external quality assurance (EQA) can be assessed. Based on existing studies of the impact of EQA in universities and colleges it is suggested that greater systematisation of how impact is measured is needed for a better understanding of how EQA can be used as a…

[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.

Child Reactivity Moderates the Over-Time Association between Mother-Child Conflict Quality and Externalizing Problems

Science.gov (United States)

Nelson, Jackie A.

2015-01-01

Constructive parent-child conflict interactions that teach children to problem-solve and negotiate can enhance children's social adjustment. This paper identifies constructive and destructive qualities of mother-child conflict and explores whether child temperament moderated associations with changes in externalizing problems over time. One…

Baseline Assessment of 25-Hydroxyvitamin D Reference Material and Proficiency Testing/External Quality Assurance Material Commutability: A Vitamin D Standardization Program Study.

Science.gov (United States)

Phinney, Karen W; Sempos, Christopher T; Tai, Susan S-C; Camara, Johanna E; Wise, Stephen A; Eckfeldt, John H; Hoofnagle, Andrew N; Carter, Graham D; Jones, Julia; Myers, Gary L; Durazo-Arvizu, Ramon; Miller, W Greg; Bachmann, Lorin M; Young, Ian S; Pettit, Juanita; Caldwell, Grahame; Liu, Andrew; Brooks, Stephen P J; Sarafin, Kurtis; Thamm, Michael; Mensink, Gert B M; Busch, Markus; Rabenberg, Martina; Cashman, Kevin D; Kiely, Mairead; Galvin, Karen; Zhang, Joy Y; Kinsella, Michael; Oh, Kyungwon; Lee, Sun-Wha; Jung, Chae L; Cox, Lorna; Goldberg, Gail; Guberg, Kate; Meadows, Sarah; Prentice, Ann; Tian, Lu; Brannon, Patsy M; Lucas, Robyn M; Crump, Peter M; Cavalier, Etienne; Merkel, Joyce; Betz, Joseph M

2017-09-01

The Vitamin D Standardization Program (VDSP) coordinated a study in 2012 to assess the commutability of reference materials and proficiency testing/external quality assurance materials for total 25-hydroxyvitamin D [25(OH)D] in human serum, the primary indicator of vitamin D status. A set of 50 single-donor serum samples as well as 17 reference and proficiency testing/external quality assessment materials were analyzed by participating laboratories that used either immunoassay or LC-MS methods for total 25(OH)D. The commutability test materials included National Institute of Standards and Technology Standard Reference Material 972a Vitamin D Metabolites in Human Serum as well as materials from the College of American Pathologists and the Vitamin D External Quality Assessment Scheme. Study protocols and data analysis procedures were in accordance with Clinical and Laboratory Standards Institute guidelines. The majority of the test materials were found to be commutable with the methods used in this commutability study. These results provide guidance for laboratories needing to choose appropriate reference materials and select proficiency or external quality assessment programs and will serve as a foundation for additional VDSP studies.

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.

Propagación in vitro de Heliconia bihai (L. cv. Lobster Salmón a partir de meristemos florales

Directory of Open Access Journals (Sweden)

Marta Leonor Marulanda-ángel

2011-04-01

Full Text Available Se desarrolló un protocolo de propagación in vitro a partir de meristemos florales para Heliconia bihai cv. Lobster Salmón. Para el efecto se establecieron 250 yemas florales en diferentes tiempos utilizando NaClO al 1% durante 20 min. El medio de establecimiento Murashige y Skoog con mejores resultados fue BAP (2 mg/lt, AIA (1 mg/lt y 0.1 g/lt de L-cisteína. La mayor produccion de brotes en multiplicación se obtuvo con 6 mg/lt de BAP y con un subcultivo posterior en medio con 2 mg/lt de BAP y 0.5 mg/lt de AIA, alcanzando una tasa de multiplicación de tres nuevas yemas. El enraizamiento de las plántulas in vitro se logró con 1.3 mg/lt de AIA. La aclimatación en vivero fue 92% de supervivencia. Se realizó un análisis de varianza (Anova y un test de Tukey para las variables evaluadas las cuales mostraron diferencias estadísticas en cada fase. La propagación in vitro de heliconias a partir de yemas florales requiere mayor tiempo en la fase de establecimiento y multiplicación, no obstante permite mayores porcentajes de supervivencia y una menor contaminación, ofreciendo material de siembra de diferentes especies de esta planta de interés comercial.

Establishing an external quality assessment scheme for point-of-care international normalized ratio in Thailand.

Science.gov (United States)

Tientadakul, P; Chuntarut, A

2015-08-01

Effective warfarin therapy management has gained national interest, resulting in the increased use of point-of-care testing (POCT) for international normalized ratio (INR). External quality assessment (EQA) is recommended to ensure quality of the testing. CoaguChek XS and CoaguChek XS Plus are the only commonly available POCT INR monitors in Thailand. Therefore, Thailand NEQAS for Blood Coagulation initiated the scheme for POCT INR in 2013, including only hospitals using these devices. Questionnaires were sent to the hospitals, enquiring about their interest in EQA participation. Two surveys were distributed; each included five certified European Concerted Action on Anticoagulation (ECAA) INR plasma sets. Unsatisfactory performance was indicated by a 15% deviation from the certified mean INR value. There were 156 hospitals using the devices. Thirty-five hospitals responded to the questionnaires. Medical personnel undertaking POCT INR were limited to laboratory staff in 29 (83%) of these centers, and 31 hospitals actually participated. The medians of results from participants were the same or nearly the same as the certified mean INRs. External quality assessment for POCT INR in Thailand is feasible using the ECAA plasmas as control materials. The results therefore appear encouraging to other developing countries to establish their own EQA schemes. © 2014 John Wiley & Sons Ltd.

A criterion-based audit of the technical quality of external beam radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Brundage, Michael; Danielson, Brita; Pearcey, Robert; Bass, Brenda; Pickles, Tom; Bahary, Jean-Paul; Peng, Yingwei; Wallace, David; Mackillop, William

2013-01-01

Purpose: To evaluate the technical quality of external beam radiotherapy for prostate cancer in Canada. Methods: This was a multi-institution, retrospective study of a random sample of patients undergoing radiotherapy (RT) for prostate cancer in Canada. Patterns of care were determined by abstracting details of the patients’ management from original records. The quality of patient’s technical care was measured against a previously published, comprehensive suite of quality indicators. Results: 32 of the 37 RT centres participated. The total study population of 810 patients included 25% low-risk, 44% intermediate-risk, and 28% high-risk cases. 649 received external beam RT (EBRT) only, for whom compliance with 12 indicators of the quality of pre-treatment assessment ranged from 56% (sexual function documented) to 96% (staging bone scan obtained in high-risk patients). Compliance with treatment-related indicators ranged from 78% (dose to prostate ⩾74 Gy in intermediate risk patients not receiving hormone therapy) to 100% (3DCRT or IMRT plan). Compliance varied among centres; no centre demonstrated 100% compliance on all indicators and every centre was 100% compliant on at least some indicators. The number of assessment-related indicators (n = 13) with which a given centre was 100% compliant ranged from 4 to 11 (median 7) and the number of the treatment-specific indicators (n = 8) with which a given centre was 100% compliant ranged from 6 to 8 (median 8). ADT therapy was utilised in most high-risk cases (191, 92.3%). Conclusions: While patterns of prostate cancer care in Canada vary somewhat, compliance on the majority of quality indicators is very high. However, all centres showed room for improvement on several indicators and few individual patients received care that met target benchmarks on all quality measures. This variation is particularly important for indicators such as delivered dose where impact on disease outcome is known to exist, and suggests that

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.

Internal and external quality control in the determinations of the thyroid hormones

International Nuclear Information System (INIS)

Rodriguez, S.; Richmond, M.; Gonzalez, L.; Saenz, E.

1990-01-01

An evaluation of the thyroid hormone level in young adults and the results of an External Quality Control (EQC) for the thyroid related hormones: Thyroxine (T4), Triidothyronine (T3) and Thyroid Stinulating Hormone (TSH) are presented for Costa Rica. Hormone level in the 1053 sera evaluated range 0,2 to 3,52 nmol/1, from 43 to 207 nmol/1, and from 0 to 6,2 uUl/ml, for the nine radioimmunoassay laboratories that participated in the EQC. The mean variability among laboratories was 19.3%, 18% and 20.5% for T3, T4 and TSH, respectively. The Internal Quality Control (IQC) in the reference laboratory (immunoassay, INCIENSA) showed a mean variability of 5.6%, 6.22% and 6.93% for T3, T4 and TSH, respectively. (author). 19 refs, 4 figs

Associations of Perceived Sibling and Parent-Child Relationship Quality With Internalizing and Externalizing Problems: Comparing Indian and Dutch Early Adolescents

NARCIS (Netherlands)

Buist, K. L.|info:eu-repo/dai/nl/241099218; Verhoeven, Marjolein|info:eu-repo/dai/nl/304349747; Hoksbergen, R.|info:eu-repo/dai/nl/068229127; Ter Laak, J.; Watve, S.; Paranjpe, A.

2017-01-01

The aims of the present study were (a) to examine whether Dutch and Indian early adolescents differ concerning sibling and parent-child relationship quality and externalizing and internalizing problems, and (b) to compare the associations between sibling and parent-child relationship quality and

[An analysis of the effectiveness of external quality assurance programmes using changes in quality indicators of individual hospitals].

Science.gov (United States)

Lack, Nicholas; Gerhardinger, Ursula

2010-01-01

Judging the effectiveness of external quality assurance programmes by comparing current performance with unadjusted regional or national crude averages is misleading because the influence of the actual size of the populations under consideration as well as the variance of performance between hospitals is underestimated. Not only do these artefacts lead to a general overestimation of changes in regional averages. They also may lead to a ranking confounded by regional size. An assessment at unit level circumvents these difficulties. The differential grading of degree of departure of a unit's performance from national targets available from funnel plots allows, in addition, for the discrimination between effects due to the monitoring institution and achievements attributable to the hospital under surveillance. A central role is played by the scoring system adopted for evaluating incremental changes of performance indicator values in successive years. The following proposal is intended to both assist the assessment of effectiveness of quality assurance programmes and identify areas requiring urgent improvement. Bavarian quality assurance data (BAQ 1995) are used to illustrate the method. Copyright © 2010. Published by Elsevier GmbH.

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.

SWGELLA DYSENTERIAE TYPE 1 IN KwAZuLU-NATAL

African Journals Online (AJOL)

-control. 1995: 15. ure co. LABORATORY SURV~ILLAN.CEOF. SWGELLA DYSENTERIAE TYPE 1 IN. KwAZuLU- ... freeze-dried quality-eontrol specimens were prepared containing ... (National Committee for Clinical Laboratory Standards,.

Quality of life outcomes' in early motherhood in Austria : The impact of internal and external resources

OpenAIRE

Mautner, Eva

2014-01-01

The aim of this paper is to provide results of two studies, which were conducted in Austria to examine the impact of internal and external factors on quality of life and depressive symptoms in early motherhood. In general early motherhood may be a critical life event for a woman and their partner and can lead to decreased well-being. Emotional aspects such as depression affects not only the quality of life of the mothers but also her new-born child, her other children, partner and relati...

Propagación in vitro de Heliconia bihai (L. cv. Lobster Salmón a partir de meristemos florales

Directory of Open Access Journals (Sweden)

Londoño-Giraldo Lina María

2011-06-01

Full Text Available

Se desarrolló un protocolo de propagación in vitro a partir de meristemos florales para Heliconia bihai cv. Lobster Salmón. Para el efecto se establecieron 250 yemas florales en diferentes tiempos utilizando NaClO al 1% durante 20 min. El medio de establecimiento Murashige y Skoog con mejores resultados fue BAP (2 mg/lt, AIA (1 mg/lt y 0.1 g/lt de L-cisteína. La mayor produccion de brotes en multiplicación se obtuvo con 6 mg/lt de BAP y con un subcultivo posterior en medio con 2 mg/lt de BAP y 0.5 mg/lt de AIA, alcanzando una tasa de multiplicación de tres nuevas yemas. El enraizamiento de las plántulas in vitro se logró con 1.3 mg/lt de AIA. La aclimatación en vivero fue 92% de supervivencia. Se realizó un análisis de varianza (Anova y un test de Tukey para las variables evaluadas las cuales mostraron diferencias estadísticas en cada fase. La propagación in vitro de heliconias a partir de yemas florales requiere mayor tiempo en la fase de establecimiento y multiplicación, no obstante permite mayores porcentajes de supervivencia y una menor contaminación, ofreciendo material de siembra de diferentes especies de esta planta de interés comercial.

External Quality Assessment for the Detection of Measles Virus by Reverse Transcription-PCR Using Armored RNA.

Directory of Open Access Journals (Sweden)

Dong Zhang

Full Text Available In recent years, nucleic acid tests for detection of measles virus RNA have been widely applied in laboratories belonging to the measles surveillance system of China. An external quality assessment program was established by the National Center for Clinical Laboratories to evaluate the performance of nucleic acid tests for measles virus. The external quality assessment panel, which consisted of 10 specimens, was prepared using armored RNAs, complex of noninfectious MS2 bacteriophage coat proteins encapsulated RNA of measles virus, as measles virus surrogate controls. Conserved sequences amplified from a circulating measles virus strain or from a vaccine strain were encapsulated into these armored RNAs. Forty-one participating laboratories from 15 provinces, municipalities, or autonomous regions that currently conduct molecular detection of measles virus enrolled in the external quality assessment program, including 40 measles surveillance system laboratories and one diagnostic reagent manufacturer. Forty laboratories used commercial reverse transcription-quantitative PCR kits, with only one laboratory applying a conventional PCR method developed in-house. The results indicated that most of the participants (38/41, 92.7% were able to accurately detect the panel with 100% sensitivity and 100% specificity. Although a wide range of commercially available kits for nucleic acid extraction and reverse transcription polymerase chain reaction were used by the participants, only two false-negative results and one false-positive result were generated; these were generated by three separate laboratories. Both false-negative results were obtained with tests performed on specimens with the lowest concentration (1.2 × 104 genomic equivalents/mL. In addition, all 18 participants from Beijing achieved 100% sensitivity and 100% specificity. Overall, we conclude that the majority of the laboratories evaluated have reliable diagnostic capacities for the detection

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

Implementation of External Quality Assurance Trials for Immunohistochemically Determined Breast Cancer Biomarkers in Germany

OpenAIRE

von Wasielewski, Reinhard; Krusche, Claudia A.; Rüschoff, Joseph; Fisseler-Eckhoff, Anette; Kreipe, Hans

2008-01-01

Besides typing and grading of breast cancer, Pathologists are involved in the determination of biomarkers, such as steroid hormone receptors and HER2, which are of utmost importance in adjuvant therapy. There have been concerns with regard to security and reproducibility of the biomarker assays done on tissue sections applying either immunohistochemistry or in-situ hybridisation. In order to assure the quality of these biomarker assays, a number of measures are required, among them external p...

External quality assurance of malaria nucleic acid testing for clinical trials and eradication surveillance.

Science.gov (United States)

Murphy, Sean C; Hermsen, Cornelus C; Douglas, Alexander D; Edwards, Nick J; Petersen, Ines; Fahle, Gary A; Adams, Matthew; Berry, Andrea A; Billman, Zachary P; Gilbert, Sarah C; Laurens, Matthew B; Leroy, Odile; Lyke, Kristen E; Plowe, Christopher V; Seilie, Annette M; Strauss, Kathleen A; Teelen, Karina; Hill, Adrian V S; Sauerwein, Robert W

2014-01-01

Nucleic acid testing (NAT) for malaria parasites is an increasingly recommended diagnostic endpoint in clinical trials of vaccine and drug candidates and is also important in surveillance of malaria control and elimination efforts. A variety of reported NAT assays have been described, yet no formal external quality assurance (EQA) program provides validation for the assays in use. Here, we report results of an EQA exercise for malaria NAT assays. Among five centers conducting controlled human malaria infection trials, all centers achieved 100% specificity and demonstrated limits of detection consistent with each laboratory's pre-stated expectations. Quantitative bias of reported results compared to expected results was generally Quality Assessment program that fulfills the need for EQA of malaria NAT assays worldwide.

[Analysis of the results of the 2010 External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology].

Science.gov (United States)

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

2011-12-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most important conclusions and lessons of the 2010 controls. As a whole, the results obtained in 2010 confirm the excellent skill and good technical standards found in previous years. However, 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 to ensure maximal quality of microbiological tests(1). Copyright © 2011 Elsevier España S.L. All rights reserved.

[10 years of external quality assurance in dialysis in Germany: Results and future prospects].

Science.gov (United States)

Büchtemann, Dorothea; Meinhold, Stefan; Follert, Peter

2017-10-01

In 2006, the Federal Joint Committee introduced a quality assurance programme for ambulatory dialysis treatment in Germany. Regarding the impact of chronic dialysis treatment on the quality of life of patients and on health care costs, quality assurance in dialysis is considered highly relevant. The directive on Quality Assurance in Dialysis (QSD-RL) established an external quality assurance programme on the basis of the assessment of certain quality parameters combined with an internal quality management system based on benchmarking parameters in all dialysis practices and centres. Data on quality parameters are collected and analysed quarterly. Regional associations of statutory health insurance physicians take responsibility for quality improvement measures and sanctions. This article aims to provide an overview of the development of quality parameters from 2008 to 2015. We analysed the summarised annual quality reports published on the website of the Federal Joint Committee between 2009 and 2016. We present results on the so-called core quality parameters duration and frequency of dialysis sessions (both for haemodialysis patients), wKt/V for peritoneal dialysis patients, and percentage of haemodialysis patients with central venous catheters which has only been measured since 2014. In 2015, 92,000 patients received outpatient dialysis. Between 2008 and 2015, the results for the core quality parameters duration and frequency of haemodialysis improved while the results for wKt/V seemingly show an unfavourable trend. The percentage of patients with central venous catheters appears to be quite high, and thus indicates that there is potential for quality improvement. For the future, the Federal Joint Committee has resolved to merge the quality assurance programmes in dialysis and in kidney transplantation into a newly designed programme that has the potential to follow patients through all stages and kinds of renal replacement therapy and to focus on further aspects

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.

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),

Development of an evidence-based approach to external quality assurance for breast cancer hormone receptor immunohistochemistry: comparison of reference values.

Science.gov (United States)

Makretsov, Nikita; Gilks, C Blake; Alaghehbandan, Reza; Garratt, John; Quenneville, Louise; Mercer, Joel; Palavdzic, Dragana; Torlakovic, Emina E

2011-07-01

External quality assurance and proficiency testing programs for breast cancer predictive biomarkers are based largely on traditional ad hoc design; at present there is no universal consensus on definition of a standard reference value for samples used in external quality assurance programs. To explore reference values for estrogen receptor and progesterone receptor immunohistochemistry in order to develop an evidence-based analytic platform for external quality assurance. There were 31 participating laboratories, 4 of which were previously designated as "expert" laboratories. Each participant tested a tissue microarray slide with 44 breast carcinomas for estrogen receptor and progesterone receptor and submitted it to the Canadian Immunohistochemistry Quality Control Program for analysis. Nuclear staining in 1% or more of the tumor cells was a positive score. Five methods for determining reference values were compared. All reference values showed 100% agreement for estrogen receptor and progesterone receptor scores, when indeterminate results were excluded. Individual laboratory performance (agreement rates, test sensitivity, test specificity, positive predictive value, negative predictive value, and κ value) was very similar for all reference values. Identification of suboptimal performance by all methods was identical for 30 of 31 laboratories. Estrogen receptor assessment of 1 laboratory was discordant: agreement was less than 90% for 3 of 5 reference values and greater than 90% with the use of 2 other reference values. Various reference values provide equivalent laboratory rating. In addition to descriptive feedback, our approach allows calculation of technical test sensitivity and specificity, positive and negative predictive values, agreement rates, and κ values to guide corrective actions.

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...

The Czech External Quality Control system in medical microbiology and parasitology.

Science.gov (United States)

Slosárek, M; Kríz, B

2000-11-01

The External Quality Control (EQC) system in activities of laboratories engaged in medical microbiology and parasitology was established in the Czech Republic in 1993 when to the first laboratories which applied coded serum samples were sent for diagnosis of viral hepatitis and bacterial strains for identification. In the course of years the number of control areas increased and in 2000 there were 31 and the number of those interested in participation in EQC increased from 79 in 1993 to 434 in 2000. This year a total of 13,239 samples will be sent to laboratories. Gradually thus almost all microbiological and parasitological laboratories concerned with examination of clinical material became involved. Seven-year experience with EQC in the Czech Republic revealed that gradually the results of various examinations became more accurate, that methods became standardized and the most suitable examination sets are used.

The development of an interdepartmental audit as part of a physics quality assurance programme for external beam therapy

International Nuclear Information System (INIS)

Bonnett, D.E.; Jaukett, R.J.; Mills, J.A.; Martin-Smith, P.

1994-01-01

A cost-effective audit system has been developed that will both detect systematic error in data and procedures, and evaluate the quality assurance programme provided by a physics department for radiotherapy. The audit has been developed for external beam radiotherapy and assesses one modality and one treatment machine per year. The method of assessing the quality assurance programme and the schedule of measurements are described. The process is illustrated using the results of trial audits between the medical physics department at Coventry and Leicester. (author)

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)

Swenson, Lance P; Rose, Amanda J

2009-08-01

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.

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

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...... expand this program to more laboratories to provide a robust estimate of the quality of KRAS testing in Europe, and provide the basis for remedial measures and harmonization....... prepared and distributed the samples for the participants of their own country. The samples included unstained sections of 10 invasive colorectal carcinomas with known KRAS mutation status. The samples were centrally validated by one of two reference laboratories. The laboratories were allowed to use...

A new approach to define acceptance limits for hematology in external quality assessment schemes.

Science.gov (United States)

Soumali, Mohamed Rida; Van Blerk, Marjan; Akharif, Abdelhadi; Albarède, Stéphanie; Kesseler, Dagmar; Gutierrez, Gabriela; de la Salle, Barbara; Plum, Inger; Guyard, Anne; Favia, Ana Paula; Coucke, Wim

2017-10-26

A study performed in 2007 comparing the evaluation procedures used in European external quality assessment schemes (EQAS) for hemoglobin and leukocyte concentrations showed that acceptance criteria vary widely. For this reason, the Hematology working group from the European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM) decided to perform a statistical study with the aim of establishing appropriate acceptance limits (AL) allowing harmonization between the evaluation procedures of European EQAS organizers. Eight EQAS organizers from seven European countries provided their hematology survey results from 2010 to 2012 for red blood cells (RBC), hemoglobin, hematocrit, mean corpuscular volume (MCV), white blood cells (WBC), platelets and reticulocytes. More than 440,000 data were collected. The relation between the absolute value of the relative differences between reported EQA results and their corresponding assigned value (U-scores) was modeled by means of an adaptation of Thompson's "characteristic function". Quantile regression was used to investigate the percentiles of the U-scores for each target concentration range. For deriving AL, focus was mainly on the upper percentiles (90th, 95th and 99th). For RBC, hemoglobin, hematocrit and MCV, no relation was found between the U-scores and the target concentrations for any of the percentiles. For WBC, platelets and reticulocytes, a relation with the target concentrations was found and concentration-dependent ALs were determined. The approach enabled to determine state of the art-based ALs, that were concentration-dependent when necessary and usable by various EQA providers. It could also easily be applied to other domains.

Improvement of the quality of BRAF testing in melanomas with nationwide external quality assessment, for the BRAF EQA group

International Nuclear Information System (INIS)

Emile, Jean-François; Hofman, Paul; Sabourin, Jean-Christophe; Laurent-Puig, Pierre; Tisserand, Julie; Bergougnoux, Loic; Nowak, Frédérique; Faucher, Gladwys; Surel, Sylvie; Lamy, Aude; Lecorre, Delphine; Helias-Rodzewicz, Zofia

2013-01-01

Knowledge about tumour gene mutation status is essential for the treatment of increasing numbers of cancer patients, and testing quality has a major impact on treatment response and cost. In 2012, 4,629 tests for BRAF p.V600 were performed in France, in patients with melanomas. Two batches of unstained melanoma sections were sent, in May and November 2012, to the 46 laboratories supported by the French National Institute of Cancer (INCa). An external quality assessment (EQA) evaluated mutation status, response times and compliance with INCa recommendations. All the French laboratories involved in testing participated in the EQA. Fourteen different methods were used to detect BRAF mutations, most consisting of combinations of in-house techniques. False responses were noted in 25/520 cases (4.8%), 11 of which concerned confusion between p.V600E and p.V600K. Thus, 2.7% of responses would have led to inappropriate treatment. Within six months, mean response times decreased from 22 to 12 days (P<0.001), and the percentage of samples evaluated by a pathologist for tumour cell content increased, from 75.2% to 96.9% (P<0.001). Despite the use of non-certified methods, the false response rate was low. Nationwide EQA can improve the quality of molecular pathology tests on tumours

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...... lasers emerge as the next generation of compact lasers that have the potential of replacing conventional high power laser systems in many existing applications....

Public health investigations of Salmonella Enteritidis in catering raw shell eggs, 2002-2004.

Science.gov (United States)

Little, C L; Surman-Lee, S; Greenwood, M; Bolton, F J; Elson, R; Mitchell, R T; Nichols, G N; Sagoo, S K; Threlfall, E J; Ward, L R; Gillespie, I A; O'Brien, S

2007-06-01

In response to a dramatic change in the epidemiology of Salmonella Enteritidis in England and Wales thought to be associated with raw shell eggs, the Health Protection Agency initiated public health investigations to establish the incidence of Salmonella contamination and origin of eggs used by catering premises implicated in outbreaks of Salm. Enteritidis. Between October 2002 and November 2004, 16 971 eggs were sampled and Salmonella were recovered from 3.4%. Salmonella was isolated from 5.5% and 6.3% of Spanish and eggs of unknown origin, respectively, used in catering premises linked to outbreaks, a level significantly higher than that (1.1%) found in nonLion Quality UK eggs sampled. The small sample of UK Lion Quality eggs tested (reflecting their lack of use in premises visited) did not contain Salmonella. Several phage types of Salm. Enteritidis other than phage type 4 (PT 4) were identified with nonUK eggs. Eggs from Spain were implicated as a major source of infection. Eggs were contaminated more frequently with Salmonella when shells were dirty and/or cracked, and stored at above 8 degrees C. The use of Spanish eggs by the catering sector has been identified as a consistent significant factor in many of the outbreaks caused by Salm. Enteritidis nonPT4 in England and Wales during 2002-2004. Advice to caterers and hospitals that raw shell eggs should not be used in food that will either not be cooked or only lightly cooked should be reinforced.

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

Does external evaluation of laboratories improve patient safety?

Science.gov (United States)

Noble, Michael A

2007-01-01

Laboratory accreditation and External Quality Assessment (also called proficiency testing) are mainstays of laboratory quality assessment and performance. Both practices are associated with examples of improved laboratory performance. The relationship between laboratory performance and improved patient safety is more difficult to assess because of the many variables that are involved with patient outcome. Despite this difficulty, the argument to continue external evaluation of laboratories is too compelling to consider the alternative.

Quality assurance for external radiotherapy equipment in Japan

International Nuclear Information System (INIS)

Tomaru, Teizo

1993-01-01

In Japan, quality assurance (QA) for external beam teletherapy equipment is carried out according to QA protocols issued by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO), which are modified from the IEC recommendations. The QA program in Japan is introduced in this paper. It is advisable to do several tests daily, including the accuracy of the optical distance indicator, alignment of the sidelight, check of 10 x 10 cm light field, and constancy of the dose monitor. Pencil marks on the wall and floor can be used to check light alignment. Dose monitor calibration and flatness/symmetry should be checked weekly. Monthly tests should include 8 items: depth dose characteristics of electron beam, radiation-light field congruence, indication of x-ray beam axis (patient entry and exit), indication of isocenter, distance indicator, and vertical movement of table. Film is used to test the flatness/symmetry, and congruence of the radiation and light field. The alignment of the intersection of the cross hair is useful to check the x-ray beam axis indication and vertical movement of table. Checks of stability of each dose monitor system and mechanical alignment should be performed every 6 months or annually. Mechanical alignment is fundamentally important for the performance of a teletherapy unit. As a constancy check of the overall system, a split-field test is recommended due to its rapid and simple execution. (author)

Digital test objects (D.T.O.) for treatment planning systems quality control in external beam radiotherapy

International Nuclear Information System (INIS)

Denis, E.

2008-04-01

This work presents the conception and implementation of new automatic and quantitative quality assessment methods for geometric treatment planning in external radiotherapy. Treatment planning Systems (T.P.S.) quality control is mandatory in France and in the world because of encountered risks but the physical tools recommended to lead this quality control are not adapted to the situation. We present a new methodology for control quality based on the definition of Digital Test Objects (D.T.O.) that are directly introduced in the T.P.S. without acquisition device. These D.T.O. are consistently defined in a continuous and discrete modes. The T.P.S. responses to input D.T.O. are compared to theoretical results thanks to figures of merit specifically designed for each elementary control. The tests we carried out during this study allow to validate our solutions for the quality assessment of the auto-contouring, auto-margining, isocenter computation, collimator conformation and digitally reconstructed radiograph generation tools, as well as our solutions for marker positioning, collimator and displayed bean rotation, incidence, divergence and dimensions. Quality assessment solutions we propose are then fast and effective (no acquisition by the device, reduced manipulations), and more precise thanks to the continuous-discrete equivalence realized at the beginning of the modelling

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.

Quality Assurance - Construction

DEFF Research Database (Denmark)

Gaarslev, Axel

1996-01-01

Gives contains three main chapters:1. Quality Assurance initiated by external demands2. Quality Assurance initiated by internal company goals3. Innovation strategies......Gives contains three main chapters:1. Quality Assurance initiated by external demands2. Quality Assurance initiated by internal company goals3. Innovation strategies...

External quality assessment of malaria microscopy diagnosis in selected health facilities in Western Oromia, Ethiopia.

Science.gov (United States)

Sori, Getachew; Zewdie, Olifan; Tadele, Geletta; Samuel, Abdi

2018-06-18

Accurate early diagnosis and prompt treatment are one of the key strategies to control and prevent malaria disease. External quality assessment is the most effective method for evaluation of the quality of malaria microscopy diagnosis. The aim of this study was to assess the quality of malaria microscopy diagnosis and its associated factors in selected public health facility laboratories in East Wollega Zone, Western Ethiopia. Facility-based cross-sectional study design was conducted in 30 randomly selected public health facility laboratories from November 2014 to January 2015 in East Wollega Zone, Western Ethiopia. Ten validated stained malaria panel slides with known Plasmodium species, developmental stage and parasite density were distributed. Data were captured; cleaned and analyzed using SPSS version 20 statistical software-multivariate logistic regressions and the agreement in reading between the peripheral diagnostic centers and the reference laboratory were done using kappa statistics. A total of 30 health facility laboratories were involved in the study and the overall quality of malaria microscopy diagnosis was poor (62.3%). The associated predictors of quality in this diagnosis were in-service training [(AOR = 16, 95% CI (1.3, 1.96)], smearing quality [(AOR = 24, 95% CI (1.8, 3.13)], staining quality [(AOR = 15, 95% CI (2.35, 8.61), parasite detection [(AOR = 9, 95% CI (1.1, 8.52)] and identification skills [(AOR = 8.6, 95% CI (1.21, 1.63)]. Eighteen (60%) of health facility laboratories had in-service trained laboratory professionals on malaria microscopy diagnosis. Overall quality of malaria microscopy diagnosis was poor and a significant gap in this service was observed that could impact on its diagnostic services.

Coordination-driven self-assembly of a novel carbonato-bridged heteromolecular neutral nickel(II) triangle by atmospheric CO2 fixation.

Science.gov (United States)

Mukherjee, Pampa; Drew, Michael G B; Estrader, Marta; Ghosh, Ashutosh

2008-09-01

Formation of a quasi-symmetrical mu 3-carbonato-bridged self-assembled heteromolecular triangle of Ni(II), [(mu 3-CO 3){Ni 2(salmeNH) 2(NCS) 2}{Ni(salmeNH 2) 2].Et 2O.H 2O (HsalmeNH = 2-[(3-methylamino-propylimino)-methyl]-phenol) involves atmospheric CO 2 uptake in a neutral medium, by spontaneous self-reorganization of the starting mononuclear Ni(II)-Schiff-base complex, [Ni(salmeNH) 2]. The environment around Ni(II) in two of the subunits is different from the third one. The starting complex, [Ni(salmeNH) 2], and one of the possible intermediate species, [Ni(salmeNH 2) 2(NCS) 2], which has a very similar coordination environment to that in the third Ni(II) center, have been characterized structurally. A plausible mechanism for the formation of such a triangle has also been proposed. The compound shows a very strong antiferromagnetic coupling. Fit as a regular triangular arrangement gave J = -53.1, g = 2.24, and R = 1.5 x 10 (-4).

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

Bovine mastitis is the most common and costly dairy cattle disease. Mastitis is most frequently caused by bacterial species, and to ensure optimal treatment and control strategies, proper quality assured diagnosis and identification of the causative agent is important. With the aim to assess...... 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...

The external quality assurance programme (EQAP) for the FAO/IAEA antibody FMD ELISA in Southeast Asia

International Nuclear Information System (INIS)

Colling, A.

2000-01-01

The external quality assurance programme (EQAP) consists of three equally important items: the questionnaire, the monitoring of the internal quality control data and the external quality control test panel. The EQAP is conducted twice per year. The first round of the EQAP for the FAO/IAEA liquid phase blocking ELISA being used in Southeast Asia was carried out in 1995-1996. A total of 10 laboratories from Asia participated. The round consisted of three FMD sero-types (O, A and Asia) for both, the antigen and antibody ELISA. No interim report was produced, but results were communicated on an individual basis. The second round was initiated in late 1998. Participating laboratories were the same as in 1996. This time the EQA proficiency exercise consisted only of one sero-type (O 1 Manisa) for the FMD Antibody ELISA. The results of this round are presented in this report. All participants replied to this EQA exercise. Out of ten participants six laboratories returned all EQA components (EQC results, IQC data and questionnaire). Four laboratories did not return the complete set of the EQA panel. Three out of five EQC samples achieved an overall agreement of 100%. Two EQC samples were excluded from the evaluation because a minimum of 80% of agreement between participants was not achieved. In comparison to the reference values for the EQC samples as established by the World Reference Center (WRC), UK, the participating laboratories produced lower PI values for the three positive samples 2, 8 and 5 and higher PI values for the negative samples 10 and 9 resulting in a decreased binding ratio. Nevertheless results show that all laboratories are able to detect a strong positive sample and no equivocally result was obtained for the two negative samples. Weak positive sera close to the cut-off are problematical for a minority of the laboratories, which tested these samples negative. The closer the sample comes to the cut-off the less agreement between laboratories is reached

Infancy Parenting and Externalizing Psychopathology from Childhood through Adulthood: Developmental Trends

OpenAIRE

Lorber, Michael F.; Egeland, Byron

2009-01-01

Developmental models and previous findings suggest that early parenting is more strongly associated with externalizing problems in early childhood than in adolescence. In this brief report, we addressed the question of whether the association of poor quality infancy parenting and externalizing problems “rebounds” in adulthood. Poor quality infancy parenting was associated with externalizing problems at kindergarten and first grade (mother report), as well as at 23 and 26 years (self-report). ...

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.)

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.

External quality control in ground-water sampling and analysis at the Hanford Site

International Nuclear Information System (INIS)

Hall, S.H.; Juracich, S.P.

1991-11-01

At the US Department of Energy's Hanford Site, external Quality Control (QC) for ground-water monitoring is extensive and has included routine submittal of intra- and interlaboratory duplicate samples, blind samples, and several kinds of blank samples. Examination of the resulting QC data for nine of the constituents found in ground water at the Hanford Site shows that the quality of analysis has generally been within the expectations of precision and accuracy that have been established by the US Environmental Protection Agency (EPA). The constituents subjected to review were nitrate, chromium, sodium, fluoride, carbon tetrachloride, tritium, ammonium, trichloroethylene, and cyanide. Of these, the fluoride measurements were notable exceptions and were poor by EPA standards. The review has shown that interlaboratory analysis of duplicate samples yields the most useful QC data for evaluating laboratory performance in determining commonly encountered constituents. For rarely encountered constituents, interlaboratory comparisons may be augmented with blind samples (synthetic samples of known composition). Intralaboratory comparisons, blanks, and spikes should be generally restricted to studies of suspected or known sample contamination and to studies of the adequacy of sampling and analytical procedures

Infancy Parenting and Externalizing Psychopathology from Childhood through Adulthood: Developmental Trends

Science.gov (United States)

Lorber, Michael F.; Egeland, Byron

2009-01-01

Developmental models and previous findings suggest that early parenting is more strongly associated with externalizing problems in early childhood than it is in adolescence. In this article, the authors address whether the association of poor-quality infancy parenting and externalizing problems "rebounds" in adulthood. Poor-quality infancy…

RAS screening in colorectal cancer: a comprehensive analysis of the results from the UK NEQAS colorectal cancer external quality assurance schemes (2009-2016).

Science.gov (United States)

Richman, Susan D; Fairley, Jennifer; Butler, Rachel; Deans, Zandra C

2017-12-01

Evidence strongly indicates that extended RAS testing should be undertaken in mCRC patients, prior to prescribing anti-EGFR therapies. With more laboratories implementing testing, the requirement for External Quality Assurance schemes increases, thus ensuring high standards of molecular analysis. Data was analysed from 15 United Kingdom National External Quality Assessment Service (UK NEQAS) for Molecular Genetics Colorectal cancer external quality assurance (EQA) schemes, delivered between 2009 and 2016. Laboratories were provided annually with nine colorectal tumour samples for genotyping. Information on methodology and extent of testing coverage was requested, and scores given for genotyping, interpretation and clerical accuracy. There has been a sixfold increase in laboratory participation (18 in 2009 to 108 in 2016). For RAS genotyping, fewer laboratories now use Roche cobas®, pyrosequencing and Sanger sequencing, with more moving to next generation sequencing (NGS). NGS is the most commonly employed technology for BRAF and PIK3CA mutation screening. KRAS genotyping errors were seen in ≤10% laboratories, until the 2014-2015 scheme, when there was an increase to 16.7%, corresponding to a large increase in scheme participants. NRAS genotyping errors peaked at 25.6% in the first 2015-2016 scheme but subsequently dropped to below 5%. Interpretation and clerical accuracy scores have been consistently good throughout. Within this EQA scheme, we have observed that the quality of molecular analysis for colorectal cancer has continued to improve, despite changes in the required targets, the volume of testing and the technologies employed. It is reassuring to know that laboratories clearly recognise the importance of participating in EQA schemes.

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.

External quality measurements reveal internal processes

NARCIS (Netherlands)

Schouten, R.E.; Costa, J.M.; Kooten, van O.

2003-01-01

With the present developments in CA technology it becomes possible to fine tune the storage conditions to the specific needs of the product. This generates the need to know the exact quality conditions of the product before storage starts. By measuring the initial quality we can determine these

External quality assurance of malaria nucleic acid testing for clinical trials and eradication surveillance.

Directory of Open Access Journals (Sweden)

Sean C Murphy

Full Text Available Nucleic acid testing (NAT for malaria parasites is an increasingly recommended diagnostic endpoint in clinical trials of vaccine and drug candidates and is also important in surveillance of malaria control and elimination efforts. A variety of reported NAT assays have been described, yet no formal external quality assurance (EQA program provides validation for the assays in use. Here, we report results of an EQA exercise for malaria NAT assays. Among five centers conducting controlled human malaria infection trials, all centers achieved 100% specificity and demonstrated limits of detection consistent with each laboratory's pre-stated expectations. Quantitative bias of reported results compared to expected results was generally <0.5 log10 parasites/mL except for one laboratory where the EQA effort identified likely reasons for a general quantitative shift. The within-laboratory variation for all assays was low at <10% coefficient of variation across a range of parasite densities. Based on this study, we propose to create a Molecular Malaria Quality Assessment program that fulfills the need for EQA of malaria NAT assays worldwide.

Pilot Quality Control Program for Audit RT External Beams at Mexican Hospitals

International Nuclear Information System (INIS)

Alvarez R, J T; Tovar M, V M

2008-01-01

A pilot quality control program for audit 18 radiotherapy RT external beams at 13 Mexican hospitals is described--for eleven 60 Co beams and seven photon beams of 6, 10 and 15 MV from accelerators. This program contains five parts: a) Preparation of the TLD-100 powder: washing, drying and annealing (one hour 400 deg. C plus 24 hrs 80 deg. C). b) Sending two IAEA type capsules to the hospitals for irradiation at the hospital to a nominal D W = 2 Gy·c) Preparation at the SSDL of ten calibration curves CC in the range of 0.5 Gy to 6 Gy in terms of absorbed dose to water D W for 60 Co with traceability to primary laboratory NRC (Canada), according to a window irradiation: 26/10/2007-7/12/2007. d) Reading all capsules that match their hospital time irradiation and the SSDL window irradiation. f) Evaluation of the Dw imparted by the hospitals

Pilot Quality Control Program for Audit RT External Beams at Mexican Hospitals

Science.gov (United States)

Álvarez R., J. T.; Tovar M., V. M.

2008-08-01

A pilot quality control program for audit 18 radiotherapy RT external beams at 13 Mexican hospitals is described—for eleven 60 Co beams and seven photon beams of 6, 10 and 15 MV from accelerators. This program contains five parts: a) Preparation of the TLD-100 powder: washing, drying and annealing (one hour 400 °C plus 24 hrs 80 °C). b) Sending two IAEA type capsules to the hospitals for irradiation at the hospital to a nominal DW = 2 Gy ṡ c ) Preparation at the SSDL of ten calibration curves CC in the range of 0.5 Gy to 6 Gy in terms of absorbed dose to water DW for 60 Co with traceability to primary laboratory NRC (Canada), according to a window irradiation: 26/10/2007-7/12/2007. d) Reading all capsules that match their hospital time irradiation and the SSDL window irradiation. f) Evaluation of the Dw imparted by the hospitals.

Digital versus traditional: are diagnostic accuracy rates similar for glass slides versus whole slide images in a non-gynaecological external quality assurance setting?

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Ross, Jennifer; Greaves, Janelle; Earls, Peter; Shulruf, Boaz; Van Es, Simone L

2018-04-17

The Royal College of Pathologists of Australasia Quality Assurance Programs introduced virtual microscopy cases into its cytopathology non-gynaecological program after a short pilot phase, to address the challenges of providing a purely glass slide-based external quality assurance program to multiple participants both locally and internationally. The use of whole slide image (WSI) cases has facilitated a more robust program in relation to standardised material and statistical analysis, with access to a wider variety of specimen types and diagnostic entities. Diagnostic accuracy rates on 56 WSI were assessed against the reference diagnosis. A portion (12) of these WSI slides had been used in glass slide format in previous EQA surveys, and the results of these were compared to the responses received as glass slide cases. Overall diagnostic accuracy for the 56 WSI cases was acceptable in comparison to the reference diagnosis. When these 12 cases were analysed individually, for seven of the twelve cases, virtual format was found to be not inferior to glass slides for diagnostic accuracy. For one case, accuracy using WSI for diagnosis was superior to glass format. Diagnostic accuracy, using WSI for cases in our external quality assurance program is acceptable. As the use of digital microscopy in a large scale external quality assurance program (eQAP) offers extensive advantages over a glass slide-based format, our results encourage future comparison of diagnostic accuracy for virtual compared to glass slide format at a point in time where pathologists are becoming increasingly familiar with virtual microscopy in everyday practice. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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

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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 (plaboratories 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 (plaboratories remains relatively unsatisfactory. It is important that the Ministry of Health put in place a national program of EQA with mandatory participation.

External quality control assessment of thyroid related hormones in India. Final report for the period 1 December 1983 - 31 January 1988

International Nuclear Information System (INIS)

Shah, D.H.; Kumar, A.; Rajan, M.G.R.; Thakare, U.R.; Sharma, S.M.

1989-11-01

An external quality assessment scheme for thyroid related hormones was undertaken to assess the performance of various laboratories in India. The programme was conducted in two phases. The report summarizes the findings obtained on performances of the laboratories for radioimmunoassay of thyroid related hormones over the two phases. Figs and tabs

[External quality control system in medical microbiology and parasitology in the Czech Republic].

Science.gov (United States)

Slosárek, M; Petrás, P; Kríz, B

2004-11-01

The External Quality Control System (EQAS) of laboratory activities in medical microbiology and parasitology was implemented in the Czech Republic in 1993 with coded sera samples for diagnosis of viral hepatitis and bacterial strains for identification distributed to first participating laboratories. The number of sample types reached 31 in 2003 and the number of participating laboratories rised from 79 in 1993 to 421 in 2003. As many as 15.130 samples were distributed to the participating laboratories in 2003. Currently, almost all microbiology and parasitology laboratories in the Czech Republic involved in examination of clinical material participate in the EQAS. Based on the 11-year experience gained with the EQAS in the Czech Republic, the following benefits were observed: higher accuracy of results in different tests, standardisation of methods and the use of most suitable test kits.

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.

[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 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.

EFFECT OF EXTERNAL ENVIRONMENT ORGANIZATION AND APPLICATION OF TOTAL QUALITY MANAGEMENT (TQM AND PERFORMANCE OF THE COMPANY AND ITS EFFECT ON COMPETITIVE ADVANTAGE IN PTISM BOGASARI FLOURMILLS, JAKARTA

Directory of Open Access Journals (Sweden)

Ana Retno Mawarti

2016-04-01

Full Text Available This research aimed to discover the impact of external environment and Total Quality Management implementation on company performance in order to create competitive advantage in PT. ISM Bogasari Flourmills. This research is an associative explanatory research with quantitative method. The data sources used are primary data and secondary data. The primary data collected by spreading 122 questionnaires to employees of PT. ISM Bogasari on chief officers level, assistant manager level, and manager level. Sampling method used is Proportion able Stratified Random Sampling. The result showed that external environment with indicator of complexity, dynamics and environment carrying capacity, has positive and significant impact on company’s performance. Total Quality Management implementation with indicators of costumer focus, continuous refinement and staff training program, brings positive and significant impact on company’s performance. The company’s performance with its indicators of efficiency, effectiveness, and adaptability, has positive and significant impact on the creation of competitive advantage. The Research also proved that external environment and Total Quality Management Implementation directly affect the creation of competitive advantage.

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.

Three Rounds of External Quality Assessment in France to Evaluate the Performance of 28 Platforms for Multiparametric Molecular Testing in Metastatic Colorectal and Non-Small Cell Lung Cancer

NARCIS (Netherlands)

Dequeker, E.M.; Keppens, C.; Egele, C.; Delen, S.; Lamy, A.; Lemoine, A.; Sabourin, J.C.; Andrieu, C.; Ligtenberg, M.; Fetique, D.; Tops, B.; Descarpentries, C.; Blons, H.; Denoux, Y.; Aube, C.; Penault-Llorca, F.; Hofman, P.; Leroy, K.; Marechal, C. Le; Doucet, L.; Duranton-Tanneur, V.; Pedeutour, F.; Soubeyran, I.; Cote, J.F.; Emile, J.F.; Vignaud, J.M.; Monhoven, N.; Haddad, V.; Laurent-Puig, P.; Krieken, H. van; Nowak, F.; Lonchamp, E.; Bellocq, J.P.; Rouleau, E.

2016-01-01

Personalized medicine has gained increasing importance in clinical oncology, and several clinically important biomarkers are implemented in routine practice. In an effort to guarantee high quality of molecular testing in France, three subsequent external quality assessment rounds were organized at

An examination of the hexokinase method for serum glucose assay using external quality assessment data.

Science.gov (United States)

Westwood, A; Bullock, D G; Whitehead, T P

1986-01-01

Hexokinase methods for serum glucose assay appeared to give slightly but consistently higher inter-laboratory coefficients of variation than all methods combined in the UK External Quality Assessment Scheme; their performance over a two-year period was therefore compared with that for three groups of glucose oxidase methods. This assessment showed no intrinsic inferiority in the hexokinase method. The greater variation may be due to the more heterogeneous group of instruments, particularly discrete analysers, on which the method is used. The Beckman Glucose Analyzer and Astra group (using a glucose oxidase method) showed the least inter-laboratory variability but also the lowest mean value. No comment is offered on the absolute accuracy of any of the methods.

Effect of External Quality Assurance Evaluation for Chest Radiography: 3-Year Follow-Up in the Medical Institution for Pneumoconiosis

International Nuclear Information System (INIS)

Lee, Won Jeong; Choi, Soon Byung

2012-01-01

The aim of this study was to determine the effect of external quality assurance (QA) evaluation for chest radiography in the medical institution for pneumoconiosis (MIP). The chest radiography of the MIPs were evaluated for a radiological technique (RT), image quality (IQ), and reading environment (RE), during a 3-year follow up according to the Korean guidelines. Same methods were implemented each year to ensure that the results are reliable. RT, IQ, and RE were compared between examination and medical care (EMP), and only medical care (MCP) for pneumoconiosis, film-screen (FSR) and digital (DR) radiography. Uneducated and educated for QA during a 3-year follow up referencing with 2008 were realized. RT and IQ of the MIPs showed a significantly higher score in 2009 and 2010 compared with 2008 (p < 0.01). However, RE was not significantly improved. The score of RT, IQ, and RE of the EMPs were higher than those of MCPs every year, and FSR showed a lower score in all evaluations, although, more improvement was seen than the DR. The chest radiography of the MIPs showed a significant effect as a result of a repeated external QA evaluation. However, the MIPs need to transfer from FSR to DR, and maintain a continuous QA evaluation for the MCPs.

Effects of thermosonication on the fate of Escherichia coli O157:H7 and Salmonella Enteritidis in mango juice.

Science.gov (United States)

Kiang, W-S; Bhat, R; Rosma, A; Cheng, L-H

2013-04-01

In this study, the effects of thermosonication and thermal treatment on Escherichia coli O157:H7 and Salmonella Enteritidis in mango juice were investigated at 50 and 60°C. Besides, nonlethal injury of Salm. Enteritidis after both treatments was also examined. The highest inactivation was attained with thermosonication at 60°C. The inactivation rate was different for both pathogens, and Salm. Enteritidis was found to be more sensitive to thermosonication than E. coli O157:H7. Salmonella Enteritidis was recovered in all treated samples, except those subjected to more than 5-min thermosonication at 60°C. It was found that the introduction of high-intensity ultrasound enhanced the inactivation of pathogens compared to thermal treatment alone. On the other hand, Salm. Enteritidis was detected in a number of samples following incubation in universal pre-enrichment broth, but no growth was detected after incubation in mango juice. Fruit juices are commonly heat treated to inactivate micro-organisms and enzymes. However, excessive heat treatments may result in undesirable changes in juice quality. Treatment by power ultrasound, a nonthermal technology, may be an alternative processing technique to pasteurize fruit juices. This study highlights the effectiveness of thermosonication in inactivating Escherichia coli O157:H7 and Salmonella Enteritidis in mango juice. © 2012 The Society for Applied Microbiology.

ExternE: Externalities of energy Vol. 4. Oil and gas

International Nuclear Information System (INIS)

Friedrich, R.; Krewitt, W.; Mayerhofer, P.

1995-01-01

Awareness of the environmental damage resulting from human activity, particularly commencing energy use, has grown greatly in recent years. Effects such as global warming, ozone depletion and acid rain are now the subjects of much research and public debate. It is now known that these and other effects damage a wide range of receptors, including human health, forests, crops, freshwater ecosystems and buildings. Such damages are typically not accounted for by the producers and consumers of the good in question (in this case energy). They are thus referred to as 'external costs' or 'externalities', to distinguish them from the private costs which account for the construction of plant, cost of fuel, wages, etc. In recent years there has been a growing interest in the assessment of the environmental and health impacts of energy, and the related external costs. This concern is driven by a number of different factors: the need to integrate environmental concerns in decision making over the choice between different fuels and energy technologies; the need to evaluate the costs and benefits of stricter environmental standards; increased attention to the use of economic instruments for environmental policy, the need to develop overall indicators of environmental performance of different technologies; major changes in the energy sector, including privatisation, liberalisation of markets, reduction of subsidies, etc. An agreed methodology for calculation and integration of external costs has not been established. Earlier work is typically of a preliminary nature and tends to be deficient with respect to both the methods employed and the quality of models and data used. In consequence of this a collaborative project, the EC/US Fuel Cycles Study, was established between Directorate General XLI (Science, Research and Technology) of the European Commission and the United States Department of Energy. This ran for the period 1991 to 1993, and good agreement on a variety of

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…

Sex Work as an Emerging Risk Factor for Human Immunodeficiency Virus Seroconversion Among People who Inject Drugs in the SurvUDI Network.

Science.gov (United States)

Blouin, Karine; Leclerc, Pascale; Morissette, Carole; Roy, Élise; Blanchette, Caty; Parent, Raymond; Serhir, Bouchra; Alary, Michel

2016-10-01

Recent analyses have shown an emerging positive association between sex work and human immunodeficiency virus (HIV) incidence among people who inject drugs (PWIDs) in the SurvUDI network. Participants who had injected in the past 6 months were recruited across the Province of Quebec and in the city of Ottawa, mainly in harm reduction programs. They completed a questionnaire and provided gingival exudate for HIV antibody testing. The associations with HIV seroconversion were tested with a Cox proportional hazard model using time-dependent covariables including the main variable of interest, sexual activity (sex work; no sex work; sexually inactive). The final model included significant variables and confounders of the associations with sexual activity. Seventy-two HIV seroconversions were observed during 5239.2 person-years (py) of follow-up (incidence rates: total = 1.4/100 py; 95% confidence interval [CI], 1.1-1.7; sex work = 2.5/100 py; 95% CI, 1.5-3.6; no sex work = 0.8/100 py; 95% CI, 0.5-1.2; sexually inactive = 1.8/100 py; 95% CI, 1.1-2.5). In the final multivariate model, HIV incidence was significantly associated with sexual activity (sex work: adjusted hazard ratio [AHR], 2.19; 95% CI, 1.13-4.25; sexually inactive: AHR, 1.62; 95% CI, 0.92-2.88), and injection with a needle/syringe used by someone else (AHR, 2.84; 95% CI, 1.73-4.66). Sex work is independently associated with HIV incidence among PWIDs. At the other end of the spectrum of sexual activity, sexually inactive PWIDs have a higher HIV incidence rate, likely due to more profound dependence leading to increased vulnerabilities, which may include mental illness, poverty, and social exclusion. Further studies are needed to understand whether the association between sex work and HIV is related to sexual transmission or other vulnerability factors.

Reproducibility of cervical cytopathology following an intervention by an external quality control laboratory.

Science.gov (United States)

Ázara, Cinara Zago Silveira; Manrique, Edna Joana Claudio; Tavares, Suelene Brito do Nascimento; Alves de Souza, Nadja Lindany; Magalhães, Juliana Cristina; Amaral, Rita Goreti

2016-04-01

This study assessed the effects of a continued education program on the agreement between cervical cytopathology exams interpreted by local laboratories and interpretation made by an external quality control laboratory (LabMEQ). Overall, 9,798 exams were analyzed between 2007 and 2008, prior to implementation of a continued education program, and 10,028 between 2010 and 2011, following implementation. Continued education consisted of theoretical and practical classes held every two months. The chi-square test and the kappa coefficient were used in the statistical analysis. Following implementation of continued education, the rate of false-negative results, and those leading to delays in clinical management fell in eight laboratories and the rate of false-positive results in five. Agreement between the results reported by the laboratories and the findings of LabMEQ, evaluated according to clinical management, remained excellent in three laboratories (kappa >0.80 and 0.60 and clinical management. © 2016 Wiley Periodicals, Inc.

A pilot evaluation of external quality assessment of GenoType MTBDRplus versions 1 and 2 using dried culture spot material.

Science.gov (United States)

Gous, N; Isherwood, L E; David, A; Stevens, W; Scott, L E

2015-04-01

Dried culture spots (DCS) of inactivated Mycobacteria strains designed as part of an external quality assessment (EQA) program for the GeneXpert system has applications to other molecular tuberculosis (TB) diagnostic platforms. DCS tested on the GenoType MTBDRplus and Mycobacterium CM assays performed well with MTBDRplus version 2 but require increased bacterial concentration for use with version 1. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators.

Science.gov (United States)

Fernando, Shannon M; Vaillancourt, Christian; Morrow, Stanley; Stiell, Ian G

2018-07-01

Little is known regarding the quality of cardiopulmonary resuscitation (CPR) performed by bystanders in out-of-hospital cardiac arrest (OHCA). We sought to determine quality of bystander CPR provided during OHCA using CPR quality data stored by Automated External Defibrillators (AEDs). We used the Resuscitation Outcomes Consortium database to identify OHCA cases of presumed cardiac etiology where an AED was utilized. We then matched AED data to each case identified. AED data was analyzed using manufacturer software in order to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and adherence to existing 2010 Resuscitation Quality Guidelines. 100 cases of OHCA of presumed cardiac etiology involving bystander CPR and with corresponding AED data. Mean age was 62.3 years, and 75% were male. Bystanders demonstrated high-quality CPR over all minutes of resuscitation, with a chest compression fraction of 76%, a compression depth of 5.3 cm, and a compression rate of 111.2 compressions/min. Mean perishock pause was 26.8 s. Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were found to be 66% and 55%, respectively. CPR quality was lowest in the first minute, resulting from increased delay to rhythm analysis (mean 40.7 s). In cases involving shock delivery, latency from initiation of AED to shock delivery was 59.2 s. We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. High-quality CPR is maintained over the first five minutes of resuscitation, but was lowest in the first minute. Copyright © 2018 Elsevier B.V. All rights reserved.

Automatic analysis of image quality control for Image Guided Radiation Therapy (IGRT) devices in external radiotherapy

International Nuclear Information System (INIS)

Torfeh, Tarraf

2009-01-01

On-board imagers mounted on a radiotherapy treatment machine are very effective devices that improve the geometric accuracy of radiation delivery. However, a precise and regular quality control program is required in order to achieve this objective. Our purpose consisted of developing software tools dedicated to an automatic image quality control of IGRT devices used in external radiotherapy: 2D-MV mode for measuring patient position during the treatment using high energy images, 2D-kV mode (low energy images) and 3D Cone Beam Computed Tomography (CBCT) MV or kV mode, used for patient positioning before treatment. Automated analysis of the Winston and Lutz test was also proposed. This test is used for the evaluation of the mechanical aspects of treatment machines on which additional constraints are carried out due to the on-board imagers additional weights. Finally, a technique of generating digital phantoms in order to assess the performance of the proposed software tools is described. Software tools dedicated to an automatic quality control of IGRT devices allow reducing by a factor of 100 the time spent by the medical physics team to analyze the results of controls while improving their accuracy by using objective and reproducible analysis and offering traceability through generating automatic monitoring reports and statistical studies. (author) [fr

Social Ontology Documentation for Knowledge Externalization

Science.gov (United States)

Aranda-Corral, Gonzalo A.; Borrego-Díaz, Joaquín; Jiménez-Mavillard, Antonio

Knowledge externalization and organization is a major challenge that companies must face. Also, they have to ask whether is possible to enhance its management. Mechanical processing of information represents a chance to carry out these tasks, as well as to turn intangible knowledge assets into real assets. Machine-readable knowledge provides a basis to enhance knowledge management. A promising approach is the empowering of Knowledge Externalization by the community (users, employees). In this paper, a social semantic tool (called OntoxicWiki) for enhancing the quality of knowledge is presented.

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...

External built residential environment characteristics that affect mental health of adults.

Science.gov (United States)

Ochodo, Charles; Ndetei, D M; Moturi, W N; Otieno, J O

2014-10-01

External built residential environment characteristics include aspects of building design such as types of walls, doors and windows, green spaces, density of houses per unit area, and waste disposal facilities. Neighborhoods that are characterized by poor quality external built environment can contribute to psychosocial stress and increase the likelihood of mental health disorders. This study investigated the relationship between characteristics of external built residential environment and mental health disorders in selected residences of Nakuru Municipality, Kenya. External built residential environment characteristics were investigated for 544 residents living in different residential areas that were categorized by their socioeconomic status. Medically validated interview schedules were used to determine mental health of residents in the respective neighborhoods. The relationship between characteristics of the external built residential environment and mental health of residents was determined by multivariable logistic regression analyses and chi-square tests. The results show that walling materials used on buildings, density of dwelling units, state of street lighting, types of doors, states of roofs, and states of windows are some built external residential environment characteristics that affect mental health of adult males and females. Urban residential areas that are characterized by poor quality external built environment substantially expose the population to daily stressors and inconveniences that increase the likelihood of developing mental health disorders.

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.

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...

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.

Poor quality of external validity reporting limits generalizability of overweight and/or obesity lifestyle prevention interventions in young adults: a systematic review.

Science.gov (United States)

Partridge, S R; Juan, S J-H; McGeechan, K; Bauman, A; Allman-Farinelli, M

2015-01-01

Young adulthood is a high-risk life stage for weight gain. Evidence is needed to translate behavioural approaches into community practice to prevent weight gain in young adults. This systematic review assessed the effectiveness and reporting of external validity components in prevention interventions. The search was limited to randomized controlled trial (RCT) lifestyle interventions for the prevention of weight gain in young adults (18-35 years). Mean body weight and/or body mass index (BMI) change were the primary outcomes. External validity, quality assessment and risk of bias tools were applied to all studies. Twenty-one RCTs were identified through 14 major electronic databases. Over half of the studies were effective in the short term for significantly reducing body weight and/or BMI; however, few showed long-term maintenance. All studies lacked full reporting on external validity components. Description of the intervention components and participant attrition rates were reported by most studies. However, few studies reported the representativeness of participants, effectiveness of recruitment methods, process evaluation detail or costs. It is unclear from the information reported how to implement the interventions into community practice. Integrated reporting of intervention effectiveness and enhanced reporting of external validity components are needed for the translation and potential upscale of prevention strategies. © 2014 World Obesity.

The Effect of Landuse and Other External Factors on Water Quality Within two Creeks in Northern Kentucky

Science.gov (United States)

Boateng, S.

2006-05-01

The purpose of this study was to monitor the water quality in two creeks in Northern Kentucky. These are the Banklick Creek in Kenton County and the Woolper Creek in Boone County, Kentucky. The objective was to evaluate the effect of landuse and other external factors on surface water quality. Landuse within the Banklick watershed is industrial, forest and residential (urban) whereas that of Woolper Creek is agricultural and residential (rural). Two testing sites were selected along the Banklick Creek; one site was upstream the confluence with an overflow stream from an adjacent lake; the second site was downstream the confluence. Most of the drainage into the lake is over a near-by industrial park and the urban residential areas of the cities of Elsmere and Erlanger, Kentucky. Four sampling locations were selected within the Woolper Creek watershed to evaluate the effect of channelization and subsequent sedimentation on the health of the creek. Water quality parameters tested for include dissolved oxygen, phosphates, chlorophyll, total suspended sediments (TSS), pH, oxidation reduction potential (ORP), nitrates, and electrical conductivity. Sampling and testing were conducted weekly and also immediately after storm events that occurred before the regular sampling dates. Sampling and testing proceeded over a period of 29 weeks. Biological impact was determined, only in Woolper Creek watershed, by sampling benthic macroinvertebrates once every four weeks. The results showed significant differences in the water quality between the two sites within the Banklick Creek. The water quality may be affected by the stream overflow from the dammed lake. Also, channelization in the Woolper Creek seemed to have adverse effects on the water quality. A retention pond, constructed to prevent sediments from flowing into the Woolper Creek, did not seem to be effective. This is because the water quality downstream of the retention pond was significantly worse than that of the

Variation in Adherence to External Beam Radiotherapy Quality Measures Among Elderly Men With Localized Prostate Cancer

International Nuclear Information System (INIS)

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

2007-01-01

Purpose: 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. Methods and Materials: We evaluated EBRT quality measures proposed by a RAND expert panel of physicians among men aged ≥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. Results: 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. Conclusions: 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

Real-Time Autonomous Obstacle Avoidance for Low-Altitude Fixed-Wing Aircraft

Science.gov (United States)

Owlia, Shahboddin

The GeoSurv II is an Unmanned Aerial Vehicle (UAV) being developed by Carleton University and Sander Geophysics. This thesis is in support of the GeoSurv II project. The objective of the GeoSurv II project is to create a fully autonomous UAV capable of performing geophysical surveys. In order to achieve this level of autonomy, the UAV, which due to the nature of its surveys flies at low altitude, must be able to avoid potential obstacles such as trees, powerlines, telecommunication towers, etc. Developing a method to avoid these obstacles is the objective of this thesis. The literature is rich in methods for trajectory planning and mid-air collision avoidance with other aircraft. In contrast, in this thesis, a method for avoiding static obstacles that are not known a priori is developed. The potential flow theory and panel method are borrowed from fluid mechanics and are employed to generate evasive maneuvers when obstacles are encountered. By means of appropriate modelling of obstacles, the aircraft's constraints are taken into account such that the evasive maneuvers are feasible for the UAV. Moreover, the method is developed with consideration of the limitations of obstacle detection in GeoSurv II. Due to the unavailability of the GeoSurv II aircraft, and the lack of a complete model for GeoSurv II, the method developed is implemented on the non-linear model of the Aerosonde UAV. The Aerosonde model is then subjected to various obstacle scenarios and it is seen that the UAV successfully avoids the obstacles.

Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study

DEFF Research Database (Denmark)

Briggs, A; Glick, H; Lozano-Ortega, G

2009-01-01

regions, 3-yr all-cause hospitalisation, medication and outpatient care costs were calculated. The sample was restricted to the 21 countries (n = 4,237) in which European quality of life five-dimension (EQ-5D) data were collected in order to estimate the number of quality-adjusted life years (QALYs...... in Western Europe. Compared with P, SFC has a lower incremental cost-effectiveness ratio than either FP or Salm used alone, and is, therefore, preferred to these monotherapies on the grounds of cost-effectiveness....

Externalities of energy. Swedish implementation of the ExternE methodology

International Nuclear Information System (INIS)

Nilsson, Maans; Gullberg, M.

1998-01-01

The growing interest for developing economic instruments for efficient environmental policies has opened up a large area of multi-disciplinary research. ExternE is an example of this research, combining disciplines such as engineering, ecology, immunology and economics expertise to create new knowledge about how environmental pressures from energy production affect our nature and society. The ExternE Project aims to identify and, as far as possible quantify the externalities of energy production in Europe. The Stockholm Environment Institute has carried out a preliminary aggregation: -Coal Fuel Cycle: centred around Vaesteraas Kraftvaermeverk, Vaesteraas. This is the largest co-generation plant in Sweden, with four blocks and a maximum co-generation output of 520 MW electricity and 950 MW heat. The analysis is carried out on boiler B4. -Biomass Fuel Cycle: centred around Haendeloeverket, Norrkoeping. This plant predominately burns forestry residues, but a variety of fuels are combusted. Haendeloeverket has an installed capacity of 100 MW electricity and 375 MW heat, in a total of three boilers and two back-pressure turbines. The analysis is carried out on boiler P13. -Hydro Fuel Cycle: Klippens Kraftstation, Storuman. Built in 1990-1994, it is the youngest hydro power station in Sweden. It has been designed and built with significant efforts to account for and protect environmental values. Installed capacity is 28 MW. The environmental impact assessment from the construction of this plant is carried out, but the evaluation is still not finalized. The preliminary aggregation aimed to test whether ExternE results could be used to make estimates for the entire Swedish electricity production system. Hence, national results as well as results from other partner countries in ExternE has been applied

Point-of-care urine albumin in general practice offices: effect of participation in an external quality assurance scheme.

Science.gov (United States)

Bukve, Tone; Røraas, Thomas; Riksheim, Berit Oddny; Christensen, Nina Gade; Sandberg, Sverre

2015-01-01

The Norwegian Quality Improvement of Primary Care Laboratories (Noklus) offers external quality assurance (EQA) schemes (EQASs) for urine albumin (UA) annually. This study analyzed the EQA results to determine how the analytical quality of UA analysis in general practice (GP) offices developed between 1998 (n=473) and 2012 (n=1160). Two EQA urine samples were distributed yearly to the participants by mail. The participants measured the UA of each sample and returned the results together with information about their instrument, the profession and number of employees at the office, frequency of internal quality control (IQC), and number of analyses per month. In the feedback report, they received an assessment of their analytical performance. The number of years that the GP office had participated in Noklus was inversely related to the percentage of "poor" results for quantitative but not semiquantitative instruments. The analytical quality improved for participants using quantitative instruments who received an initial assessment of "poor" and who subsequently changed their instrument. Participants using reagents that had expired or were within 3 months of the expiration date performed worse than those using reagents that were expiring in more than 3 months. Continuous participation in the Noklus program improved the performance of quantitative UA analyses at GP offices. This is probably in part attributable to the complete Noklus quality system, whereby in addition to participating in EQAS, participants are visited by laboratory consultants who examine their procedures and provide practical advice and education regarding the use of different instruments.

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.

Performance of External Quality Control Reviews by Military Department Audit Agencies

National Research Council Canada - National Science Library

Berry, Wayne

2000-01-01

The Government auditing standards issued by the Comptroller General of the United States require organizations conducting audits in accordance with Government auditing standards to undergo an external...

Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer

International Nuclear Information System (INIS)

Morton, Gerard C.; Loblaw, D. Andrew; Chung, Hans; Tsang, Gail; Sankreacha, Raxa; Deabreu, Andrea; Zhang Liying; Mamedov, Alexandre; Cheung, Patrick; Batchelar, Deidre; Danjoux, Cyril; Szumacher, Ewa

2011-01-01

Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose

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......The European Commission has launched a major study project, ExternE, to develop a methodology to quantify externalities. A “National Implementation Phase”, was started under the Joule II programme with the purpose of implementing the ExternE methodology in all member states. The main objective...

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.

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.)

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.)

ExternE National Implementation Finland

International Nuclear Information System (INIS)

Pingoud, K.; Maelkki, H.; Wihersaari, M.; Pirilae, P.; Hongisto, M.; Siitonen, S.; Johansson, M.

1999-01-01

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.)

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

Determinants of External Debt: The Case of Malaysia

OpenAIRE

Rafik, Rabiatul Adawiyah Mohamed

2015-01-01

Over the past 30 years, Malaysia‘s external debt has been on an increase, with the increase closely linked to a number of economic factors. The changing quantities and qualities of external debt have become a national concern. Data related to the changes in dependent and independent variables between 1970 and 2013 was used in the study. The model was tested for unit root tests, cointegration test, vector error correction model, and Granger causality test. The cointegration test indicates ther...

Externalities - an analysis using the EU ExternE-results

International Nuclear Information System (INIS)

2003-10-01

The EU project ExternE quantified the externalities for the different energy technologies. In this work, the ExternE results are used in a MARKAL-analysis for the Nordic countries. The analysis does not go into detail, but gives some interesting indications: The external costs are not fully covered in the Nordic energy systems, the present taxes and charges are not high enough. The emissions from the energy systems would be strongly reduced, if taxes/environmental charges were set at the level ExternE calculate. The emissions from power production would be reduced most. Renewable energy sources and natural gas dominate the energy systems in the ExternE case

ExternE: Externalities of energy Vol. 1. Summary

International Nuclear Information System (INIS)

Holland, M.; Berry, J.

1995-01-01

There is a growing requirement for policy analysts to take account of the environment in their decision making and to undertake the specified cost-benefit analysis. Within the European Union this is reflected in the 5th Environmental Action Programme, and the Commission's White Paper entitled 'Growth, competitiveness, employment and the ways forward to the 21st century'. This has led to a need for evaluation of environmental externalities. The ExternE Project commenced in 1991 as the European part of a collaborative study between the European Commission and the US Department of Energy. It aims to be the first systematic approach to the evaluation of external costs of a wide range of different fuel cycles. The project will result in an operational accounting framework for the quantification and monetarisation of priority environmental and other externalities. This framework will allow the calculation of the marginal external costs and benefits for specific power plants, at specific sites using specified technologies. There are three major phases in the project. Phase 1 was undertaken in collaboration with the US Department of Energy. In this phase the teams jointly developed the conceptual approach and methodology and shared scientific information for application to a number of fuel cycles. On the European side work concentrated on the nuclear and coal fuel cycles which together were expected to raise many of the fundamental issues in fuel cycle analysis. The project is currently nearing completion of Phase 2. During this phase the methodology has been applied to a wide range of different fossil, nuclear and renewable fuel cycles for power generation and energy conservation options. Also a series of National Implementation Programmes is underway in which the methodology and accounting framework are being applied to reference sites throughout Europe. In addition the general methodology is being extended to address the evaluation of externalities associated with

ExternE: Externalities of energy Vol. 2. Methodology

International Nuclear Information System (INIS)

Berry, J.; Holland, M.; Watkiss, P.

1995-01-01

This report describes the methodology used by the ExternE Project of the European Commission (DGXII) JOULE Programme for assessment of the external costs of energy. It is one of a series of reports describing analysis of nuclear, fossil and renewable fuel cycles for assessment of the externalities associated with electricity generation. Part I of the report deals with analysis of impacts, and Part II with the economic valuation of those impacts. Analysis is conducted on a marginal basis, to allow the effect of an incremental investment in a given technology to be quantified. Attention has been paid to the specificity of results with respect to the location of fuel cycle activities, the precise technologies used, and the type and source of fuel. The main advantages of this detailed approach are as follows: It takes full and proper account of the variability of impacts that might result from different power projects; It is more transparent than analysis based on hypothetically 'representative' cases for each of the different fuel cycles; It provides a framework for consistent comparison between fuel cycles. A wide variety of impacts have been considered. These include the effects of air pollution on the natural and human environment, consequences of accidents in the workplace, impacts of noise and visual intrusion on amenity, and the effects of climate change arising from the release of greenhouse gases. Wherever possible we have used the 'impact pathway' or 'damage function' approach to follow the analysis from identification of burdens (e.g. emissions) through to impact assessment and then valuation in monetary terms. This has required a detailed knowledge of the technologies involved, pollutant dispersion, analysis of effects on human and environmental health, and economics. In view of this the project brought together a multi-disciplinary team with experts from many European countries and the USA. The spatial and temporal ranges considered in the analysis are

[Quality management in intensive care medicine].

Science.gov (United States)

Martin, J; Braun, J-P

2013-09-01

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

COOPERATION AND COORDINATION BETWEEN INTERNAL AND EXTERNAL AUDITING

Directory of Open Access Journals (Sweden)

DIANA DUMITRESCU

2016-02-01

Full Text Available Between external and internal auditors it is necessary to be a good cooperation and coordination; both professionals have to be involved in building a good working relationship. Objectives of the external and internal auditors are different from the company point of view, but in the achievement of the specific goals, there are interactions and work cooperation. If the internal auditors work together with the external auditors the results will be an increasing of the quality and the effectiveness of the organization`s systems and activities. If the external auditors work together with the internal auditors will result a decreasing of the amount of the testing they do, and as consequences’ a reducing of the fees. Because there are many benefits of the cooperation between external and internal auditing it is important to find out how could be coordinated these two professional activities. This study has the purpose to examine the most important provisions that promote such kind of cooperation and work like necessary tools for coordination and to identify the Romanian`s internal and external auditors perceptions regarding that cooperation and coordination. The objective of the study is to identify the nature of the relationship between the internal audit function and the organizations’ external auditors regarding their interactions and their cooperation.

Laboratory Performance Evaluation in Terms of Water Analysis Through an External Quality Control

International Nuclear Information System (INIS)

Rakotozafy, L.V.; Ramaherison, H.; Andriamahenina, N.J.; Rasoazanany, E.O.; Ravoson, H.N.; Raoelina Andriambololona

2015-01-01

This paper presents the results of participation of Institut National des Sciences et Techniques Nucleaires-Madagascar (INSTN-Madagascar) in interlaboratory comparisons organized annually, since 2007, by Southern African Development Community WaterLab Association. The following text describes an overview of the utility of provided proficiency testing programs used as an external quality control with respect to proving consistency and reliability of water analysis at INSTN-Madagascar. Total reflection X-Ray Fluorescence spectrometry and Atomic Absorption Spectrometry are both used to measure the following trace metals: Al, Cr, Mn, Fe, Ni, Co, Cu, Zn, As, Cd, Pb. The analysis of minor and major ions such as Cl - , F - , NO 3 - , SO 4 2- , PO 4 3- ,K + , Na + , Ca 2+ , Mg 2+ are conducted by using Ion Chromatography. To illustrate, graphical distributions of z-scores calculated from the results of water measurements are presented. During the consecutive proficiency testing rounds, INSTN-Madagascar has succeeded to have more than 80% of the values within tolerance limits on 2007, 2008, 2010, 2011, 2012 and 2013. This paper shows some of the considerations for participating to proficiency testing exercises which could be used to obtain certain value from the schemes.

Sequential acquisition of R-plasmids in vivo by Salmonella typhimurium.

Science.gov (United States)

Platt, D J; Sommerville, J S; Gribben, J

1984-01-01

Salmonella typhimurium, resistant only to trimethoprim and sulphamethoxazole, was isolated from the faeces and blood of a chronic alcoholic patient in acute renal failure. The isolates harboured an 18 Md non-conjugative plasmid. He was dialysed peritoneally and treated with ampicillin; four days later there was no clinical improvement and his peritoneal dialysis fluid (PDF) had become infected. Salm. typhimurium was isolated from faeces and PDF. Both isolates were additionally resistant to ampicillin and contained two plasmids (55 Md and 18 Md). Therapy was changed to chloramphenicol and gentamicin was added to the PDF. Two weeks later Salm. typhimurium was again isolated from PDF and faeces. The PDF isolate was unchanged but 4% of the colonies isolated from this faecal specimen were resistant to chloramphenicol and had acquired an additional 62 Md plasmid. From all PDF and faecal specimens two different strains of Escherichia coli and one strain of Klebsiella pneumoniae were isolated which contained plasmids indistinguishable, on the basis of molecular weight and transferable resistance markers, from those acquired by Salm. typhimurium. The transferability of these plasmids in vitro to E. coli K12 and to the patient's initial Salm. typhimurium was studied and the results discussed.

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.

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

International Nuclear Information System (INIS)

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 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

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.

Influent of Carbonization of Sol Solution at the External Gelation Process on the Quality of Uranium Oxide Kernel

International Nuclear Information System (INIS)

Damunir; Sukarsono

2007-01-01

The influent of carbonization of sol solution at the external gelation process on the quality of uranium oxide kernel was done. Variables observed are the influent of carbon, temperature and time of reduction process of U 3 O 8 kernel resulted from carbonization of sol solution. First of all, uranyl nitrate was reacted with 1 M NH 4 OH solution, producing the colloid of UO 3 . Then by mixing and heating up to the temperature of 60-80 °C, the colloid solution was reacted with PVA, mono sorbitol oleate and paraffin producing of uranium-PVA sol. Then sol solution was carbonized with carbon black of mol ratio of carbon to uranium =2.32-6.62, produce of carbide gel. Gel then washed, dried and calcined at 800 °C for 4 hours to produce of U 3 O 8 kernel containing carbon. Then the kernel was reduced by H 2 gas in the medium of N 2 gas at 500-800 °C, 50 mmHg pressure for 3 hours. The process was repeated at 700 °C, 50 mmHg pressure for 1-4 hours. The characterization of chemical properties of the gel grains and uranium oxide kernel using FTIR covering the analysis of absorption band of infra red spectrum of UO 3 , C-OH, NH 3 , C-C, C-H and OH functional group. The physical properties of uranium oxide covering specific surface area, void volume, mean diameter using surface area meter Nova-1000 and as N 2 gas an absorbent. And O/U ratio of uranium dioxide kernel by gravimetry method. The result of experiment showed that carbonization of sol solution at the external gelation process give influencing the quality of uranium oxide kernel. (author)

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)

Clinical governance and external audit.

Science.gov (United States)

Glazebrook, S G; Buchanan, J G

2001-01-01

This paper describes a model of clinical governance that was developed at South Auckland Health during the period 1995 to 2000. Clinical quality and safety are core objectives. A multidisciplinary Clinical Board is responsible for the development and publicising of sound clinical policies together with monitoring the effects of their implementation on quality and safety. The Clinical Board has several committees, including an organization-wide Continuous Quality Improvement Committee to enhance the explicit nature of the quality system in terms of structure, staff awareness and involvement, and to develop the internal audit system. The second stream stems from the Chief Medical Officer and clinical directors in a clinical management sense. The Audit Committee of the Board of Directors covers both clinical and financial audit. The reporting lines back to that committee are described and the role of the external auditor of clinical standards is explained. The aim has been to create a supportive culture where quality initiatives and innovation can flourish, and where the emphasis is not on censure but improvement.

Influence of external beam technique and brachytherapy quality assurance on the side effects in the combined external beam- and brachytherapy treatment of local advanced prostate cancer

International Nuclear Information System (INIS)

Kovacs, G.; Galalae, R.; Wirth, B.; Bertermann, H.; Wilhelm, R.; Kohr, P.; Kimmig, B.

1996-01-01

Transrectal ultrasound(TRUS) guided HDR implantation of the prostate has been established at the Kiel University by Bertermann and Brix in 1986 and there are to date 179 (T1b-T3 No Mo) patients treated in a combined modality. The dose for the implant was 2x 15 Gy on the capsule of the prostate in 14-20 days. For local and regional lymph nodes 20 Gy external beam therapy (AP-PA pelvic portals), 20 Gy with an individual transmission block (100% for subclinical disease, 70% and 50% according to the implant dosimetry for the prostate) and 10 Gy small volume irradiation for the prostate was applied, conventional fractioned. Total dose after the therapy 70 Gy for the prostate and 50 Gy for the subclinical disease in 6-7 weeks. As a quality control method we use since 1991 in vivo dosimetry on the medial rectum wall as well as in the prostatic part of the urethra. Regular follow-up 3-118 months after therapy (median 55) with PSA, digital rectal examination, control TRUS with volumetry (after one year with biopsy) and bone scan. There were no major early side effects within the first three months. Proctitis till 1991 with a duration up to 12 months 49%, prolonging more than one year in 23 %, (total proctitis 72.6%). Dysuria in up to 12 months 30 %, long lasting 30% (total number of dysuria 60 %). Erectile dysfunction in 56 %. Because of the number of the side effects 1991 we changed the external beam technique: instead of the biaxial arch therapy the AP-PA portals, and reduced irradiated volume (from 6480 cm 3 to 5040 cm 3 ). We introduced instead of the small volume arch therapy for 10 Gy external boost the box-technique with shielding the back part of the rectum and the upper part of the bladder resulting additional volume reduction. Through the 15 Gy HDR brachytherapy dose on the prostate capsule there are up to 8 Gy on the medial rectal wall, measured by in vivo dosimetry. This dose could not be responsible for the high number of side effects (see gynecological

ExternE: Externalities of energy Vol. 3. Coal and lignite

International Nuclear Information System (INIS)

Berry, J.; Holland, M.; Lee, D.

1995-01-01

Awareness of the environmental damage resulting from human activity, particularly concerning energy use, has grown greatly in recent years. Effects such as global warming, ozone depletion and acid rain are now the subjects of much research and public debate. It is now known that these and other effects damage a wide range of receptors, including human health, forests, crops, freshwater ecosystems and buildings. Such damages are typically not accounted for by the producers and consumers of the good in question (in this case energy). They are thus referred to as 'external costs' or 'externalities', to distinguish them from the private costs which account for the construction of plant, cost of fuel, wages, etc. In recent years there has been a growing interest in the assessment of the environmental and health impacts of energy, and the related external costs. This concern is driven by a number of different factors: the need to integrate environmental concerns in decision making over the choice between different fuels and energy technologies; the need to evaluate the costs and benefits of stricter environmental standards; increased attention to the use of economic instruments for environmental policy; the need to develop overall indicators of environmental performance of different technologies; major changes in the energy sector, including privatisation, liberalisation of markets, reduction of subsidies, etc. An agreed methodology for calculation and integration of external costs has not been established. Earlier work is typically of a preliminary nature and tends to be deficient with respect to both the methods employed and the quality of models and data used. In consequence of this a collaborative project, the EC/US Fuel Cycles Study, was established between Directorate General XII (Science, Research and Technology) of the European Commission and the United States Department of Energy. This ran for the period 1991 to 1993, and good agreement on a variety of

Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation

International Nuclear Information System (INIS)

Klee, Marianne; Machin, David

2001-01-01

Health-related quality of life (HQoL) is assessed through the patients' own evaluation of the impact that a disease and its treatment may have on some of the physical, psychological and social aspects of their lives. The purpose of this study is to describe the HQoL of patients with endometrial cancer who are free of disease after undergoing external irradiation. An HQoL questionnaire was designed and validated, and consisted of the EORTC QLQ-C30 and 80 additional questions. The patients provided self-reported assessments at the end of radiotherapy, and 1, 3, 6, 12, 18 and 24 months later. Forty-nine out of 66 potential subjects participated in the study, which was confined to the period during which the women were disease free. Most patients experience physical side effects at the end of treatment and up to 6 months thereafter; 10% of the patients have chronic local symptoms and a large number of the patients think about their treatment even two years later. The patients' overall evaluation of their quality of life is lower than that of a matched population of healthy women

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.

Externalities of fuel cycles 'ExternE' project. Summary report

International Nuclear Information System (INIS)

Holland, M.; Berry, J.

1994-01-01

There is a growing requirement for policy analysts to take account of the environment in their decision making and to undertake the specified cost-benefit analysis. Within the European Union this is reflected in the 5th Environmental Action Programme, and the Commission's White Paper entitled 'Growth, competitiveness, employment and the ways forward to the 21st century'. This has led to a need for evaluation of environmental externalities. The ExternE Project commenced in 1991 as the European part of a collaborative study between the European Commission and the US Department of Energy. It aims to be the first systematic approach to the evaluation of external costs of a wide range of different fuel cycles. The project will result in an operational accounting framework for the quantification and monetarisation of priority environmental and other externalities. This framework will allow the calculation of the marginal external costs and benefits for specific power plants, at specific sites using specified technologies. There are three major phases in the project. Phase I was undertaken in collaboration with the US Department of Energy. In this phase the teams jointly developed the conceptual approach and methodology and shared scientific information for application to a number of fuel cycles. On the European side work concentrated on the nuclear and coal fuel cycles which together were expected to raise many of the fundamental issues in fuel cycle analysis. The project is currently nearing completion of Phase 2. During this phase the methodology has been applied to a wide range of different fossil, nuclear and renewable fuel cycles for power generation and energy conservation options. Also a series of National Implementation Programmes are underway in which the methodology and accounting framework are being applied to reference sites throughout Europe. In addition the general methodology is being extended to address the evaluation of externalities associated with

In-house quality audit and benefits of some quality control procedures in the quality assurance of TL dosimetry system at NRPB

International Nuclear Information System (INIS)

Dutt, J.C.

1993-01-01

A number of Quality Control (QC) procedures have been introduced into the running and operation of the NRPB personal monitoring services. Those described here apply to the whole-body TL dosimetry system. These QC procedures comprise Quality Assurance (QA) of incoming raw materials and equipment, reader stabilisation, daily, routine and periodic QA checks on all phases of the service. In-house quality audit, periodic internal and external 'blind QA checks' on the dosimetry system as a whole have assured the continuing high quality and reliability of the NRPB TL dosimetry service for assessing body and skin doses of radiation workers from external photon and beta radiations. (author)

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.

Low-wealth Entrepreneurs and Access to External Financing

DEFF Research Database (Denmark)

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

2016-01-01

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...... 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...... endowments at the outset. Originality/value: -Unlike prior studies, the data used are not subject to survivor bias or an underrepresentation of self-employment. The statistical model jointly estimates acquisition of financing and the amount received. This resolves selection and censoring problems. Finally...

External costs of energy - do the answers match the questions? Looking back at 10 years of ExternE

International Nuclear Information System (INIS)

Krewitt, W.

2002-01-01

While the claim for 'getting prices right' is quite popular in conceptual policy papers, the implementation of appropriate internalisation strategies is still hampered by a lack of reliable external cost data. Great expectations were set into the ExternE project, a major research programme launched by the European Commission at the beginning of the 1990s to provide a scientific basis for the quantification of energy related externalities and to give guidance supporting the design of internalisation measures. After more than a decade of research, the ExternE label became a well recognised standard source for external cost data. Looking back into the ExternE history, the paper pursues how emerging new scientific insights and changing background assumptions affected external cost estimates and related recommendations to policy over time. Based on ExternE results, the usefulness and inherent limitations of external cost estimates for impact categories like climate change or nuclear waste disposal is discussed. The paper also gives examples on how external costs in spite of remaining uncertainties are successfully used to support environmental policy. (Author)

Guide of external radiotherapy procedures 2007

International Nuclear Information System (INIS)

Anon.

2008-01-01

This work aims at participating in the permanent optimization of the returned medical service and the ratio profit-risk. This first version of the guide of external radiotherapy procedures 2007 processes only techniques of external radiotherapy, by opposition to the techniques of brachytherapy which use radioactive sources (iridium 192 , iodine 125 , cesium 137 ) placed in the contact of the tumor to be irradiated. Only, also, will be considered the irradiations of the most frequent cunning(malignant) tumors with the exception of the radiotherapy of the mild pathologies and the re-irradiations after a first radiotherapy. The first part is shared in eight chapters as follow: introduction, the steps of a treatment by radiotherapy, infrastructure, equipment and human resources, radiobiology mechanism of action of ionising radiations in radiotherapy, dose in radiotherapy, quality of treatment and radiation protection of patients in radiotherapy, prevention and risk management in radiotherapy, quality assurance and radiation protection for the pediatrics cancers and the case of pregnant women. The second part gives the tumoral localizations and the procedures; the third part is a glossary and different annexes such regulations and legislative texts. (N.C.)

Quality assurance and auditing for tissue banking

International Nuclear Information System (INIS)

Strong, M.; Tayo, E.

1999-01-01

Implementation of quality systems can provide many benefits and have a direct impact on the cost of tissue banking. These benefits are achieved by reducing redundancies, streamlining work processes, reducing and waste, and implementing of a process of continuous monitoring and quality improvement, There have been various models written for the use of quality systems in tissue banking but most can be indexed and correlated with the universal ISO 9000 Quality Management System used world-wide in all types of businesses and services since 1986. These standards contain 20 system elements that define the broad-based quality system. Within these elements are included audited systems. The auditing system includes internal assessment and external assessment. An audit is a planned, independent and documented assessment to determine whether agreed upon requirements are being met. Audits are performed by qualified individuals with knowledge of procedures, regulations and associated standards with the primary intention of improving processes. Internal and external assessments are the primary types of audits performed at the tissue center. Internal assessment is performed by the employees of the organization to determine whether activities and -the results of the activities comply with requirements and procedures. External assessment is carried out by independent examinations performed by an external agency. This presentation will describe procedures for internal quality auditing and results of external assessment of tissue banking in North America, as performed by the American Association of Tissue Banks (AATB). The AATB system for external auditing will be described. Examples will be given of the most common errors found by such auditing assessments and procedures for establishing internal quality auditing

Externalizing symptoms, effortful control, and intrusive parenting: A test of bidirectional longitudinal relations during early childhood.

Science.gov (United States)

Eisenberg, Nancy; Taylor, Zoe E; Widaman, Keith F; Spinrad, Tracy L

2015-11-01

At approximately 30, 42, and 54 months of age (N = 231), the relations among children's externalizing symptoms, intrusive maternal parenting, and children's effortful control (EC) were examined. Both intrusive parenting and low EC have been related to psychopathology, but children's externalizing problems and low EC might affect the quality of parenting and one another. Mothers' intrusive behavior with their children was assessed with observations, children's EC was measured with mothers' and caregivers' reports, and children's externalizing symptoms were assessed with mothers', fathers', and caregivers' reports. In a structural equation panel model, bidirectional relations between intrusive parenting and EC were found: EC at 30 and 42 months predicted low levels of intrusive parenting a year later, controlling for prior levels of parenting and vice versa. Moreover, high levels of children's externalizing problems at both 30 and 42 months negatively predicted EC a year later, controlling for prior levels of EC. Although externalizing problems positively predicted high EC over time, this appeared to be a suppression effect because these variables had a strong negative pattern in the zero-order correlations. Moreover, when controlling for the stability of intrusive parenting, EC, and externalizing (all exhibited significant stability across time) and the aforementioned cross-lagged predictive paths, EC and externalizing problems were still negatively related within the 54-month assessment. The findings are consistent with the view that children's externalizing behavior undermines their EC and contributes to intrusive mothering and that relations between intrusive parenting and EC are bidirectional across time. Thus, interventions that focus on modifying children's externalizing problems (as well as the quality of parenting) might affect the quality of parenting they receive and, hence, subsequent problems with adjustment.

Multicentre validation of IMRT pre-treatment verification: Comparison of in-house and external audit

International Nuclear Information System (INIS)

Jornet, Núria; Carrasco, Pablo; Beltrán, Mercè; Calvo, Juan Francisco; Escudé, Lluís; Hernández, Victor; Quera, Jaume; Sáez, Jordi

2014-01-01

Background and purpose: We performed a multicentre intercomparison of IMRT optimisation and dose planning and IMRT pre-treatment verification methods and results. The aims were to check consistency between dose plans and to validate whether in-house pre-treatment verification results agreed with those of an external audit. Materials and methods: Participating centres used two mock cases (prostate and head and neck) for the intercomparison and audit. Compliance to dosimetric goals and total number of MU per plan were collected. A simple quality index to compare the different plans was proposed. We compared gamma index pass rates using the centre’s equipment and methodology to those of an external audit. Results: While for the prostate case, all centres fulfilled the dosimetric goals and plan quality was homogeneous, that was not the case for the head and neck case. The number of MU did not correlate with the plan quality index. Pre-treatment verifications results of the external audit did not agree with those of the in-house measurements for two centres: being within tolerance for in-house measurements and unacceptable for the audit or the other way round. Conclusions: Although all plans fulfilled dosimetric constraints, plan quality is highly dependent on the planner expertise. External audits are an excellent tool to detect errors in IMRT implementation and cannot be replaced by intercomparison using results obtained by centres

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.

How does context affect intimate relationships? linking external stress and cognitive processes within marriage.

Science.gov (United States)

Neff, Lisa A; Karney, Benjamin R

2004-02-01

Stressors external to the marriage frequently affect the way spouses evaluate their marital quality. To date, however, understanding of the interplay between external stress and internal relationship processes has been limited in two ways. First, research has generally examined only the short-term consequences of stress. Second, the mechanisms through which external stressors influence relationship outcomes are unclear. This study addressed both limitations by examining relationship cognitions that may mediate the effects of external stress throughout 4 years of marriage. Analyses confirmed that stressful experiences were associated with the trajectory of marital quality overtime. Furthermore, both the content and the organization of spouses' specific relationship cognitions mediated this effect. That is, stress negatively influenced the nature of spouses' marital perceptions as well as the way spouses interpreted and processed those perceptions. These findings draw attention to ways that the context of relationships shapes and constrains relationship processes.

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.

Image denoising by exploring external and internal correlations.

Science.gov (United States)

Yue, Huanjing; Sun, Xiaoyan; Yang, Jingyu; Wu, Feng

2015-06-01

Single image denoising suffers from limited data collection within a noisy image. In this paper, we propose a novel image denoising scheme, which explores both internal and external correlations with the help of web images. For each noisy patch, we build internal and external data cubes by finding similar patches from the noisy and web images, respectively. We then propose reducing noise by a two-stage strategy using different filtering approaches. In the first stage, since the noisy patch may lead to inaccurate patch selection, we propose a graph based optimization method to improve patch matching accuracy in external denoising. The internal denoising is frequency truncation on internal cubes. By combining the internal and external denoising patches, we obtain a preliminary denoising result. In the second stage, we propose reducing noise by filtering of external and internal cubes, respectively, on transform domain. In this stage, the preliminary denoising result not only enhances the patch matching accuracy but also provides reliable estimates of filtering parameters. The final denoising image is obtained by fusing the external and internal filtering results. Experimental results show that our method constantly outperforms state-of-the-art denoising schemes in both subjective and objective quality measurements, e.g., it achieves >2 dB gain compared with BM3D at a wide range of noise levels.

The ExternE project: methodology, objectives and limitations

International Nuclear Information System (INIS)

Rabl, A.; Spadaro, J.V.

2002-01-01

This paper presents a summary of recent studies on external costs of energy systems, in particular the ExternE (External Costs of Energy) Project of the European Commission. To evaluate the impact and damage cost of a pollutant, one needs to carry out an impact pathway analysis; this involves the calculation of increased pollutant concentrations in all affected regions due to an incremental emission (e.g. μg/m 3 of particles, using models of atmospheric dispersion and chemistry), followed by the calculation of physical impacts (e.g. number of cases of asthma due to these particles, using a dose-response function). The entire so-called fuel chain (or fuel cycle) is evaluated and compared on the basis of delivered end use energy. Even though the uncertainties are large, the results provide substantial evidence that the classical air pollutants (particles, NO x and SO x ) from the combustion of fossil fuels impose a heavy toll, in addition to the cost of global warming. The external costs are especially large for coal; even for 'good current technology' they may be comparable to the price of electricity. For natural gas the external costs are about a third to a half of coal. The external costs of nuclear are small compared to the price of electricity (at most a few %), and so are the external costs of most renewable energy systems. (authors)

Establishment of external quality assurance procedures with FAO/IAEA ELISA kits. Report of an FAO/IAEA consultants meeting

International Nuclear Information System (INIS)

1994-01-01

As part of the programme of support to scientists in developing countries, the Joint FAO/IAEA Division has developed and distributed ELISA kits for detecting both the causative agent and the immune response of animals to a number of the major diseases affecting livestock. In many cases these kits are now being used as part of national and international control and/or eradication programmes (e.g. for rinderpest, trypanosomosis, foot and mouth disease, brucellosis) and are likely to form the basis for establishing a country's freedom from particular diseases (e.g. rinderpest) at the national and international level. To further encourage international trade in livestock and livestock products, and to assist in the regional or global control and eradication of a number of the major diseases affecting livestock, there has been a strong move towards international standardization for animal disease diagnosis. Central to this is the need for internal and external quality assurance procedures to ensure that a standardized approach is being adhered to and that the results can be relied upon. In 1992, an FAO/IAEA consultants meeting was convened to define and establish for the ELISA, standards for internal quality control of reagents and procedures and for the expression of results. The recommendations of that meeting have now been incorporated in all FAO/IAEA ELISA kits and have been adopted by the OIE (Office International des Epizooties). The primary function of the internal quality controls is to ensure that the assay is performing within defined limits. Equally important, is an assurance to all outside interested bodies (national veterinary authorities, international organizations, donor organizations, trading partners) that the results being provided by a laboratory are valid. The procedures for ascertaining this assurance would form the basis of an external quality assurance programme (EQAP). Between 1990 and 1993, as part of establishing an EQAP, laboratories using

Advertising in Markets with Consumption Externalities

OpenAIRE

Whelan, Adele

2014-01-01

This paper extends the entry deterrence literature by examining coordinating advertising in markets with consumption externalities using a stochastic success function. Optimal advertising and pricing strategies are analysed when an incumbent firm faces a challenger with a product of equal quality. I show that strategic entry deterrence using advertising is possible and optimal entry deterrence involves strategic pre-commitment to over-investment relative to the non-strategic simultaneous adve...

When attention wanders: Pupillometric signatures of fluctuations in external attention.

Science.gov (United States)

Konishi, Mahiko; Brown, Kevin; Battaglini, Luca; Smallwood, Jonathan

2017-11-01

Attention is not always directed to events in the external environment. On occasion our thoughts wander to people and places distant from the here and now. Sometimes, this lack of external attention can compromise ongoing task performance. In the current study we set out to understand the extent to which states of internal and external attention can be determined using pupillometry as an index of ongoing cognition. In two experiments we found that periods of slow responding were associated with elevations in the baseline pupil signal over three and a half seconds prior to a behavioural response. In the second experiment we found that unlike behavioural lapses, states of off-task thought, particularly those associated with a focus on the past and with an intrusive quality, were associated with reductions in the size of the pupil over the same window prior to the probe. These data show that both states of large and small baseline pupil size are linked to states when attention is not effectively focused on the external environment, although these states have different qualities. More generally, these findings illustrate that subjective and objective markers of task performance may not be equivalent and underscore the importance of developing objective indicators that can allow these different states to be understood. Copyright © 2017 Elsevier B.V. All rights reserved.

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

International Nuclear Information System (INIS)

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

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.

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...... European countries. The project use a “bottom-up” methodology to evaluate the external costs associated with a wide range of different fuel cycles. The project has identified priority impacts, where most are impacts from air emissions. Externalities due to atmospheric emissions are calculated through...

Technology usage, quality management system, and service quality in Thailand.

Science.gov (United States)

Sivabrovornvatana, Nilubon; Siengthai, Sununta; Krairit, Donyaprueth; Paul, Himangshu

2005-01-01

This article aims to explore the relationship between technology and quality management for enhancing Thai hospital service quality. The paper presents the findings of an exploratory study that investigates service quality from the customer and service provider perception. In-depth interviews were conducted with respondents in Thai hospitals. The interviews explored service-related factors that patients and service providers perceive to be important for hospital services. The first interview group consisted of professionals as internal customers in direct contact with external customers, while the second group consisted of external customers of the same hospitals. The study's outcomes clearly suggest factors that make significant contribution to service quality. These factors can be categorized according to five SERVQUAL dimensions (reliability, responsiveness, assurance, empathy, and tangibility), although some factors required slightly different interpretation. The findings suggest that hospitals can develop an appropriate approach to their advantage, which can yield sustainable improvement in service quality as perceived by patients and professionals. Hospitals can make better quality decisions based on structured measurement and knowledge. It is recommended that managers apply this knowledge for successful implementation of activities related to service quality in their organizations.

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.

Commutability of possible external quality assessment materials for cardiac troponin measurement.

Directory of Open Access Journals (Sweden)

Shunli Zhang

Full Text Available The measurement of cardiac troponin is crucial in the diagnosis of myocardial infarction. The performance of troponin measurement is most conveniently monitored by external quality assessment (EQA programs. The commutability of EQA samples is often unknown and the effectiveness of EQA programs is limited.Commutability of possible EQA materials was evaluated. Commercial control materials used in an EQA program, human serum pools prepared from patient samples, purified analyte preparations, swine sera from model animals and a set of patient samples were measured for cTnI with 4 assays including Abbott Architect, Beckman Access, Ortho Vitros and Siemens Centaur. The measurement results were logarithm-transformed, and the transformed data for patient samples were pairwise analyzed with Deming regression and 95% prediction intervals were calculated for each pair of assays. The commutability of the materials was evaluated by comparing the logarithmic results of the materials with the limits of the intervals. Matrix-related biases were estimated for noncommutable materials. The impact of matrix-related bias on EQA was analyzed and a possible correction for the bias was proposed.Human serum pools were commutable for all assays; purified analyte preparations were commutable for 2 of the 6 assay pairs; commercial control materials and swine sera were all noncommutable; swine sera showed no reactivity to Vitros assay. The matrix-related biases for noncommutable materials ranged from -83% to 944%. Matrix-related biases of the EQA materials caused major abnormal between-assay variations in the EQA program and correction of the biases normalized the variations.Commutability of materials has major impact on the effectiveness of EQA programs for cTnI measurement. Human serum pools prepared from patient samples are commutable and other materials are mostly noncommutable. EQA programs should include at least one human serum pool to allow proper interpretation of

Investigating the effect of externalizing perspectives on cognitives biases

DEFF Research Database (Denmark)

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

2007-01-01

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...... 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 analyses....

Quality assurance and product quality

International Nuclear Information System (INIS)

Lacroix, D.; Bastiani, P. de

2004-01-01

The basic quality assurance requirements have to be completed by means that are oriented towards the quality of products; in COGEMA LOGISTICS our approach is based on four principles: 1) an integrated management system: Quality, health and safety, environment 2) an organization based on the responsibility of all actors, trust and transparency 3) a methodical approach to continuously improve the methods that are employed to achieve quality: -process management -corrective and preventive actions -self assessments and various surveys 4) but at the same time strong procedures for control and monitoring of all activities: -technical and quality audits (external and internal) -at source inspections -engineering activities inspections This performance-based approach is necessary to guaranty the effectiveness of the traditional formal QA means

Variables Affecting a Level of Practice and Quality of Educational Quality Assurance in Basic Education Schools

Directory of Open Access Journals (Sweden)

Jakkapong Prongprommarat

2016-10-01

Full Text Available The purposes of this research were to study the Level of Practice and Quality of Educational Quality Assurance in Basic Education Schools of the Office of the Basic Education Commission. The sample consisted of 60 secondnary schools in Office of the basic Education Commission in the provinces of Chaiyaphum, Nakhon Ratchasima, Burirum, Surin and Khon Kaen were drawn by using proportionally with the number of teachers in each school. The data were collected by using (1 the questionnaire on the acting of educational quality assurance in basic education schools. (2 the record form the external assessment of the office for National Education Standards and Quality Assessment, (3 the questionnaire on the director leadership, (2 test of the directors and teachers attitudes towards educational quality assurance, (5 test of the directors and teachers inquirying motive, (6 test of the directors and teachers working responsibility, and (7 the questionnaire on the directors and teachers cooperative. The statistical methods used to analysis the data were mean, standard deviation, coefficient of variation and path analysis. The findings revealed that: 1. The level of acting of educational quality assurance in basic education schools was at a high level. There was just a fairly difference in acting of educational quality assurance in basic education schools. 2. The level of external quality assessment in basic education schools was at a good level. There was just a little difference in external quality assessment in basic education schools. 3. The variables affecting level of acting of educational quality assurance in basic education schools were the level of the school directors attitudes towards educational quality assurance (β = 0.10, the level of the school directors working responsibility (β = 0.13, the level of the teacher attitudes towards educational quality assurance (β = 0.23 and the level of the teachers inquirying motive (β = 0.49 These four

Can We Predict Plan Quality for External Beam Partial Breast Irradiation: Results of a Multicenter Feasibility Study (Trans Tasman Radiation Oncology Group Study 06.02)

Energy Technology Data Exchange (ETDEWEB)

Kron, Tomas, E-mail: Tomas.Kron@petermac.org [Peter MacCallum Cancer Centre, Departments of Radiation Oncology, Physical Sciences and Radiation Therapy, Melbourne, Victoria (Australia); Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria (Australia); School of Science, Engineering and Technology, Royal Melbourne Institute of Technology University, Melbourne, Victoria (Australia); Willis, David; Link, Emma [Peter MacCallum Cancer Centre, Departments of Radiation Oncology, Physical Sciences and Radiation Therapy, Melbourne, Victoria (Australia); Lehman, Margot [Princess Alexandra Hospital, Department of Radiation Oncology, Brisbane, Queensland (Australia); Campbell, Gillian [Auckland City Hospital, Department of Radiation Oncology, Auckland (New Zealand); O' Brien, Peter [Newcastle Calvary Mater Hospital, Department of Radiation Oncology, Newcastle, NSW (Australia); Chua, Boon [Peter MacCallum Cancer Centre, Departments of Radiation Oncology, Physical Sciences and Radiation Therapy, Melbourne, Victoria (Australia); Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria (Australia)

2013-11-15

Purpose: Partial breast irradiation (PBI) after lumpectomy may be an option for selected patients with early breast cancer. A feasibility study of accelerated PBI delivered using external beam 3-dimensional conformal radiation therapy (RT) was undertaken at 8 Australasian centers. The present study evaluated the impact of patient, tumor, and RT technique-related factors on the quality of RT plans as determined by the dose–volume parameters of organs at risk. Methods and Materials: Forty-eight patients were enrolled in the study. All RT plans were centrally reviewed using predefined dosimetric criteria before commencement and after completion of protocol therapy. The RT plans of 47 patients met the dose–volume constraints, and all 47 patients received PBI to a prescribed dose of 38.5 Gy in 10 fractions. The RT plan quality was determined by volumes of the ipsilateral whole breast, lung, and heart that received 50% and 95%; 30%; and 5% of the prescribed dose, respectively. Patient, tumor, and RT technique-related factors were investigated for association with the parameters of RT plan quality. Results: The ratio of the planning target volume to the ipsilateral whole-breast volume was significantly associated with the ipsilateral breast doses on multiple variable analyses. The distance of the postlumpectomy surgical cavity from the heart and lung were predictive for heart and lung doses, respectively. A distance between surgical cavity and heart of >4 cm typically resulted in <1% of the heart volume receiving 5 Gy or less. It was more difficult to meet the heart dose constraint for left-sided and medially located tumors. Conclusions: Partial breast irradiation using 3-dimensional conformal RT was feasible within the study constraints. The ratio of planning target volume to ipsilateral whole-breast volume and the distance of surgical cavity from the heart were significant predictors of the quality of treatment plan for external beam PBI.

Can We Predict Plan Quality for External Beam Partial Breast Irradiation: Results of a Multicenter Feasibility Study (Trans Tasman Radiation Oncology Group Study 06.02)

International Nuclear Information System (INIS)

Kron, Tomas; Willis, David; Link, Emma; Lehman, Margot; Campbell, Gillian; O'Brien, Peter; Chua, Boon

2013-01-01

Purpose: Partial breast irradiation (PBI) after lumpectomy may be an option for selected patients with early breast cancer. A feasibility study of accelerated PBI delivered using external beam 3-dimensional conformal radiation therapy (RT) was undertaken at 8 Australasian centers. The present study evaluated the impact of patient, tumor, and RT technique-related factors on the quality of RT plans as determined by the dose–volume parameters of organs at risk. Methods and Materials: Forty-eight patients were enrolled in the study. All RT plans were centrally reviewed using predefined dosimetric criteria before commencement and after completion of protocol therapy. The RT plans of 47 patients met the dose–volume constraints, and all 47 patients received PBI to a prescribed dose of 38.5 Gy in 10 fractions. The RT plan quality was determined by volumes of the ipsilateral whole breast, lung, and heart that received 50% and 95%; 30%; and 5% of the prescribed dose, respectively. Patient, tumor, and RT technique-related factors were investigated for association with the parameters of RT plan quality. Results: The ratio of the planning target volume to the ipsilateral whole-breast volume was significantly associated with the ipsilateral breast doses on multiple variable analyses. The distance of the postlumpectomy surgical cavity from the heart and lung were predictive for heart and lung doses, respectively. A distance between surgical cavity and heart of >4 cm typically resulted in <1% of the heart volume receiving 5 Gy or less. It was more difficult to meet the heart dose constraint for left-sided and medially located tumors. Conclusions: Partial breast irradiation using 3-dimensional conformal RT was feasible within the study constraints. The ratio of planning target volume to ipsilateral whole-breast volume and the distance of surgical cavity from the heart were significant predictors of the quality of treatment plan for external beam PBI

Prostatic pathology reporting in the UK: development of a national external quality assurance scheme.

Science.gov (United States)

Harnden, P; Coleman, D; Moss, S; Kodikara, S; Patnick, J; Melia, J

2008-01-01

To develop a baseline picture of prostatic pathology reporting in the UK, identify areas of particular difficulty and assess the feasibility of a national external quality assurance scheme based on prostatic biopsy specimens using the same format as the National Health Service breast pathology scheme, as recommended by the National Institute for Clinical Excellence. Eight expert uropathologists and 32 randomly selected pathologists participated in four circulations each of 12 cases of prostatic biopsy specimens. A fixed text proforma was developed and responses were analysed for interobserver agreement using kappa statistics. Consistency of reporting the main diagnostic categories of benign and invasive carcinoma was good (kappa values 0.77 and 0.88, respectively), but only after excluding 19% of cases for which the experts did not reach 75% agreement. Areas of difficulty included the diagnosis of high-grade prostatic intraepithelial neoplasia and small foci of cancer. Prognostic factor reporting was more variable, with lower overall kappas for the assessment of Gleason grading (experts 0.55, others 0.50), perineural invasion (experts 0.64, others 0.50) and number of positive cores (experts 0.74, others 0.61). Given the difficulties in diagnosis of prostatic biopsy specimens and the assessment of prognostic factors, the expansion of the scheme could deliver important educational benefits.

Quality Assurance and Quality Control in TLD Measurement

International Nuclear Information System (INIS)

Bhuiyan, S.I.; Qronfla, M.M.; Abulfaraj, W.H.; Kinsara, A.A.; Taha, T.M.; Molla, N.I.; Elmohr, S.M.

2008-01-01

TLD technique characterized by high precision and reproducibility of dose measurement is presented by addressing pre-readout annealing, group sorting, dose evaluation, blind tests, internal dose quality audit and external quality control audits. Two hundred and forty TLD chips were annealed for 1 hour at 4000 degree C followed by 2 h at 1000 degree C. After exposure of 1 mGy from 90 Sr irradiator TLDs were subjected to pre-readout annealing at 1000 degree C, then readout, sorted into groups each with nearly equal sensitivity. Upon repeating the procedures, TLDs having response >3.5% from group mean were dropped to assuring group stability. Effect of pre-readout annealing has been studied. Series of repeated measurements were conducted to stabilize calibration procedures and DCF generation using SSDL level 137 Cs calibrator, dose master, ionization chambers. Performed internal dose quality audits, blind tests and validated by external QC tests with King Abdulaziz City of Science and Technology

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...

Guide for the implementation in external radiation therapy of quality insurance by in vivo measurements by thermoluminescent dosimeters and semi-conductors. S.F.P.M. report nr 18-2000

International Nuclear Information System (INIS)

Goyet, Dominique; Dusserre, Andree; Marcie, Serge; Telenczak, Pascale; Waultier, Serge; Costa, Andre; Lisbona, Albert; Noel, Alain

2000-01-01

This report aims at gathering all necessary information for the implementation of treatment quality insurance procedures by in vivo measurements in the case of external radiation therapy. It presents the different techniques, describes characteristics of TL meters, electro-meters, TL dosimeters, and semi-conductors currently available on the French market, and indicates all accessories required by these techniques. It also recalls principles of in vivo measurements, as well as calibration procedures. The last part proposes a description of acceptance and quality control procedures for these equipment

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

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.

The osseous external auditory canal : Surgery, shape, and sound

NARCIS (Netherlands)

van Spronsen, E.

2018-01-01

This thesis describes three aspects of the osseous external auditory canal (OEAC) which are related to each other: Surgery of the OEAC, the shape of the OEAC and the perceived sound quality due to the resonance function of the OEAC. Several aspects of the surgical intervention (Canalplasty) in

Approaches in estimation of external cost for fuel cycles in the ExternE project

International Nuclear Information System (INIS)

Afanas'ev, A.A.; Maksimenko, B.N.

1998-01-01

The purposes, content and main results of studies realized within the frameworks of the International Project ExternE which is the first comprehensive attempt to develop general approach to estimation of external cost for different fuel cycles based on utilization of nuclear and fossil fuels, as well as on renewable power sources are discussed. The external cost of a fuel cycle is treated as social and environmental expenditures which are not taken into account by energy producers and consumers, i.e. these are expenditures not included into commercial cost nowadays. The conclusion on applicability of the approach suggested for estimation of population health hazards and environmental impacts connected with electric power generation growth (expressed in money or some other form) is made

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

International Nuclear Information System (INIS)

Hoffman, D; Chung, E; Hess, C; Stern, R; Benedict, S

2015-01-01

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

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

Assessment of external dose indoors in Lithuania

International Nuclear Information System (INIS)

Pilkyte, L.; Butkus, D.; Morkunas, G.

2006-01-01

The aim of this paper was an assessment of external exposure indoors and its dependence on construction materials and indoor radon concentrations in Lithuanian living houses. Relationship of absorbed dose rate in air indoors and activity indexes of the most commonly used construction materials (wood, concrete and bricks) have been studied using results received in measurements done in >4700 rooms in 1995-2005. Possible connections of dose rate indoors with indoor radon concentrations are also discussed. Findings of this study helped to make an assessment of the mean value of effective dose of Lithuanian population due to external exposure indoors which is equal to 0.58 mSv y -1 . The received data might also be used in improvement of quality of personal dosimetric measurements done in premises constructed of different construction materials. (authors)

Energy efficiency subsidies with price-quality discrimination

International Nuclear Information System (INIS)

Nauleau, Marie-Laure; Giraudet, Louis-Gaëtan; Quirion, Philippe

2015-01-01

We compare various designs of energy efficiency subsidies in a market subject to both energy-use externalities and price-quality discrimination by a monopolist. We find that differentiated subsidies can establish the social optimum. Unlike per-quality regimes, ad valorem regimes generate downstream interferences: Subsidising of the high-end good leads the monopolist to reduce the quality of the low-end good. For this reason, ad valorem differentiated rates should always decrease with energy efficiency, a result seemingly at odds with actual practice. In contrast, with per-quality differentiated subsidies, the rates can increase if the externality is large enough relative to the market share of “low” type consumers. Contrary to differentiated subsidies, what we shall call single-instrument subsidies only achieve second-best outcomes. A uniform ad valorem subsidy should have a rate higher than that needed to specifically internalise energy-use externalities. Lastly, if, as is often observed in practice, only the high-end good is to be incentivised, a per-quality regime should be preferred to an ad valorem one. An ad valorem tax on the high-end good may even be preferred to an ad valorem subsidy if the externality is small enough and low-end consumers dominate the market.

Assessment of patient radiation protection in external radiotherapy departments after inspections performed by the ASN 2008

International Nuclear Information System (INIS)

Franchi, Vincent; Marchal, Carole

2009-10-01

This report proposes an assessment of patient radiation protection in external radiotherapy. It is based on inter-regional syntheses of inspections performed by the ASN in external radiotherapy departments during 2008. It addresses 6 main themes related to patient radiation protection: human and material resources, organisation of medical physics, training in patient radiation protection, mastering of equipment (maintenance, internal quality controls of medical devices), safety and care quality management (formalization of the patient care process and definition of responsibilities, patient identity control, treatment preparation, and treatment execution), and risk management (a priori risk analysis, declaration, recording and internal processing of dysfunctions, improvements of care quality and safety management system)

Detecting effects of the indicated prevention Programme for Externalizing Problem behaviour (PEP) on child symptoms, parenting, and parental quality of life in a randomized controlled trial.

Science.gov (United States)

Hanisch, Charlotte; Freund-Braier, Inez; Hautmann, Christopher; Jänen, Nicola; Plück, Julia; Brix, Gabriele; Eichelberger, Ilka; Döpfner, Manfred

2010-01-01

Behavioural parent training is effective in improving child disruptive behavioural problems in preschool children by increasing parenting competence. The indicated Prevention Programme for Externalizing Problem behaviour (PEP) is a group training programme for parents and kindergarten teachers of children aged 3-6 years with externalizing behavioural problems. To evaluate the effects of PEP on child problem behaviour, parenting practices, parent-child interactions, and parental quality of life. Parents and kindergarten teachers of 155 children were randomly assigned to an intervention group (n = 91) and a nontreated control group (n = 64). They rated children's problem behaviour before and after PEP training; parents also reported on their parenting practices and quality of life. Standardized play situations were video-taped and rated for parent-child interactions, e.g. parental warmth. In the intention to treat analysis, mothers of the intervention group described less disruptive child behaviour and better parenting strategies, and showed more parental warmth during a standardized parent-child interaction. Dosage analyses confirmed these results for parents who attended at least five training sessions. Children were also rated to show less behaviour problems by their kindergarten teachers. Training effects were especially positive for parents who attended at least half of the training sessions. CBCL: Child Behaviour Checklist; CII: Coder Impressions Inventory; DASS: Depression anxiety Stress Scale; HSQ: Home-situation Questionnaire; LSS: Life Satisfaction Scale; OBDT: observed behaviour during the test; PCL: Problem Checklist; PEP: prevention programme for externalizing problem behaviour; PPC: Parent Problem Checklist; PPS: Parent Practices Scale; PS: Parenting Scale; PSBC: Problem Setting and Behaviour checklist; QJPS: Questionnaire on Judging Parental Strains; SEFS: Self-Efficacy Scale; SSC: Social Support Scale; TRF: Caregiver-Teacher Report Form.

Quantifying the external cost of oil consumption within the context of sustainable development

International Nuclear Information System (INIS)

Abdel Sabour, S.A.

2005-01-01

The concept of sustainability implies that the flow of services derived from the use of natural capital must be constant over time and should be obtained at a constant price. For a depletable resource such as oil, the future generations are highly impacted due to the consumption behavior of the current generation. Since the ultimate oil stock within the Earth declines with cumulative consumption, excessive consumption of oil now reduces the availability of oil for future needs. Moreover, since oil reserves are normally extracted in the order of ascending cost and descending quality, excessive consumption of relatively high-quality, cheap oil reserves by the current generation raises the cost at which future generations can meet their needs of oil and hence imposes an external cost on the future generations. This study aims to quantify the external cost of consuming a barrel of oil within the context of sustainable development. An option-pricing model is developed to quantify this external cost assuming that the external cost of consuming a barrel of oil now equals the value of the option to get a barrel of oil in the future at the same current cost. Then, the total cost of consuming a barrel of oil now, that should be used in lifecycle costing to design more sustainable products, is the summation of the oil price and the external cost

Quality assurance technique for absorbed dose distribution in external radiation therapy with non-physical wedges in consideration of the character of the imaging plate

International Nuclear Information System (INIS)

Fujibuchi, Toshioh; Fujisaki, Tatsuya; Kurokawa, Masayuki; Sakae, Takeji

2011-01-01

The film dose distribution method is used for profile measurements of non-physical wedges, because three-dimensional automatic control water phantoms cannot be used. Recently, many hospitals have adopted computed radiography (CR) systems in preference to automatic developing processors and films. This may allow use of automatic processors to be discontinued. In this study, a beam was irradiated to an Imaging Plate (IP), and then IP was exposed to a fixed amount of light with fading, and we then measured the off-center ratio (OCR) absorbed dose distribution in external radiation therapy with non-physical wedge. This was compared with the OCR measured with an ionization chamber dosimeter. It was consequently possible for IP to approximate the value measured by the ionization chamber dosimeter by using a metal filter. This method offers a simple quality assurance technique for absorbed dose distribution in external radiation therapy with non-physical wedges in consideration of the character of the IP. (author)

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.

Analysis of External Treatment Methods and Technical Characteristics of External Treatment

Science.gov (United States)

Zhang, Rui; Miao, Mingsan; Bai, Ming

2018-01-01

Chinese medicine external therapy is a treatment method of Chinese medicine with Chinese characteristics. The effect of traditional Chinese medicine external treatment, convenient operation, external treatment and technology has great prospects for development. The traditional Chinese medicine external treatment method and technical characteristics were analyzed.

External Quality Assessment for KRAS Testing Is Needed: Setup of a European Program and Report of the First Joined Regional Quality Assessment Rounds

Science.gov (United States)

Bellon, Ellen; Ligtenberg, Marjolijn J.L.; Tejpar, Sabine; Cox, Karen; de Hertogh, Gert; de Stricker, Karin; Edsjö, Anders; Gorgoulis, Vassilis; Höfler, Gerald; Jung, Andreas; Kotsinas, Athanassios; Laurent-Puig, Pierre; López-Ríos, Fernando; Hansen, Tine Plato; Rouleau, Etienne; Vandenberghe, Peter; van Krieken, Johan J.M.

2011-01-01

The use of epidermal growth factor receptor–targeting antibodies in metastatic colorectal cancer has been restricted to patients with wild-type KRAS tumors by the European Medicines Agency since 2008, based on data showing a lack of efficacy and potential harm in patients with mutant KRAS tumors. 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 prepared and distributed the samples for the participants of their own country. The samples included unstained sections of 10 invasive colorectal carcinomas with known KRAS mutation status. The samples were centrally validated by one of two reference laboratories. The laboratories were allowed to use 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, and written reports. We conclude that only 70% of laboratories correctly identified the KRAS mutational status in all samples. Both the false-positive and false-negative results observed negatively affect patient care. Reports of the KRAS test results often lacked essential information. We aim to further expand this program to more laboratories to provide a robust estimate of the quality of KRAS testing in Europe, and provide the basis for remedial measures and harmonization. PMID:21441573

ExternE: Externalities of energy Vol. 5. Nuclear

International Nuclear Information System (INIS)

Dreicer, M.; Tort, V.; Manen, P.

1995-01-01

Since the early 1970s, there has been increased interest in the environmental impacts that are caused by the generation of electricity. The comparative risk assessment studies at that time used mainly deaths and injuries as impact indicators. By the end of the 1980s studies changed to the assessment of the costs imposed on society and the environment that were not included in the market price of the energy produced, the so-called external costs. The preliminary studies that were published set the conceptual basis, grounded in neo-classical economics, for the valuation of the health and environmental impacts that could be assessed. As a consequence of the many questions raised by the methodologies employed by these early studies, Directorate General XII (DG XII) of the Commission of the European Communities established a collaborative research programme with the United States Department of Energy to identify an appropriate methodology for this type of work. Following the completion of this collaboration, the DG XII programme has continued as the ExternE project. The main objective of the work carried out at CEPN was to develop an impact pathway methodology for the nuclear fuel cycle that would be consistent with the methodologies developed for other fuel cycles, without loosing the nuclear-specific techniques required for a proper evaluation. In this way, comparisons between the different fuel cycles would be possible. This report presents the methodology and demonstration of the results in the context of the French nuclear fuel cycle. The United States team at Oak Ridge National Laboratory has previously issued a draft report on the results of their assessment. The French fuel cycle was broken down into 8 separate stages. Reference sites and 1990s technology were chosen to represent the total nuclear fuel cycle, as it exists today. In addition, the transportation of material between the sites was considered. The facilities are assessed for routine operation, except

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

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

International Nuclear Information System (INIS)

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

2012-01-01

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 using

Environmental externalities: Applying the concept to Asian coal-based power generation. [Includes external environmental and societal costs and methods of evaluating them

Energy Technology Data Exchange (ETDEWEB)

Szpunar, C.B.; Gillette, J.L.

1993-03-01

This report examines the concept of environmental externality. It discusses various factors -- the atmospheric transformations, relationship of point-source emissions to ambient air quality, dose-response relationships, applicable cause-and-effect principles, and risk and valuation research -- that are considered by a number of state utilities when they apply the environmental externality concept to energy resource planning. It describes a methodology developed by Argonne National Laboratory for general use in resource planning, in combination with traditional methods that consider the cost of electricity production. Finally, it shows how the methodology can be applied in Indonesia, Thailand, and Taiwan to potential coal-fired power plant projects that will make use of clean coal technologies.

External quantum efficiency enhancement by photon recycling with backscatter evasion.

Science.gov (United States)

Nagano, Koji; Perreca, Antonio; Arai, Koji; Adhikari, Rana X

2018-05-01

The nonunity quantum efficiency (QE) in photodiodes (PD) causes deterioration of signal quality in quantum optical experiments due to photocurrent loss as well as the introduction of vacuum fluctuations into the measurement. In this paper, we report that the external QE enhancement of a PD was demonstrated by recycling the reflected photons. The external QE for an InGaAs PD was increased by 0.01-0.06 from 0.86-0.92 over a wide range of incident angles. Moreover, we confirmed that this technique does not increase backscattered light when the recycled beam is properly misaligned.

Analysis of quality control tests done by the Canadian power utilities on their external dosimetry systems (June 1985 to May 1988)

International Nuclear Information System (INIS)

Poirier, G.S.

1989-04-01

The Canadian nuclear power utilities, Hydro Quebec, New Brunswick Electric Power Commission and Ontario Hydro, use thermoluminescent dosimetry systems to perform their own external beta/gamma dosimetry. In order to help ensure that these systems perform satisfactorily, they are subjected to routine quality control testing by their parent organizations. The test results for the period of June 1985 to May 1988 have been analyzed, at the AECB, using the pass criterion which was originally agreed upon by the organizations involved. The present analysis offers a comparison of the performance of the different sites which operate such a service. Finally, recommendations are made in the hope that they will help the organizations in refining their dosimetry

External and internal influences as driving forces and/or stumbling ...

African Journals Online (AJOL)

The development of national and institutional quality assurance and management systems is often forced (rightfully or wrongly) into a specific direction by external and internal environmental influences. In South Africa such influences play a major role in both the national higher education policy developments and the ...

Externalities of fuel cycles 'ExternE' project. Coal fuel cycle. Estimation of physical impacts and monetary valuation for priority impact pathways

International Nuclear Information System (INIS)

Berry, J.E.; Holland, M.R.; Watkiss, P.R.

1994-01-01

Background to the ExternE Project Awareness of the environmental damage resulting from human activity, particularly concerning energy use, has grown greatly in recent years. Effects such as global warming, ozone depletion and acid rain are now the subjects of much research and public debate. It is now known that these and other effects damage a wide range of receptors, including human health, forests, crops, freshwater ecosystems and buildings. Such damages are typically not accounted for by the producers and consumers of the good in question (in this case energy). They are thus referred to as 'external costs' or 'externalities', to distinguish them from the private costs which account for the construction of plant, cost of fuel, wages, etc. In recent years there has been a growing interest in the assessment of the environmental and health impacts of energy, and the related external costs. This concern is driven by a number of different factors; The need to integrate environmental concerns in decision making over the choice between different fuels and energy technologies. The need to evaluate the costs and benefits of stricter environmental standards. Increased attention to the use of economic instruments for environmental policy. The need to develop overall indicators of environmental performance of different technologies. Major changes in the energy sector, including privatisation, liberalisation of markets, reduction of subsidies, etc. An agreed methodology for calculation and integration of external costs has not been established. Earlier work is typically of a preliminary nature and tends to be deficient with respect to both the methods employed and the quality of models and data used. In consequence of this a collaborative project, the EC/US Fuel Cycles Study, was established between Directorate General XII (Science, Research and Technology) of the European Commission and the United States Department of Energy. This ran for the period 1991 to 1993, and good

Quality Assurance of Quality Assurance Agencies from an Asian Perspective: Regulation, Autonomy and Accountability

Science.gov (United States)

Hou, Angela Yung-Chi; Ince, Martin; Tsai, Sandy; Chiang, Chung Lin

2015-01-01

As quality guardians of higher education, quality assurance agencies are required to guarantee the credibility of the review process and to ensure the objectivity and transparency of their decisions and recommendations. These agencies are therefore expected to use a range of internal and external approaches to prove the quality of their review…

Energy, Externalities and Environmental Quality: Will Development Cure the Ills It Creates?

Energy Technology Data Exchange (ETDEWEB)

Pearson, P.J.G. [Imperial College of Science, Technology, and Medicine, London (United Kingdom)

1994-12-31

Environmental quality in the context of economic development was discussed. Factors that influence environmental quality were emphasized. Main empirical studies performed in this area, including studies that have produced the inverted U-shaped environmental ``Kuznet Curve``were reviewed. The `Kuznet curve` represents the hypothesized relationship between inequality of income distribution and economic development. This author attempted to incorporate environmental quality into this relationship, and to look for the policy implications of these estimates. Determinants of environmental quality such as the supply of environmental quality, waste receptors and energy resources, the demand for environmental quality, environmental quality outcomes, environmental and quality/development models were discussed, and an attempt was made to answer the question of whether or not these Kuznet curves really imply that development will automatically cure environmental ills. One of the main conclusions was that as income rises, the demand for environmental quality rises proportionately faster, while the supply of environmentally destructive activities decreases. Other conclusions called for the improvement of the data base on environmental quality, especially by developing countries. There was also a call for more studies to be done to understand the factors that affect environmental quality and policy in different developmental situations.

Energy, Externalities and Environmental Quality: Will Development Cure the Ills It Creates?

International Nuclear Information System (INIS)

Pearson, P.J.G.

1994-01-01

Environmental quality in the context of economic development was discussed. Factors that influence environmental quality were emphasized. Main empirical studies performed in this area, including studies that have produced the inverted U-shaped environmental ''Kuznet Curve''were reviewed. The 'Kuznet curve' represents the hypothesized relationship between inequality of income distribution and economic development. This author attempted to incorporate environmental quality into this relationship, and to look for the policy implications of these estimates. Determinants of environmental quality such as the supply of environmental quality, waste receptors and energy resources, the demand for environmental quality, environmental quality outcomes, environmental and quality/development models were discussed, and an attempt was made to answer the question of whether or not these Kuznet curves really imply that development will automatically cure environmental ills. One of the main conclusions was that as income rises, the demand for environmental quality rises proportionately faster, while the supply of environmentally destructive activities decreases. Other conclusions called for the improvement of the data base on environmental quality, especially by developing countries. There was also a call for more studies to be done to understand the factors that affect environmental quality and policy in different developmental situations

Identification of Performance Problems in a Commercial Human Immunodeficiency Virus Type 1 Enzyme Immunoassay by Multiuser External Quality Control Monitoring and Real-Time Data Analysis▿ †

OpenAIRE

Kim, J.; Swantee, C.; Lee, B.; Gunning, H.; Chow, A.; Sidaway, F.; Sherlock, C.; Garceau, R.; Dimech, W.; Malloch, L.

2009-01-01

In June 2005, a pilot program was implemented in Canadian laboratories to monitor the performance of the Abbott human immunodeficiency virus types 1 and 2 (HIV-1/2) gO enzyme immunoassay (EIA). Two different external quality control (QC) reagents and a “real-time” software analysis program were evaluated. In November 2005, higher-than-expected calibrator rate values in these kits were first reported at the Ontario Ministry of Health (Etobicoke), followed by the Alberta Provincial Public Healt...

External cephalic version facilitation for breech presentation at term.

Science.gov (United States)

Hofmeyr, G J

2001-01-01

Tocolytic drugs to relax the uterus as well as other methods have been also used in an attempt to facilitate external cephalic version at term. The objective of this review is to assess the effects of routine tocolysis, fetal acoustic stimulation, epidural or spinal analgesia and transabdominal amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth Group Trials Register and the Cochrane Controlled Trials Register were searched. Date of last search: April 2001. Randomised and quasi-randomised trials comparing routine versus selective tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural or spinal analgesia versus no regional analgesia; or transabdominal amnioinfusion versus no amnioinfusion for external cephalic version at term. Eligibility and trial quality were assessed by the reviewer. In seven trials, routine tocolysis was associated with fewer failures of external cephalic version (relative risk 0.74, 95% confidence interval 0.64 to 0.87). There were no significant differences between non-cephalic presentations at birth. Caesarean sections were reduced (relative risk 0.85, confidence interval 0.72-0.99). Fetal acoustic stimulation in midline fetal spine positions was associated with fewer failures of external cephalic version at term (relative risk 0.17, 95% confidence interval 0.05 to 0.60). With epidural or spinal analgesia, external cephalic version failure, non-cephalic births and caesarean sections were reduced in one trial but not the other. The overall differences were not statistically significant. No randomised trials of transabdominal amnioinfusion for external cephalic version at term were located. Routine tocolysis appears to reduce the failure rate of external cephalic version at term. Although promising, there is not enough evidence to evaluate the use of fetal acoustic stimulation in midline fetal

Cultivo de la trucha café anádroma: una nueva alternativa para la diversificación de la salmonicultura nacional

Directory of Open Access Journals (Sweden)

Nelson Colihueque

2015-03-01

Full Text Available Con el propósito de aportar información para contribuir al desarrollo del cultivo de la trucha café anádroma (Salmo trutta trutta en Chile, también llamada seatrout, en este trabajo se revisan los siguientes aspectos: i características genéticas y origen evolutivo de la trucha café naturalizada existente en el país, ii rendimiento reproductivo bajo condiciones de cautiverio, and iii eficiencia del proceso de esmoltificación, tasa de crecimiento y maduración sexual en agua dulce y agua de mar de la trucha café anádroma. Estos últimos parámetros son particularmente relevantes para una apropiada evaluación de su desempeño bajo condiciones de cultivo intensivo. El análisis de estos aspectos indica que las poblaciones naturalizadas de trucha café en Chile presentan un alto grado de variación genética, junto con un probable origen único (línea filogenética Atlántica, norte de Europa; éstas también presentan un rendimiento reproductivo óptimo, que excede aquel observado en otros salmónidos. Además, el proceso de esmoltificación de la trucha café anádroma es equivalente al observado en salmónidos totalmente anádromos, como el salmón del Atlántico y el salmón coho. Asimismo, con excepción de la maduración precoz, que es más alta que en el salmón del Atlántico, sobre todo en los machos, esta variedad también muestra una favorable tasa de crecimiento y sobrevivencia en agua de mar. Todos estos antecedentes indican que el cultivo de la trucha café anádroma es una alternativa interesante, con potencial para ser incorporada en la salmonicultura nacional.

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

Quality of Information

OpenAIRE

Christensen, Leif

2016-01-01

Accounting and auditing is closely related to the quality of data. Two important elements supporting the quality of information are internal controls and materiality. Inspired by Simons (1994), these elements can be considered “basic building blocks”. Internal controls are perhaps the most important element, as they ensure that information used for management purposes has the required quality (Kinney, 2000). This information can be used as a basis for preparing the external ...

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.

Genetic Compatibility Underlies Benefits of Mate Choice in an External Fertilizer.

Science.gov (United States)

Aguirre, J David; Blows, Mark W; Marshall, Dustin J

2016-05-01

Mate choice is a common feature of sexually reproducing species. In sessile or sedentary external fertilizers, however, direct interactions between reproductive partners are minimal, and instead mate recognition and choice must occur at the level of gametes. It is common for some sperm and egg combinations to have higher fertilization success than others, but it remains unclear whether differences in fertilization reflect gamete-level mate choice (GMC) for paternal quality or parental compatibility. Here, we examine the mechanisms underlying GMC in an externally fertilizing ascidian. A manipulative mate-choice assay confirmed that offspring viability was greater in clutches where we allowed GMC than in clutches where we precluded GMC. A complementary quantitative genetic experiment then revealed that paternal quality effects were generally weaker than parental compatibility effects, particularly for the trait combination underlying the benefits of GMC. Overall, our data suggest that gametes that are more compatible at fertilization produce more viable offspring than gametes that are less compatible at fertilization. Therefore, although the regalia we typically associate with sexual selection are absent in external fertilizers, mechanisms that allow females to bias fertilization in favor of some males over others produce significant fitness benefits in organisms reproducing via the ancestral strategy.

Next decade in external dosimetry

International Nuclear Information System (INIS)

Griffith, R.V.

1988-01-01

In recent years, a number of external dosimetry problems have been solved. However, changes in standards and legal concepts relating to the application of dosimetry results will require further enhancements in measurement techniques and philosophy in the next 10 y. The introduction of effective dose equivalent and the legal use of probability of causation will require that much greater attention be given to determination of weighted organ dose from external exposure. An imminent change--an increase in the fast neutron quality factor--will require a new round of technology development in a field that has just received a decade of close scrutiny. For the future, we must take advantage of developments in microelectronics. The use of random access memory (RAM) and metal-on-silicon (MOS) devices as detector elements, particularly for neutron dosimetry, has exciting possibilities that are just beginning to be explored. Advances in microcircuitry are leading, and will continue to lead, in the development of a new generation of small, rugged and smart radiation survey instruments that will make the most of detector data. It has become possible with very compact instruments to obtain energy spectra, linear-energy-transfer (LET) spectra, and quality factors in addition to the usual integrated dosimetric quantities: exposure, absorbed dose, and dose equivalent. These instruments will be reliable and easy to use. The user will be able to select the level of sophistication that is required for any specific application. Moreover, since the processing algorithms can be changed, changes in conversion factors can be accommodated with relative ease. During the next decade, the use of computers will continue to grow in value to the health physicist

Diminished neural responses predict enhanced intrinsic motivation and sensitivity to external incentive.

Science.gov (United States)

Marsden, Karen E; Ma, Wei Ji; Deci, Edward L; Ryan, Richard M; Chiu, Pearl H

2015-06-01

The duration and quality of human performance depend on both intrinsic motivation and external incentives. However, little is known about the neuroscientific basis of this interplay between internal and external motivators. Here, we used functional magnetic resonance imaging to examine the neural substrates of intrinsic motivation, operationalized as the free-choice time spent on a task when this was not required, and tested the neural and behavioral effects of external reward on intrinsic motivation. We found that increased duration of free-choice time was predicted by generally diminished neural responses in regions associated with cognitive and affective regulation. By comparison, the possibility of additional reward improved task accuracy, and specifically increased neural and behavioral responses following errors. Those individuals with the smallest neural responses associated with intrinsic motivation exhibited the greatest error-related neural enhancement under the external contingency of possible reward. Together, these data suggest that human performance is guided by a "tonic" and "phasic" relationship between the neural substrates of intrinsic motivation (tonic) and the impact of external incentives (phasic).

Diagnosis of West Nile Virus Human Infections: Overview and Proposal of Diagnostic Protocols Considering the Results of External Quality Assessment Studies

Directory of Open Access Journals (Sweden)

Ana Vázquez

2013-09-01

Full Text Available West Nile virus, genus Flavivirus, is transmitted between birds and occasionally other animals by ornithophilic mosquitoes. This virus also infects humans causing asymptomatic infections in about 85% of cases and <1% of clinical cases progress to severe neuroinvasive disease. The virus also presents a threat since most infections remain unapparent. However, the virus contained in blood and organs from asymptomatically infected donors can be transmitted to recipients of these infectious tissues. This paper reviews the presently available methods to achieve the laboratory diagnosis of West Nile virus infections in humans, discussing the most prominent advantages and disadvantages of each in light of the results obtained during four different External Quality Assessment studies carried out by the European Network for ‘Imported’ Viral Diseases (ENIVD.

Performance of different mono- and multiplex nucleic acid amplification tests on a multipathogen external quality assessment panel.

Science.gov (United States)

Loens, K; van Loon, A M; Coenjaerts, F; van Aarle, Y; Goossens, H; Wallace, P; Claas, E J C; Ieven, M

2012-03-01

An external quality assessment (EQA) panel consisting of a total of 48 samples in bronchoalveolar lavage (BAL) fluid or transport medium was prepared in collaboration with Quality Control for Molecular Diagnostics (QCMD) (www.qcmd.org). The panel was used to assess the proficiency of the three laboratories that would be responsible for examining the 6,000 samples to be collected in the GRACE Network of Excellence (www.grace-lrti.org). The main objective was to decide on the best-performing testing approach for the detection of influenza viruses A and B, parainfluenza virus types 1 to 3, respiratory syncytial virus (RSV), human metapneumovirus, coronavirus, rhinovirus, adenovirus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila by nucleic acid amplification techniques (NAATs). Two approaches were chosen: (i) laboratories testing samples using their in-house procedures for extraction and amplification and (ii) laboratories using their in-house amplification procedures on centrally extracted samples. Furthermore, three commercially available multiplex NAAT tests-the ResPlex (Qiagen GmbH, Hilden, Germany), RespiFinder plus (PathoFinder, Maastricht, The Netherlands), and RespiFinder Smart 21 (PathoFinder) tests-were evaluated by examination of the same EQA panel by the manufacturer. No large differences among the 3 laboratories were noticed when the performances of the assays developed in-house in combination with the in-house extraction procedures were compared. Also, the extraction procedure (central versus local) had little effect on performance. However, large differences in amplification efficacy were found between the commercially available tests; acceptable results were obtained by using the PathoFinder assays.

Quality of life after radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Joly, F.; Degrendel, A.C.; Guizard, A.V.

2010-01-01

The goal of localized prostate cancer radiotherapy is to cure patients. The decision-making must integrate the survival but also the quality of life of patients. Some French validated self-reported questionnaires are available to evaluate quality of life. Whatever the treatments (radical prostatectomy, brachytherapy, external beam radiation, with or without hormono-therapy), even if patients report more sequelae, their long-term quality of life is similar to that of the general population, except for patients treated with hormono-therapy who complain more decline of physical quality of life. In comparison with prostatectomy, patients treated with external beam radiation report less long-lasting urinary symptoms, but more bowel side effects, with no difference in global quality of life. Sexual disorders are initially less important with external beam radiation but increase over time. Brachytherapy shows no sexual function preservation benefit relative to radiation and may be less favourable with more urinary sequelae. The association of hormono-therapy and external beam radiation decreases the quality of life of the patients, with a negative impact on vitality, sexuality and increase urinary disorders. Intensity-modulated radiotherapy (IMRT) seems to better preserve the long-term digestive quality of life in comparison with conformal radiation therapy. Post-prostatectomy could induce more digestive toxicity, such as rectal irritation. The adjunction of hormono-therapy to radiation, the previous medical history of abdominal surgery, the field of radiation and the acute reactions to radiation are the main predictive factors to late toxicity and should be considered in the choice of initial treatment and for the follow-up. (authors)

External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon using dried tube specimens: results of an effectiveness evaluation

Directory of Open Access Journals (Sweden)

Andréa Mônica Brandão Beber

2015-06-01

Full Text Available INTRODUCTION : In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV tests using the dried tube specimen (DTS method (EQA-RT/DTS-HIV. Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs in the Brazilian Legal Amazonian area one year after its introduction. METHODS : Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs (n=39 and VCTC coordinators (n=32 were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. RESULTS: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure, registration in Quali-TR online system 38.7% (process, and VCTC completed the full process in the program's first round 63.4% (result. Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. CONCLUSIONS: All three program dimensions exhibited satisfactory results (>75%. Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment.

Results of ten centers, participating to the S.T.I.C. P.D.R. programme in relation with the external quality control in brachytherapy

International Nuclear Information System (INIS)

Metayer, Y.; Peiffert, D.; Brenier, J.P.; Bellec, J.; Goubard, O.; Chemin, A.; Chea, M.; Gaillot, N.

2007-01-01

Under the programme of S.T.I.C. P.D.R. brachytherapy a part of the quality control is realized internally (control of the Ir-192 source, the projector, treatment) and another is performed externally. It mainly concerns the use planning software. This control has helped to detect two problems of reconstruction, assess and validate the procedures for the acquisition, transfer and use of 3D images, check that the agreement issued on the dose is better than 5% on 10 projectors sources. S.T.I.C. ( supporting to costly innovative techniques; P.D.R (pulsed dose rate). (N.C.)

Parents' attachment histories and children's externalizing and internalizing behaviors: exploring family systems models of linkage.

Science.gov (United States)

Cowan, P A; Cowan, C P; Cohn, D A; Pearson, J L

1996-02-01

Twenty-seven mothers and 27 fathers were given the Adult Attachment Interview (M. Main & R. Goldwyn, in press) when their children were 3.5 years old. Continuous ratings of narrative coherence, probable experience quality (parents perceived as loving), and state of mind (current anger at parents) were entered as latent variables in partial least squares structural equation models that included observational measures of marital quality and parenting style. Models that include fathers' attachment histories predicted more variance in kindergarten teachers' descriptions of children's externalizing behavior, whereas models that include mothers' attachment histories predicted more variance in children's internalizing behavior. Marital data added predictive power to the equations. Discussion is focused on the importance of integrating attachment and family systems approaches, and of parents' gender and marital quality, in understanding specific links between parents' attachment histories and their young children's externalizing and internalizing behaviors.

External Evaluation of Education and Teacher Work: The Brazilian Case

Science.gov (United States)

Rothen, José Carlos; da Cunha Malheiros Santana, Andréia

2015-01-01

This article aims to discuss whether external evaluations are instruments to ensure increased quality of public school education. It is part of a research that investigated how evaluation results and the resulting indices were used in two schools in the state of São Paulo (Brazil). The methodology adopted was the case study, using different…

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.

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.

[External cephalic version].

Science.gov (United States)

Navarro-Santana, B; Duarez-Coronado, M; Plaza-Arranz, J

2016-08-01

To analyze the rate of successful external cephalic versions in our center and caesarean sections that would be avoided with the use of external cephalic versions. From January 2012 to March 2016 external cephalic versions carried out at our center, which were a total of 52. We collected data about female age, gestational age at the time of the external cephalic version, maternal body mass index (BMI), fetal variety and situation, fetal weight, parity, location of the placenta, amniotic fluid index (ILA), tocolysis, analgesia, and newborn weight at birth, minor adverse effects (dizziness, hypotension and maternal pain) and major adverse effects (tachycardia, bradycardia, decelerations and emergency cesarean section). 45% of the versions were unsuccessful and 55% were successful. The percentage of successful vaginal delivery in versions was 84% (4% were instrumental) and 15% of caesarean sections. With respect to the variables studied, only significant differences in birth weight were found; suggesting that birth weight it is related to the outcome of external cephalic version. Probably we did not find significant differences due to the number of patients studied. For women with breech presentation, we recommend external cephalic version before the expectant management or performing a cesarean section. The external cephalic version increases the proportion of fetuses in cephalic presentation and also decreases the rate of caesarean sections.

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

Tesis Doctorales

OpenAIRE

TE TESIS DOCTORALES

2009-01-01

Resúmenes de tesis doctorales: ALARCÓN ALARCÓN, María del Mar, Biografía histórica de Pedro Alcántara de Toledo y Salm-Salm, duque del Infantado (1768-1841), tesis doctoral dirigida por el Dr. Emilio La Parra López, defendida el 25 de septiembre de 2015 en el Departamento de Humanidades Contemporáneas de la Universidad de Alicante; PÉREZ CASANOVA, Guillermo Jorge, La búsqueda de la unidad europea: el europeísmo español entre 1914 y 1931, tesis doctoral dirigida por el Dr. Salvador Forner Muño...

The Effectiveness of the Higher Education Quality Assessment System: Problems and Countermeasures in China

Science.gov (United States)

Guangli, Zhou

2016-01-01

The effectiveness of the higher education quality assessment system is essentially a matter of policy evaluation. On the macro level, such a system refers to external quality assessment, which includes government evaluation, quality certification, and university rankings. Depending on the degree of government intervention, the external quality…

[Quality assurance in interventional cardiology].

Science.gov (United States)

Gülker, H

2009-10-01

Quality assurance in clinical studies aiming at approval of pharmaceutical products is submitted to strict rules, controls and auditing regulations. Comparative instruments to ensure quality in diagnostic and therapeutic procedures are not available in interventional cardiology, likewise in other fields of cardiovascular medicine. Quality assurance simply consists of "quality registers" with basic data not externally controlled. Based on the experiences of clinical studies and their long history of standardization it is assumed that these data may be severely flawed thus being inappropriate to set standards for diagnostic and therapeutic strategies. The precondition for quality assurance are quality data. In invasive coronary angiography and intervention medical indications, the decision making process interventional versus surgical revascularization, technical performance and after - care are essential aspects affecting quality of diagnostics and therapy. Quality data are externally controlled data. To collect quality data an appropriate infrastructure is a necessary precondition which is not existent. For an appropriate infrastructure investments have to be done both to build up as well as to sustain the necessary preconditions. As long as there are no infrastructure and no investments there will be no "quality data". There exist simply registers of data which are not proved to be a basis for significant assurance and enhancement in quality in interventional coronary cardiology. Georg Thieme Verlag KG Stuttgart, New York.

Online fibre optic OSL in vivo dosimetry for quality assurance of external beam radiation therapy treatments: The ANR-TECSAN Codofer Project

International Nuclear Information System (INIS)

Magne, S.; Ferdinand, P.; De Carlan, L.; Bridier, A.; Isambert, A.; Hugon, R.; Guillon, J.

2010-01-01

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)

Evaluation of the use of digital images for a national prostate core external quality assurance scheme.

Science.gov (United States)

Harnden, Patricia; Coleman, Derek; Moss, Sue; Kodikara, Sandhya; Griffin, Nick R; Melia, Jane

2011-10-01

To evaluate the use of virtual images as an alternative to glass slides to expand the number of participants in the External Quality Assurance Scheme for prostatic biopsies. Benign and neoplastic cases, previously circulated as glass slides, were selected to include cases that had demonstrated a high level of agreement (n = 10) and a lesser degree of agreement (n = 10). Whole slide virtual images were circulated to 68 pathologists; 51 responses were returned. The levels of agreement for the primary diagnosis and for Gleason grading of cancers were analysed using kappa statistics. Responses for glass slides versus images were compared for the 24 pathologists for whom data were available. Levels of agreement for diagnostic categories using virtual slides were moderate to substantial, comparable to those found using glass slides. The level of agreement for Gleason grades 8-10 was substantial, but for lower grades was fair or moderate, poorer than for the glass slide circulation. Circulation of virtual images of biopsy material is a suitable alternative to glass slide-based schemes for the evaluation of diagnostic consistency. The majority of participants agreed that the ability to evaluate limited diagnostic material outweighed the disadvantages of a virtual system. 2011 Blackwell Publishing Limited.

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.

External radiation surveillance

International Nuclear Information System (INIS)

Antonio, E.J.

1995-01-01

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

Audit Quality of Government Auditor

Directory of Open Access Journals (Sweden)

Agus Setiawaty

2013-12-01

Full Text Available This study explores the relationship between government’s auditors’ personal characteristics and acceptance of dysfunctional behavior situational factors on government’s audit quality. Data collection was conducted by distributing questionnaires to 111 government’s auditors. The data was analyzed using PLS application. The results showed that government’s auditors who increasingly accept dysfunctional behavior tend to have characteristic of external locus of control and that government’s auditors with external locus of control tend to have low organizational commitment. Leadership style of the audit team leader during the audit process improved the government’s auditors’ commitment to their organization which leads to high-quality audit.

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.

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.

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.

Quality management, a directive approach to patient safety.

Science.gov (United States)

Ayuso-Murillo, Diego; de Andrés-Gimeno, Begoña; Noriega-Matanza, Concha; López-Suárez, Rafael Jesús; Herrera-Peco, Ivan

Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

the effect of external knowledge on brand equity

OpenAIRE

sajad khani; abdolhamid ebrahimi

2014-01-01

Most traditional organizations managers focus on tangible and financial assets such as land, money, labor and ... One of the industries where competition is intense day by day the concept of competitive advantage and value creation in its resolution finds the banking industry. In this regard, the present study sought to examine the impact of intangible assets (external knowledge) to improve service quality and brand equity in the banking industry and the Export Development Bank of Iran. ...

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

Comorbidity in illness-induced posttraumatic stress disorder versus posttraumatic stress disorder due to external events in a nationally representative study.

Science.gov (United States)

Sommer, Jordana L; Mota, Natalie; Edmondson, Donald; El-Gabalawy, Renée

2018-05-10

The current study compared physical and mental health characteristics and quality of life of illness-induced posttraumatic stress disorder (PTSD) versus those with PTSD due to external traumatic events in a population-based sample. PTSD was assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5) using DSM-5 criteria in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Participants with past-year PTSD (n = 1779) were categorized into two groups: illness-induced (6.5%) and other trauma-induced PTSD (92.9%) based on index trauma. Group differences in physical health, mental health, and quality of life were estimated using multiple logistic and linear regressions with adjustment for demographics and medical morbidity. Compared to PTSD due to external events, illness-induced PTSD had higher rates of life-threatening illness in the past year. Illness-induced PTSD compared to PTSD due to external events was associated with reduced odds of depressive/bipolar disorders and antisocial personality disorder, but increased odds of cannabis use disorder. The groups did not differ on quality of life after accounting for medical morbidity. Illness-induced PTSD is common among American adults and has a similar impact on quality of life as PTSD due to external events, but may have distinct mental health correlates. Copyright © 2018 Elsevier Inc. All rights reserved.

Salme Reegi nimelise auhinna nominendid

Index Scriptorium Estoniae

2006-01-01

Valiti järgmised nominendid : Taago Tubin - lavastus "Suur kuri hunt" Vanemuises, Marika Vaarik - õpetaja Klamm VAT Teatri lavastuses "Klammi sõda", Finn Poulsen - "Trollpoiss" Eesti Nukuteatris, Leino Rei - lavastused "Kuusepuu", "Karjatüdruk ja korstnapühkija", Taavi Tõnisson - Papageno "Võluflöödis" Eesti Nukuteatri lavastuses

Guide for External Beam Radiotherapy. Procedures 2007

International Nuclear Information System (INIS)

Ardiet, Jean-Michel; Bourhis, Jean; Eschwege, Francois; Gerard, Jean-Pierre; Martin, Philippe; Mazeron, Jean-Jacques; Barillot, Isabelle; Bey, Pierre; Cosset, Jean-Marc; Thomas, Olivier; Bolla, Michel; Bourguignon, Michel; Godet, Jean-Luc; Krembel, David; Valero, Marc; Bara, Christine; Beauvais-March, Helene; Derreumaux, Sylvie; Vidal, Jean-Pierre; Drouard, Jean; Sarrazin, Thierry; Lindecker-Cournil, Valerie; Robin, Sun Hee Lee; Thevenet, Nicolas; Depenweiller, Christian; Le Tallec, Philippe; Ortholan, Cecile; Aimone, Nicole; Baldeschi, Carine; Cantelli, Andree; Estivalet, Stephane; Le Prince, Cyrille; QUERO, Laurent; Costa, Andre; Gerard, Jean-Pierre; Ardiet, Jean-Michel; Bensadoun, Rene-Jean; Bourhis, Jean; Calais, Gilles; Lartigau, Eric; Ginot, Aurelie; Girard, Nicolas; Mornex, Francoise; Bolla, Michel; Chauvet, Bruno; Maingon, Philippe; Martin, Etienne; Azria, David; Gerard, Jean-Pierre; Grehange, Gilles; Hennequin, Christophe; Peiffert, Didier; Toledano, Alain; Belkacemi, Yazid; Courdi, Adel; Belliere, Aurelie; Peignaux, Karine; Mahe, Marc; Bondiau, Pierre-Yves; Kantor, Guy; Lepechoux, Cecile; Carrie, Christian; Claude, Line

2007-01-01

In order to optimize quality and security in the delivery of radiation treatment, the French SFRO (Societe francaise de radiotherapie oncologique) is publishing a Guide for Radiotherapy. This guide is realized according to the HAS (Haute Autorite de sante) methodology of 'structured experts consensus'. This document is made of two parts: a general description of external beam radiation therapy and chapters describing the technical procedures of the main tumors to be irradiated (24). For each procedure, a special attention is given to dose constraints in the organs at risk. This guide will be regularly updated

Fifteen years of external quality assessment in leukemia/lymphoma immunophenotyping in The Netherlands and Belgium: A way forward.

Science.gov (United States)

Preijers, Frank W M B; van der Velden, Vincent H J; Preijers, Tim; Brooimans, Rik A; Marijt, Erik; Homburg, Christa; van Montfort, Kees; Gratama, Jan W

2016-05-01

In 1985, external quality assurance was initiated in the Netherlands to reduce the between-laboratory variability of leukemia/lymphoma immunophenotyping and to improve diagnostic conclusions. This program consisted of regular distributions of test samples followed by biannual plenary participant meetings in which results were presented and discussed. A scoring system was developed in which the quality of results was rated by systematically reviewing the pre-analytical, analytical, and post-analytical assay stages using three scores, i.e., correct (A), minor fault (B), and major fault (C). Here, we report on 90 consecutive samples distributed to 40-61 participating laboratories between 1998 and 2012. Most samples contained >20% aberrant cells, mainly selected from mature lymphoid malignancies (B or T cell) and acute leukemias (myeloid or lymphoblastic). In 2002, minimally required monoclonal antibody (mAb) panels were introduced, whilst methodological guidelines for all three assay stages were implemented. Retrospectively, we divided the study into subsequent periods of 4 ("initial"), 4 ("learning"), and 7 years ("consolidation") to detect "learning effects." Uni- and multivariate models showed that analytical performance declined since 2002, but that post-analytical performance improved during the entire period. These results emphasized the need to improve technical aspects of the assay, and reflected improved interpretational skills of the participants. A strong effect of participant affiliation in all three assay stages was observed: laboratories in academic and large peripheral hospitals performed significantly better than those in small hospitals. © 2015 International Clinical Cytometry Society. © 2015 International Clinical Cytometry Society.

A PILOT EXTERNAL QUALITY ASSURANCE STUDY OF TRANSFUSION SCREENING FOR HIV, HCV AND HBSAG IN TWELVE AFRICAN COUNTRIES

Science.gov (United States)

Bloch, Evan M; Shah, Avani; Kaidarova, Zhanna; Laperche, Syria; Lefrere, Jean-Jacques; van Hasselt, James; Zacharias, Peter; Murphy, Edward L

2014-01-01

Background and Objectives Serologic screening for the major transfusion transmissible viruses (TTV) is critical to blood safety and has been widely implemented. However, actual performance as measured by proficiency testing has not been well studied in Sub-Saharan Africa. Therefore, we conducted an external quality assessment of laboratories engaged in transfusion screening in the region. Materials and Methods Blinded test panels, each comprising 25 serum samples that were pedigreed for HIV, HBsAg, HCV and negative status, were sent to participating laboratories. The panels were tested using the laboratories’ routine donor screening methods and conditions. Sensitivity and specificity were calculated and multivariable analysis was used to compare performance against mode of testing, country and infrastructure. Results A total of 12 African countries and 44 laboratories participated in the study. The mean (range) sensitivities for HIV, HBsAg and HCV were 91.9% (14.3-100), 86.7% (42.9-100) and 90.1% (50-100), respectively. Mean specificities for HIV, HBsAg and HCV were 97.7%, 97% and 99.5% respectively. After adjusting for country and infrastructure, rapid tests had significantly lower sensitivity than enzyme immunoassays (EIA) for both HBsAg (p<0.0001) and HCV (p<0.05). Sensitivity also varied by country and selected infrastructure variables. Conclusion While specificity was high, sensitivity was more variable and deficient in a substantial number of testing laboratories. These findings underscore the importance of proficiency testing and quality control, particularly in Africa where TTV prevalence is high. PMID:25052195

What factors determine use of quality-related marketing research information? an empirical investigation

NARCIS (Netherlands)

Birgelen, van M.; Ruyter, de J.C.; Wetzels, M.G.M.

2001-01-01

For effective total quality management (TQM), internal, process-related, as well as external, market-oriented, information is crucial. In particular, external marketing information seems to be very valuable since customers are the ultimate evaluators of the quality of an organization. In this paper,

Neointima development in externally stented saphenous vein grafts

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Przemysław Węglarz

2016-11-01

Full Text Available Introduction : The main limitation of coronary artery bypass grafting (CABG is rapid neointimal hyperplasia leading to graft failure. Aim : To assess plaque formation in saphenous vein grafts (SVG covered by an external Dacron stent in comparison with the classical technique. Material and methods : In the study group vein grafts covered by external stent mesh made of Dacron were implanted. An intravascular ultrasonography (IVUS study was performed in 35 aorto-coronary SVG covered by an external Dacron stent and in 64 normal SVG during the first year after CABG. In each SVG 25 mm of good quality IVUS image, volumes of lumen, plaque (neointima, outer border of the vein graft (external SVG and adventitia were calculated in three time periods: 0–130 days, 130–260 days and 260–390 days. Results : Between the first and second time period, lumen volume (mm3 was reduced from 10.33 ±4.4, to 6.80 ±2.23 in the second period and 5.69 ±1.26 in the third one. This effect was much less marked in normal grafts. The corresponding lumen volume (mm3 was: 10.90 ±3.9, 9.15 ±2.94 and 8.92 ±2.93 in consecutive time periods. Plaque volume (mm3 did not change in control grafts during the course of the study, but it increased very significantly in stented grafts from 0.86 ±1.24 in the first period to 2.70 ±1.58 in the second and 3.29 ±2.66 in the third one. Conclusions : The experimental technique of implanting SVG covered with an external elastic Dacron stent seems to be inferior to traditional ones. This is probably due to the more complicated process of vein implantation and higher micro-injury occurrence during the surgery.

Retrospective Study on External Canine Limb Prosthesis used in 24 patients

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Brittany Jean Carr

2018-03-01

Full Text Available Objective: The purpose of this retrospective study is to provide data regarding external prosthetic use in small animal patients, evaluate the common complications associated with external prosthetics, and evaluate the outcome of patients using an external prosthetic.Background: The use of external canine limb prosthetics is relatively uncommon in veterinary medicine today.  However, there is growing interest in prosthetics and their clinical application because these devices may offer an alternative to euthanasia in severe cases where full amputation or alternative methods of limb spare are not an option. The goal of the prosthesis is to provide a better quality of life, help prevent further deformation and degeneration of existing joints, decrease leg length discrepancies, increase exercise and activity levels, provide a means to participate in rehabilitation therapy and maintain the ability to perform daily acts of living. To the author’s knowledge, there is no report of external prosthetic use in small animal veterinary medicine, providing the profession with baseline information for use in, not only general practice or referral practice, but also future research.Evidentiary value: This retrospective study provides data regarding external prosthetic use in small animal patients, evaluates the procedures, manufacturing, rehabilitation and common complications associated with external prosthetics, and evaluates the factors that determine a patient’s prosthetic candidacy.Methods: Patients that had an external prosthesis custom manufactured for them at Animal Orthocare, LLC and had a complete medical record were identified for this study.  A client survey was completed via e-mail or telephone to collect further data about the patients, including age, weight, breed, sex, affected limb(s, reason for prosthesis, level of amputation, activities patient could perform with prosthesis in place, prosthetic fit, prosthetic migration (e

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).

Rewiew of history lessons during 2001-2012 academic year by the external assessors

OpenAIRE

Survutaitė, Dalia; Vaičekauskienė, Snieguolė

2012-01-01

Recently a lot of attention has been paid to the search of education innovation and modernization. However in the educational environment empirical data analysis and evaluation of subjects of general education of educational practice are rarely found. This article analyzes quality characteristics of history lessons for years 5-12 in the educational practice, reports of external evaluation of the quality of the activities of country's different general education schools were used. Data interpr...

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.

Development and validation of the ExPRESS instrument for primary health care providers' evaluation of external supervision.

Science.gov (United States)

Schriver, Michael; Cubaka, Vincent Kalumire; Vedsted, Peter; Besigye, Innocent; Kallestrup, Per

2018-01-01

External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. "External supervision: Provider Evaluation of Supervisor Support" (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test-retest design, the second for confirmatory factor analysis. We included 16 items in section A ('The most recent experience with an external supervisor'), and 13 items in section B ('The overall experience with external supervisors'). Item-content validity index was acceptable. In field test I, test-retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.

Estimating fuel cycle externalities: Analytical methods and issues. Report number 2 on the external costs and benefits of fuel cycles: A study by the U.S. Department of Energy and the Commission of the European Communities

Energy Technology Data Exchange (ETDEWEB)

NONE

1994-07-01

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.' Part I illustrates the use of the atmospheric dispersion and transformation modeling that this study recommends for airborne pollutants in the coal, biomass, oil, and natural gas fuel cycles. Part II of this volume contains a paper which reviews the scientific literature on ecological impacts associated with power plant discharges. Part III contains papers summarizing the relevant health effects literature. Part IV contains papers on methods of economic evaluation. Part V contains four papers on various issues related to the estimation of externalities and their use in public policy. The final part is Part VI, and it contains a paper which describes a system for summarizing analysts' assessments of the quality of the information that an analysis uses to estimate externalities. This system allows analysts to provide information, not only on their best estimates, but also on a range of estimates, on uncertainty, on the quality of the data, and on other factors that better reflect the full dimension of making estimates under uncertainty. The system has broad applicability beyond fuel cycle externalities, as well.

Estimating fuel cycle externalities: Analytical methods and issues. Report number 2 on the external costs and benefits of fuel cycles: A study by the U.S. Department of Energy and the Commission of the European Communities

International Nuclear Information System (INIS)

1994-07-01

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.' Part I illustrates the use of the atmospheric dispersion and transformation modeling that this study recommends for airborne pollutants in the coal, biomass, oil, and natural gas fuel cycles. Part II of this volume contains a paper which reviews the scientific literature on ecological impacts associated with power plant discharges. Part III contains papers summarizing the relevant health effects literature. Part IV contains papers on methods of economic evaluation. Part V contains four papers on various issues related to the estimation of externalities and their use in public policy. The final part is Part VI, and it contains a paper which describes a system for summarizing analysts' assessments of the quality of the information that an analysis uses to estimate externalities. This system allows analysts to provide information, not only on their best estimates, but also on a range of estimates, on uncertainty, on the quality of the data, and on other factors that better reflect the full dimension of making estimates under uncertainty. The system has broad applicability beyond fuel cycle externalities, as well

Stress Fractures of Tibia Treated with Ilizarov External Fixator.

Science.gov (United States)

Górski, Radosław; Żarek, Sławomir; Modzelewski, Piotr; Górski, Ryszard; Małdyk, Paweł

2016-08-30

Stress fractures are the result of cyclic loading of the bone, which gradually becomes damaged. Most often they are treated by rest or plaster cast and, in rare cases, by internal fixation. There is little published data on initial reposition followed by stabilization with the Ilizarov apparatus in such fractures. Six patients were treated with an external fixator according to the Ilizarov method for a stress fracture of the tibia between 2007 and 2015. Three patients were initially treated conservatively. Due to increasing tibial deformation, they were qualified for surgical treatment with external stabilization. In the other patients, surgery was the first-line treatment. All patients demonstrated risk factors for a stress fracture. After the surgery, they fully loaded the operated limb. No patient developed malunion, nonunion, infection or venous thrombosis. The average time from the first operation to the removal of the external fixator was 19 weeks. Radiographic and clinical outcomes were satisfactory in all patients. 1. The Ilizarov method allows for successful stabilization of stress fractures of the tibia. 2. It may be a good alternative to internal stabilization, especially in patients with multiple comorbidities which affect bone quality and may impair soft tissue healing.

Effect of polyunsatured aldehyde (A3 as an antiparasitary ingredient of Caligus rogercresseyi in the feed of Atlantic salmon, Salmo salar Efecto del aldehído poli-insaturado (A3 como ingrediente antiparasitario de Caligus rogercresseyi en la alimentación de salmón del atlántico, Salmo salar

Directory of Open Access Journals (Sweden)

José Troncoso

2011-11-01

Full Text Available Some polyunsaturated aldehydes (PUAs such as 2-trans, 4-trans decadenial (A3 have a detrimental effect on the development of copepod sharmful to the salmon industrysuch as Caligus rogercresseyi (sea lice. The purpose of this study was to evaluate the potential use of A3 as a salmon feed ingredient in order to reduce reproduction of Caligus rogercresseyi in infested Atlantic salmon (Salmo salar. The toxicity of A3 was assessed histopathologically for 7 days, using intra-peritoneal injections of different doses (0, 0.24, 0.47, 2.37, 11.86, and 23.71 mg kg-1 in brain, intestine, skin, liver, and muscletissues of Salmosalar at the end of each treatment. The effect of A3 on sea lice was evaluated using 250 Atlantic salmon in an open-flow system of seawater (~13°C. The effect of the dosage in the fish diet was evaluated at two levels (9 mg kg-1, 18 mg kg-1 and considering a control (without A3 for 4, 8, and 12 days, once the sea lice had reached maturity. As a complement, the persistent effect of diluted A3 in sea water (0.5 g L-1 was evaluated at 10, 12, and 14°C for 0, 1, 3, 6, 10, and 15 days; and the maximum persistence was found at 10 days at 10°C. The results showed that the dosages over 0.47 mg kg-1 had no toxic effect on Atlantic salmon, but induced a detrimental effect on Caligus rogercresseyi (reduction of 15% of mature females with a dose of 18 mg kg-1, which could be attributed to alterations in the embryonic development of the sea lice. A3 is a potential supplement in the diet of salmon. However, studies ofits mechanism of action should be undertaken prior to its use.Algunos aldehídos poli-insaturados (PUAs tales como 2-trans, 4-trans decadenal (A3 tienen efecto perjudicial para el desarrollo de copépodos perjudiciales para la industria del salmón, tales como Caligus rogercresseyi (piojo de mar. El objetivo del presente estudio fue evaluar el uso potencial de A3 en alimentación de salmones, de forma de reducir la reproducción de

Implantation of a new certification systematic of external individual monitoring services in Brazil

International Nuclear Information System (INIS)

Salati, Ivan P.A.; Cunha, Paulo G. da; Mauricio, Claudia L.P.; Mota, Helvecio C.; Ramos, Manoel M.O.; Silva, Teogenes A. da

1996-01-01

Brazilian regulations for External Individual Monitoring Services (SMIE) were established since 1981 and they weren't able to accomplish that these services reached the standards of quality assurance programs appointed for both national and international recommendations. Intercomparisons and audits took in course in 80's showed the necessity of improving the quality of services operating in Brazil. These services are responsible for monitoring more than 40.000 workers in this country. In 1992, the Committee of Assessment of External Individual Monitoring (named CASMIE) was created in the Instituto de Radioprotecao e Dosimetria (IRD/CNEN) in the aim of developing technical standards and to propose new procedures of SMIEs accreditation by Comissao Nacional de Energia Nuclear (CNEN). The new procedures are implemented in 1995. In this work, the relevant aspects of this process are presented, as well as a summary of the technical documents that were developed by CASMIE. (author)

Piezosurgery in External Dacryocystorhinostomy.

Science.gov (United States)

Czyz, Craig N; Fowler, Amy M; Dutton, Jonathan J; Cahill, Kenneth V; Foster, Jill A; Hill, Robert H; Everman, Kelly R; Nabavi, Cameron B

Dacryocystorhinostomy (DCR) can be performed via an external or endoscopic approach. The use of ultrasonic or piezosurgery has been well described for endoscopic DCRs but is lacking for external DCRs. This study presents a case series of external DCRs performed using piezosurgery evaluating results and complications. Prospective, consecutive case series of patients undergoing primary external DCR for lacrimal drainage insufficiency. A standard external DCR technique was used using 1 of 2 piezosurgery systems for all bone incision. All patients received silicone intubation to the lacrimal system. Surgical outcome was measured in terms of patient-reported epiphora as follows: 1) complete resolution, 2) improvement >50%, 3) improvement 50% improvement. There were 4 patients (7%) who had <50% improvement. There was 1 (2%) intraoperative complication and 2 (4%) postoperative complications recorded. Piezourgery is a viable modality for performing external DCRs. The lack of surgical complications shows a potential for decreased soft tissues damage. The surgical success rate based on patient-reported epiphora is similar to those published for mechanical external DCRs. This modality may benefit the novice surgeon in the reduction of soft and mucosal tissue damage.

Externalities in a life cycle model with endogenous survival☆

Science.gov (United States)

Kuhn, Michael; Wrzaczek, Stefan; Prskawetz, Alexia; Feichtinger, Gustav

2011-01-01

We study socially vs individually optimal life cycle allocations of consumption and health, when individual health care curbs own mortality but also has a spillover effect on other persons’ survival. Such spillovers arise, for instance, when health care activity at aggregate level triggers improvements in treatment through learning-by-doing (positive externality) or a deterioration in the quality of care through congestion (negative externality). We combine an age-structured optimal control model at population level with a conventional life cycle model to derive the social and private value of life. We then examine how individual incentives deviate from social incentives and how they can be aligned by way of a transfer scheme. The age-patterns of socially and individually optimal health expenditures and the transfer rate are derived. Numerical analysis illustrates the working of our model. PMID:28298810

Trajectories of Classroom Externalizing Behavior: Contributions of Child Characteristics, Family Characteristics, and the Teacher-Child Relationship during the School Transition

Science.gov (United States)

Silver, R.B.; Measelle, J.R.; Armstrong, J.M.; Essex, M.J.

2005-01-01

The unique and interactive contributions of past externalizing behavior, negative parenting, and teacher-child relationship quality to externalizing behavior trajectories after the transition to school were examined. In a sample of 283 children, random regression analyses indicated that conflict in the teacher-child relationship during the school…

Documenting Quality Improvement and Patient Safety Efforts: The Quality Portfolio. A Statement from the Academic Hospitalist Taskforce

OpenAIRE

Taylor, Benjamin B.; Parekh, Vikas; Estrada, Carlos A.; Schleyer, Anneliese; Sharpe, Bradley

2013-01-01

Physicians increasingly investigate, work, and teach to improve the quality of care and safety of care delivery. The Society of General Internal Medicine Academic Hospitalist Task Force sought to develop a practical tool, the quality portfolio, to systematically document quality and safety achievements. The quality portfolio was vetted with internal and external stakeholders including national leaders in academic medicine. The portfolio was refined for implementation to include an outlined fr...

Environmental externalities: Applying the concept to Asian coal-based power generation

International Nuclear Information System (INIS)

Szpunar, C.B.; Gillette, J.L.

1993-03-01

This report examines the concept of environmental externality. It discusses various factors -- the atmospheric transformations, relationship of point-source emissions to ambient air quality, dose-response relationships, applicable cause-and-effect principles, and risk and valuation research -- that are considered by a number of state utilities when they apply the environmental externality concept to energy resource planning. It describes a methodology developed by Argonne National Laboratory for general use in resource planning, in combination with traditional methods that consider the cost of electricity production. Finally, it shows how the methodology can be applied in Indonesia, Thailand, and Taiwan to potential coal-fired power plant projects that will make use of clean coal technologies

Environmental externalities: Applying the concept to Asian coal-based power generation

Energy Technology Data Exchange (ETDEWEB)

Szpunar, C.B.; Gillette, J.L.

1993-03-01

This report examines the concept of environmental externality. It discusses various factors -- the atmospheric transformations, relationship of point-source emissions to ambient air quality, dose-response relationships, applicable cause-and-effect principles, and risk and valuation research -- that are considered by a number of state utilities when they apply the environmental externality concept to energy resource planning. It describes a methodology developed by Argonne National Laboratory for general use in resource planning, in combination with traditional methods that consider the cost of electricity production. Finally, it shows how the methodology can be applied in Indonesia, Thailand, and Taiwan to potential coal-fired power plant projects that will make use of clean coal technologies.

Quality management in a department of radiology

International Nuclear Information System (INIS)

Fischer, U.; Vosshenrich, R.; Baum, F.; Schorn, C.; Funke, M.; Grabbe, E.; Strasser, G.; Staudacher, J.

2002-01-01

Purpose. To increase the quality of internal and external interactions (patients, clinical colleagues, technicians, radiologists) in a department of radiology.Method. Accompanied by a well-experienced adviser workshops have been performed dealing with different topics like ''contact to patients'', ''performance of the radiological report and interaction with the referring colleague'' or ''research and teaching''. A catalogue of different actions was defined to reduce hindrances within the internal and external work-flow.Results. A total number of 53 actions was defined and related to different persons who were responsible for the realisation of the measures within a time interval. Six months after starting the quality management 46 (86%) of the defined actions were realised successfully, and another 4 (8%) measures were still running. There was a moderate increase of satisfaction of the patients and clinical colleagues considering the waiting time.Conclusions. A quality management in a radiological department allows an optimisation of the internal and external interactions. However, the guidance of a well-experienced adviser is as essential as the continuous control of successful finished measures. (orig.) [de

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

Science.gov (United States)

Legagneux, Pierre; Harms, N Jane; Gauthier, Gilles; Chastel, Olivier; Gilchrist, H Grant; Bortolotti, Gary; Bêty, Joël; Soos, Catherine

2013-01-01

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.

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.

Weighing environmental externalities: Let's do it right

International Nuclear Information System (INIS)

Joskow, P.L.

1992-01-01

Should we as a society adopt policies to internalize external environmental costs? Of course we should. But we should do it correctly. State public utility commissions (PUCs) that are using numerical 'externality adders' reflecting global and regional environmental impacts in the resource planning and selection process are doing it wrong. The use of these adders is likely to lead to higher electricity prices without a commensurate improvement in environmental impacts in the resource planning and selection process are doing it wrong. The use of these adders is likely to lead to higher electricity prices without a commensurate improvement in environmental quality. Alternative approaches for dealing with environmental damages or externalities exist that can lead utilities to take account of the environmental costs associated with the generation of electricity more effectively and at lower cost. This article discusses what an externality is and why the use of environmental adders by PUCs in the resource selection process, while well intentioned, is a bad idea. The author discusses how the most egregious errors associated with the use of adders can be corrected if PUCs insist on using them. Finally, he outlines an alternative approach that state PUCs can pursue which will better serve the electricity customers they are supposed to protect and promote a cleaner environment at the lowest reasonable cost. The author emphasizes that this is not a debate about whether or not environmental costs should be factored into the investment and operating decisions of firms that produce pollution. Rather, it is about how it should be done and whether state PUCs are in a particularly good position to do it well, given their expertise, legal authorities, other responsibilities and scarce resources

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.

QUALITY ASSURANCE SYSTEMS IN POLISH AND UKRAINIAN HIGHER EDUCATION. A COMPARATIVE ANALYSIS

Directory of Open Access Journals (Sweden)

Marta Tutko

2015-02-01

Full Text Available The article deals with the progress made to develop external and internal quality assurance systems in Polish and Ukrainian higher education in the European Higher Education Area background. The focus of the paper is on the extent to which quality assurance systems in these countries are following the Standards and Guidelines for Quality Assurance in the European Higher Education Area. Furthermore, internal and external quality assur-ance in the European context is presented in the article. The authors of the article also conducted a comparative analysis of quality assurance systems in Polish and Ukrainian higher education.

Methodology of social and environmental external costs estimation in the Ukraine’s energy sector

Directory of Open Access Journals (Sweden)

Karaieva Nataliia Veniaminivna

2016-09-01

Full Text Available Paper objective is analysis of the external costs assessment model for the eco-social damage, and/or human capital losses caused by environmental pollution from the energy enterprises in Ukraine. Using the given method, necessary initial socio-economic parameters were defined and used for calculating the social costs of capital health losses in Ukraine due to deterioration of the environment, and due to the negative impact of energy sector on the air quality for the period 2002-2013. On the proposed technique determines the range value of social losses due to the negative impact of energy on air quality in Ukraine excluding future external costs for years 2002 – 2013 ranges from 1.6 – 4.5% of GDP, and the range of values of taking into account future costs is 2.0 – 6.2% of GDP.

Conditionally replicating adenovirus prevents pluripotent stem cell–derived teratoma by specifically eliminating undifferentiated cells

Directory of Open Access Journals (Sweden)

Kaoru Mitsui

Full Text Available Incomplete abolition of tumorigenicity creates potential safety concerns in clinical trials of regenerative medicine based on human pluripotent stem cells (hPSCs. Here, we demonstrate that conditionally replicating adenoviruses that specifically target cancers using multiple factors (m-CRAs, originally developed as anticancer drugs, may also be useful as novel antitumorigenic agents in hPSC-based therapy. The survivin promoter was more active in undifferentiated hPSCs than the telomerase reverse transcriptase (TERT promoter, whereas both promoters were minimally active in differentiated normal cells. Accordingly, survivin-responsive m-CRA (Surv.m-CRA killed undifferentiated hPSCs more efficiently than TERT-responsive m-CRAs (Tert.m-CRA; both m-CRAs exhibited efficient viral replication and cytotoxicity in undifferentiated hPSCs, but not in cocultured differentiated normal cells. Pre-infection of hPSCs with Surv.m-CRA or Tert.m-CRA abolished in vivo teratoma formation in a dose-dependent manner following hPSC implantation into mice. Thus, m-CRAs, and in particular Surv.m-CRAs, represent novel antitumorigenic agents that could facilitate safe clinical applications of hPSC-based regenerative medicine.

What do external consultants from private and not-for-profit companies offer healthcare commissioners? A qualitative study of knowledge exchange.

Science.gov (United States)

Wye, Lesley; Brangan, Emer; Cameron, Ailsa; Gabbay, John; Klein, Jonathan H; Anthwal, Rachel; Pope, Catherine

2015-02-25

The use of external consultants from private and not-for-profit providers in the National Health Service (NHS) is intended to improve the quality of commissioning. The aim of this study was to learn about the support offered to healthcare commissioners, how external consultants and their clients work together and the perceived impact on the quality of commissioning. NHS commissioning organisations and private and not-for-profit providers. Mixed methods case study of eight cases. 92 interviews with external consultants (n=36), their clients (n=47) and others (n=9). Observation of 25 training events and meetings. Documentation, for example, meeting minutes and reports. Constant comparison. Data were coded, summarised and analysed by the research team with a coding framework to facilitate cross-case comparison. In the four contracts presented here, external providers offered technical solutions (eg, software tools), outsourcing and expertise including project management, data interpretation and brokering relationships with experts. In assessing perceived impact on quality of commissioning, two contracts had limited value, one had short-term benefits and one provided short and longer term benefits. Contracts with commissioners actively learning, embedding and applying new skills were more valued. Other elements of success were: (1) addressing clearly agreed problems of relevance to managerial and operational staff (2) solutions co-produced at all organisational levels (3) external consultants working directly with clients to interpret data outputs to inform locally contextualised commissioning strategies. Without explicit knowledge exchange strategies, outsourcing commissioning to external providers resulted in the NHS clients becoming dependent. NHS commissioning will be disadvantaged if commissioners both fail to learn in the short term from the knowledge of external providers and in the longer term lose local skills. Knowledge exchange mechanisms are a vital

ASH External Web Portal (External Portal) -

Data.gov (United States)

Department of Transportation — The ASH External Web Portal is a web-based portal that provides single sign-on functionality, making the web portal a single location from which to be authenticated...

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....

Dosimetry quality assurance in Martin Marietta Energy Systems' centralized external dosimetry system

International Nuclear Information System (INIS)

Souleyrette, M.L.

1992-01-01

External dosimetry needs at the four Martin Marietta Energy Systems facilities are served by Energy Systems Centralized External Dosimetry System (CEDS). The CEDS is a four plant program with four dosimeter distribution centers and two dosimeter processing centers. Each plant has its own distribution center, while processing centers are located at ORNL and the Y-12 Plant. The program has been granted accreditation by the Department of Energy Laboratory Accreditation Program (DOELAP). The CEDS is a TLD based system which is responsible for whole-body beta-gamma, neutron, and extremity monitoring. Beta-gamma monitoring is performed using the Harshaw/Solon Technologies model 8805 dosimeter. Effective October 1, 1992 the standard silver mylar has been replaced with an Avery mylar foil blackened on the underside with ink. This was done in an effort to reduce the number of light induced suspect readings. At this time we have little operational experience with the new blackened mylars-The CEDS neutron dosimeter is the Harshaw model 8806B. This card/holder configuration contains two TLD-600/TLD-700 chip pairs; one pair is located beneath a cadmium filter and one pair is located beneath a plastic filter. In routine personnel monitoring the CEDS neutron dosimeter is always paired with a CEDS beta-gamma dosimeter.The CEDS extremity dosimeter is composed of a Harshaw thin TLD-700 dosiclip placed inside a Teledyne RB-4 finger sachet. The finger sachet provides approximately 7 mg/cm 2 filtration over the chip. A teflon ring surrounds the dosiclip to help prevent tearing of the vinyl sachet

"Detski biznes" molodõh dizainerov 2007 / Ksenia Repson

Index Scriptorium Estoniae

Repson, Ksenia

2007-01-01

ERKI moeshow 2007 Tallinnas Salme kultuurikeskuses. Moeetenduse teemaks oli "Beebibissness ruulib!". Osalejate Kirill Safonovi, Kristina Tatarinova, Jekaterina Kravtshenko ja Ksenia Jedomskihhi kollektsioonidest. Osalejate nimekiri

Interpreting biomarker data from the COPHES/DEMOCOPHES twin projects: Using external exposure data to understand biomarker differences among countries

International Nuclear Information System (INIS)

Smolders, R.; Den Hond, E.; Koppen, G.; Govarts, E.; Willems, H.; Casteleyn, L.; Kolossa-Gehring, M.; Fiddicke, U.; Castaño, A.; Koch, H.M.; Angerer, J.; Esteban, M.; Sepai, O.; Exley, K.; Bloemen, L.; Horvat, M.; Knudsen, L.E.; Joas, A.; Joas, R.; Biot, P.

2015-01-01

In 2011 and 2012, the COPHES/DEMOCOPHES twin projects performed the first ever harmonized human biomonitoring survey in 17 European countries. In more than 1800 mother–child pairs, individual lifestyle data were collected and cadmium, cotinine and certain phthalate metabolites were measured in urine. Total mercury was determined in hair samples. While the main goal of the COPHES/DEMOCOPHES twin projects was to develop and test harmonized protocols and procedures, the goal of the current paper is to investigate whether the observed differences in biomarker values among the countries implementing DEMOCOPHES can be interpreted using information from external databases on environmental quality and lifestyle. In general, 13 countries having implemented DEMOCOPHES provided high-quality data from external sources that were relevant for interpretation purposes. However, some data were not available for reporting or were not in line with predefined specifications. Therefore, only part of the external information could be included in the statistical analyses. Nonetheless, there was a highly significant correlation between national levels of fish consumption and mercury in hair, the strength of antismoking legislation was significantly related to urinary cotinine levels, and we were able to show indications that also urinary cadmium levels were associated with environmental quality and food quality. These results again show the potential of biomonitoring data to provide added value for (the evaluation of) evidence-informed policy making. - Highlights: • External data was collected to interpret HBM data from DEMOCOPHES. • Hg in hair could be related to fish consumption across different countries. • Urinary cotinine was related to strictness of anti-smoking legislation. • Urinary Cd was borderline significantly related to air and food quality. • Lack of comparable data among countries hampered the analysis

Interpreting biomarker data from the COPHES/DEMOCOPHES twin projects: Using external exposure data to understand biomarker differences among countries

Energy Technology Data Exchange (ETDEWEB)

Smolders, R., E-mail: roel.smolders@vito.be [Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol (Belgium); Den Hond, E.; Koppen, G.; Govarts, E.; Willems, H. [Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol (Belgium); Casteleyn, L. [KU LEUVEN (Belgium); Kolossa-Gehring, M.; Fiddicke, U. [Federal Environment Agency (UBA) (Germany); Castaño, A. [Instituto de Salud Carlos III (Spain); Koch, H.M.; Angerer, J. [Institute for Prevention and Occupational Medicine of the German Social Accident Insurance - Institute of the Ruhr-Universität Bochum (IPA) (Germany); Esteban, M. [Instituto de Salud Carlos III (Spain); Sepai, O.; Exley, K. [Public Health England (United Kingdom); Bloemen, L. [Environmental Health Sciences International (Netherlands); Horvat, M. [Jožef Stefan Institute (Slovenia); Knudsen, L.E. [University of Copenhagen (Denmark); Joas, A.; Joas, R. [BiPRO (Germany); Biot, P. [FPS Health, Food Chain Safety and Environment (Belgium); and others

2015-08-15

In 2011 and 2012, the COPHES/DEMOCOPHES twin projects performed the first ever harmonized human biomonitoring survey in 17 European countries. In more than 1800 mother–child pairs, individual lifestyle data were collected and cadmium, cotinine and certain phthalate metabolites were measured in urine. Total mercury was determined in hair samples. While the main goal of the COPHES/DEMOCOPHES twin projects was to develop and test harmonized protocols and procedures, the goal of the current paper is to investigate whether the observed differences in biomarker values among the countries implementing DEMOCOPHES can be interpreted using information from external databases on environmental quality and lifestyle. In general, 13 countries having implemented DEMOCOPHES provided high-quality data from external sources that were relevant for interpretation purposes. However, some data were not available for reporting or were not in line with predefined specifications. Therefore, only part of the external information could be included in the statistical analyses. Nonetheless, there was a highly significant correlation between national levels of fish consumption and mercury in hair, the strength of antismoking legislation was significantly related to urinary cotinine levels, and we were able to show indications that also urinary cadmium levels were associated with environmental quality and food quality. These results again show the potential of biomonitoring data to provide added value for (the evaluation of) evidence-informed policy making. - Highlights: • External data was collected to interpret HBM data from DEMOCOPHES. • Hg in hair could be related to fish consumption across different countries. • Urinary cotinine was related to strictness of anti-smoking legislation. • Urinary Cd was borderline significantly related to air and food quality. • Lack of comparable data among countries hampered the analysis.

eLearning-radiology.com. Sustainability for quality assurance

International Nuclear Information System (INIS)

Ketelsen, D.; Talanow, R.; Uder, M.; Grunewald, M.

2009-01-01

Purpose: The aim of the study was to analyze the availability of published radiological e-learning tools and to establish a solution for quality assurance. Materials and Methods: Substantial pubmed research was performed to identify radiological e-learning tools. 181 e-learning programs were selected. As examples two databases expanding their programs with external links, Compare (n = 435 external links) and TNT-Radiology (n = 1078 external links), were evaluated. A concept for quality assurance was developed by an international taskforce. Results: At the time of assessment, 56.4 % (102/181) of the investigated e-learning tools were accessible at their original URL. A subgroup analysis of programs published 5 to 8 years ago showed significantly inferior availability to programs published 3 to 5 years ago (p < 0.01). The analysis of external links showed 49.2 % and 61.0 % accessible links for the programs Compare (published 2003) and TNT-Radiology (published 2006), respectively. As a consequence, the domain www.eLearning-radiology.com was developed by the taskforce and published online. This tool allows authors to present their programs and users to evaluate the e-learning tools depending on several criteria in order to remove inoperable links and to obtain information about the complexity and quality of the e-learning tools. (orig.)

The role of employees in quality development

DEFF Research Database (Denmark)

Jørgensen, Michael Søgaard; Hvid, Helge

1999-01-01

A framework is developed for research on the role of employees in quality development in companies seen as formed thorugh the interaction between management, employees and the external relations to customers and suppliers. The impact of quality assurance on working life is discussed....

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%.

A quality audit program for external beam radiotherapy

International Nuclear Information System (INIS)

Hanson, W.F.; Stovall, M.

1993-01-01

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%

Longitudinal effects of sibling relationship quality on adolescent problem behavior: a cross-ethnic comparison.

Science.gov (United States)

Buist, Kirsten L; Paalman, Carmen H; Branje, Susan J T; Deković, Maja; Reitz, Ellen; Verhoeven, Marjolein; Meeus, Wim H J; Koot, Hans M; Hale, William W

2014-04-01

The aim of the present study was to examine whether adolescents of Moroccan and Dutch origin differ concerning sibling relationship quality and to examine whether the associations between quality of the sibling relationship and level and change in externalizing and internalizing problem behavior are comparable for Moroccan and Dutch adolescents. Five annual waves of questionnaire data on sibling support and conflict as well as externalizing problems, anxiety and depression were collected from 159 ethnic Moroccan adolescents (Mage = 13.3 years) and from 159 ethnic Dutch adolescents (Mage = 13.0 years). Our findings demonstrated significant mean level differences between the Moroccan and Dutch sample in sibling relationship quality, externalizing problems, and depression, with Moroccan adolescents reporting higher sibling relationship quality and less problem behavior. However, effects of sibling relationship quality on externalizing problems, anxiety, and depression were similar for the Moroccan and Dutch samples. Sibling support was not related to level of externalizing problems, nor to changes in externalizing problems, anxiety, and depression. Additionally, more sibling conflict was related to a higher starting level of and faster decreases in problem behaviors. Our results support the ethnic equivalence model, which holds that the influence of family relationships is similar for different ethnic groups. Moreover, sibling support and conflict affect both the level and the fluctuations in problem behavior over time in specific ethnic groups similarly. Implications for future studies and interventions are subsequently discussed.

External quality assessment in gynaecological cytology: The Trent Region experience. The Trent Regional Gynaecological Pathology Quality Assurance Group for the National Health Service Cervical Screening Programme.

Science.gov (United States)

Slater, D N; Hewer, E M; Melling, S E; Rice, S

2002-08-01

A Department of Health Executive Letter stated in 1998 that the principal function of external quality assessment (EQA) is educational. Subsequently, in England, it has no longer been acceptable to assess performance in gynaecological cytology by proficiency testing. This paper describes the EQA scheme in gynaecological cytology that has been run by the Trent Regional Gynaecological Pathology Quality Assurance Group for the NHS Cervical Screening Programme (NHSCSP) since 1998. It conforms as closely as possible to the recommendations published by the Department of Health Working Group on Histopathology EQA Accreditation, and replaced the national proficiency testing protocol. The educational value of the scheme is derived predominantly from a numerical score which provides confidential and quantitative feedback to all participants. Personal performance monitoring occurs as a secondary function. For primary screeners and checkers, this is based purely on the distinction between negative, inadequate and abnormal smears. For pathologists, personal performance monitoring also includes grading of abnormalities. The EQA has been designed so that all professional groups participate in a manner that closely mimics normal practice. Only slides that have achieved an 80% consensus amongst participants are used in the EQA. Substandard performance has been defined as those participants with scores falling below the 2.5%ile. The paper describes the EQA in detail and illustrates its use by means of the second round results. The EQA protocol developed within Trent and described in this paper has contributed to proposals contained in the current national EQA in gynaecological cytology for the NHSCSP. In particular this paper highlights the effectiveness of the scoring system contained within the Trent and National EQA protocols.

CRITERIA AND QUALITY INDICATORS OF INFORMATION AND COMMUNICATION TECHNOLOGIES OF LEARNING

OpenAIRE

Oleg M. Spirin

2013-01-01

In the article the concept of information and communication technology and information and communication technology of learning is specified. It is grounded an external and internal criteria of information and communication technologies of learning quality assessment based on experience of information and communication technology quality assessment of the methodical system of informatics teachers vocational training. There are considered the external indexes – design, structural, organization...

Egg shell quality in Japanese quail: characteristics, heritabilities and genetic and phenotypic relationships.

Science.gov (United States)

Narinc, D; Aygun, A; Karaman, E; Aksoy, T

2015-07-01

The objective of the present study was to estimate heritabilities as well as genetic and phenotypic correlations for egg weight, specific gravity, shape index, shell ratio, egg shell strength, egg length, egg width and shell weight in Japanese quail eggs. External egg quality traits were measured on 5864 eggs of 934 female quails from a dam line selected for two generations. Within the Bayesian framework, using Gibbs Sampling algorithm, a multivariate animal model was applied to estimate heritabilities and genetic correlations for external egg quality traits. The heritability estimates for external egg quality traits were moderate to high and ranged from 0.29 to 0.81. The heritability estimates for egg and shell weight of 0.81 and 0.76 were fairly high. The genetic and phenotypic correlations between egg shell strength with specific gravity, shell ratio and shell weight ranging from 0.55 to 0.79 were relatively high. It can be concluded that it is possible to determine egg shell quality using the egg specific gravity values utilizing its high heritability and fairly high positive correlation with most of the egg shell quality traits. As a result, egg specific gravity may be the choice of selection criterion rather than other external egg traits for genetic improvement of egg shell quality in Japanese quails.

Quality Assurance in Post-Secondary Education: Some Common Approaches

Science.gov (United States)

Law, Dennis Chung Sea

2010-01-01

Purpose: The common approaches to quality assurance (QA), as practiced by most post-secondary education institutions for internal quality monitoring and most QA authorities for external quality monitoring (EQM), have been considered by many researchers as having largely failed to address the essence of educational quality. The purpose of this…

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.

[Quality assurance and quality improvement. Personal experiences and intentions].

Science.gov (United States)

Roche, B G; Sommer, C

1995-01-01

In may 1994 we were selected by the surgical Swiss association to make a study about quality in USA. During our travel we visited 3 types of institutions: Hospitals, National Institute of standard and Technology, Industry, Johnson & Johnson. We appreciate to compare 2 types of quality programs: Quality Assurance (QA) and Continuous Quality Improvement (CQI). In traditional healthcare circles, QA is the process established to meet external regulatory requirements and to assure that patient care is consistent with established standards. In a modern quality terms, QA outside of healthcare means designing a product or service, as well as controlling its production, so well that quality is inevitable. The ideas of W. Edward Deming is that there is never improvement just by inspection. He developed a theory based on 14 principles. A productive work is accomplished through processes. Understanding the variability of processes is a key to improve quality. Quality management sees each person in an organisation as part of one or more processes. The job of every worker is to receive the work of others, add value to that work, and supply it to the next person in the process. This is called the triple role the workers as customer, processor, and supplier. The main source of quality defects is problems in the process. The old assumption is that quality fails when people do the right thing wrong; the new assumption is that, more often, quality failures arise when people do the wrong think right. Exhortation, incentives and discipline of workers are unlikely to improve quality. If quality is failing when people do their jobs as designed, then exhorting them to do better is managerial nonsense. Modern quality theory is customer focused. Customers are identified internally and externally. The modern approach to quality is thoroughly grounded in scientific and statistical thinking. Like in medicine, the symptom is a defect in quality. The therapist of process must perform diagnostic

Early parenting, represented family relationships, and externalizing behavior problems in children born preterm.

Science.gov (United States)

Poehlmann, Julie; Burnson, Cynthia; Weymouth, Lindsay A

2014-01-01

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.

Serotonin Transporter Genotype (5HTTLPR) Moderates the Longitudinal Impact of Atypical Attachment on Externalizing Behavior.

Science.gov (United States)

Humphreys, Kathryn L; Zeanah, Charles H; Nelson, Charles A; Fox, Nathan A; Drury, Stacy S

2015-01-01

To test whether genotype of the serotonin transporter-linked polymorphic region (5HTTLPR) and atypical attachment interact to predict externalizing psychopathology prospectively in a sample of children with a history of early institutional care. Caregiver report of externalizing behavior at 54 months was examined in 105 children initially reared in institutional care and enrolled in the Bucharest Early Intervention Project, a randomized controlled trial of high quality foster care. 5HTTLPR genotype, attachment status at 42 months of age (typical [secure, avoidant, or ambivalent] or atypical [disorganized-controlling, insecure-other]), and their interaction were examined as predictors of externalizing behavior at age 54 months. 5HTTLPR genotype and atypical attachment at age 42 months interacted to predict externalizing behavior at age 54 months. Specifically, children with the s/s genotype with an atypical attachment had the highest externalizing scores. However, s/s children with a typical attachment demonstrated the lowest externalizing scores, even after controlling for intervention group status. There was no association between attachment status and externalizing behavior among children carrying at least 1 copy of the l allele. These findings indicate that genetic variation in the serotonergic system moderates the association between atypical attachment status and externalizing in young children. Our findings suggest that children, as a result of genetic variability in the serotonergic system, demonstrate differential sensitivity to the attachment relationship.

Practical implications of the ICRP - Publication 26 on the neutron external monitoring

International Nuclear Information System (INIS)

Sordi, G.-M.A.A.

1983-01-01

The following topics are dealt with: radiation monitoring (monitoring of the work place, individual monitoring, application of models to the interpretation of the monitoring results, monitoring complementary functions); monitoring of the work place for the external neutronic radiation (a project for a monitoring program, interpretation of the results) and confidence quality. (M.A.) [pt

Aboriginal research coalition externalities associated with energy production: Types, measures and integration

International Nuclear Information System (INIS)

Goodman, I.

1992-01-01

A system that has evolved to determine the environmental externalities associated with energy generation is described. The system involves identification and understanding of the activity being considered (power generation from a specific type of plant), effects such as air pollution, measures such as pollution control that can influence the levels of the preceding effects, the resources affected, impacts on human resource uses, and the values humans place on the use of the resources. Considerations in estimating external costs are then discussed. These include property rights, air emissions, electromagnetic fields, pollution control effectiveness and costs, valuation of air emissions, water quality and quantity, effects on fisheries and recreational activities, and effects of dams and inundation. A least-cost, or integrated management process, selects the combination of electricity supply and demand sources that have the least social cost. Total externality costs are estimated, based on emissions or effects from each source multiplied by unit costs, and control measures selected. The external costs are combined with the usual fixed and variable cost calculations to provide a total social cost measure. This monetization procedure allows a complete accounting of all costs to society on an equal basis. 53 refs., 4 figs

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

[Analysis of the results of the 2010 External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology for HIV-1, HCV, and HBV viral loads].

Science.gov (United States)

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

2011-12-01

Human immunodeficiency virus type 1 (HIV-1) and hepatitis B (HBV) and C virus (HCV) viral load determinations are among the most important markers for 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 summarized the results obtained in the 2010 External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology for HIV-1, HCV, and HBV viral loads and HCV genotyping. 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 3-5 log(10) copies/mL; two of these standards were identical, with the aim of determining repeatability. A significant proportion of the laboratories (22.6% on average) obtained values out of 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 limits (Δ<0.5 log(10)copies/mL). The HBV and HCV program consisted of two standards with different viral load contents. Most of the participants, 86.1% in the case of HCV and 87.1% in HBV, obtained all the results within the accepted range (mean ± 1.96 SD log(10)UI/mL). Post-analytical errors due to mistranscription of the results were detected in these controls. 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 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.

Quality of higher education: organisational or educational?

DEFF Research Database (Denmark)

Zou, Yihuan; Du, Xiangyun; Rasmussen, Palle

2012-01-01

Based on a study of Chinese university self-evaluation reports, this paper argues that higher education institutions are trying to manage the tensions between educational and organisational quality and the increasing and worldwide concerns about quality assurance. After 30 years of dramatic...... remain an important basis for external review. In an attempt to examine the institutional understanding of quality in higher education, the authors conducted a content analysis study of 53 self-evaluation reports written by a wide range of higher education institutions in China. This study concludes...... educational reform, China has established a nationwide evaluation system for assessing its higher education institutions. This comprehensive system includes a series of procedures for both internal self-evaluation and external peer reviewing, among which self-evaluation reports prepared by each institution...

External Quality Control Review of the Defense Information Systems Agency Audit Organization

Science.gov (United States)

2012-08-07

We are providing this report for your information and use. We have reviewed the system of quality control for the audit organization of the Defense...audit organization encompasses the audit organization’s leadership, emphasis on performing high quality work, and policies and procedures established

External school evaluation in Portugal : a glance at the impacts on curricular and pedagogical practices

OpenAIRE

Leite, Carlinda; Morgado, José Carlos; Seabra, Filipa

2014-01-01

Conferência realizada na Universidade do Minho, em Braga de 18-19 de outubro de 2013 Answering demands for an increase of accountability in terms of public education, and intending to lead to an improvement of the quality of education (Conselho Nacional de Educação, 2010), external school evaluation has been taking place in the continental territory of Portugal since 2006. All the schools having been evaluated once, in what is known as the 1st cycle of external evaluation, and a 2nd cycle ...

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

Improving Keyhole Stability by External Magnetic Field in Full Penetration Laser Welding

Science.gov (United States)

Li, Min; Xu, Jiajun; Huang, Yu; Rong, Youmin

2018-05-01

An external magnetic field was used to improve the keyhole stability in full penetration laser welding 316L steel. The increase of magnetic field strength gave rise to a shorter flying time of the spatter, a weaker size and brightness of the spatter, and a larger spreading area of vapor plume. This suggested that the dynamic behavior of the keyhole was stabilized by the external magnetic field. In addition, a stronger magnetic field could result in a more homogeneous distribution of laser energy, which increased the width of the weld zone, and the height of the bottom weld zone from 381 μm (0 mT) to 605 μm (50 mT). Dendrite and cellular crystal near the weld center disappeared, and grain size was refined. The external magnetic field was beneficial to the keyhole stability and improved the joint quality, because the weld pool was stirred by a Lorentz force resulting from the coupling effect of the magnetic field and inner thermocurrent.

A critical scoping review of external uses of comfrey (Symphytum spp.).

Science.gov (United States)

Frost, R; MacPherson, H; O'Meara, S

2013-12-01

External preparations of the herb comfrey (most commonly Symphytum officinale L.) are widely available for over-the-counter, practitioner and healthcare professional usage. Traditional practice suggests comfrey can be used to treat musculoskeletal disorders, wounds and various other conditions; however a full and critical coverage of the evidence base has not yet been undertaken. A critical scoping review was undertaken. Six bibliographic databases, 10 grey literature databases and nine trials registers were searched plus reference lists of included studies and a descriptive overview of comfrey. Randomised or non-randomised clinical trials assessing the external use of comfrey for any indication were included and methodological and reporting quality were assessed. Observational studies were included only in the assessment of adverse events. Studies were grouped and summarised according to the type of indication treated. Of 1348 identified records, 64 full texts were screened for inclusion and 26 were included in the review - 13 RCTs, 5 non-randomised controlled trials and 8 observational studies evaluating treatments for ankle distortion, back pain, abrasion wounds, venous leg ulcers and osteoarthritis. The majority of included trials had an overall unclear risk of bias due to poor quality of reporting. Few adverse events were reported. Individual clinical trials showed evidence of benefit for ankle distortion, back pain, abrasion wounds and osteoarthritis. Topical application appears to be safe but further rigorous assessment is needed. Systematic reviews focussing on particular indications may clarify the treatment effect and safety of external comfrey preparations. Copyright © 2013 Elsevier Ltd. All rights reserved.

The quality assurance liaison: Combined technical and quality assurance support

International Nuclear Information System (INIS)

Bolivar, S.L.; Day, J.L.

1993-01-01

This paper describes the role of the quality assurance liaison, the responsibilities of this position, and the evolutionary changes in duties over the last six years. The role of the quality assurance liaison has had a very positive impact on the Los Alamos Yucca Mountain Site Characterization (YW) quality assurance program. Having both technical and quality assurance expertise, the quality assurance liaisons are able to facilitate communications with scientists on quality assurance issues and requirements, thereby generating greater productivity in scientific investigations. The quality assurance liaisons help ensure that the scientific community knows and implements existing requirements, is aware of new or changing regulations, and is able to conduct scientific work within Project requirements. The influence of the role of the quality assurance liaison can be measured by an overall improvement in attitude of the staff regarding quality assurance requirements and improved job performance, as well as a decrease in deficiencies identified during both internal and external audits and surveillances. This has resulted in a more effective implementation of quality assurance requirements

Keerulised ja põnevad / Tõnu Kaalep

Index Scriptorium Estoniae

Kaalep, Tõnu, 1966-2018

2009-01-01

22. oktoobril Tallinnas Rock Cafes toimunud ansambli KTU (Kimmo Pohjonen, Lee Patrick Mastelotto, Trey Gunn) kontserdist ja 25. oktoobril Salme Kultuurikeskuses etendunud Heiner Goebbelsi lavastusest "Eraritjaritjaka"

Improvement of the beam quality of a diode laser with two active broad-area segments

DEFF Research Database (Denmark)

Chi, Mingjun; Thestrup, B.; Mortensen, J.L.

2003-01-01

The beam quality of a diode laser with two active segments was improved using an external cavity with collimating optics, a grating, and an output coupler. The beam quality of the output beam, which is the first-order diffractive beam from the grating, was improved by a factor of 2, and at least...... half of the freely running power of the laser was coupled out from the external cavity. The output power can be enhanced further by the feedback from the zeroth-order beam. The possibility of improving the beam quality further is discussed and a new double-external-cavity configuration is suggested....

Quality Assurance in Higher Education: Proposals for Consultation.

Science.gov (United States)

Higher Education Funding Council for England, Bristol.

This document sets out for consultation proposals for a revised method for quality assurance of teaching and learning in higher education. The proposals cover: (1) the objectives and principles of quality assurance; (2) an approach to quality assurance based on external audit principles; (3) the collection and publication of information; (4)…

Quality assurance protocol for linear accelerators used in radiotherapy

International Nuclear Information System (INIS)

Petkovska, Sonja

2012-01-01

Radiotherapy is a modality of choice for treatment of malignant diseases. Linear accelerators are the most common devices for implementing external radiation therapy. Taking into account the fact during the treatment, healthy tissue will inevitably be exposed to ionizing radiation, predicted dose in each radiotherapy case should be delivered with the greatest possible accuracy. Medical requirement for quality treatment achieving means as mach as possible dose into volume of interest and the greatest possible healthy tissue protection. From radiation protection point of view, occupational exposure of the staff involved in radiotherapy process should be minimized. To be able to reach it, consistent adherence to the Quality Assurance Programme is necessary. It should be in accordance with higher national and international protocols, because they give guidelines on the necessary standards, procedures, processes, resources and responsibilities that should be defined in structuring the overall radiotherapy quality management. As a part of this Master thesis, quality management as well as Quality Assurance Programme that is necessary to be applied in each radiotherapy center have been prepared. Mandatory dosimetry measurements included in the internal recommendations are also emphasized. Measurement results and external audit by IAEA indicated high accuracy and quality radiotherapy dose delivering in Macedonia. Based on the measurements and analysis, the aim of this Master thesis is offering a Quality Assurance Protocol for external beam radiotherapy that can be used on the national level in Republic of Macedonia. (Author)

[Quality management in pathology--an executive function and political implications].

Science.gov (United States)

Turzynski, A

2013-09-01

Quality management (QM) is primarily an in-house executive function. It conduces to ensure a high quality service and has the external object to satisfy customer expectations. In Germany the implementation of quality management systems (QMS) is made compulsory for all medical facilities by law. However, details are not regulated and there is no need to certify the in-house QMS. Within the last 10 years many pathology institutions have become certified or accredited and have implemented voluntary measures of external quality assurance, such as quality circles and round robin trials. For non-certified institutions it might be helpful to be guided by established QM standards like the ISO 9001:2008. The fundamental concepts of QM, some pathology-specific aspects and some implications for the professional associations are discussed in this article.

Effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes

Science.gov (United States)

Flodgren, Gerd; Pomey, Marie-Pascale; Taber, Sarah A; Eccles, Martin P

2014-01-01

Background Inspection systems are used in health care 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 health care. However, the benefits of external inspection in terms of organisational, provider and patient level outcomes are not clear. Objectives To evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. Search methods We searched the following electronic databases for studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Scopus, HMIC, Index to Theses and Intute from their inception dates up to May 2011. There was no language restriction and studies were included regardless of publication status. We searched the reference lists of included studies and contacted authors of relevant papers, accreditation bodies and the International Organization for Standardisation (ISO), regarding any further published or unpublished work. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time-series (ITSs) and controlled before and 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. Data collection and analysis Two review authors independently applied eligibility criteria, extracted data and assessed the risk of bias of each included study. Since meta-analysis was

Externalities of fuel cycles 'ExternE' project. Natural gas fuel cycle. Estimation of physical impacts and monetary valuation for priority impact pathways

International Nuclear Information System (INIS)

Holland, M.; Watkiss, P.; Berry, J.; Johnson, C.; Lee, D.

1994-01-01

been established. Earlier work is typically of a preliminary nature and tends to be deficient with respect to both the methods employed and the quality of models and data used. In consequence of this the ExternE Project was established in 1991, with the following main objectives; 1) To identify and develop a suitable methodology with which to quantify the external costs and benefits of the major fuel cycles for electricity generation and conservation, using the best available models and data. This to be done using a common framework for assessment of different fuel cycles, in order that fair comparison can be made between them. 2) To use this methodology to assess the external costs for a number of case studies representative of each fuel cycle. 3) To make recommendations on areas in which further research is required in order that future estimates of damages can be made with greater confidence. To meet these objectives we have stressed transparency, consistency and comprehensiveness as guiding principles for the work. This applies particularly to the methods used, definition of study boundaries and listing of effects that are considered and those that are not. These principles are essential to allow valid comparison to be made between different fuel cycles, for which priority impacts may differ greatly, as illustrated by comparison of the gas, nuclear and wind fuel cycles. The present report is one of a series covering the following fuel cycles; coal, uranium, lignite, oil, gas, wind, photovoltaics, biomass and small scale hydroelectric projects. Energy security and energy conservation are also being considered within a similar framework. The methodology used is broadly similar to that identified for Life Cycle Analysis (LCA) by The Society for Environmental Toxicology and Chemistry. It is split into the following stages; 1) Definition of objectives and system boundaries; 2) Collation of an inventory of burdens associated with the process in question; 3

The external jugular vein as an injection site in radionuclide angiography

International Nuclear Information System (INIS)

Humphrey, S.; Shelton, J.; Wollum, P.; Leguizamon, E.

1982-01-01

The first-pass radionuclide angiogram has been shown to be an effective method for evaluation of left ventricular function. When the first-pass technique is used, however, delivery of a compact radionuclide bolus is imperative. The external jugular vein is a safe, effective route of delivery for the bolus; it provides for a high quality, technically accurate test without deleterious effects to the patient

Analysis of quality control tests done by the Canadian power utilities on their external dosimetry systems (June 1988 to May 1993)

International Nuclear Information System (INIS)

Butt, K.A.; Poirier, G.S.

1995-09-01

The Canadian nuclear power utilities, Hydro-Quebec, New Brunswick Electric Power Commission and Ontario Hydro, use thermoluminescent dosimetry systems to perform their own external beta/gamma dosimetry. In order to help ensure that these systems perform satisfactorily, they are subjected to routine quality control testing by their parent organizations. The test results for the period of June 1988 to May 1993 have been analyzed, at the Atomic Energy Control Board (AECB), using the pass criterion which was originally agreed upon the organizations involved and which is described in section 2.3 of this document. The present analysis offers an indication of the performance of the different sites which operate such a service. Comparisons are made each site's performance during the period June 1985 to May 1988 which has been summarized previously (INFO--0301). Finally, recommendations are made in the hope that they will help the organizations in refining their dosimetry. (author) 1 ref., 7 tabs

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.

External corners as heat bridges

Energy Technology Data Exchange (ETDEWEB)

Berber, J.

1984-08-01

The maximum additional heat loss in vertical external corners depending on wall thickness is determined. In order to amire at a low k-value, a much smaller wall thickness is required in externally insulated walls than in monolithic constructions; the greater loss of heat bridge with external insulation stands in contrast to a higher loss in thick, monolithic walls. In relation to total losses, the additional losses through external corners are practically negligible.

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.

Tunable single and dual mode operation of an external cavity quantum-dot injection laser

International Nuclear Information System (INIS)

Biebersdorf, A; Lingk, C; De Giorgi, M; Feldmann, J; Sacher, J; Arzberger, M; Ulbrich, C; Boehm, G; Amann, M-C; Abstreiter, G

2003-01-01

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

Hanford External Dosimetry Program

International Nuclear Information System (INIS)

Fix, J.J.

1990-10-01

This document describes the Hanford External Dosimetry Program as it is administered by Pacific Northwest Laboratory (PNL) in support of the US Department of Energy (DOE) and its Hanford contractors. Program services include administrating the Hanford personnel dosimeter processing program and ensuring that the related dosimeter data accurately reflect occupational dose received by Hanford personnel or visitors. Specific chapters of this report deal with the following subjects: personnel dosimetry organizations at Hanford and the associated DOE and contractor exposure guidelines; types, characteristics, and procurement of personnel dosimeters used at Hanford; personnel dosimeter identification, acceptance testing, accountability, and exchange; dosimeter processing and data recording practices; standard sources, calibration factors, and calibration processes (including algorithms) used for calibrating Hanford personnel dosimeters; system operating parameters required for assurance of dosimeter processing quality control; special dose evaluation methods applied for individuals under abnormal circumstances (i.e., lost results, etc.); and methods for evaluating personnel doses from nuclear accidents. 1 ref., 14 figs., 5 tabs

Serotonin Transporter Genotype (5HTTLPR) Moderates the Longitudinal Impact of Atypical Attachment on Externalizing Behavior

Science.gov (United States)

Humphreys, Kathryn L.; Zeanah, Charles H.; Nelson, Charles A.; Fox, Nathan A.; Drury, Stacy S.

2015-01-01

Objective To test whether genotype of the serotonin transporter-linked polymorphic region (5HTTLPR) and atypical attachment interact to predict externalizing psychopathology prospectively in a sample of children with a history of early institutional care. Methods Caregiver report of externalizing behavior at 54 months was examined in 105 children initially reared in institutional care and enrolled in the Bucharest Early Intervention Project, a randomized controlled trial of high quality foster care. 5HTTLPR genotype, attachment status at 42 months of age (typical [secure, avoidant, or ambivalent] or atypical [disorganized-controlling, insecure-other]), as well as their interaction, were examined as predictors of externalizing behavior at age 54 months. Results 5HTTLPR genotype and atypical attachment at age 42 months interacted to predict externalizing behavior at age 54 months. Specifically, children with the s/s genotype with an atypical attachment had the highest externalizing scores. However, s/s children with a typical attachment demonstrated the lowest externalizing scores, even after controlling for intervention group status. There was no association between attachment status and externalizing behavior among children carrying at least one copy of the l allele. Discussion These findings indicate that genetic variation in the serotonergic system moderates the association between atypical attachment status and externalizing in young children. Our findings suggest that children, as a result of genetic variability in the serotonergic system, demonstrate differential sensitivity to the attachment relationship. PMID:25933228

Externalities of fuel cycles 'ExternE' project. Oil fuel cycle. Estimation of physical impacts and monetary valuation for priority impact pathways

International Nuclear Information System (INIS)

Friedrich, R.; Krewitt, W.; Mayerhofer, P.; Trukenmueller, A.; Gressmann, A.; Runte, K.-H.; Kortum, G.; Weltschev, M.

1994-01-01

Fuel cycle externalities are the costs imposed on society and the environment that are not accounted for by the producers and consumers of energy. They include damage to health, forests, crops, natural ecosystems and the built environment. Traditional assessment of fuel cycles has ignored these effects and the energy sector is consequently distorted in favor of technologies with significant environmental burdens. Concern over widespread degradation of the environment resulting from fuel cycle emissions has mounted since the late 1960s. In the early 1970s the potential for long range atmospheric transport of certain pollutants was recognized. The effects of acidifying pollutants, ozone precursors and greenhouse gases have caused particular concern. This is reflected in recent trends in economic thought, particularly the emphasis on sustainable development and the use of market mechanisms for environmental regulation. It has thus become increasingly clear that the external impacts of energy use are significant and should be considered by energy planners. Although the theoretical basis for including external costs in decision making processes has been generally agreed, an acceptable methodology for their calculation and integration has not been established. The studies of Hohmeyer (1988), Ottinger et al. (1990) and Friedrich and Voss (1993) provide the background for such work, though they are of a somewhat preliminary nature. We need to improve the methods employed and the quality of models and data used so that planning decisions can be based at least partly on the results. It is particularly important that the site and project specificity of many impacts is recognized. In consequence of this a collaborative project between Directorate General XII (Science, Research and Technology) of the European Commission and the United States Department of Energy has been established to identify the most appropriate methodology for this type of work. The current study has three

Externalities of fuel cycles 'ExternE' project. Lignite fuel cycle. Estimation of physical impacts and monetary valuation for priority impact pathways

International Nuclear Information System (INIS)

Friedrich, R.; Krewitt, W.; Mayerhofer, P.; Trukenmueller, A.; Gressmann, A.

1994-01-01

Fuel cycle externalities are the costs imposed on society and the environment that are not accounted for by the producers and consumers of energy. They include damage to health, forests, crops, natural ecosystems and the built environment. Traditional assessment of fuel cycles has ignored these effects and the energy sector is consequently distorted in favor of technologies with significant environmental burdens. Concern over widespread degradation of the environment resulting from fuel cycle emissions has mounted since the late 1960s. In the early 1970s the potential for long range atmospheric transport of certain pollutants was recognized. The effects of acidifying pollutants, ozone precursors and greenhouse gases have caused particular concern. This is reflected in recent trends in economic thought, particularly the emphasis on sustainable development and the use of market mechanisms for environmental regulation. It has thus become increasingly clear that the external impacts of energy use are significant and should be considered by energy planners. Although the theoretical basis for including external costs in decision making processes has been generally agreed, an acceptable methodology for their calculation and integration has not been established. The studies of Hohmeyer (1988] and Ottinger et al. [1990] provide the background for such work, though they are of a somewhat preliminary nature [Friedrich, Voss, 1993]. We need to improve the methods employed and the quality of models and data used so that planning decisions can be based at least partly on the results. If is particularly important that the site and project specificity of many impacts is recognized. In consequence of this a collaborative project between Directorate General XII (Science, Research and Technology) of the European Commission and the United States Department of Energy has been established to identify the most appropriate methodology for this type of work. The current study has three

Study on principle and method of measuring system for external dimensions, geometric density and appearance quality of uranium dioxide pellet

International Nuclear Information System (INIS)

Cao Wei; Deng Hua; Wang Tao

2010-01-01

To adapt to the need of nuclear power development, and keep in step with the increasingly growing nuclear fuel element production, a special measuring system for integrated measuring, calculation, data processing method of External Dimensions, Tolerance of figure and place, Geometric Density and Appearance Quality of Uranium Dioxide Pellet is studied and discussed. This system is with important guiding significance for the improvement of technologic and frocking level.. The measuring system is primarily applied to sampling test during production and is the same with several types of products.The successful application of this measuring method ensures the accuracy and reliability of measured data, reduces the artificial error and makes the measuring be move convenient and fast, thus achieves high precision and high efficiency of measuring process. The measuring method is approach the advanced world level of measuring method at the same industry. So, based on the product inspection requirement, using special measuring instrument and computer data processing system is an important approach we use for nonce and future. (authors)

Uterine activity monitoring during labour--a multi-centre, blinded two-way trial of external tocodynamometry against electrohysterography.

Science.gov (United States)

Reinhard, J; Hayes-Gill, B R; Schiermeier, S; Löser, H; Niedballa, L M; Haarmann, E; Sonnwald, A; Hatzmann, W; Heinrich, T M; Louwen, F

2011-10-01

The aim of this study was to determine the quality of intrapartum uterine activity (UA) monitoring in daily practice during the first and second stages of labour. The total duration of inadequate UA monitoring is quantified in relation to the technique applied, namely, external tocodynamometry (TOCO) or electrohysterography (EHG). 144 UA recordings, collected from 1st September 2008 until 15th October 2009 from deliveries at the Marien-Hospital Witten, Germany, were analysed by obstetricians based at different centres. The included recordings were from singleton and simultaneously with external TOCO and EHG monitored pregnancies. External TOCO and EHG UA recordings were blinded. The percentages of "adequate" UA recordings in the first and second stages of labour were much higher for the external EHG than the external TOCO mode (pTOCO. Intrapartum UA monitoring in -daily practice via the EHG mode provides a more recognisable UA trace than the TOCO. © Georg Thieme Verlag KG Stuttgart · New York.

An external standard method for quantification of human cytomegalovirus by PCR

International Nuclear Information System (INIS)

Rongsen, Shen; Liren, Ma; Fengqi, Zhou; Qingliang, Luo

1997-01-01

An external standard method for PCR quantification of HCMV was reported. [α- 32 P]dATP was used as a tracer. 32 P-labelled specific amplification product was separated by agarose gel electrophoresis. A gel piece containing the specific product band was excised and counted in a plastic scintillation counter. Distribution of [α- 32 P]dATP in the electrophoretic gel plate and effect of separation between the 32 P-labelled specific product and free [α- 32 P]dATP were observed. A standard curve for quantification of HCMV by PCR was established and detective results of quality control templets were presented. The external standard method and the electrophoresis separation effect were appraised. The results showed that the method could be used for relative quantification of HCMV. (author)

Moda po maksimumu

Index Scriptorium Estoniae

2008-01-01

Teisest rahvusvahelisest noorte moeteatrite festival-konkursist "Max Moda 2008" Tallinnas Salme Kultuurikeskuses 10.-11. aprillil. Demonstreeriti Maksim Hlebnikovi uut kollektsiooni. Kommenteerivad ürituse korraldajad Tatjana ja Maksim Hlebnikov

Current External Beam Radiation Therapy Quality Assurance Guidance: Does It Meet the Challenges of Emerging Image-Guided Technologies?

International Nuclear Information System (INIS)

Palta, Jatinder R.; Liu, Chihray; Li, Jonathan G.

2008-01-01

The traditional prescriptive quality assurance (QA) programs that attempt to ensure the safety and reliability of traditional external beam radiation therapy are limited in their applicability to such advanced radiation therapy techniques as three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, inverse treatment planning, stereotactic radiosurgery/radiotherapy, and image-guided radiation therapy. The conventional QA paradigm, illustrated by the American Association of Physicists in Medicine Radiation Therapy Committee Task Group 40 (TG-40) report, consists of developing a consensus menu of tests and device performance specifications from a generic process model that is assumed to apply to all clinical applications of the device. The complexity, variation in practice patterns, and level of automation of high-technology radiotherapy renders this 'one-size-fits-all' prescriptive QA paradigm ineffective or cost prohibitive if the high-probability error pathways of all possible clinical applications of the device are to be covered. The current approaches to developing comprehensive prescriptive QA protocols can be prohibitively time consuming and cost ineffective and may sometimes fail to adequately safeguard patients. It therefore is important to evaluate more formal error mitigation and process analysis methods of industrial engineering to more optimally focus available QA resources on process components that have a significant likelihood of compromising patient safety or treatment outcomes

Continuous quality improvement

NARCIS (Netherlands)

Rohlin, Madeleine; Schaub, Rob M.H.; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

2002-01-01

Versch. in: Eur J Dent Educ; 6 (Suppl. 3): 67–77 Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of

Accreditation and ISO certification: do they explain differences in quality management in European hospitals?

Science.gov (United States)

Shaw, Charles; Groene, Oliver; Mora, Nuria; Sunol, Rosa

2010-12-01

Hospital accreditation and International Standardisation Organisation (ISO) certification offer alternative mechanisms for improving safety and quality, or as a mark of achievement. There is little published evidence on their relative merits. To identify systematic differences in quality management between hospitals that were accredited, or certificated, or neither. Research design of compliance with measures of quality in 89 hospitals in six countries, as assessed by external auditors using a standardized tool, as part of the EC-funded of Assessing Response to Quality Improvement Strategies project. Compliance scores in six dimensions of each hospital-grouped according to the achievement of accreditation, certification or neither. Of the 89 hospitals selected for external audit, 34 were accredited (without ISO certification), 10 were certificated under ISO 9001 (without accreditation) and 27 had neither accreditation nor certification. Overall percentage scores for 229 criteria of quality and safety were 66.9, 60.0 and 51.2, respectively. Analysis confirmed statistically significant differences comparing mean scores by the type of external assessment (accreditation, certification or neither); however, it did not substantially differentiate between accreditation and certification only. Some of these associations with external assessments were confounded by the country in which the sample hospitals were located. It appears that quality and safety structures and procedures are more evident in hospitals with either the type of external assessment and suggest that some differences exist between accredited versus certified hospitals. Interpretation of these results, however, is limited by the sample size and confounded by variations in the application of accreditation and certification within and between countries.

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...

On charged particle equilibrium violation in external photon fields.

Science.gov (United States)

Bouchard, Hugo; Seuntjens, Jan; Palmans, Hugo

2012-03-01

In a recent paper by Bouchard et al. [Med. Phys. 36(10), 4654-4663 (2009)], a theoretical model of quality correction factors for idealistic so-called plan-class specific reference (PCSR) fields was proposed. The reasoning was founded on the definition of PCSR fields made earlier by Alfonso et al. [Med. Phys. 35(11), 5179-5186 (2008)], requiring the beam to achieve charged particle equilibrium (CPE), in a time-averaged sense, in the reference medium. The relation obtained by Bouchard et al. was derived using Fano's theorem (1954) which states that if CPE is established in a given medium, the dose is independent of point-to-point density variations. A potential misconception on the achievability of the condition required by Fano (1954) might be responsible for false practical conclusions, both in the definition of PCSR fields as well as the theoretical model of quality correction factor. In this paper, the practical achievability of CPE in external beams is treated in detail. The fact that this condition is not achievable in single or composite deliveries is illustrated by an intuitive method and is also formally demonstrated. Fano's theorem is not applicable in external beam radiation dosimetry without (virtually) removing attenuation effects, and therefore, the relation conditionally defined by Bouchard et al. (2009) cannot be valid in practice. A definition of PCSR fields in the recent formalism for nonstandard beams proposed by Alfonso et al. (2008) should be modified, revising the criterion of CPE condition. The authors propose reconsidering the terminology used to describe standard and nonstandard beams. The authors argue that quality correction factors of intensity modulated radiation therapy PCSR fields (i.e., k(Q(pcsr),Q) (f(pcsr),f(ref) )) could be unity under ideal conditions, but it is concluded that further investigation is necessary to confirm that hypothesis.

On charged particle equilibrium violation in external photon fields

International Nuclear Information System (INIS)

Bouchard, Hugo; Seuntjens, Jan; Palmans, Hugo

2012-01-01

Purpose: In a recent paper by Bouchard et al.[Med. Phys. 36(10), 4654-4663 (2009)], a theoretical model of quality correction factors for idealistic so-called plan-class specific reference (PCSR) fields was proposed. The reasoning was founded on the definition of PCSR fields made earlier by Alfonso et al.[Med. Phys. 35(11), 5179-5186 (2008)], requiring the beam to achieve charged particle equilibrium (CPE), in a time-averaged sense, in the reference medium. The relation obtained by Bouchard et al. was derived using Fano's theorem (1954) which states that if CPE is established in a given medium, the dose is independent of point-to-point density variations. A potential misconception on the achievability of the condition required by Fano (1954) might be responsible for false practical conclusions, both in the definition of PCSR fields as well as the theoretical model of quality correction factor. Methods: In this paper, the practical achievability of CPE in external beams is treated in detail. The fact that this condition is not achievable in single or composite deliveries is illustrated by an intuitive method and is also formally demonstrated. Conclusions: Fano's theorem is not applicable in external beam radiation dosimetry without (virtually) removing attenuation effects, and therefore, the relation conditionally defined by Bouchard et al. (2009) cannot be valid in practice. A definition of PCSR fields in the recent formalism for nonstandard beams proposed by Alfonso et al. (2008) should be modified, revising the criterion of CPE condition. The authors propose reconsidering the terminology used to describe standard and nonstandard beams. The authors argue that quality correction factors of intensity modulated radiation therapy PCSR fields (i.e., k Q pcsr ,Q f pcsr ,f ref ) could be unity under ideal conditions, but it is concluded that further investigation is necessary to confirm that hypothesis.

Using Quality Improvement to Improve Internal and External Coordination and Referrals.

Science.gov (United States)

Cain, Katherine L; Collins, Ragan P

As part of accreditation, Public Health Accreditation Board site visitors recommended that the New Orleans Health Department strengthen its quality improvement program. With support from the Public Health Accreditation Board, the New Orleans Health Department subsequently embarked on a data-driven planning process through which it prioritized quality improvement projects for 2016. One of these projects aimed to improve referrals to New Orleans Health Department's direct services programs from local clinics and hospitals to better provide our most vulnerable residents with a continuum of care. After completing a cause-and-effect analysis, we implemented a solution involving increased outreach to health care institutions and saw annual participation increase in 3 out of 4 of our programs. We leveraged this work to successfully apply for funding to create a centralized referral system, which will facilitate partnerships among local health and human service agencies and improve access to services. This is one example of how accreditation has benefited our health department and our community. We have found that the accreditation process promotes a culture of quality and helps health departments identify and address areas for improvement.

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.

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.

External Quality Assurance: Annual Proficiency Test on 15N and 13C isotopic abundance in plant materials [Activities of the Soil and Water Management and Crop Nutrition Laboratory, Seibersdorf

International Nuclear Information System (INIS)

Aigner, Martina

2014-01-01

Eight out of twelve laboratories (67%) participating in the nitrogen analysis reported 15 N-data within the control limits for the enriched plant sample and eight out of nine (89%) participating laboratories for carbon analysis reported 13 C isotopic abundance results within the control limits for this test sample. The reported analytical data and WEPAL evaluation of the 15 N enriched plant material produced by SWMCNL is shown. All participants received a certificate of participation. Worldwide comparison of stable 15 N and 13 C isotope measurements will provide confidence in the laboratory's analytical performance and is hence an invaluable tool for external quality control. It is hoped that in the future more stable isotope laboratories will make use of this unique opportunity to assess their analytical performance and provide evidence of the high quality of their analytical data

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...... as a market mechanism that can be brought inside the firm to provide incentives for continuous improvement and the development of competitive advances. However, whereas extant research primarily has focused on the importance and effects of using external benchmarks, less attention has been directed towards...... the conditions upon which the market mechanism is performing within organizations. This paper aims to contribute to research by providing more insight to the conditions for the use of external benchmarking as an element in performance management in organizations. Our study explores a particular type of external...

Virumaal elab hiphopkultuur rampidel ja tänavatel / Britta aka BB

Index Scriptorium Estoniae

Britta aka BB

2008-01-01

Rakvere JJ-Street on esimene ametlik tänavatantsukool Eestis. 26.-28. septembril toimub Tallinnas Salme kultuurikeskuses tänavatantsufestival JJ-Street Baltic Session, festivali korraldaja on Joel Juht

Meeskõhutantsija Egiptusest / Mari Klein

Index Scriptorium Estoniae

Klein, Mari

2006-01-01

3. nov. algab Tallinnas Salme Kultuurikeskuses rahvusvaheline idamaise tantsu festival, millega tähistatakse kõhutantsu 10ndat tegevusaastat Eestis. Galakontserdi annab Egiptuse meeskõhutantsija ja tantsupedagoog Ashraf Mahdy

National CO2 policy and externalities. Some general equilibrium results for Switzerland

International Nuclear Information System (INIS)

Felder, Stefan; Schleiniger, Reto

2002-01-01

Switzerland, following the Kyoto agreement, plans to reduce CO 2 emissions by 10% over the next decade with a tax on the use of fossil fuels. This policy, while having a marginal effect on global CO 2 emission levels, will have a positive effect on local environmental quality. However, since different sources of energy produce different local external effects, a uniform CO 2 tax is ill targeted. This paper shows that a policy setting tax rates equal to the lower bounds of the estimated local marginal external effects would reduce the national CO 2 level by 30%. Using a computable general equilibrium model of the Swiss economy, it also finds substantial efficiency gains of Pigovian taxes as compared to a uniform CO 2 tax

Stored Energy and Quality Factor of Spherical Wave Functions–in Relation to Spherical Antennas With Material Cores

DEFF Research Database (Denmark)

Hansen, Troels V.; Kim, Oleksiy S.; Breinbjerg, Olav

2012-01-01

wave, the excitation coefficients for the internal and external spherical waves, the radiated power, the internal and external stored electric and magnetic energies, the difference of total electric and total magnetic energy, the cavity and radiating resonance conditions, and the quality factor. We...... investigate the variation of the internal/external and electric/magnetic stored energies with the electrical size of the antenna to study their relative significance for the quality factor....

External Otitis (Swimmer's Ear)

Science.gov (United States)

... otitis. Fungal external otitis (otomycosis), typically caused by Aspergillus niger or Candida albicans, is less common. Boils are ... in the ear. Fungal external otitis caused by Aspergillus niger usually causes grayish black or yellow dots (called ...

Hydropower externalities: A meta-analysis

International Nuclear Information System (INIS)

Mattmann, Matteo; Logar, Ivana; Brouwer, Roy

2016-01-01

This paper presents a meta-analysis of existing research related to the economic valuation of the external effects of hydropower. A database consisting of 81 observations derived from 29 studies valuing the non-market impacts of hydropower electricity generation is constructed with the main aim to quantify and explain the economic values for positive and negative hydropower externalities. Different meta-regression model specifications are used to test the robustness of significant determinants of non-market values, including different types of hydropower impacts. The explanatory and predictive power of the estimated models is relatively high. Whilst controlling for sample and study characteristics, we find significant evidence for public aversion towards deteriorations of landscape, vegetation and wildlife caused by hydropower projects. There is however only weak evidence of willingness to pay for mitigating these effects. The main positive externality of hydropower generation, the avoidance of greenhouse gas emission, positively influences welfare estimates when combined with the share of hydropower in national energy production. Sensitivity to scope is detected, but not linked to specific externalities or non-market valuation methods. - Highlights: • A global meta-analysis of valuation studies of hydropower externalities is presented. • Positive and negative externalities are distinguished. • Welfare losses due to environmental deteriorations outweigh gains of GHG reductions. • There is only weak evidence of public WTP for mitigating negative externalities. • The non-market values of hydropower externalities are sensitive to scope.

Nuclear technology education in Mongolia: Issues of quality assurance

International Nuclear Information System (INIS)

Davaa, S.; Khuukhenkhuu, G.

2007-01-01

The Nuclear Research Centre (NRC) at the National University of Mongolia, founded in 1965, is the only educational and research institution in Mongolia that carries out fundamental and applied low energy nuclear physics research. The main activities of the NRC are described in the Mission, Strategic Goals, and Objectives Statement of the NRC (http://www.num.edu.mn/nrc). The mission of the Nuclear Research Center is to be the leading national institution that conducts both training and research/development to obtain new information and results, to develop new methodology and technology in fundamental and applied nuclear physics, and also to develop equipment and devices. In order to implement quality management in nuclear technology training activities and conduct quality assurance, the Bachelor's education program has been required to create a self evaluation and the first copy of the report had been produced. It is a common perception that the main mechanism of higher education quality assurance is the internal quality management, and quality external monitoring. Therefore a general model used in most countries for higher education quality assurance. This model's main device is internal and external evaluation. The external evaluation has responsibility to improve accreditation, responsibility/commitment. Based on its self evaluation, the organization will develop its quality plan and, combined with external evaluation conclusions, will be lead toward quality improvement. The most important part of quality assessment is the use of external experts' assessment. Our nuclear research center is the only educational and research institution in the country, and, thus, it is impossible to find respectable independent experts (who do not get involved in our operations). In order to hire reputable foreign expert there are several obstacles: It is not easy to find a person who would know not only nuclear technology training but also do the benchmarking based on our

Nokia liidrikoht surve all / Tõnis Arnover

Index Scriptorium Estoniae

Arnover, Tõnis, 1952-

2003-01-01

Kuigi III kvartali tulemuste alusel on Nokia jätkuvalt turuliider, on tema kasv peatunud ning kiiresti arenevad konkurendid - Sony Ericsson, Motorola ja Siemens seavad ettevõtte positsiooni ohtu. Mobiiltelefonideturule tulemise plaanist on märku andnud ka Microsoft. Diagrammid: Nokia annab järele

External tank program productivity and quality enhancements - A case study

Science.gov (United States)

Locke, S. R.

1988-01-01

The optimization of the Manned Space Systems productivity and quality enhancement program is described. The guidelines and standards of the program and the roles played in it by various employee groups are addressed. Aspects of the program involving job/organization redefinition, production and planning in automation, and artificial intelligence and robotics are examined.

Quality control in mutation analysis: the European Molecular Genetics Quality Network (EMQN).

Science.gov (United States)

Müller, C R

2001-08-01

The demand for clinical molecular genetics testing has steadily grown since its introduction in the 1980s. In order to reach and maintain the agreed quality standards of laboratory medicine, the same internal and external quality assurance (IQA/EQA) criteria have to be applied as for "conventional" clinical chemistry or pathology. In 1996 the European Molecular Genetics Quality Network (EMQN) was established in order to spread QA standards across Europe and to harmonise the existing national activities. EMQN is operated by a central co-ordinator and 17 national partners from 15 EU countries; since 1998 it is being funded by the EU commission for a 3-year period. EMQN promotes QA by two tools: by providing disease-specific best practice meetings (BPM) and EQA schemes. A typical BPM is focussed on one disease or group of related disorders. International experts report on the latest news of gene characterisation and function and the state-of-the-art techniques for mutation detection. Disease-specific EQA schemes are provided by experts in the field. DNA samples are sent out together with mock clinical referrals and a diagnostic question is asked. Written reports must be returned which are marked for genotyping and interpretation. So far, three BPMs have been held and six EQA schemes are in operation at various stages. Although mutation types and diagnostic techniques varied considerably between schemes, the overall technical performance showed a high diagnostic standard. Nevertheless, serious genotyping errors have been occurred in some schemes which underline the necessity of quality assurance efforts. The European Molecular Genetics Quality Network provides a necessary platform for the internal and external quality assurance of molecular genetic testing.

Analysis of Sustainable Performance in Romania’s Local Public Administrations: An External Stakeholders Perspective

Directory of Open Access Journals (Sweden)

Diana MIHAIU

2016-12-01

Full Text Available Building a sustainable performance system at the level of the local public administrations must have as starting point the local public administration’s (LPA mission and must go down to the level of the individual. This system must follow the external performance that it delivers to the citizens, the outcomes generated, but also the internal performance which suggests how to achieve the external performance. We propose in this regard the simultaneous use of the Balanced Scorecard tool for managing the internal performance and the Public Service Value Model for measuring the external performance measurement which derives from the organization's mission. In the second part of the work we analyzed comparatively the external performance created by the county capitals of Romania in the year 2013 using the Public Service Value Model (PSVM. Based on this analysis, the county capitals of Romania can be divided in the following categories: high performance organizations (value driven, budget conscious organizations, low performance organizations (sleeping giants and quality conscious organizations. This classification is useful both for the external and internal stakeholders because it shows the efficiency of public money spending and the areas in which the LPA is performing well, and also the ones that need to be improved.

Congenital External Carotid-External Jugular Arteriovenous Fistula: Diagnosis With Contrast-Enhanced Computed Tomography

International Nuclear Information System (INIS)

Faghihi Langroudi, Taraneh; Arjmand Shabestari, Abbas; Pourghorban, Ramin; Khalili Pouya, Ensi

2015-01-01

Arteriovenous fistula (AVF) between the external carotid artery and external jugular vein is extremely rare, with only few cases reported in the literature so far. Most of these AVFs have been either iatrogenic or secondary to previous trauma. Herein, we report a 42-year-old woman with congenital AVF between the external carotid artery and external jugular vein, presenting with palpitation and dyspnea. The patient was suffering from mitral and tricuspid regurgitation. On physical examination, a thrill on the left side of the neck and an audible bruit over the left mandibular angle were detected. The possibility of abnormal AVF was considered and it was confirmed on contrast-enhanced computed tomography (CT), inferring that this modality is not only fast and non-invasive, but also accurate in detecting vascular abnormalities

External rotation immobilization for primary shoulder dislocation: a randomized controlled trial.

Science.gov (United States)

Whelan, Daniel B; Litchfield, Robert; Wambolt, Elizabeth; Dainty, Katie N

2014-08-01

The traditional treatment for primary anterior shoulder dislocations has been immobilization in a sling with the arm in a position of adduction and internal rotation. However, recent basic science and clinical data have suggested recurrent instability may be reduced with immobilization in external rotation after primary shoulder dislocation. We performed a randomized controlled trial to compare the (1) frequency of recurrent instability and (2) disease-specific quality-of-life scores after treatment of first-time shoulder dislocation using either immobilization in external rotation or immobilization in internal rotation in a group of young patients. Sixty patients younger than 35 years of age with primary, traumatic, anterior shoulder dislocations were randomized (concealed, computer-generated) to immobilization with either an internal rotation sling (n = 29) or an external rotation brace (n = 31) at a mean of 4 days after closed reduction (range, 1-7 days). Patients with large bony lesions or polytrauma were excluded. The two groups were similar at baseline. Both groups were immobilized for 4 weeks with identical therapy protocols thereafter. Blinded assessments were completed by independent observers for a minimum of 12 months (mean, 25 months; range, 12-43 months). Recurrent instability was defined as a second documented anterior dislocation or multiple episodes of shoulder subluxation severe enough for the patient to request surgical stabilization. Validated disease-specific quality-of-life data (Western Ontario Shoulder Instability index [WOSI], American Shoulder and Elbow Surgeons evaluation [ASES]) were also collected. Ten patients (17%, five from each group) were lost to followup. Reported compliance with immobilization in both groups was excellent (80%). With the numbers available, there was no difference in the rate of recurrent instability between groups: 10 of 27 patients (37%) with the external rotation brace versus 10 of 25 patients (40%) with the

Energy policy and externalities

International Nuclear Information System (INIS)

Bertel, E.; Fraser, P.

2002-01-01

External costs of energy have been assessed in a number of authoritative and reliable studies based upon widely accepted methodologies such as life cycle analysis (LCA). However, although those costs are recognised by most stakeholders and decision makers, results from analytical work on externalities and LCA studies are seldom used in policy making. The International Energy Agency (IEA) and the Nuclear Energy Agency (NEA) convened a joint workshop in November 2001 to offer experts and policy makers an opportunity to present state-of-the-art results from analytical work on externalities and debate issues related to the relevance of external costs and LCA for policy-making purposes. The findings from the workshop highlight the need for further work in the field and the potential rote of international organisations like the IEA and the NEA in this context. (authors)

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.

Malignant external otitis: CT evaluation

International Nuclear Information System (INIS)

Curtin, H.D.; Wolfe, P.; May, M.

1982-01-01

Malignant external otitis is an aggressive infection caused by Pseudomonas aeruginosa that most often occurs in elderly diabetics. Malignant external otitis often spreads inferiorly from the external canal to involve the subtemporal area and progresses medially towards the petrous apex leading to multiple cranial nerve palsies. The computed tomographic (CT) findings in malignant external otitis include obliteration of the normal fat planes in the subtemporal area as well as patchy destruction of the bony cortex of the mastoid. The point of exit of the various cranial nerves can be identified on CT scans, and the extent of the inflammatory mass correlates well with the clinical findings. Four cases of malignant external otitis are presented. In each case CT provided a good demonstration of involvement of the soft tissues at the base of the skull

External costs of electricity; Les couts externes de l'electricite

Energy Technology Data Exchange (ETDEWEB)

Rabl, A. [Ecole des Mines de Paris, 75 (France); Spadaro, J.V. [International Atomic Energy Agency (IAEA), Vienna (Austria)

2005-07-01

This article presents a synthesis of the ExternE project (External costs of Energy) of the European community about the external costs of power generation. Pollution impacts are calculated using an 'impact pathways' analysis, i.e. an analysis of the emission - dispersion - dose-response function - cost evaluation chain. Results are presented for different fuel cycles (with several technological variants) with their confidence intervals. The environmental impact costs are particularly high for coal: for instance, in France, for coal-fired power plants it is of the same order as the electricity retail price. For natural gas, this cost is about a third of the one for coal. On the contrary, the environmental impact costs for nuclear and renewable energies are low, typically of few per cent of the electricity price. The main part of these costs corresponds to the sanitary impacts, in particular the untimely mortality. In order to avoid any controversy about the cost evaluation of mortality, the reduction of the expectation of life due to the different fuel cycles is also indicated and the risks linked with nuclear energy are presented using several comparisons. (J.S.)

External-environmental and internal-health early life predictors of adolescent development.

Science.gov (United States)

Hartman, Sarah; Li, Zhi; Nettle, Daniel; Belsky, Jay

2017-12-01

A wealth of evidence documents associations between various aspects of the rearing environment and later development. Two evolutionary-inspired models advance explanations for why and how such early experiences shape later functioning: (a) the external-prediction model, which highlights the role of the early environment (e.g., parenting) in regulating children's development, and (b) the internal-prediction model, which emphasizes internal state (i.e., health) as the critical regulator. Thus, by using data from the NICHD Study of Early Child Care and Youth Development, the current project draws from both models by investigating whether the effect of the early environment on later adolescent functioning is subject to an indirect effect by internal-health variables. Results showed a significant indirect effect of internal health on the relation between the early environment and adolescent behavior. Specifically, early environmental adversity during the first 5 years of life predicted lower quality health during childhood, which then led to problematic adolescent functioning and earlier age of menarche for girls. In addition, for girls, early adversity predicted lower quality health that forecasted earlier age of menarche leading to increased adolescent risk taking. The discussion highlights the importance of integrating both internal and external models to further understand the developmental processes that effect adolescent behavior.

Võttetrupp jootis meid iga päev viina ja õllega! / Oliver Rand

Index Scriptorium Estoniae

Rand, Oliver, 1971-

2007-01-01

Sulev Keeduse dokumentaalfilm "Jonathan Austraaliast" pahandas Mustjala vallavanemat Kalle Kolterit, vallavolikogu esimeest Toivo Lõhmust ja sotsiaaltöötajat Saima Lõhmust. Süüdistustele vastab võttegrupi assistent Salme Poopuu

ERKI moesõu toob lavale beebid

Index Scriptorium Estoniae

2007-01-01

13.01.2007 toimub Tallinnas Salme kultuurikeskuses moeetendus "Beebibissness ruulib!". Osaleb rootslane Daniel Ivarsson. Londonis tegutsev Piret Paal ja taanlane Anders Henk näitavad second hand riietest disainitud kollektsiooni

External Quality Control for Dried Blood Spot Based C-reactive Protein Assay: Experience from the Indonesia Family Life Survey and the Longitudinal Aging Study in India

Science.gov (United States)

Hu, Peifeng; Herningtyas, Elizabeth H.; Kale, Varsha; Crimmins, Eileen M.; Risbud, Arun R.; McCreath, Heather; Lee, Jinkook; Strauss, John; O’Brien, Jennifer C.; Bloom, David E.; Seeman, Teresa E.

2015-01-01

Measurement of C-reactive protein, a marker of inflammation, in dried blood spots has been increasingly incorporated in community-based social surveys internationally. Although the dried blood spot based CRP assay protocol has been validated in the United States, it remains unclear whether laboratories in other less developed countries can generate C-reactive protein results of similar quality. We therefore conducted external quality monitoring for dried blood spot based C-reactive protein measurement for the Indonesia Family Life Survey and the Longitudinal Aging Study in India. Our results show that dried blood spot based C-reactive protein results in these two countries have excellent and consistent correlations with serum-based values and dried blood spot based results from the reference laboratory in the United States. Even though the results from duplicate samples may have fluctuations in absolute values over time, the relative order of C-reactive protein levels remains similar and the estimates are reasonably precise for population-based studies that investigate the association between socioeconomic factors and health. PMID:25879265

Health-related external cost assessment in Europe: methodological developments from ExternE to the 2013 Clean Air Policy Package.

Science.gov (United States)

van der Kamp, Jonathan; Bachmann, Till M

2015-03-03

"Getting the prices right" through internalizing external costs is a guiding principle of environmental policy making, one recent example being the EU Clean Air Policy Package released at the end of 2013. It is supported by impact assessments, including monetary valuation of environmental and health damages. For over 20 years, related methodologies have been developed in Europe in the Externalities of Energy (ExternE) project series and follow-up activities. In this study, we aim at analyzing the main methodological developments over time from the 1990s until today with a focus on classical air pollution-induced human health damage costs. An up-to-date assessment including the latest European recommendations is also applied. Using a case from the energy sector, we identify major influencing parameters: differences in exposure modeling and related data lead to variations in damage costs of up to 21%; concerning risk assessment and monetary valuation, differences in assessing long-term exposure mortality risks together with assumptions on particle toxicity explain most of the observed changes in damage costs. These still debated influencing parameters deserve particular attention when damage costs are used to support environmental policy making.

THEORETICAL BASIS OF MOTOR CAR QUALITY EVALUTION

Directory of Open Access Journals (Sweden)

T. Bazhinova

2016-12-01

Full Text Available Comprehensive assessment of the quality of cars, which is based on the integral parameters of comfort, reliability, safety, environmental and technical solutions are considered and defined. The amount of parameters that define the quality level of the car use throughout the country is defined. Mathematical formulas and quality indicators of the integral index are developed. The integral quality index of vehicles allows comparing the vehicles of different classes based on external operating conditions. The numerical values of the integral index determines the quality of the car.

Interventions to help external cephalic version for breech presentation at term.

Science.gov (United States)

Hofmeyr, G J

2004-01-01

Breech presentation places a fetus at increased risk. The outcome for the baby is improved by planned caesarean section compared with planned vaginal delivery. External cephalic version attempts to reduce the chances of breech presentation at birth, but is not always successful. Tocolytic drugs to relax the uterus as well as other methods have been used in an attempt to facilitate external cephalic version at term. To assess the effects of routine tocolysis, fetal acoustic stimulation, epidural or spinal analgesia and transabdominal amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth Group trials register (September 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2003) were searched. Randomised and quasi-randomised trials comparing routine versus selective or no tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural or spinal analgesia versus no regional analgesia; or transabdominal amnioinfusion versus no amnioinfusion for external cephalic version at term. The reviewer assessed eligibility and trial quality. In six trials, routine tocolysis with beta-stimulants was associated with fewer failures of external cephalic version (relative risk (RR) 0.74, 95% confidence interval (CI) 0.64 to 0.87). The reduction in non-cephalic presentations at birth was not statistically significant. Caesarean sections were reduced (RR 0.85, 95% CI 0.72 to 0.99). In four small trials, sublingual nitroglycerine used as a tocolytic was associated with significant side-effects, and was not found to be effective. Fetal acoustic stimulation in midline fetal spine positions was associated with fewer failures of external cephalic version at term (RR 0.17, 95% CI 0.05 to 0.60). With epidural or spinal analgesia, external cephalic version failure, non-cephalic births and caesarean sections were

[eLearning-radiology.com--sustainability for quality assurance].

Science.gov (United States)

Ketelsen, D; Talanow, R; Uder, M; Grunewald, M

2009-04-01

The aim of the study was to analyze the availability of published radiological e-learning tools and to establish a solution for quality assurance. Substantial pubmed research was performed to identify radiological e-learning tools. 181 e-learning programs were selected. As examples two databases expanding their programs with external links, Compare (n = 435 external links) and TNT-Radiology (n = 1078 external links), were evaluated. A concept for quality assurance was developed by an international taskforce. At the time of assessment, 56.4 % (102 / 181) of the investigated e-learning tools were accessible at their original URL. A subgroup analysis of programs published 5 to 8 years ago showed significantly inferior availability to programs published 3 to 5 years ago (p eLearning-radiology.com was developed by the taskforce and published online. This tool allows authors to present their programs and users to evaluate the e-learning tools depending on several criteria in order to remove inoperable links and to obtain information about the complexity and quality of the e-learning tools. More than 50 % of investigated radiological e-learning tools on the Internet were not accessible after a period of 5 to 8 years. As a consequence, an independent, international tool for quality assurance was designed and published online under www.eLearning-radiology.com .

Dicty_cDB: Contig-U04229-1 [Dicty_cDB

Lifescience Database Archive (English)

Full Text Available 9 ) HAE00002983 Home-made, regular (lib1_ha) Histiona... 44 0.001 2 ( CK888692 ) SGP160684 Atlantic salmon Liver cDNA library...2 ( DE224908 ) Trifolium pratense DNA, clone:RCG16896. 42 4e-04 2 ( CK888010 ) SGP149211 Atlantic salmon Liver cDNA library...A for TCP1 protein. 46 6e-04 2 ( CK887535 ) SGP164401 Atlantic salmon Kidney cDNA library Sal... 44 6e-04 2 ...mo salar cDNA, mRNA sequence. 44 0.001 2 ( CK889382 ) SGP161400 Atlantic salmon Liver cDNA library Salm... 4... salmon Liver cDNA library Salm... 44 0.001 2 ( CK888710 ) SGP160704 Atlantic salmon Liver cDNA library

Technical basis document for external events

International Nuclear Information System (INIS)

OBERG, B.D.

2003-01-01

This document supports the Tank Farms Documented Safety Analysis and presents the technical basis for the FR-equencies of externally initiated accidents. The consequences of externally initiated events are discussed in other documents that correspond to the accident that was caused by the external event. The external events include aircraft crash, vehicle accident, range fire, and rail accident

Prediction models for successful external cephalic version: a systematic review.

Science.gov (United States)

Velzel, Joost; de Hundt, Marcella; Mulder, Frederique M; Molkenboer, Jan F M; Van der Post, Joris A M; Mol, Ben W; Kok, Marjolein

2015-12-01

To provide an overview of existing prediction models for successful ECV, and to assess their quality, development and performance. We searched MEDLINE, EMBASE and the Cochrane Library to identify all articles reporting on prediction models for successful ECV published from inception to January 2015. We extracted information on study design, sample size, model-building strategies and validation. We evaluated the phases of model development and summarized their performance in terms of discrimination, calibration and clinical usefulness. We collected different predictor variables together with their defined significance, in order to identify important predictor variables for successful ECV. We identified eight articles reporting on seven prediction models. All models were subjected to internal validation. Only one model was also validated in an external cohort. Two prediction models had a low overall risk of bias, of which only one showed promising predictive performance at internal validation. This model also completed the phase of external validation. For none of the models their impact on clinical practice was evaluated. The most important predictor variables for successful ECV described in the selected articles were parity, placental location, breech engagement and the fetal head being palpable. One model was assessed using discrimination and calibration using internal (AUC 0.71) and external validation (AUC 0.64), while two other models were assessed with discrimination and calibration, respectively. We found one prediction model for breech presentation that was validated in an external cohort and had acceptable predictive performance. This model should be used to council women considering ECV. Copyright © 2015. Published by Elsevier Ireland Ltd.

QUALITY OF AN ACADEMIC STUDY PROGRAMME - EVALUATION MODEL

Directory of Open Access Journals (Sweden)

Mirna Macur

2016-01-01

Full Text Available Quality of an academic study programme is evaluated by many: employees (internal evaluation and by external evaluators: experts, agencies and organisations. Internal and external evaluation of an academic programme follow written structure that resembles on one of the quality models. We believe the quality models (mostly derived from EFQM excellence model don’t fit very well into non-profit activities, policies and programmes, because they are much more complex than environment, from which quality models derive from (for example assembly line. Quality of an academic study programme is very complex and understood differently by various stakeholders, so we present dimensional evaluation in the article. Dimensional evaluation, as opposed to component and holistic evaluation, is a form of analytical evaluation in which the quality of value of the evaluand is determined by looking at its performance on multiple dimensions of merit or evaluation criteria. First stakeholders of a study programme and their views, expectations and interests are presented, followed by evaluation criteria. They are both joined into the evaluation model revealing which evaluation criteria can and should be evaluated by which stakeholder. Main research questions are posed and research method for each dimension listed.

CIEMAT external dosimetry service: ISO/IEC 17025 accreditation and 3 y of operational experience as an accredited laboratory

International Nuclear Information System (INIS)

Romero, A.M.; Rodriguez, R.; Lopez, J.L.; Martin, R.; Benavente, J.F.

2016-01-01

In 2008, the CIEMAT Radiation Dosimetry Service decided to implement a quality management system, in accordance with established requirements, in order to achieve ISO/IEC 17025 accreditation. Although the Service comprises the approved individual monitoring services of both external and internal radiation, this paper is specific to the actions taken by the External Dosimetry Service, including personal and environmental dosimetry laboratories, to gain accreditation and the reflections of 3 y of operational experience as an accredited laboratory. (authors)

Все по МАХимуму / Светлана Карабут

Index Scriptorium Estoniae

Карабут, Светлана

2011-01-01

Viies rahvusvaheline laste ja noorte moeteatrite festival-konkurss „Max Moda 2011" Tallinnas Salme Kultuurikeskuses 24.-26. märtsini. Festivali korraldas moeteater Max Moda, kunstiline juht ja direktor Maksim Hlebnikov

"Printsessa Alissija" rodilas v Tallinne / Eteri Kekelidze

Index Scriptorium Estoniae

Kekelidze, Eteri, 1944-

1999-01-01

Tallinnas Vene Romansi Klubis sündis lasteooper - Boriss Kisseljovi "Printsess Alicia", mille aluseks on Charles Dickensi "Jõulumuinasjutt". Lavastaja Olga Bunder, esitasid lapsed erinevatest Tallinna koolidest. Esietendus Salme Kultuurimajas 10. dets

Rahvatants paneb silmad särama. Särulised õpivad pulmanalju

Index Scriptorium Estoniae

2006-01-01

Vabariiklikust koolinoorte rahvatantsufestivalist 1. apr. Salme kultuurikeskuses Tallinnas ja 2. apr. Keila Tervisekeskuses. Viru Säru koolitusest 3. apr. Lääne-Viru maavalitsuse õppeklassis (koolituse läbiviija Igor Tõnurist)

International Accreditations as Drivers of Business School Quality Improvement

Science.gov (United States)

Bryant, Michael

2013-01-01

Business schools are under pressure to implement continuous improvement and quality assurance processes to remain competitive in a globalized higher education market. Drivers for quality improvement include external, environmental pressures, regulatory bodies such as governments, and, increasingly, voluntary accreditation agencies such as AACSB…

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

Quality of Life After Whole Pelvic Versus Prostate-Only External Beam Radiotherapy for Prostate Cancer: A Matched-Pair Comparison

International Nuclear Information System (INIS)

Pinkawa, Michael; Piroth, Marc D.; Holy, Richard; Fischedick, Karin; Klotz, Jens; Szekely-Orban, Dalma; Eble, Michael J.

2011-01-01

Purpose: Comparison of health-related quality of life after whole pelvic (WPRT) and prostate-only (PORT) external beam radiotherapy for prostate cancer. Methods and Materials: A group of 120 patients (60 in each group) was surveyed prospectively before radiation therapy (RT) (time A), at the last day of RT (time B), at a median time of 2 months (time C) and >1 year after RT (time D) using a validated questionnaire (Expanded Prostate Cancer Index Composite). All patients were treated with 1.8- to 2.0-Gy fractions up to 70.2 to 72.0 Gy with or without WPRT up to 45 to 46 Gy. Pairs were matched according to the following criteria: age ± 5years, planning target volume ± 10 cc (considering planning target volume without pelvic nodes for WPRT patients), urinary/bowel/sexual function score before RT ± 10, and use of antiandrogens. Results: With the exception of prognostic risk factors, both groups were well balanced with respect to baseline characteristics. No significant differences were found with regard to urinary and sexual score changes. Mean bladder function scores reached baseline levels in both patient subgroups after RT. However, bowel function scores decreased significantly more for patients after WPRT than in those receiving PORT at all times (p once a day in 15% vs. 3%; p = 0.03), bloody stools (≥half the time in 7% vs. 0%; p = 0.04) and frequent bowel movements (>two on a typical day in 32% vs. 7%; p < 0.01) more often than did patients after PORT. Conclusion: In comparison to PORT, WPRT (larger bladder and rectum volumes in medium dose levels, but similar volumes in high dose levels) was associated with decreased bowel quality of life in the acute and chronic phases after treatment but remained without adverse long-term urinary effects.

AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty.

Science.gov (United States)

Pijls, Bart G; Dekkers, Olaf M; Middeldorp, Saskia; Valstar, Edward R; van der Heide, Huub J L; Van der Linden-Van der Zwaag, Henrica M J; Nelissen, Rob G H H

2011-07-22

In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

[Domestic external fixator application in the treatment of limb deformities: 7 289 cases application report].

Science.gov (United States)

Qin, S H; Guo, B F; Zheng, X J; Jiao, S F; Xia, H T; Peng, A M; Pan, Q; Zang, J C; Wang, Z J

2017-09-01

Objective: To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs. Methods: A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on. Results: All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on. Conclusions: The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical

Chapter 8: Quality assurance

International Nuclear Information System (INIS)

2001-01-01

The main efforts of Nuclear Regulatory Authority of the Slovak Republic (UJD) have been focused on inspection of quality assurance programmes of Slovak Power Stations, plc. and its daughter companies at Bohunice and Mochovce. Two quality assurance inspections in the area of periodical in service inspections (V-2 units) and tests of selected equipment (NPP V-2 units) and operation control (V-1 units) has been performed at NPPs Bohunice. One violation of decree on quality assurance of selected equipment has been found in the area of documentation archiving. The inspection concerning the implementation of quality assurance programme for operation of NPP Mochovce in the area of operation control has been performed focused on safety aspects of operation, operational procedures, control of operational events and feedback from operational experience. The results of this inspection were positive. Inspection of implementation of quality assurance programme for operation of radioactive waste repository (RU RAW) at the Mochovce location has been performed focused on receiving of containers, with radioactive wastes, containers handling, radiation monitoring, activities of documentation control and radiation protection at the repository site. No serious deficiencies have been found out. Also one inspection of experimental nuclear installations of VUJE Trnava at Jaslovske Bohunice site has been performed focused on procurement control, quality audits, documentation and quality records control when performing activities at experimental nuclear installations. The activity on development of internal quality assurance system continued. The implementation of this system will assure quality and effective fulfilment enlarged tasks of UJD with limited resources for its activity. The analyses of possible use of existing internal administrative control documentation as a basis for future quality system procedures was performed in co-operation with an external specialised organisation. The

2nd International external quality control assessment for the molecular diagnosis of dengue infections.

Directory of Open Access Journals (Sweden)

Cristina Domingo

Full Text Available BACKGROUND: Currently dengue viruses (DENV pose an increasing threat to over 2.5 billion people in over 100 tropical and sub-tropical countries worldwide. International air travel is facilitating rapid global movement of DENV, increasing the risk of severe dengue epidemics by introducing different serotypes. Accurate diagnosis is critical for early initiation of preventive measures. Different reverse transcriptase PCR (RT-PCR methods are available, which should be evaluated and standardized. Epidemiological and laboratory-based surveillance is required to monitor and guide dengue prevention and control programmes, i.e., by mosquito control or possible vaccination (as soon as an effective and safe vaccine becomes available. OBJECTIVE: The purpose of the external quality assurance (EQA study described is to assess the efficiency and accuracy of dengue molecular diagnosis methods applied by expert laboratories. STUDY DESIGN: A panel of 12 human plasma samples was distributed and tested for DENV-specific RNA. The panel comprised 9 samples spiked with different DENV serotypes (DENV-1 to DENV-4, including 10-fold dilution series of DENV-1 and DENV-3. Two specificity controls consisted of a sample with a pool of 4 other flaviviruses and a sample with chikungunya virus. A negative control sample was also included. RESULTS: Thirty-seven laboratories (from Europe, Middle East Asia, Asia, the Americas/Caribbean, and Africa participated in this EQA study, and reports including 46 sets of results were returned. Performance among laboratories varied according to methodologies used. Only 5 (10.9% data sets met all criteria with optimal performance, and 4 (8.7% with acceptable performance, while 37 (80.4% reported results showed the need for improvement regarding accomplishment of dengue molecular diagnosis. Failures were mainly due to lack of sensitivity and the presence of false positives. CONCLUSIONS: The EQA provides information on each laboratory

Biomechanical Comparison of External Fixation and Compression Screws for Transverse Tarsal Joint Arthrodesis.

Science.gov (United States)

Latt, L Daniel; Glisson, Richard R; Adams, Samuel B; Schuh, Reinhard; Narron, John A; Easley, Mark E

2015-10-01

which can be obtained with 3 headless compression screws. Screw and external fixator performance did not correlate with bone mineral density. This study supports the use of external fixation as an alternative method of generating compression to help stimulate fusion across the transverse tarsal joints. The findings provide biomechanical evidence to support the use of external fixation as a viable option in transverse tarsal joint fusion cases in which screw fixation has failed or is anticipated to be inadequate due to suboptimal bone quality. © The Author(s) 2015.

Quality in pathology laboratory practice.

Science.gov (United States)

Weinstein, S

1995-06-01

Quality refers not only to analytical quality control, a traditional area of laboratory excellence, but to the entire science of quality management. As measures of quality, structural indicators refer to staffing and physical facilities, process indicators to the institutions operations and, perhaps most importantly, outcome indicators address the ultimate patient care uses that pathology information is put to. Comparison of performance to peer laboratories, external quality control, is a practical, if limited, yardstick of performance. Customer satisfaction and turn-around-time of tests are receiving more recent attention as quality measures. Blood banking, because of its inherently complex cycle from donor phlebotomy to product infusion, requires special considerations with regard to quality management. Reporting of anatomical pathology, where the only gold standard is a consensus of experts, also does not lend itself to classical numerical quality assessment.

Comparison of infection between internal-external and external percutaneous transhepatic biliary drainage in treating patients with malignant obstructive jaundice.

Science.gov (United States)

Xu, Chuan; Huang, Xin-En; Wang, Shu-Xiang; Lv, Peng-Hua; Sun, Ling; Wang, Fu-An

2015-01-01

Percutaneous transhepatic biliary drainage (PTBD) is a form of palliative care for patients with malignant obstructive jaundice. We here compared the infection incidence between internal-external and external drainage for patients with malignant obstructive jaundice. Patients with malignant obstructive jaundice without infection before surgery receiving internal-external or external drainage from January 2008 to July 2014 were recruited. According to percutaneous transhepatic cholangiography (PTC), if the guide wire could pass through the occlusion and enter the duodenum, we recommended internal-external drainage, and external drainage biliary drainage was set up if the occlusion was not crossed. All patients with infection after procedure received a cultivation of blood and a bile bacteriological test. Among 110 patients with malignant obstructive jaundice, 22 (52.4%) were diagnosed with infection after the procedure in the internal-external drainage group, whereas 19 (27.9%) patients were so affected in the external drainage group, the difference being significant (pinternal-external group infection was controlled, as compared to 12 (63.1%) in the external group (pinternal-external group in one month was 42.8%, while this rate in external group was 28.6% (pExternal drainage is a good choice, which could significantly reduce the chance of biliary infection caused by bacteria, and decrease the mortality rate at one month and improve the long-term prognosis.

Implementation of a system for external audits beam radiation therapy in terms of reference no

International Nuclear Information System (INIS)

Alonso Samper, Jose Luis; Dominguez, Lourdes; Alert Silva, Jose; Alfonso Laguardia, Rodolfo; Larrinaga Cortina, Eduardo; Garcia Yip, Fernando; Rodriguez Machado, Jorge; Morales Lopez, Jorge Luis; Silvestre Patallo, Ileana

2009-01-01

This paper presents our experience in implementing a external audit system for radiotherapy beam in no reference conditions with the use of CIRS and a summary of the measurements with him made.This paper presents our experience in implementing a external audit system for radiotherapy beam in no reference conditions with the use of CIRS and a summary of the measurements with him made. Centers were audited with external beam high-energy Co-60, 6 MV and 15 MV and were considered 4 treatment planning systems (TPS): AMEPLAN, Theraplan Plus, Precise Plan and MIRS to calculate doses prescribed in each test case. All measurements were acquired by the audit team using the anthropomorphic phantom CIRS, Semiflex chamber PTW 31010 and PTW electrometer STATES. The implementation and development of the external audits of beams radiotherapy in terms of 'no reference' has brought an improvement in both clinical aspects of treatment and the radiation safety and the quality control, has given us greater confidence and for this reason we believe has become essential. (Author)

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

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

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

effects of extended period of storage and strain of layer on quality

African Journals Online (AJOL)

User

strain of layers and extended storage length on internal and external qualities of chicken eggs. ... storage of egg on some important egg quality determinants like egg weight, albumen height and ... of information on the quality of eggs of these.

Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries.

Science.gov (United States)

Secanell, Mariona; Groene, Oliver; Arah, Onyebuchi A; Lopez, Maria Andrée; Kutryba, Basia; Pfaff, Holger; Klazinga, Niek; Wagner, Cordula; Kristensen, Solvejg; Bartels, Paul Daniel; Garel, Pascal; Bruneau, Charles; Escoval, Ana; França, Margarida; Mora, Nuria; Suñol, Rosa

2014-04-01

This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.

Comprehensive quality management program for radiation oncology

International Nuclear Information System (INIS)

Dawson, J.; Roy, T.; Abrath, F.; Wu, T.; Gu, J.; McDonald, R.; Kim, H.; Haenchen, M.

1994-01-01

A quality management program for both external beam irradiation (electron and photon modes) and brachytherapy (high dose rate (HDR) and low dose rate (LDR) has been developed. The program follows current USA federal regulations for therapeutic administration of by-product materials. After implementation of the program, 54 HDR patients, 36 LDR brachytherapy patients and 311 external beam patients (including 30 stereotactic radiosurgery cases) were treated. The results of this program are presented

The Influence of Organizational External Factors on Construction Risk Management among Nigerian Construction Companies

Directory of Open Access Journals (Sweden)

A.Q. Adeleke

2018-03-01

aforementioned factors have the chance to deliver their projects within the stipulated time, cost, and qualities, which can be used as a yardstick to measure a good project. Keywords: construction risk management, Nigeria, organizational control theory, organizational external factors, rules and regulations

Energy policy and externalities: an overview

International Nuclear Information System (INIS)

Pearce, D.

2002-01-01

Substantial progress has been made in estimating the monetary value of the environmental impacts of different energy systems. Perhaps the best known study in Europe is that sponsored by the European Commission and known as the ExternE programme. In the USA a comparable project is that jointly sponsored by the US Department of Energy and the European Commission. There are many others. In each case what is sought is a monetary value of an environmental impact arising from a unit of energy, usually standardised as a kilowatt hour. These environmental impacts are usually termed 'externalities'. An externality exists if two conditions are met. First, some negative (or positive) impact is generated by an economic activity and imposed on third parties. Second, that impact must not be priced in the market place, i.e. if the effect is negative, no compensation is paid by the generator of the externality to the sufferer. If the effect is positive, the generator of the externality must not appropriate the gains to the third party, e.g. via some price that is charged. In the energy externality literature, the procedure of expressing the externalities in, say, cents or milli-euros (1000 th of an Euro = m-euro) per kWh results in an 'adder'. An adder is simply the unit externality cost added to the standard resource cost of energy. Thus, if an electricity source costs X m/euros to produce or deliver, the final social cost of it is (X+y) m-euros where y is the externality adder. While externality adders have been researched most in the context of energy, they are increasingly being estimated for other economic sectors, notably transport and agriculture. This paper presents the uses of such figures. (author)

Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials.

Science.gov (United States)

Whelan, Daniel B; Kletke, Stephanie N; Schemitsch, Geoffrey; Chahal, Jaskarndip

2016-02-01

The recurrence rate after primary anterior shoulder dislocation is high, especially in young, active individuals. Recent studies have suggested external rotation immobilization as a method to reduce the rate of recurrent shoulder dislocation in comparison to traditional sling immobilization. To assess and summarize evidence from randomized controlled trials on the effect of internal rotation versus external rotation immobilization on the rate of recurrence after primary anterior shoulder dislocation. Meta-analysis. PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and abstracts from recent proceedings were searched for eligible studies. Two reviewers selected studies for inclusion, assessed methodological quality, and extracted data. Six randomized controlled trials (632 patients) were included in this review. Demographic and prognostic variables measured at baseline were similar in the pooled groups. The average age was 30.1 years in the pooled external rotation group and 30.3 years in the pooled internal rotation group. Two studies found that external rotation immobilization reduced the rate of recurrence after initial anterior shoulder dislocation compared with conventional internal rotation immobilization, whereas 4 studies failed to find a significant difference between the 2 groups. This meta-analysis suggested no overall significant difference in the rate of recurrence among patients treated with internal rotation versus external rotation immobilization (risk ratio, 0.69; 95% CI, 0.42-1.14; P = .15). There was no significant difference in the rate of compliance between internal and external rotation immobilization (P = .43). The Western Ontario Shoulder Instability Index scores were pooled across 3 studies, and there was no significant difference between the 2 groups (P = .54). Immobilization in external rotation is not significantly more effective in reducing the recurrence rate after primary anterior shoulder dislocation than

A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.

Science.gov (United States)

Williams, Linda; Daggett, Virginia; Slaven, James E; Yu, Zhangsheng; Sager, Danielle; Myers, Jennifer; Plue, Laurie; Woodward-Hagg, Heather; Damush, Teresa M

2016-04-01

Quality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators. We conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables. Patients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, pimproved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period. Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Alignment of the External Evaluation and Specific Features of Waldorf1 Pedagogy

Directory of Open Access Journals (Sweden)

Andrea Liszka

2016-12-01

Full Text Available Evaluation and assessment have increasing importance in education. Because of an international trend toward greater school autonomy, evaluation and assessment is fueling a need to monitor how schools are doing as, simultaneously, with demand is increasing for effectiveness, equity and quality in all fields of education, whether mainstream or alternative (OECD, 2013. This study aims to observe the state-required external evaluation of Waldorf kindergartens in Berlin, until now the only case in international practice in which the state has evaluated Waldorf/Steiner institutions’ professional work. The main question is how these institutions can preserve their own profiles during the external evaluation process. This question also has great importance in Hungary because a new state evaluation system has recently been introduced that will concern the Waldorf/Steiner schools.

Kunstielu / Jaak Kangilaski

Index Scriptorium Estoniae

Kangilaski, Jaak, 1939-

2016-01-01

Kunstipoliitiline retoorika. Kunsti esteetilised paradigmad. Võimude pragmaatika. Majanduslik soosing ja poliitilised keelud. Kunstnike Liit. Näitused. Noortekoondis. Surve tugevnemine viis perestroikani. Kunstielu uuel ärkamisajal.

Externality-correcting taxes and regulation

OpenAIRE

Christiansen, V.; Smith, S.

2009-01-01

Much of the literature on externalities has considered taxes and direct regulation as alternative policy instruments. Both instruments may in practice be imperfect, reflecting informational deficiencies and other limitations. We analyse the use of taxes and regulation in combination, to control externalities arising from individual consumption behaviour. We consider cases where taxes are either imperfectly differentiated to reflect individual differences in externalities, or where some consum...

The external Q factor of a dual-feed coupling for superconducting radio frequency cavities: Theoretical and experimental studies

Science.gov (United States)

Dai, J.; Belomestnykh, S.; Ben-Zvi, I.; Xu, Wencan

2013-11-01

We propose a theoretical model based on network analysis to study the external quality factor (Q factor) of dual-feed coupling for superconducting radio-frequency (SRF) cavities. Specifically, we apply our model to the dual-feed 704 MHz half-cell SRF gun for Brookhaven National Laboratory's prototype Energy Recovery Linac (ERL). The calculations show that the external Q factor of this dual-feed system is adjustable from 104 to 109 provided that the adjustment range of a phase shifter covers 0°-360°. With a period of 360°, the external Q factor of the coupling system changes periodically with the phase difference between the two coupling arms. When the RF phase of both coupling arms is adjusted simultaneously in the same direction, the external Q factor of the system also changes periodically, but with a period of 180°.

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...... were simulated via headphones using individualized binaural room impulse responses (BRIRs). An investigation of the influence of spectral content of a sound source on externalization showed that effective externalization cues are present across the entire frequency range. The fluctuation of interaural...

Annad Miksikesele sõrme, võtab terve käe / Sirje Tohver

Index Scriptorium Estoniae

Tohver, Sirje, 1948-

2005-01-01

Miksikese õppekeskkonnast ja online-kontrolltöödest erinevate Eesti koolide näitel. Kogemusi jagavad õpetajad: Age Tamm, Eha Kaukvere, Tiia Salm, Kaja Kiis, Mare Kütt, Lemme Sulaoja, Annika Lõhmus

Kliiniline kapitalism ja naise neim / Vaapo Vaher

Index Scriptorium Estoniae

Vaher, Vaapo, 1945-

2011-01-01

Tutvustus: Kõiv, Salme. Reet Tammiku. Tallinn : Eesti Raamat, 2011 ; Kalda, Katrin. Eesti romaan / tõlkinud Anti Saar. Tallinn : Varrak, 2011 ; Zola, Émile. Saak / tõlkinud Kaja Riesen. Tallinn : Eesti Raamat, 2011

F. Herve operett "Mam'zelle Nitouche" majandusgümnaasiumi laval / Ulvi Tamm

Index Scriptorium Estoniae

Tamm, Ulvi

2003-01-01

Lauluõpetaja Ulvi Tamme ja tema õpilaste lavastatud operetist "Mam'zelle Nitouche". Esiettekanne 18. veebr. Pärnu majandusgümnaasiumi aulas ja 14. märtsil Tallinnas Salme Kultuurikeskuses vabariiklikul muusikateatrite festivalil

Quality assurance in the structural installations of nuclear power stations

International Nuclear Information System (INIS)

Schnellenbach, G.; Wrage, S.

1985-01-01

The concept of quality assurance distinguishes between self-monitoring of the design, manufacturing and executing firms and external monitoring by state institutions or by experts commissioned by them. The long-term control of structures is within the area of responsibility of the owner. This quality assurance concept is controlled in detail by statutes, which clearly define responsibilities. This structural engineering quality assurance system also forms the basis for the design, construction and utilization of structural installations of nuclear power stations; requirements emanating from the Atomic Energy Acts for the structural installations demand, however, to some extent a sharpening of self- and external monitoring. Therefore, today a quality concept has been developed for the important engineering safety-related buildings of nuclear power stations. This concept takes account of the strict requirements imposed and fulfils the requirement of KTA 1401. (orig.) [de

Malignant external otitis

International Nuclear Information System (INIS)

Dupuch, K.M.; Iryboz, T.; Firat, M.; Levy, C.; Tubiana, J.M.

1991-01-01

This paper illustrates the value of CT and MR in early diagnosis and spread of malignant external otitis. The authors retrospectively analyzed 15 patients with proved malignant external otitis examined with postcontrast high-resolution CT (15/15) and MR (6/15) (T1- and T2-weighting). Gallium studies were done in 6/15 patients. Early diagnosis was made when CT demonstrated a soft-tissue mass of the external auditory canal associated with scattered zones of cortical bone erosions (13/15). Spread of the disease was better delineated by MR than CT, especially skull base extension (6/15). Temporomandibular joint involvement with extension into parotid or/and masticator spaces 6/15 was as well detected with CT as with MR. If CT remains the first and best procedure for diagnosis, MR - despite its cost - appears a good procedure to depict exact anatomic spread, allowing therapeutic management

Antimicrobial susceptibility and internalization of Salmonella Typhimurium in vacuum-tumbled marinated beef products.

Science.gov (United States)

Pokharel, S; Brooks, J C; Martin, J N; Brashears, M M

2016-12-01

As the incidence of multidrug resistance (MDR) Salmonella enterica serotype Typhimurium is increasing, data regarding the antimicrobial interventions and pathogen internalization in marinated meat products are important. This study evaluated the antimicrobial intervention and internalization of Salm. Typhimurium in marinated beef sirloin steaks. Beef bottom sirloin flaps (IMPS #185A; USDA Select) inoculated (10 8  log 10  CFU ml -1 ) with Salm. Typhimurium were sprayed (lactic acid (4%) and buffered vinegar (2%)) prior to vacuum-tumbled marination (0·35% sodium chloride and 0·45% sodium tripolyphosphate) for 30 min. Pathogen presence after antimicrobial spray, vacuum-tumbled marination, and translocation was determined by direct plating on Xylose Lysine Deoxycholate (XLD) agar with tryptic soy agar (TSA) overlay. The data imply varied internalization and antimicrobial susceptibility pattern of Salm. Typhimurium in marinated meat. Lactic acid (4%) spray (P internalization and potential survival of Salmonella spp. in marinated beef products is a major concern. These results highlight the internalization of pathogens in vacuum-tumbled meat products and emphasize the importance of considering these products as nonintact. Similarly, these data confirm the efficacy and utility of interventions prior to vacuum-tumbled marination. Further research is needed to identify additional strategies to mitigate internalization and translocation of pathogens into vacuum-marinated meat products. © 2016 The Society for Applied Microbiology.

Eurados trial performance test for personal dosemeters for external beta radiation