WorldWideScience

Sample records for varnum national quality

  1. National Recommended Water Quality Criteria

    Data.gov (United States)

    U.S. Environmental Protection Agency — The National Recommended Water Quality Criteria is a compilation of national recommended water quality criteria for the protection of aquatic life and human health...

  2. National Coal Quality Inventory (NACQI)

    Energy Technology Data Exchange (ETDEWEB)

    Robert Finkelman

    2005-09-30

    The U.S. Geological Survey (USGS) conducted the National Coal Quality Inventory (NaCQI) between 1999 and 2005 to address a need for quality information on coals that will be mined during the next 20-30 years. Collaboration between the USGS, State geological surveys, universities, coal burning utilities, and the coal mining industry plus funding support from the Electric Power Research Institute (EPRI) and the U.S. Department of Energy (DOE) permitted collection and submittal of coal samples for analysis. The chemical data (proximate and ultimate analyses; major, minor and trace element concentrations) for 729 samples of raw or prepared coal, coal associated shale, and coal combustion products (fly ash, hopper ash, bottom ash and gypsum) from nine coal producing States are included. In addition, the project identified a new coal reference analytical standard, to be designated CWE-1 (West Elk Mine, Gunnison County, Colorado) that is a high-volatile-B or high-volatile-A bituminous coal with low contents of ash yield and sulfur, and very low, but detectable contents of chlorine, mercury and other trace elements.

  3. National Water Quality Standards Database (NWQSD)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The National Water Quality Standards Database (WQSDB) provides access to EPA and state water quality standards (WQS) information in text, tables, and maps. This data...

  4. The Danish national quality database for births

    DEFF Research Database (Denmark)

    Andersson, Charlotte Brix; Flems, Christina; Kesmodel, Ulrik Schiøler

    2016-01-01

    Aim of the database: The aim of the Danish National Quality Database for Births (DNQDB) is to measure the quality of the care provided during birth through specific indicators. Study population: The database includes all hospital births in Denmark. Main variables: Anesthesia/pain relief, continuous...... Medical Birth Registry. Registration to the Danish Medical Birth Registry is mandatory for all maternity units in Denmark. During the 5 years, performance has improved in the areas covered by the process indicators and for some of the outcome indicators. Conclusion: Measuring quality of care during...

  5. Slovak National Prize for Quality 2004

    International Nuclear Information System (INIS)

    Steflik, Marian

    2009-01-01

    Competition for the Slovak National Prize for Quality is a milestone in the history of the Mochovce NPP. The Mochovce NPP won the prize in 2004. The article describes in detail the preparatory efforts including not only technological issues but also various administrative challenges. The impacts of this achievement on the plant's subsequent development are also highlighted. (orig.)

  6. National Quality Improvement Center on Early Childhood

    Science.gov (United States)

    Browne, Charlyn Harper

    2014-01-01

    The national Quality Improvement Center on early Childhood (QIC-eC) funded four research and demonstration projects that tested child maltreatment prevention approaches. The projects were guided by several key perspectives: the importance of increasing protective factors in addition to decreasing risk factors in child maltreatment prevention…

  7. Quality system in Malaysian National Tissue Bank

    International Nuclear Information System (INIS)

    Go Boon Thong; Firdaus, M. N.; Abd Rani Shamsudin

    1999-01-01

    Quality System in Malaysian National Tissue Bank is based on the Quality Manual which has been drawn up by the chairman, who is the Dean, School of Medical Sciences. The Quality Manual include general standard for Tissue Banking in University Science of Malaysia which describe and explain a set of general standard similar to the EATB standard. The primary aim of the quality system is to produce a safe and effective tissue graft for successful clinical use and to ensure the safety of tissue bank operators. The Quality Manual also related the role of a Technical Manual, which explain the standard of technical aspect of tissue bank in a Quality Assurance. The safe working environment and Good Laboratory Practice is highlight in Quality System. Documentation of tissue bank activities is the key to the administration to tissue bank. Finally Quality System in tissue banking will never be complete without a Tissue Bank Auditing System which allow the tissue bank coordinator and staff to look into the problem and further enhance the progress of the tissue bank

  8. National Program of Quality Assurance in Radiotherapy in Cuba

    International Nuclear Information System (INIS)

    Alonso Samper, J. L.; Dominguez Hung, L.; Morales Lopez, J. L.; Alfonso Laguardia, R.; Garcia Yip, F.

    2001-01-01

    It tries on the establishment of a Quality Assurance Nacional System, a Quality Assurance Committee implemented in Cuba, and a Quality Auditory National Program implemented in Cuba to control and assure radiotherapy quality

  9. Consumers' quality perception of national branded, national store branded, and imported store branded beef

    DEFF Research Database (Denmark)

    Banovic, Marija; Grunert, Klaus G.; Barreira, Maria Madalena

    2010-01-01

    This study investigated the differences in the consumers' quality perception of national branded, national store branded, and imported store branded beef. Partial Least Squares analysis is used for modelling the quality perception process. Results show that consumers perceived national branded...

  10. National trends in drinking water quality violations.

    Science.gov (United States)

    Allaire, Maura; Wu, Haowei; Lall, Upmanu

    2018-02-27

    Ensuring safe water supply for communities across the United States is a growing challenge in the face of aging infrastructure, impaired source water, and strained community finances. In the aftermath of the Flint lead crisis, there is an urgent need to assess the current state of US drinking water. However, no nationwide assessment has yet been conducted on trends in drinking water quality violations across several decades. Efforts to reduce violations are of national concern given that, in 2015, nearly 21 million people relied on community water systems that violated health-based quality standards. In this paper, we evaluate spatial and temporal patterns in health-related violations of the Safe Drinking Water Act using a panel dataset of 17,900 community water systems over the period 1982-2015. We also identify vulnerability factors of communities and water systems through probit regression. Increasing time trends and violation hot spots are detected in several states, particularly in the Southwest region. Repeat violations are prevalent in locations of violation hot spots, indicating that water systems in these regions struggle with recurring issues. In terms of vulnerability factors, we find that violation incidence in rural areas is substantially higher than in urbanized areas. Meanwhile, private ownership and purchased water source are associated with compliance. These findings indicate the types of underperforming systems that might benefit from assistance in achieving consistent compliance. We discuss why certain violations might be clustered in some regions and strategies for improving national drinking water quality.

  11. 77 FR 30087 - Air Quality Designations for the 2008 Ozone National Ambient Air Quality Standards

    Science.gov (United States)

    2012-05-21

    ... and 81 Air Quality Designations for the 2008 Ozone National Ambient Air Quality Standards; Implementation of the 2008 National Ambient Air Quality Standards for Ozone: Nonattainment Area Classifications...-9668-2] RIN 2060-AP37 Air Quality Designations for the 2008 Ozone National Ambient Air Quality...

  12. The National Security Strategy and National Interests: Quantity or Quality?

    National Research Council Canada - National Science Library

    Mercado, Leo

    2001-01-01

    The national security strategy (NSS), National Security Strategy for a New Century, published in December 1999, categorizes national interests as vital, important, and humanitarian and other interests...

  13. 76 FR 72097 - Air Quality Designations for the 2008 Lead (Pb) National Ambient Air Quality Standards

    Science.gov (United States)

    2011-11-22

    ... Air Quality Designations for the 2008 Lead (Pb) National Ambient Air Quality Standards AGENCY: Environmental Protection Agency (EPA). ACTION: Final rule. SUMMARY: This rule establishes air quality designations for most areas in the United States for the 2008 lead (Pb) National Ambient Air Quality Standards...

  14. Data quality in the Danish National Acute Leukemia Registry

    DEFF Research Database (Denmark)

    Ostgård, Lene Sofie Granfeldt; Nørgaard, Jan Maxwell; Severinsen, Marianne Tang

    2013-01-01

    The Danish National Acute Leukemia Registry (DNLR) has documented coverage of above 98.5%. Less is known about the quality of the recorded data.......The Danish National Acute Leukemia Registry (DNLR) has documented coverage of above 98.5%. Less is known about the quality of the recorded data....

  15. Nationwide quality improvement of cholecystectomy: results from a national database

    DEFF Research Database (Denmark)

    Harboe, Kirstine M; Bardram, Linda

    2011-01-01

    To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones.......To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones....

  16. Air Quality Modelling and the National Emission Database

    DEFF Research Database (Denmark)

    Jensen, S. S.

    The project focuses on development of institutional strengthening to be able to carry out national air emission inventories based on the CORINAIR methodology. The present report describes the link between emission inventories and air quality modelling to ensure that the new national air emission...... inventory is able to take into account the data requirements of air quality models...

  17. Good Governance and Happiness in Nations: Technical Quality Precedes Democracy and Quality Beats Size

    NARCIS (Netherlands)

    J.C. Ott (Jan Cornelis)

    2010-01-01

    textabstractAverage happiness differs markedly across nations and there appears to be a system in these differences. This paper considers the role of quality of governance, and in particular the role of technical quality as opposed to democratic quality. A comparison of 127 nations in 2006 shows

  18. [Extraction of management information from the national quality assurance program].

    Science.gov (United States)

    Stausberg, Jürgen; Bartels, Claus; Bobrowski, Christoph

    2007-07-15

    Starting with clinically motivated projects, the national quality assurance program has established a legislative obligatory framework. Annual feedback of results is an important means of quality control. The annual reports cover quality-related information with high granularity. A synopsis for corporate management is missing, however. Therefore, the results of the University Clinics in Greifswald, Germany, have been analyzed and aggregated to support hospital management. Strengths were identified by the ranking of results within the state for each quality indicator, weaknesses by the comparison with national reference values. The assessment was aggregated per clinical discipline and per category (indication, process, and outcome). A composition of quality indicators was claimed multiple times. A coherent concept is still missing. The method presented establishes a plausible summary of strengths and weaknesses of a hospital from the point of view of the national quality assurance program. Nevertheless, further adaptation of the program is needed to better assist corporate management.

  19. Quality Management Systems for the National Qualifications Framework. Quality Assurance in Education and Training.

    Science.gov (United States)

    New Zealand Qualifications Authority, Wellington.

    This booklet explores the idea of quality and its management as it applies to providers of education in particular, but also as it applies to national standards bodies and workplaces offering on-the-job training. It explores the focus on quality in industry and education and defines quality in terms of the features of quality and their…

  20. Groundwater quality data from the National Water-Quality Assessment Project, May 2012 through December 2013

    Science.gov (United States)

    Arnold, Terri L.; Desimone, Leslie A.; Bexfield, Laura M.; Lindsey, Bruce D.; Barlow, Jeannie R.; Kulongoski, Justin T.; Musgrove, MaryLynn; Kingsbury, James A.; Belitz, Kenneth

    2016-06-20

    Groundwater-quality data were collected from 748 wells as part of the National Water-Quality Assessment Project of the U.S. Geological Survey National Water-Quality Program from May 2012 through December 2013. The data were collected from four types of well networks: principal aquifer study networks, which assess the quality of groundwater used for public water supply; land-use study networks, which assess land-use effects on shallow groundwater quality; major aquifer study networks, which assess the quality of groundwater used for domestic supply; and enhanced trends networks, which evaluate the time scales during which groundwater quality changes. Groundwater samples were analyzed for a large number of water-quality indicators and constituents, including major ions, nutrients, trace elements, volatile organic compounds, pesticides, and radionuclides. These groundwater quality data are tabulated in this report. Quality-control samples also were collected; data from blank and replicate quality-control samples are included in this report.

  1. ANALISIS PERBANDINGAN PENGHARGAAN KUALITAS MALCOLM BALDRIGE NATIONAL QUALITY AWARD DENGAN EUROPEAN QUALITY AWARD (MBNQA vs EQA

    Directory of Open Access Journals (Sweden)

    Arfan Bakhtiar Amalia

    2012-02-01

    Full Text Available Persaingan bisnis global saat ini makin ketat. Dengan adanya Malcolm Baldrige National Quality Award (MBNQA dan juga European Quality Award (EQA diharapkan mampu mendorong dan memotivasi perusahaan-perusahaan, baik yang sudah sukses maupun yang sedang berkembang, untuk selalu meningkatkan mutu dan kinerja, serta sebagai kunci daya saing. Dalam makalah ini, kita akan membahas penghargaan kualitas mengenai tujuan, manfaat dan perkembangan, dan trend saat ini, terutama untuk MBNQA dan EQM (European Quality Model. Kita akan membandingkan antara MBNQA dan EQM melalui pengertian, latar belakang, metode-metode, dan kriteria-kriteria, serta aplikasinya, sehingga dapat kita lakukan analisa perbandingan untuk keduanya. Kata Kunci  : Penghargaan Kualitas, Malcolm Baldrige National Quality Award (MBNQA, European Quality Award (EQA   Emulation of global business in this time more and more to tighten. With existence of Malcolm Baldrige National Quality Award (MBNQA as well as European Quality Award (EQA expected can push and motivate companies, both for have successful and also which is expanding, to always increase the quality and performance, and also as competitiveness key. In this paper, we will discuss about national quality award concerning target, benefit, growth, and trend in this time, especially MBNQA and EQM (European Quality Model. We will compare between MBNQA and EQM through congeniality, background, method, and criterions, and also its application,  so that earn us to analyse comparison to both of its. Keyword        : Quality Award, Malcolm Baldrige National Quality Award (MBNQA, European Quality Award (EQA

  2. A national look at water quality

    Science.gov (United States)

    Gilliom, Robert J.; Mueller, David K.; Zogorski, John S.; Ryker, Sarah J.

    2002-01-01

    Most water-quality problems we face today result from diffuse "nonpoint" sources of pollution from agricultural land, urban development, forest harvesting and the atmosphere (U.S. Army Corps of Engineers et al., 1999). It is difficult to quantify nonpoint sources because the contaminants they deliver vary in composition and concentrations from hour to hour and season to season. Moreover, the nature of the contamination is complex and varied. When Congress enacted the Clean Water Act 30 years ago, attention was focused on water-quality issues related to the sanitation of rivers and streams - bacteria counts, oxygen in the water for fish, nutrients, temperature, and salinity. Now, attention is turning to the hundreds of synthetic organic compounds like pesticides used in agricultural and residential areas, volatile organics in solvents and gasoline, microbial and viral contamination, and pharmaceuticals and hormones.

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

    Science.gov (United States)

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

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

  4. Approach the National Quality Audit System for Radiotherapy in Latvia

    OpenAIRE

    Dehtjars, J; Popovs, S; Plaude, S

    2008-01-01

    It is very important to make National Quality Audit to ensure accurate conformal RT delivery. It is necessary to develop an Audit system to inspect all Conformal RT and IMRT delivery chain including the Quality checks of linear accelerator, Multileaf Collimator (MLC), Computer Tomography (CT) scanner or simulator, target and tissue delineation, plan evaluation, and delivery.

  5. The Quest for Strategic Malaysian Quality National Primary School Leaders

    Science.gov (United States)

    Ali, Hairuddin Mohd

    2012-01-01

    Purpose: The purpose of this paper is to investigate the nine-point strategic leadership characteristics of Malaysian Quality National Primary School Leaders (QNPSL) and to indicate the implications of these findings for the current educational management and leadership practices in their quest for Malaysian quality education.…

  6. Quality of water resources of the Ouachita National Forest, Arkansas

    Science.gov (United States)

    Cole, Elizabeth F.; Morris, E.E.

    1986-01-01

    Surface water and groundwater quality was documented in the Ouachita National Forest by collecting surface water quality data at 15 points and groundwater quality data at 11 sites from April 1984 through August 1985. The data were compared to drinking water standards and the results are tabulated. Surface water in the Ouachita National Forest is relatively abundant. It is low in mineralization and chemically suitable for most uses with minimal treatment. Groundwater is relatively scarce. The low yields of wells limit the use of groundwater primarily to domestic use. The water is chemically suitable for most purposes but may require treatment for the removal of iron. (Peters-PTT)

  7. Quality-control design for surface-water sampling in the National Water-Quality Network

    Science.gov (United States)

    Riskin, Melissa L.; Reutter, David C.; Martin, Jeffrey D.; Mueller, David K.

    2018-04-10

    The data-quality objectives for samples collected at surface-water sites in the National Water-Quality Network include estimating the extent to which contamination, matrix effects, and measurement variability affect interpretation of environmental conditions. Quality-control samples provide insight into how well the samples collected at surface-water sites represent the true environmental conditions. Quality-control samples used in this program include field blanks, replicates, and field matrix spikes. This report describes the design for collection of these quality-control samples and the data management needed to properly identify these samples in the U.S. Geological Survey’s national database.

  8. Analysis of quality data based on national clinical databases

    DEFF Research Database (Denmark)

    Utzon, Jan; Petri, A.L.; Christophersen, S.

    2009-01-01

    There is little agreement on the philosophy of measuring clinical quality in health care. How data should be analyzed and transformed to healthcare information is an ongoing discussion. To accept a difference in quality between health departments as a real difference, one should consider to which...... extent the selection of patients, random variation, confounding and inconsistency may have influenced results. The aim of this article is to summarize aspects of clinical healthcare data analyses provided from the national clinical quality databases and to show how data may be presented in a way which...... is understandable to readers without specialised knowledge of statistics Udgivelsesdato: 2009/9/14...

  9. Analysis of quality data based on national clinical databases

    DEFF Research Database (Denmark)

    Utzon, Jan; Petri, A.L.; Christophersen, S.

    2009-01-01

    extent the selection of patients, random variation, confounding and inconsistency may have influenced results. The aim of this article is to summarize aspects of clinical healthcare data analyses provided from the national clinical quality databases and to show how data may be presented in a way which......There is little agreement on the philosophy of measuring clinical quality in health care. How data should be analyzed and transformed to healthcare information is an ongoing discussion. To accept a difference in quality between health departments as a real difference, one should consider to which...

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

    Science.gov (United States)

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

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

  11. 76 FR 76048 - Air Quality Designations for the 2008 Lead (Pb) National Ambient Air Quality Standards

    Science.gov (United States)

    2011-12-06

    ... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 81 [EPA-HQ-OAR-2009-0443; FRL-9492-3] RIN 2060-AR17 Air Quality Designations for the 2008 Lead (Pb) National Ambient Air Quality Standards Correction In rule document 2011-29460 appearing on pages 72097-72120 in the issues of Tuesday, November 22, 2011...

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

    Science.gov (United States)

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

    2018-01-01

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

  13. Overview of the National Water-Quality Assessment Program

    Science.gov (United States)

    Leahy, P.P.; Thompson, T.H.

    1994-01-01

    The Nation's water resources are the basis for life and our economic vitality. These resources support a complex web of human activities and fishery and wildlife needs that depend upon clean water. Demands for good-quality water for drinking, recreation, farming, and industry are rising, and as a result, the American public is concerned about the condition and sustainability of our water resources. The American public is asking: Is it safe to swim in and drink water from our rivers or lakes? Can we eat the fish that come from them? Is our ground water polluted? Is water quality degrading with time, and if so, why? Has all the money we've spent to clean up our waters, done any good? The U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program was designed to provide information that will help answer these questions. NAWQA is designed to assess historical, current, and future water-quality conditions in representative river basins and aquifers nationwide. One of the primary objectives of the program is to describe relations between natural factors, human activities, and water-quality conditions and to define those factors that most affect water quality in different parts of the Nation. The linkage of water quality to environmental processes is of fundamental importance to water-resource managers, planners, and policy makers. It provides a strong and unbiased basis for better decisionmaking by those responsible for making decisions that affect our water resources, including the United States Congress, Federal, State, and local agencies, environmental groups, and industry. Information from the NAWQA Program also will be useful for guiding research, monitoring, and regulatory activities in cost effective ways.

  14. Distributional Benefit Analysis of a National Air Quality Rule

    Directory of Open Access Journals (Sweden)

    Jin Huang

    2011-06-01

    Full Text Available Under Executive Order 12898, the U.S. Environmental Protection Agency (EPA must perform environmental justice (EJ reviews of its rules and regulations. EJ analyses address the hypothesis that environmental disamenities are experienced disproportionately by poor and/or minority subgroups. Such analyses typically use communities as the unit of analysis. While community-based approaches make sense when considering where polluting sources locate, they are less appropriate for national air quality rules affecting many sources and pollutants that can travel thousands of miles. We compare exposures and health risks of EJ-identified individuals rather than communities to analyze EPA’s Heavy Duty Diesel (HDD rule as an example national air quality rule. Air pollutant exposures are estimated within grid cells by air quality models; all individuals in the same grid cell are assigned the same exposure. Using an inequality index, we find that inequality within racial/ethnic subgroups far outweighs inequality between them. We find, moreover, that the HDD rule leaves between-subgroup inequality essentially unchanged. Changes in health risks depend also on subgroups’ baseline incidence rates, which differ across subgroups. Thus, health risk reductions may not follow the same pattern as reductions in exposure. These results are likely representative of other national air quality rules as well.

  15. Quality of antenatal care in Zambia: a national assessment

    Science.gov (United States)

    2012-01-01

    Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress. PMID:23237601

  16. 78 FR 47191 - Air Quality Designations for the 2010 Sulfur Dioxide (SO2) Primary National Ambient Air Quality...

    Science.gov (United States)

    2013-08-05

    ... Air Quality Designations for the 2010 Sulfur Dioxide (SO[bdi2]) Primary National Ambient Air Quality... air quality designations for certain areas in the United States for the 2010 primary Sulfur Dioxide (SO 2 ) National Ambient Air Quality Standard (NAAQS). The EPA is issuing this rule to identify areas...

  17. International and national standardisation for quality assurance in nuclear engineering

    International Nuclear Information System (INIS)

    Becker, K.

    1992-01-01

    After a summarising description of international developments (ISO 6216, ISO 9000 series, IAEA 50 SG-QA) an overview of the total of around 200 national quality standards and regulations from almost 20 countries is given. Finally the relationships between rules of engineering and the rules of laws, mechanisms and trends in the development of nuclear energy standards with particular consideration of the possibilities for European harmonisation are presented in brief. 1 fig., 5 tabs

  18. Quality management in environmental programs: Los Alamos National Laboratory's approach

    International Nuclear Information System (INIS)

    Maassen, L.; Day, J.L.

    1998-03-01

    Since its inception in 1943, Los Alamos National Laboratory's (LANL's) primary mission has been nuclear weapons research and development, which involved the use of hazardous and radioactive materials, some of which were disposed of onsite. LANL has established an extensive Environmental Restoration Project (Project) to investigate and remediate those hazardous and radioactive waste disposal sites. This paper describes LANL's identification and resolution of critical issues associated with the integration and management of quality in the Project

  19. National waste terminal storage program. Supplementary quality-assurance requirements

    International Nuclear Information System (INIS)

    Garland, D.L.

    1980-01-01

    The basic Quality Assurance Program Requirements standard for the National Waste Terminal Storage Program has been developed primarily for nuclear reactors and other fairly well established nuclear facilities. In the case of waste isolation, however, there are many ongoing investigations for which quality assurance practices and requirements have not been well defined. This paper points out these problems which require supplementary requirements. Briefly these are: (1) the language barrier, that is geologists and scientists are not familiar with quality assurance (QA) terminology; (2) earth sciences deal with materials that cannot be characterized as easily as metals or other materials that are reasonably homogeneous; (3) development and control of mathematical models and associated computer programs; (4) research and development

  20. How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

    Science.gov (United States)

    Cho, Yu Kyung

    2016-07-01

    In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

  1. The National System for quality control and the European experience

    International Nuclear Information System (INIS)

    Dimov, A.; Vassileva, J.; Ingilizova, K.; Slavchev, A. and others

    2003-01-01

    Objective: The aim of the work is to present the structure and functions of the National System for quality control (NSQC) in the medical irradiation, created to guarantee the safety and the safe use of the radiological equipment. Material and method: The approaches are studies in the development of the NSQC, applied in Bulgaria and some European Union members - such as Germany and Great Britain - and the specifics of the way in which the Directive for medical irradiation EURATOM 97/43 is implemented in national legislations. Results: The advantages and disadvantages of Bulgarian NSQC are analysed and some ideas for tis improvement are suggested. Conclusions: The developed draft NSQC for medical irradiation is in compliance with the requirement of the European Directive. The real advantages and disadvantages of the NSQC will show after its implementation in the practical radiation protection and control in the country

  2. National infection prevention and control programmes: Endorsing quality of care.

    Science.gov (United States)

    Stempliuk, Valeska; Ramon-Pardo, Pilar; Holder, Reynaldo

    2014-01-01

    Core components Health care-associated infections (HAIs) are a major cause of morbidity and mortality. In addition to pain and suffering, HAIs increase the cost of health care and generates indirect costs from loss of productivity for patients and society as a whole. Since 2005, the Pan American Health Organization has provided support to countries for the assessment of their capacities in infection prevention and control (IPC). More than 130 hospitals in 18 countries were found to have poor IPC programmes. However, in the midst of many competing health priorities, IPC programmes are not high on the agenda of ministries of health, and the sustainability of national programmes is not viewed as a key point in making health care systems more consistent and trustworthy. Comprehensive IPC programmes will enable countries to reduce the mobility, mortality and cost of HAIs and improve quality of care. This paper addresses the relevance of national infection prevention and control (NIPC) programmes in promoting, supporting and reinforcing IPC interventions at the level of hospitals. A strong commitment from national health authorities in support of national IPC programmes is crucial to obtaining a steady decrease of HAIs, lowering health costs due to HAIs and ensuring safer care.

  3. Sandia National Laboratories ASCI Applications Software Quality Engineering Practices; TOPICAL

    International Nuclear Information System (INIS)

    ZEPPER, JOHN D.; ARAGON, KATHRYN MARY; ELLIS, MOLLY A.; BYLE, KATHLEEN A.; EATON, DONNA SUE

    2002-01-01

    This document provides a guide to the deployment of the software verification activities, software engineering practices, and project management principles that guide the development of Accelerated Strategic Computing Initiative (ASCI) applications software at Sandia National Laboratories (Sandia). The goal of this document is to identify practices and activities that will foster the development of reliable and trusted products produced by the ASCI Applications program. Document contents include an explanation of the structure and purpose of the ASCI Quality Management Council, an overview of the software development lifecycle, an outline of the practices and activities that should be followed, and an assessment tool. These sections map practices and activities at Sandia to the ASCI Software Quality Engineering: Goals, Principles, and Guidelines, a Department of Energy document

  4. Canadian National Dairy Study: Herd-level milk quality.

    Science.gov (United States)

    Bauman, C A; Barkema, H W; Dubuc, J; Keefe, G P; Kelton, D F

    2018-03-01

    The objective of this study was to estimate Canadian national milk quality parameters and estimate the bulk tank milk (BTM) prevalence of 4 mastitis pathogens, Staphylococcus aureus, Streptococcus agalactiae, Mycoplasma bovis, and Prototheca spp., on Canadian dairy farms. A questionnaire was sent to all Canadian dairy producers. Of the 1,062 producers who completed the questionnaire, 374 producers from across the country were visited and milking hygiene was assessed. Farm-level milk quality data for all Canadian dairy producers was collected from the provincial marketing boards and combined with the questionnaire and farm visit data. In addition, a BTM sample was collected either during the farm visit or by the marketing board in November of 2015 and was tested for 4 major mastitis pathogens using the PathoProof Mastitis Major 4 PCR Assay (Thermo Fisher Scientific Inc., Waltham, MA). Apparent herd-level prevalence was 46% for S. aureus, 6% for Prototheca spp., 0% for M. bovis, and 0% for Strep. agalactiae. Due to the low prevalence of M. bovis and Strep. agalactiae and a lack of significant factors associated with farms testing positive for Prototheca spp., an association analysis could only be carried out for Staph. aureus-positive farms. Factors associated with Staph. aureus-positive farms were not fore-stripping cows before milking (odds ratio = 1.87), milking with a pipeline system (odds ratio = 2.21), and stall bases made of a rubberized surface (mats and mattresses), whereas protective factors were using blanket dry cow therapy (odds ratio = 0.49) and applying a tag or visible mark on cows known to have chronic mastitis infections (odds ratio = 0.45). The Canadian national production-weighted geometric mean somatic cell count was determined to be 208,000 cells/mL. This is the first national dairy study conducted in Canada. Participating farms had higher milk yield; were more likely to have a loose housing system, parlor, or automated milking system; and had

  5. Quality control and quality assurance philosophy introduced in national personnel dosimetry service

    International Nuclear Information System (INIS)

    Trousil, J.; Zelenka, Z.; Kvasnicka, O.

    2008-01-01

    There in National Personnel Dosimetry Service (NPDS) the implementation of the control system to guarantee the credibility of the measured personal dose equivalents results was given on the basis of the international recommendations published by the European Commission and the IAEA and in particular of the decree of the SUJB No. 132/2008 Coll. The quality control and the quality assurance are carried out in all three personal dosimetry services introduced in NPDS: in the film badge, thermoluminescent (TL) and neutron dosimetry. (authors)

  6. Managing air quality in a rapidly developing nation: China

    Science.gov (United States)

    Fang, Ming; Chan, Chak K.; Yao, Xiaohong

    As the world gets ready to begin the second decade of the twenty-first century, global climate change has been recognized as a real threat to civilization as we know it. The rapid and successful economic growth of developing nations, particularly China and India, is contributing to climate change. The route to initial economic success in China followed that of the developed nations through the development of industries. Unfortunately, China's environmental protection efforts have not been the same as in developed countries because China is vastly different culturally, socially, economically and, especially, politically from developed nations. When China started to deal with environmental concerns in the late 1970s, it took advantage of the experiences of other countries in establishing environmental standards and regulations, but it did not have a model to follow when it came to implementing these standards and regulations because of the abovementioned differences. Economically, China is transitioning from an agricultural base into an industrial base; however, even now, 60% of the population remains farmers. China has been and still is heavily dependent upon coal for energy, resulting in serious atmospheric particulate pollution. While growing efforts have been expended on the environment, at this juncture of its economic development, China would be well served to revisit the traditional "develop first and clean up later" approach and to find a balance between development and protecting the environment. Against this backdrop, a reflective look of the effort to manage air quality from 1949-2008 (with an emphasis on the past 30 years) in China is presented in this paper. The environmental component of the 2008 Olympic Games is examined as a special example to illustrate the current measures being used to improve air quality in China.

  7. National protocol for quality assurance in DXA-bone densitometry

    Science.gov (United States)

    Slavchev, A.; Avramova-Cholakova, S.; Vassileva, J.

    2008-01-01

    Osteoporosis becomes largely one of the most important socially significant and costly diseases. Modern techniques (DXA, US) are applied for bone densitometry. The paper presents a protocol for quality assurance especially of DXA-bone densitometers including quality control made in compliance with international standards (ISCD, IOF). The methodology has been tested in practice by measurements on site-functional assessment, entrance dose, radiation protection, calibration, in-vitro precision. It is expected to raise the quality of the diagnostic process in concert with the EU Medical Directive 97/43 particularly for population screening and sensitive groups. The protocol is an essential part of the National Program for constraining osteoporosis which has been elaborated at the Ministry of Health and at present under implementation throughout the country. It aims at reducing the risk, factors spreading, at diminishing the fracture risk the morbidity and the mortality from osteoporosis. An integral multidisciplinary approach to the problem solving is applied as well as training on three levels — doctors, patients, population, which effectively will contribute for obtaining real results in preventing osteoporosis.

  8. Are data from national quality registries used in quality improvement at Swedish hospital clinics?

    Science.gov (United States)

    Fredriksson, Mio; Halford, Christina; Eldh, Ann Catrine; Dahlström, Tobias; Vengberg, Sofie; Wallin, Lars; Winblad, Ulrika

    2017-11-01

    To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels (x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs (x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks (x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x̅ 10.32). In Riksstroke, the managers requested registry data more often (x̅ 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  9. Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

    Science.gov (United States)

    Berendes, Sima; Lako, Richard L; Whitson, Donald; Gould, Simon; Valadez, Joseph J

    2014-10-01

    We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states. © 2014 John Wiley & Sons Ltd.

  10. Quality Control in diagnostic radiology according to national regulations

    International Nuclear Information System (INIS)

    Domienik, J.; Chruscielewski, W.; Jankowski, J.

    2006-01-01

    The aim of the paper is to review the main aspects of quality control of radiological devices according to the current national regulations. Explanation of the physical principles of image formation by different test phantoms used to measure focal spot sizes is presented in appendix. The obligation for quality assurance (QA) for all X-ray systems which follows European standards was enforced in updated '' Atomic Law Act '' of 29 November 2000 . This document is the main regulatory act which establishes the basic safety standards for radiation protection in Poland. The main modifications introduced by this new Act concerned the issue of radiation protection of individuals undergoing medical examinations with the use of ionizing radiation which is regulated by EC Directive 97/43 Euratom. According to this Directive quality assurance programmes, including quality control measures need to be implemented by the holder of the radiological installation. Therefore, in the above Act the Minister of Health has been obligated to impose specific regulations describing the way of implementation of general principles laid down in the Directive. Some of these regulations, like those concerning QC tests and tolerances, have already been mentioned in the document titled '' On the conditions for safe application of ionizing radiation in medicine ''. For example, the QC program in radiography is being considered; the obligatory tests- acceptance, routine and annual- are discussed and specific procedures are being indicated. The main idea of the document '' On the conditions for safe application of ionizing radiation in medicine '' which concerns radiation protection of patients and staff against ionizing radiation used in medicine is to implement the surveillance of all X-ray systems in form of acceptance tests followed by internal tests (routine and annual) performed in accordance with European standards. (author)

  11. QUALITY OF NATIONAL ECONOMIC GROWTH: FACTORS AND DETERMINANTS

    Directory of Open Access Journals (Sweden)

    Nikolaj I. Komkov

    2015-01-01

    Full Text Available The subject / topic: TThe theme of this article is very relevant in the light of changes in the global geo-economic structure and changing the role and place ofRussiain world economic and geopolitical relations. The article deals with the basic aspects of national economic growth, which slowed down in the last three years. The main reason for slowing national economic growth is associated with the depletion of the reserves of the traditional export-oriented development of the Russian economy, as well as problems with sluggish innovative transformation. In this paper, based on a systematic analysis of economic processes and the interpretation of analytical data, addresses the general theoretical and methodological aspects of the quality of economic development, as well as practical guidelines and recommendations related to sustainable national socio-economic development in the context of external constraints.The purpose / objectives: The aim of the article is to analyze the theoretical and methodological aspects of the quality of economic development of the Russian economy, which happened in the face of economic sanctions. Objectives of the article: justify practical directions and recommendations related to sustainable national socio-economic development in the context of external constraints, determine the prospects for the economy of theRussian Federationin the conditions of the introduction of sectoral sanctions by Western countries. Methodology:Methodological basis of this article are the comparative and economic-statistical methods of analysis.The Results: The study revealed that the harsh environment (sanctions, depreciation of the ruble, and others. Require surgical intervention and adjustments not only the current socio-economic plans, but also to take urgent measures to ensure the development prospects. The most important decision is the degree of support advanced scientific and technical programs and the creation of new domestic

  12. Quality assurance programme at the National Calibration Laboratory in Tanzania

    International Nuclear Information System (INIS)

    Muhogora, W.E.; Yoloye, O.; Ngaile, J.; Lema, U.S.

    2000-01-01

    A quality assurance programme at the National Calibration Laboratory for ionizing radiation in Tanzania is described. The programme focuses mainly on regular stability check source and reference output measurements, performance testing of TLD systems as well as some external audit checks. It is found that the stability check source measurements are within ± 1%. Similarly, the air kerma rate measurements agree well with calibration uncertainties, that is ± 2% for protection level measurements and ± 1.5% for clinical dosimetry. The results of comparison of dose measurements done on site and those obtained from some external audit checks are also within requirements. This shows that the working standards have been kept with good care, and that the traceability to the international measurement system is adequately maintained. Some examples on calibration transfer activities are briefly discussed

  13. NAVIGATING A QUALITY ROUTE TO A NATIONAL SAFETY AWARD

    Energy Technology Data Exchange (ETDEWEB)

    PREVETTE SS

    2009-05-26

    Deming quality methodologies applied to safety are recognized with the National Safety Council's annual Robert W. Campbell Award. Over the last ten years, the implementation of Statistical Process Control and quality methodologies at the U.S. Department of Energy's Hanford Site have contributed to improved safety. Improvements attributed to Statistical Process Control are evidenced in Occupational Safety and Health records and documented through several articles in Quality Progress and the American Society of Safety Engineers publication, Professional Safety. Statistical trending of safety, quality, and occurrence data continues to playa key role in improving safety and quality at what has been called the world's largest environmental cleanup project. DOE's Hanford Site played a pivotal role in the nation's defense beginning in the 1940s, when it was established as part of the Manhattan Project. After more than 50 years of producing material for nuclear weapons, Hanford, which covers 586 square miles in southeastern Washington state, is now focused on three outcomes: (1) Restoring the Columbia River corridor for multiple uses; (2) Transitioning the central plateau to support long-term waste management; and (3) Putting DOE assets to work for the future. The current environmental cleanup mission faces challenges of overlapping technical, political, regulatory, environmental, and cultural interests. From Oct. 1, 1996 through Sept. 30, 2008, Fluor Hanford was a prime contractor to the Department of Energy's Richland Operations Office. In this role, Fluor Hanford managed several major cleanup activities that included dismantling former nuclear-processing facilities, cleaning up the Site's contaminated groundwater, retrieving and processing transuranic waste for shipment and disposal off-site, maintaining the Site's infrastructure, providing security and fire protection, and operating the Volpentest HAMMER Training and Education

  14. Influence of Continuing Medical Education on Rheumatologists? Performance on National Quality Measures for Rheumatoid Arthritis

    OpenAIRE

    Sapir, Tamar; Rusie, Erica; Greene, Laurence; Yazdany, Jinoos; Robbins, Mark L.; Ruderman, Eric M.; Carter, Jeffrey D.; Patel, Barry; Moreo, Kathleen

    2015-01-01

    Introduction: In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists’ performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-educati...

  15. The quality of sample surveys in a developing nation

    Directory of Open Access Journals (Sweden)

    Paul A Bourne

    2010-08-01

    Full Text Available Paul A Bourne1, Christopher AD Charles2,3, Neva South-Bourne4, Chloe Morris1, Denise Eldemire-Shearer1, Maureen D Kerr-Campbell51Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica; 2King Graduate School, Monroe College, Bronx, New York, USA; 3Center for Victim Support, Harlem Hospital Center, New York, USA; 4Research assistant for Paul A Bourne; 5Systems Development Unit, Main Library, Faculty of Humanities and Education, University of the West Indies, Mona, Kingston, JamaicaBackground: In Jamaica, population census began in 1844, and many intercensal ratios obtained from the census data showed that there is a general high degree of accuracy of the data. However, statistics from the Jamaican Ministry of Health showed that there are inaccuracies in health data collected from males using sample surveys.Objectives: The objectives of the present research are to 1 investigate the accuracy of a national sample survey, 2 explore the feasibility and quality of using a subnational sample survey to represent a national survey, 3 aid other scholars in understanding the probability of using national sample surveys and subnational sample surveys, 4 assess older men’s ­evaluation of their health status, and 5 determine whether dichotomization changes self-evaluated health status.Methods: For the current study, the data used in the analysis were originally collected from 2 different sources: 1 the Jamaica Survey of Living Conditions (JSLC and 2 Survey of Older Men (SOM. Cross validation of self-evaluated data of men in Jamaica was done with comparable samples of the complete JSLC data and the SOM data, where men older than 55 years were selected from each sample.Results: In study 1, 50.2% of respondents indicated at least good self-evaluated health status compared with 74.0% in study 2. Statistical associations were found between health status and survey sample (Χ2 [df = 5

  16. 78 FR 47674 - Judges Panel of the Malcolm Baldrige National Quality Award

    Science.gov (United States)

    2013-08-06

    ... Performance Excellence Program, National Institute of Standards and Technology, Gaithersburg, Maryland 20899... Baldrige National Quality Award AGENCY: National Institute of Standards and Technology, Department of... Quality Award (Award) will meet in closed session on Wednesday, August 28, 2013, 9:00 a.m. to 3:30 p.m...

  17. 78 FR 63168 - Judges Panel of the Malcolm Baldrige National Quality Award

    Science.gov (United States)

    2013-10-23

    ... INFORMATION CONTACT: Robert Fangmeyer, Acting Director, Baldrige Performance Excellence Program, National... Baldrige National Quality Award AGENCY: National Institute of Standards and Technology, Department of... Quality Award (Judges Panel) will meet in closed session Monday through Friday, November 4-8, 2013, 8:30 a...

  18. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    Science.gov (United States)

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality

  19. Water quality data for national-scale aquatic research: The Water Quality Portal

    Science.gov (United States)

    Read, Emily K.; Carr, Lindsay; De Cicco, Laura; Dugan, Hilary A.; Hanson, Paul C.; Hart, Julia A.; Kreft, James; Read, Jordan S.; Winslow, Luke A.

    2017-02-01

    xml:id="wrcr22485-sec-1001" numbered="no">Aquatic systems are critical to food, security, and society. But, water data are collected by hundreds of research groups and organizations, many of which use nonstandard or inconsistent data descriptions and dissemination, and disparities across different types of water observation systems represent a major challenge for freshwater research. To address this issue, the Water Quality Portal (WQP) was developed by the U.S. Environmental Protection Agency, the U.S. Geological Survey, and the National Water Quality Monitoring Council to be a single point of access for water quality data dating back more than a century. The WQP is the largest standardized water quality data set available at the time of this writing, with more than 290 million records from more than 2.7 million sites in groundwater, inland, and coastal waters. The number of data contributors, data consumers, and third-party application developers making use of the WQP is growing rapidly. Here we introduce the WQP, including an overview of data, the standardized data model, and data access and services; and we describe challenges and opportunities associated with using WQP data. We also demonstrate through an example the value of the WQP data by characterizing seasonal variation in lake water clarity for regions of the continental U.S. The code used to access, download, analyze, and display these WQP data as shown in the figures is included as supporting information.

  20. Water quality data for national-scale aquatic research: The Water Quality Portal

    Science.gov (United States)

    Read, Emily K.; Carr, Lindsay; DeCicco, Laura; Dugan, Hilary; Hanson, Paul C.; Hart, Julia A.; Kreft, James; Read, Jordan S.; Winslow, Luke

    2017-01-01

    Aquatic systems are critical to food, security, and society. But, water data are collected by hundreds of research groups and organizations, many of which use nonstandard or inconsistent data descriptions and dissemination, and disparities across different types of water observation systems represent a major challenge for freshwater research. To address this issue, the Water Quality Portal (WQP) was developed by the U.S. Environmental Protection Agency, the U.S. Geological Survey, and the National Water Quality Monitoring Council to be a single point of access for water quality data dating back more than a century. The WQP is the largest standardized water quality data set available at the time of this writing, with more than 290 million records from more than 2.7 million sites in groundwater, inland, and coastal waters. The number of data contributors, data consumers, and third-party application developers making use of the WQP is growing rapidly. Here we introduce the WQP, including an overview of data, the standardized data model, and data access and services; and we describe challenges and opportunities associated with using WQP data. We also demonstrate through an example the value of the WQP data by characterizing seasonal variation in lake water clarity for regions of the continental U.S. The code used to access, download, analyze, and display these WQP data as shown in the figures is included as supporting information.

  1. 77 FR 77035 - Proposed Information Collection; Comment Request; Malcolm Baldrige National Quality Award and...

    Science.gov (United States)

    2012-12-31

    ... to Dawn Bailey, Baldrige Performance Excellence Program, 100 Bureau Drive, Stop 1020, National... Commerce is responsible for the Baldrige Performance Excellence Program (BPEP) and the Malcolm Baldrige... Collection; Comment Request; Malcolm Baldrige National Quality Award and Examiner Applications AGENCY...

  2. New international and national standards concerning quality systems

    International Nuclear Information System (INIS)

    Petrick, K.; Reihlen, H.

    1987-01-01

    The history and contents of the latest standards DIN ISO 9000 through DIN ISO 9004 concerning quality systems are outlined. Information is given referring to the establishment of an in-house quality system, and to quality assurance requirements put down in a three-step quality assurance system for contractual purposes. The services available for certification of quality systems by the 'DQS' and legal aspects are mentioned. (HP)

  3. Education for All in South Africa: Developing a National System for Quality Assurance.

    Science.gov (United States)

    Smith, William J.; Ngoma-Maema, Wendy Yolisa

    2003-01-01

    Draws on international research, policy, and practice relevant to quality assurance systems to analyze the development of a national framework for educational quality assurance in South Africa. Describes an emerging framework for quality assurance that encompasses evaluation of student achievement, quality audits and reviews, program and service…

  4. Governmental point of view on the Dutch National Cooperative Programme for Air Quality

    International Nuclear Information System (INIS)

    2008-06-01

    Dutch air quality does not yet meet the European standards throughout the Netherlands. The Dutch National Cooperative Programme for Air Quality (NSL) is expected to realize improvements. This publication explains the Dutch plans for meeting the European standards for air quality in the coming years. It addresses the following subjects: the Dutch National Cooperative Programme for Air Quality (NSL); legal framework; historical development; current situation and autonomous development for PM10 and NO2; spatial projects; measure packages and financial means. [mk] [nl

  5. [Quality of life of living kidney donor: a national report].

    Science.gov (United States)

    Briançon, S; Germain, L; Baudelot, C; Bannay, A; Virion, J-M; Thuong, M

    2011-07-01

    The renal transplantation is nowadays the reference treatment of ESRD. Living donor kidney transplantation is less often performed in France than in other countries. Nevertheless, numerous French and international surveys have evidenced that it provides the recipients a longer life expectancy and a better quality of life. Donors themselves, what do they become? How are they? For the first time in France, a survey has been implemented to investigate the quality of life of living kidney donor to one of their close relations. This study has been undertaken by the Agency of the biomedecine and the service Clinical Epidemiology and Evaluation (EEC), of the University teaching hospital of Nancy. The main objective was to describe the quality of life of the living donors having given a kidney for more than a year and less than 5 years. The secondary objective was to contribute to the knowledge of the main factors associated to the living kidney donor quality of life, one year after the donation. Participants had to be living in France at the time of the donation which had taken place between June 30(th), 2005 and March 1(st), 2009. A folder gathering various self-administrated questionnaires was sent to the place of residence of the donor between March and April, 2010. These data were completed by medical data collected near the transplantation centres by the Agency of biomedecine within the framework of the register CRISTAL. They included the characteristics of the donation and of the donor at the very time of the donation, 3 months after the donation and at the last annual assessment. Three living donors in four, that is 501 persons, agreed to fully participate. They constituted a representative national sample of all the living donors of this period. The non participants were younger (4.5 years on average) and had a less adequate annual follow-up. The women were more represented (61 %) than men. The median age was 53 years. More of 2/3 were employed at the time of the

  6. 77 FR 61572 - Malcolm Baldrige National Quality Award Panel of Judges

    Science.gov (United States)

    2012-10-10

    ... composed of twelve members prominent in the fields of quality, innovation, and performance management and... Hertz, Director, Baldrige Performance Excellence Program, National Institute of Standards and Technology... Quality Award Panel of Judges AGENCY: National Institute of Standards and Technology, Department of...

  7. 76 FR 22675 - Malcolm Baldrige National Quality Award Panel of Judges

    Science.gov (United States)

    2011-04-22

    ... prominent in the fields of quality, innovation, and performance management and appointed by the Secretary of..., Director, Baldrige Performance Excellence Program, National Institute of Standards and Technology... Quality Award Panel of Judges AGENCY: National Institute of Standards and Technology, Department of...

  8. 76 FR 67429 - National Advisory Committee on Institutional Quality and Integrity (NACIQI) Meeting

    Science.gov (United States)

    2011-11-01

    ... DEPARTMENT OF EDUCATION National Advisory Committee on Institutional Quality and Integrity (NACIQI) Meeting AGENCY: National Advisory Committee on Institutional Quality and Integrity, Office of... submissions comply with the requirements of Section 508 of the Rehabilitation Act, or be submitted in an...

  9. Using National Coastal Assessment Data to Model Estuarine Water Quality at Large Spatial Scales.

    Science.gov (United States)

    The water quality of the Nation’s estuaries is attracting scrutiny in light of population growth and enhanced nutrient delivery. The USEPA has evaluated water quality in the National Coastal Assessment (NCA) and National Aquatic Resource Surveys (NARS) programs. Here we rep...

  10. National Quality Forum Colon Cancer Quality Metric Performance: How Are Hospitals Measuring Up?

    Science.gov (United States)

    Mason, Meredith C; Chang, George J; Petersen, Laura A; Sada, Yvonne H; Tran Cao, Hop S; Chai, Christy; Berger, David H; Massarweh, Nader N

    2017-12-01

    To evaluate the impact of care at high-performing hospitals on the National Quality Forum (NQF) colon cancer metrics. The NQF endorses evaluating ≥12 lymph nodes (LNs), adjuvant chemotherapy (AC) for stage III patients, and AC within 4 months of diagnosis as colon cancer quality indicators. Data on hospital-level metric performance and the association with survival are unclear. Retrospective cohort study of 218,186 patients with resected stage I to III colon cancer in the National Cancer Data Base (2004-2012). High-performing hospitals (>75% achievement) were identified by the proportion of patients achieving each measure. The association between hospital performance and survival was evaluated using Cox shared frailty modeling. Only hospital LN performance improved (15.8% in 2004 vs 80.7% in 2012; trend test, P fashion [0 metrics, reference; 1, hazard ratio (HR) 0.96 (0.89-1.03); 2, HR 0.92 (0.87-0.98); 3, HR 0.85 (0.80-0.90); 2 vs 1, HR 0.96 (0.91-1.01); 3 vs 1, HR 0.89 (0.84-0.93); 3 vs 2, HR 0.95 (0.89-0.95)]. Performance on metrics in combination was associated with lower risk of death [LN + AC, HR 0.86 (0.78-0.95); AC + timely AC, HR 0.92 (0.87-0.98); LN + AC + timely AC, HR 0.85 (0.80-0.90)], whereas individual measures were not [LN, HR 0.95 (0.88-1.04); AC, HR 0.95 (0.87-1.05)]. Less than half of hospitals perform well on these NQF colon cancer metrics concurrently, and high performance on individual measures is not associated with improved survival. Quality improvement efforts should shift focus from individual measures to defining composite measures encompassing the overall multimodal care pathway and capturing successful transitions from one care modality to another.

  11. Development of Quality Assurance System in Culture and Nation Character Education in Primary Education in Indonesia

    Science.gov (United States)

    Susilana, Rudi; Asra

    2013-01-01

    The purpose of national education is to develop skills and build dignified national character and civilization in educating nation life (Act No. 20, 2003). The paper describes a system of quality assurance in culture and character education in primary education. This study employs the six sigma model which consists of the formula DMAIC (Define,…

  12. The National Shipbuilding Research Program, Analytical Quality Circles

    Science.gov (United States)

    1986-09-01

    standard tools for quality control, in English, see “Guide to Quality Control” by Dr. Kaoru Ishikawa , Asian Productivity Organization, Aoyama Dai-ichi...factors affect work evaluation is shown schemati- cally by Characteristic-Factor Diagrams (also called Fishbone or Ishikawa Diagrams), see Figure 2-5

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-06-01

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

  14. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

    Energy Technology Data Exchange (ETDEWEB)

    Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia; Pilch, Martin M.

    2009-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and the software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.

  15. Musicians and Nation Building- Need for Quality Control: Old and ...

    African Journals Online (AJOL)

    The growth of any nation is largely dependent upon a number of factors, which may be viewed from such perspectives as, fiscal status, economic development, political system, cultural awareness, social integration, security management, educational attainment, health facilities and other global endowment and or ...

  16. Methods for computing water-quality loads at sites in the U.S. Geological Survey National Water Quality Network

    Science.gov (United States)

    Lee, Casey J.; Murphy, Jennifer C.; Crawford, Charles G.; Deacon, Jeffrey R.

    2017-10-24

    The U.S. Geological Survey publishes information on concentrations and loads of water-quality constituents at 111 sites across the United States as part of the U.S. Geological Survey National Water Quality Network (NWQN). This report details historical and updated methods for computing water-quality loads at NWQN sites. The primary updates to historical load estimation methods include (1) an adaptation to methods for computing loads to the Gulf of Mexico; (2) the inclusion of loads computed using the Weighted Regressions on Time, Discharge, and Season (WRTDS) method; and (3) the inclusion of loads computed using continuous water-quality data. Loads computed using WRTDS and continuous water-quality data are provided along with those computed using historical methods. Various aspects of method updates are evaluated in this report to help users of water-quality loading data determine which estimation methods best suit their particular application.

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

    Science.gov (United States)

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

    1993-01-01

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

  18. 78 FR 50401 - National Advisory Committee on Institutional Quality and Integrity (NACIQI)

    Science.gov (United States)

    2013-08-19

    ... of Regents, State Education Department, Office of the Professions (Nursing Education) (NYBRN) State..., Office of the Professions (Public Postsecondary Vocational Education, Practical Nursing) 2. Oklahoma... DEPARTMENT OF EDUCATION National Advisory Committee on Institutional Quality and Integrity (NACIQI...

  19. The Water-Quality Partnership for National Parks—U.S. Geological Survey and National Park Service, 1998–2016

    Science.gov (United States)

    Nilles, Mark A.; Penoyer, Pete E; Ludtke, Amy S.; Ellsworth, Alan C.

    2016-07-13

    The U.S. Geological Survey (USGS) and the National Park Service (NPS) work together through the USGS–NPS Water-Quality Partnership to support a broad range of policy and management needs related to high-priority water-quality issues in national parks. The program was initiated in 1998 as part of the Clean Water Action Plan, a Presidential initiative to commemorate the 25th anniversary of the Clean Water Act. Partnership projects are developed jointly by the USGS and the NPS. Studies are conducted by the USGS and findings are used by the NPS to guide policy and management actions aimed at protecting and improving water quality.The National Park Service manages many of our Nation’s most highly valued aquatic systems across the country, including portions of the Great Lakes, ocean and coastal zones, historic canals, reservoirs, large rivers, high-elevation lakes and streams, geysers, springs, and wetlands. So far, the Water-Quality Partnership has undertaken 217 projects in 119 national parks. In each project, USGS studies and assessments (http://water.usgs.gov/nps_partnership/pubs.php) have supported science-based management by the NPS to protect and improve water quality in parks. Some of the current projects are highlighted in the NPS Call to Action Centennial initiative, Crystal Clear, which celebrates national park water-resource efforts to ensure clean water for the next century of park management (http://www.nature.nps.gov/water/crystalclear/).New projects are proposed each year by USGS scientists working in collaboration with NPS staff in specific parks. Project selection is highly competitive, with an average of only eight new projects funded each year out of approximately 75 proposals that are submitted. Since the beginning of the Partnership in 1998, 189 publications detailing project findings have been completed. The 217 studies have been conducted in 119 NPS-administered lands, extending from Denali National Park and Preserve in Alaska to Everglades

  20. Speech Quality Monitoring in Czech National Research Network

    Directory of Open Access Journals (Sweden)

    Miroslav Voznak

    2010-01-01

    Full Text Available This paper deals with techniques of measuring and assessment of the voice transmitted in IP networks and describes design of quality measurement, which can be used for Cisco Gateways. Cisco gateways send Calculated Planning Impairment Factor in every CDR (Call Detail Record. Our design is based on collection of CDR's, their storing into SQL database and their visualization through web page. This design was implemented and successfully tested in CESNET network.

  1. [Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"].

    Science.gov (United States)

    Nothacker, Monika Judith; Langer, Thomas; Weinbrenner, Susanne

    2011-01-01

    Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. For the National Disease Management Guideline "Chronic Heart Failure" nine rate-based indicators have been chosen. The indicators correspond to important strong recommendations (grade of recommendation: A) from the fields of diagnosis (two), general therapeutic strategy (two), specific treatment (three), clinical monitoring (one) and co-ordination of care (one). In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations.

  2. User’s manual to update the National Wildlife Refuge System Water Quality Information System (WQIS)

    Science.gov (United States)

    Chojnacki, Kimberly A.; Vishy, Chad J.; Hinck, Jo Ellen; Finger, Susan E.; Higgins, Michael J.; Kilbride, Kevin

    2013-01-01

    National Wildlife Refuges may have impaired water quality resulting from historic and current land uses, upstream sources, and aerial pollutant deposition. National Wildlife Refuge staff have limited time available to identify and evaluate potential water quality issues. As a result, water quality–related issues may not be resolved until a problem has already arisen. The National Wildlife Refuge System Water Quality Information System (WQIS) is a relational database developed for use by U.S. Fish and Wildlife Service staff to identify existing water quality issues on refuges in the United States. The WQIS database relies on a geospatial overlay analysis of data layers for ownership, streams and water quality. The WQIS provides summary statistics of 303(d) impaired waters and total maximum daily loads for the National Wildlife Refuge System at the national, regional, and refuge level. The WQIS allows U.S. Fish and Wildlife Service staff to be proactive in addressing water quality issues by identifying and understanding the current extent and nature of 303(d) impaired waters and subsequent total maximum daily loads. Water quality data are updated bi-annually, making it necessary to refresh the WQIS to maintain up-to-date information. This manual outlines the steps necessary to update the data and reports in the WQIS.

  3. Monitoring groundwater quality in South-Africa: Development of a national strategy

    CSIR Research Space (South Africa)

    Parsons, R

    1995-04-01

    Full Text Available Little is known about the temporal distribution of groundwater quality on a national scale in South Africa. The effective management of the country's groundwater resources is thus difficult and a need exists for a national network for monitoring...

  4. 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

  5. Software quality assurance plan for the National Ignition Facility integrated computer control system

    International Nuclear Information System (INIS)

    Woodruff, J.

    1996-11-01

    Quality achievement is the responsibility of the line organizations of the National Ignition Facility (NIF) Project. This Software Quality Assurance Plan (SQAP) applies to the activities of the Integrated Computer Control System (ICCS) organization and its subcontractors. The Plan describes the activities implemented by the ICCS section to achieve quality in the NIF Project's controls software and implements the NIF Quality Assurance Program Plan (QAPP, NIF-95-499, L-15958-2) and the Department of Energy's (DOE's) Order 5700.6C. This SQAP governs the quality affecting activities associated with developing and deploying all control system software during the life cycle of the NIF Project

  6. National BTS bronchiectasis audit 2012: is the quality standard being adhered to in adult secondary care?

    Science.gov (United States)

    Hill, Adam T; Routh, Chris; Welham, Sally

    2014-03-01

    A significant step towards improving care of patients with non-cystic fibrosis bronchiectasis was the creation of the British Thoracic Society (BTS) national guidelines and the quality standard. A BTS bronchiectasis audit was conducted between 1 October and 30 November 2012, in adult patients with bronchiectasis attending secondary care, against the BTS quality standard. Ninety-eight institutions took part, submitting a total of 3147 patient records. The audit highlighted the variable adoption of the quality standard. It will allow the host institutions to benchmark against UK figures and drive quality improvement programmes to promote the quality standard and improve patient care.

  7. Apparent quality-of-life in nations : how long and happy people live

    NARCIS (Netherlands)

    R. Veenhoven (Ruut)

    2005-01-01

    textabstractQuality-of-life in nations can be measured by how long and happy people live. This is assessed by combining data on life expectancy drawn from civil registration with survey data on subjective enjoyment of life as a whole. This measure of 'apparent' quality-of-life is a good alternative

  8. Global Influences on National Definitions of Quality Education: Examples from Spain and Italy

    Science.gov (United States)

    Engel, Laura C.; Rutkowski, David

    2014-01-01

    There is increasing attention worldwide to advancing quality education. Beyond a rhetorical aim, many international organizations and national education systems have articulated a commitment to promoting measures of quality education through the development of educational indicators. This article broadly explores the global influences on national…

  9. Conceptualising Education Quality in Zambia: A Comparative Analysis across the Local, National and Global Discourses

    Science.gov (United States)

    Lee, Jeongmin; Zuilkowski, Stephanie Simmons

    2017-01-01

    Building on the Education for All movement, the 2030 Agenda for Sustainable Development re-emphasises quality education as a discrete goal. Contextualising the discussion surrounding this goal in Zambia, this study examines how education quality is conceptualised by educational stakeholders at local, national, and global levels. Triangulating…

  10. 77 FR 25685 - Malcolm Baldrige National Quality Award Panel of Judges

    Science.gov (United States)

    2012-05-01

    ... members prominent in the fields of quality, innovation, and performance management and appointed by the..., Maryland 20899. FOR FURTHER INFORMATION CONTACT: Dr. Harry Hertz, Director, Baldrige Performance Excellence... Quality Award Panel of Judges AGENCY: National Institute of Standards and Technology, Department of...

  11. 76 FR 71514 - Malcolm Baldrige National Quality Award Board of Overseers

    Science.gov (United States)

    2011-11-18

    ... will include: Report from the Judges' Panel, Baldrige Performance Excellence Program (BPEP) Update... Quality Award Board of Overseers AGENCY: National Institute of Standards and Technology, Department of... Quality Award (Board of Overseers) will meet in open session on December 13, 2011. The purpose of this...

  12. 76 FR 44577 - Malcolm Baldrige National Quality Award Panel of Judges

    Science.gov (United States)

    2011-07-26

    ... prominent in the fields of quality, innovation, and performance management and appointed by the Secretary of.... FOR FURTHER INFORMATION CONTACT: Dr. Harry Hertz, Director, Baldrige Performance Excellence Program... Quality Award Panel of Judges AGENCY: National Institute of Standards and Technology, Department of...

  13. 76 FR 22674 - Malcolm Baldrige National Quality Award Board of Overseers and Panel of Judges

    Science.gov (United States)

    2011-04-22

    ... Performance Excellence Program, National Institute of Standards and Technology, Gaithersburg, Maryland 20899... prominent in the fields of quality, innovation, and performance management and appointed by the Secretary of... Judges is composed of twelve members prominent in the fields of quality, innovation, and performance...

  14. Quality Assurance in Educational Administration in the Teaching of Farm Mathematics for National Integration in Nigeria

    Science.gov (United States)

    Enemali, I. A.; Adah, Obe Christopher

    2015-01-01

    Farm mathematics, an aspect of agricultural science education is being taught in our educational institutions in the country. This effort is to enhance agricultural productivity and quality of agricultural science education for national integration. For the realization of this, a quality assured educational administration is vital. The paper…

  15. A national quality control scheme for serum HGH assays

    International Nuclear Information System (INIS)

    Hunter, W.M.; McKenzie, I.

    1979-01-01

    In the autumn of 1975 the Supraregional Assay Service established a Quality Control Sub-Committee and the intra-laboratory QC Scheme for Growth Hormone (HGH) assays which is described here has served, in many respects, as a pilot scheme for protein RIA. Major improvements in accuracy, precision and between-laboratory agreement can be brought about by intensively interactive quality control schemes. A common standard is essential and should consist of ampoules used for one or only a small number of assays. Accuracy and agreement were not good enough to allow the overall means to serve as target values but a group of 11 laboratories were sufficiently accurate to provide a 'reference group mean' to so serve. Gross non-specificity was related to poor assay design and was quickly eliminated. Within-laboratory between-batch variability was much worse than that normally claimed for simple protein hormone RIA. A full report on this Scheme will appear shortly in Annals of Clinical Biochemistry. (Auth.)

  16. A national audit of retail lamb loin quality in Australia.

    Science.gov (United States)

    Safari, E; Channon, H A; Hopkins, D L; Hall, D G; van de Ven, R

    2002-07-01

    A retail audit of lamb loin tenderness was conducted over a 12-month period to determine the variation in tenderness of Australian lamb. Tenderness was objectively measured using Warner-Bratzler (WB) shear force. Muscle pH and cooking loss were determined on all samples and colour was measured on a sub-sample of loins. A total of 909 midloins from retail butcher shops and supermarkets located in four Australian capital cities (Sydney, Canberra, Melbourne, and Perth) were evaluated at four sampling times (December 1997 and March, June, and October 1998). Overall, 20.3% of all midloins purchased had a WB shear force value above the threshold level of 5 kg. Generic samples from Melbourne butcher shops were similar for WB shear force on average to the generic samples from Canberra and Sydney, whereas those from Melbourne supermarkets had significantly (Plamb had a greater WB shear force (Plamb. No relationship was found between price per kg and shear force (r=0.02) for loins purchased in Sydney (n=220). Price per kg differed between months (Plamb sold in the domestic market. A lamb eating quality assurance system, based on set protocols, is one approach that is currently being investigated in Australia to ensure the supply of consistently high eating quality lamb to consumers.

  17. Groundwater-quality data from the National Water-Quality Assessment Project, January through December 2014 and select quality-control data from May 2012 through December 2014

    Science.gov (United States)

    Arnold, Terri L.; Bexfield, Laura M.; Musgrove, MaryLynn; Lindsey, Bruce D.; Stackelberg, Paul E.; Barlow, Jeannie R.; Desimone, Leslie A.; Kulongoski, Justin T.; Kingsbury, James A.; Ayotte, Joseph D.; Fleming, Brandon J.; Belitz, Kenneth

    2017-10-05

    Groundwater-quality data were collected from 559 wells as part of the National Water-Quality Assessment Project of the U.S. Geological Survey National Water-Quality Program from January through December 2014. The data were collected from four types of well networks: principal aquifer study networks, which are used to assess the quality of groundwater used for public water supply; land-use study networks, which are used to assess land-use effects on shallow groundwater quality; major aquifer study networks, which are used to assess the quality of groundwater used for domestic supply; and enhanced trends networks, which are used to evaluate the time scales during which groundwater quality changes. Groundwater samples were analyzed for a large number of water-quality indicators and constituents, including major ions, nutrients, trace elements, volatile organic compounds, pesticides, radionuclides, and some constituents of special interest (arsenic speciation, chromium [VI] and perchlorate). These groundwater-quality data, along with data from quality-control samples, are tabulated in this report and in an associated data release.

  18. Quality assurance consideration for cement-based grout technology programs at Oak Ridge National Laboratory

    International Nuclear Information System (INIS)

    McDaniel, E.W.; Tallent, O.K.; Sams, T.L.; Delzer, D.B.

    1987-01-01

    Oak Ridge National Laboratory has developed and is continuing to refine a method of immobilizing low-level radioactive liquid wastes by mixing them with cementitious dry-solid blends. A quality assurance program is vital to the project because Nuclear Regulatory Commission (NRC), Environmental Protection Agency (EPA) and state environmental regulations must be demonstrably met (the work must be defensible in a court of law). The end result of quality assurance (QA) is, by definition, a product of demonstrable quality. In the laboratory, this entails traceability, repeatability, and credibility. This paper describes the application of QA in grout technology development at Oak Ridge National Laboratory

  19. Data Delivery and Mapping Over the Web: National Water-Quality Assessment Data Warehouse

    Science.gov (United States)

    Bell, Richard W.; Williamson, Alex K.

    2006-01-01

    The U.S. Geological Survey began its National Water-Quality Assessment (NAWQA) Program in 1991, systematically collecting chemical, biological, and physical water-quality data from study units (basins) across the Nation. In 1999, the NAWQA Program developed a data warehouse to better facilitate national and regional analysis of data from 36 study units started in 1991 and 1994. Data from 15 study units started in 1997 were added to the warehouse in 2001. The warehouse currently contains and links the following data: -- Chemical concentrations in water, sediment, and aquatic-organism tissues and related quality-control data from the USGS National Water Information System (NWIS), -- Biological data for stream-habitat and ecological-community data on fish, algae, and benthic invertebrates, -- Site, well, and basin information associated with thousands of descriptive variables derived from spatial analysis, like land use, soil, and population density, and -- Daily streamflow and temperature information from NWIS for selected sampling sites.

  20. The UK National Air Quality Strategy: the effects of the proposed changes on Local Air Quality Management

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, C.I.; Ling, K.; Longhurst, J.W.S. [Univ. of the West of England, Faculty of Applied Sciences, Bristol (GB)] [and others

    1999-07-01

    The UK has implemented a system of Local Air Quality Management (LAQM) to tackle the many contemporary sources of air pollution, notably transport, industry and domestic fuel burning, in a holistic manner. The current legislation stems from the Environment Act 1995, which required a National Air Quality Strategy (NAQS) to be published outlining the Governments policies with respect to the assessment and management of air quality. The NAQS, originally published in March 1997, is on a rolling programme of reviews in order to reflect developments in European legislation, technological and scientific advances, improved air pollution modelling techniques and an increasingly better understanding of the economic and social issues involved. Following the first review (currently at consultation state), this paper will comment on how the proposed changes may affect the LAQM process. The proposed changes will also be summarised and discussed in the context of European Union air quality objectives and the economic analysis of NAQS.

  1. Underground Test Area Quality Assurance Project Plan Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Irene Farnham

    2011-05-01

    This Quality Assurance Project Plan (QAPP) provides the overall quality assurance (QA) program requirements and general quality practices to be applied to the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Underground Test Area (UGTA) Sub-Project (hereafter the Sub-Project) activities. The requirements in this QAPP are consistent with DOE Order 414.1C, Quality Assurance (DOE, 2005); U.S. Environmental Protection Agency (EPA) Guidance for Quality Assurance Project Plans for Modeling (EPA, 2002); and EPA Guidance on the Development, Evaluation, and Application of Environmental Models (EPA, 2009). The QAPP Revision 0 supersedes DOE--341, Underground Test Area Quality Assurance Project Plan, Nevada Test Site, Nevada, Revision 4.

  2. The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care.

    Science.gov (United States)

    Asplund, Kjell; Hulter Åsberg, Kerstin; Appelros, Peter; Bjarne, Daniela; Eriksson, Marie; Johansson, Asa; Jonsson, Fredrik; Norrving, Bo; Stegmayr, Birgitta; Terént, Andreas; Wallin, Sari; Wester, Per-Olov

    2011-04-01

    Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Annually, approximately 25,000 patients are included. In 2009, approximately 320,000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

  3. Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis.

    Science.gov (United States)

    Sapir, Tamar; Rusie, Erica; Greene, Laurence; Yazdany, Jinoos; Robbins, Mark L; Ruderman, Eric M; Carter, Jeffrey D; Patel, Barry; Moreo, Kathleen

    2015-12-01

    In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits. Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists' documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence. Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts). This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve

  4. Quality Metrics in Neonatal and Pediatric Critical Care Transport: A National Delphi Project.

    Science.gov (United States)

    Schwartz, Hamilton P; Bigham, Michael T; Schoettker, Pamela J; Meyer, Keith; Trautman, Michael S; Insoft, Robert M

    2015-10-01

    The transport of neonatal and pediatric patients to tertiary care facilities for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. In 2011, pediatric transport teams in Ohio met to identify quality indicators permitting comparisons among programs. However, no set of national consensus quality metrics exists for benchmarking transport teams. The aim of this project was to achieve national consensus on appropriate neonatal and pediatric transport quality metrics. Modified Delphi technique. The first round of consensus determination was via electronic mail survey, followed by rounds of consensus determination in-person at the American Academy of Pediatrics Section on Transport Medicine's 2012 Quality Metrics Summit. All attendees of the American Academy of Pediatrics Section on Transport Medicine Quality Metrics Summit, conducted on October 21-23, 2012, in New Orleans, LA, were eligible to participate. Candidate quality metrics were identified through literature review and those metrics currently tracked by participating programs. Participants were asked in a series of rounds to identify "very important" quality metrics for transport. It was determined a priori that consensus on a metric's importance was achieved when at least 70% of respondents were in agreement. This is consistent with other Delphi studies. Eighty-two candidate metrics were considered initially. Ultimately, 12 metrics achieved consensus as "very important" to transport. These include metrics related to airway management, team mobilization time, patient and crew injuries, and adverse patient care events. Definitions were assigned to the 12 metrics to facilitate uniform data tracking among programs. The authors succeeded in achieving consensus among a diverse group of national transport experts on 12 core neonatal and pediatric transport quality metrics. We propose that transport teams across the country use these metrics to

  5. Variation in marital quality in a national sample of divorced women.

    Science.gov (United States)

    James, Spencer L

    2015-06-01

    Previous work has compared marital quality between stably married and divorced individuals. Less work has examined the possibility of variation among divorcés in trajectories of marital quality as divorce approaches. This study addressed that hole by first examining whether distinct trajectories of marital quality can be discerned among women whose marriages ended in divorce and, second, the profile of women who experienced each trajectory. Latent class growth analyses with longitudinal data from a nationally representative sample were used to "look backward" from the time of divorce. Although demographic and socioeconomic variables from this national sample did not predict the trajectories well, nearly 66% of divorced women reported relatively high levels of both happiness and communication and either low or moderate levels of conflict. Future research including personality or interactional patterns may lead to theoretical insights about patterns of marital quality in the years leading to divorce. (c) 2015 APA, all rights reserved).

  6. National water summary 1990-91: Hydrologic events and stream water quality

    Science.gov (United States)

    Paulson, Richard W.; Chase, Edith B.; Williams, John S.; Moody, David W.

    1993-01-01

    National Water Summary 1990-91 Hydrologic Events and Stream Water Quality was planned to complement existing Federal-State water-quality reporting to the U.S. Congress that is required by the Clean Water Act of 1972. This act, formally known as the Federal Water Pollution Control Act Amendments of 1972 (Public Law 92-500), and its amendments in 1977,1979,1980,1981,1983, and 1987, is the principal basis for Federal-State cooperation on maintaining and reporting on water quality in the United States. Under section 305(b) of the Clean Water Act, the States must designate uses for waterbodies, biennially assess whether the waterbodies meet designated uses, and report to the U.S. Environmental Protection Agency (EPA), which in turn summarizes the findings of the State assessments in a biennial National Water Quality Inventory report to the Congress.

  7. Quality management status of national radiation environmental monitoring network and strategy for development

    International Nuclear Information System (INIS)

    Huang Renjie; Zhang Rongsuo; Ni Shiying; Shen Gang

    2009-01-01

    During the period of 10th five-year plan, MEP has constructed a national radiation environmental monitoring network. In the running of the network, quality management on monitoring data is of vital importance. So all the members of the radiation environmental monitoring network are required to ensure the quality of monitoring method, equipment, reagent,quality of personnel, data processing and information management and so on. Thus the monitoring result would be typical and accuracy in science. The article introduced in detail the quality management status of the National Radiation Environmental Monitoring Network and put forward the strategy for development from the institutionalized and large-scale point of view of radioactive environmental monitoring work. (authors)

  8. 76 FR 22665 - Release of Final Document Related to the Review of the National Ambient Air Quality Standards for...

    Science.gov (United States)

    2011-04-22

    ... criteria. The revised air quality criteria reflect advances in scientific knowledge on the effects of the... National Ambient Air Quality Standards, contains staff analyses of the scientific bases for alternative... Document Related to the Review of the National Ambient Air Quality Standards for Particulate Matter AGENCY...

  9. 40 CFR Appendix S to Part 50 - Interpretation of the Primary National Ambient Air Quality Standards for Oxides of Nitrogen...

    Science.gov (United States)

    2010-07-01

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

  10. Los Alamos National Laboratory Meteorology Monitoring Program: 2016 Data Completeness/ Quality Report

    Energy Technology Data Exchange (ETDEWEB)

    Bruggeman, David Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-06-15

    This report summarizes data completeness by tower and by instrument for 2016 and compares that data with the Los Alamos National Laboratory (LANL) and American National Standards Institute (ANSI) 2015 standards. This report is designed to make data users aware of data completeness and any data quality issues. LANL meteorology monitoring goals include 95% completeness for all measurements. The ANSI 2015 standard requires 90% completeness for all measurements. This report documents instrument/tower issues as they impact data completeness.

  11. Los Alamos National Laboratory Yucca Mountain Site Characterization Project 1994 quality program status report

    Energy Technology Data Exchange (ETDEWEB)

    Bolivar, S.L.

    1996-03-01

    This status report is for calendar year 1994. It summarizes the annual activities and accomplishments of the Los Alamos National Laboratory Yucca Mountain Site Characterization Project (YMP or Project) quality assurance program. By identifying the accomplishments of the quality program, a baseline is established that will assist in decision making, improve administrative controls and predictability, and allow us to annually identify adverse trends and to evaluate improvements. This is the fourth annual status report.

  12. Los Alamos National Laboratory Yucca Mountain Site Characterization Project 1994 quality program status report

    International Nuclear Information System (INIS)

    Bolivar, S.L.

    1996-03-01

    This status report is for calendar year 1994. It summarizes the annual activities and accomplishments of the Los Alamos National Laboratory Yucca Mountain Site Characterization Project (YMP or Project) quality assurance program. By identifying the accomplishments of the quality program, a baseline is established that will assist in decision making, improve administrative controls and predictability, and allow us to annually identify adverse trends and to evaluate improvements. This is the fourth annual status report

  13. Quality assurance on the Idaho National Engineering Laboratory Buried Waste Program

    International Nuclear Information System (INIS)

    Rasmussen, T.L.

    1989-01-01

    This paper discusses the clean-up of an Idaho National Engineering Laboratory (INEL) site utilized for disposal of transuranic contaminated waste from 1954 until 1970. The author presents requirements of the environmental protection statutes that have generated quality assurance requirements in addition to those historically implemented as a part of facility design, construction and operation. A hierarchy of program guidance quality documentation and procedures is discussed. Data qualification and computer database management are identified as requirements

  14. Diagnosis of the quality of service, in customer service, at the National University of Chimborazo- Ecuador

    OpenAIRE

    Salazar Yépez, Wilfrido; Cabrera Vallejo, Mario

    2016-01-01

    The purpose of this article is to determine the quality of service of improvements in the enrollment processes at the National University of Chimborazo- Ecuador. This cross-sectional research is the result of a field work, where an analysis of the collected information was carried out, through surveys applied to the students, through the SERVQUAL model, afterwards, comparing these found aspects and determining The gap between perceptions and expectations, thus determining the quality of servi...

  15. Laboratory quality stepwise implementation tool: National reference TB laboratory of Iran

    OpenAIRE

    Ali Naghi Kebriaee; Donya Malekshahian; Mojtaba Ahmadi; Parissa Farnia

    2015-01-01

    Background and objective: During recent years, the World Health Organization (WHO) proposed new software for improving the tuberculosis (TB) laboratory services. The protocol is known as “quality stepwise implementation tool” and is based on enforcement of quality assurance services through accreditation by the International Organization for Standardization (ISO) 15189. As a national reference TB laboratory (NRL) of Iran, the benefit and challenges of implementing this standard were analyzed....

  16. Real-Time Water Quality Monitoring and Habitat Assessment in the San Luis National Wildlife Refuge

    OpenAIRE

    Quinn, Nigel W.T.; Hanlon, Jeremy S.; Burns, Josephine R.; Stromayer, Karl A.K.; Jordan, Brandon M.; Ennis, Mike J.; Woolington, Dennis W.

    2005-01-01

    The project report describes a two year experiment to control wetland drainage to the San Joaquin River of California from the San Luis National Wildlife Refuge using a decision support system for real-time water quality management. This system required the installation and operation of one inlet and three drainage flow and water quality monitoring stations which allowed a simnple mass balance model to be developed of the seasonally managed wetlands in the study area. Remote sensing meth...

  17. Calibrations and evaluation of the quality assurance during 1999 at the National Laboratory for ionising radiation

    International Nuclear Information System (INIS)

    Grindborg, Jan-Erik; Israelsson, Karl-Erik; Kylloenen, Jan-Erik; Samuelson, Goeran

    2000-06-01

    The Swedish Radiation Protection Institute is the National Laboratory for the dosimetric quantities kerma, absorbed dose and dose equivalent. The activity is based on established calibration procedures and a quality assurance program for the used standards. This report gives a brief summary of the calibrations performed during 1999 and a more detailed description and analysis of the quality assurance during this year. The report makes it easier to draw conclusions about the long-term stability and possible malfunctions

  18. Los Alamos National Laboratory transuranic waste quality assurance project plan. Revision 1

    International Nuclear Information System (INIS)

    1997-01-01

    This Transuranic (TRU) Waste Quality Assurance Project Plan (QAPjP) serves as the quality management plan for the characterization of transuranic waste in preparation for certification and transportation. The Transuranic Waste Characterization/Certification Program (TWCP) consists of personnel who sample and analyze waste, validate and report data; and provide project management, quality assurance, audit and assessment, and records management support, all in accordance with established requirements for disposal of TRU waste at the Waste Isolation Pilot Plant (WIPP) facility. This QAPjP addresses how the TWCP meets the quality requirements of the Carlsbad Area Office (CAO) Quality Assurance Program Description (QAPD) and the technical requirements of the Transuranic Waste Characterization Quality Assurance Program Plan (QAPP). The TWCP characterizes and certifies retrievably stored and newly generated TRU waste using the waste selection, testing, sampling, and analytical techniques and data quality objectives (DQOs) described in the QAPP, the Los Alamos National Laboratory Transuranic Waste Certification Plan (Certification Plan), and the CST Waste Management Facilities Waste Acceptance Criteria and Certification [Los Alamos National Laboratory (LANL) Waste Acceptance Criteria (WAC)]. At the present, the TWCP does not address remote-handled (RH) waste

  19. Software quality assurance plan for the National Ignition Facility integrated computer control system

    Energy Technology Data Exchange (ETDEWEB)

    Woodruff, J.

    1996-11-01

    Quality achievement is the responsibility of the line organizations of the National Ignition Facility (NIF) Project. This Software Quality Assurance Plan (SQAP) applies to the activities of the Integrated Computer Control System (ICCS) organization and its subcontractors. The Plan describes the activities implemented by the ICCS section to achieve quality in the NIF Project`s controls software and implements the NIF Quality Assurance Program Plan (QAPP, NIF-95-499, L-15958-2) and the Department of Energy`s (DOE`s) Order 5700.6C. This SQAP governs the quality affecting activities associated with developing and deploying all control system software during the life cycle of the NIF Project.

  20. National Ignition Facility quality assurance plan for laser materials and optical technology

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, C.R.

    1996-05-01

    Quality achievement is the responsibility of the line organizations of the National Ignition Facility (NIF) Project. This subtier Quality Assurance Plan (QAP) applies to activities of the Laser Materials & Optical Technology (LM&OT) organization and its subcontractors. It responds to the NIF Quality Assurance Program Plan (QAPP, L-15958-2, NIF-95-499) and Department of Energy (DOE) Order 5700.6C. This Plan is organized according to 10 Quality Assurance (QA) criteria and subelements of a management system as outlined in the NIF QAPP. This Plan describes how those QA requirements are met. This Plan is authorized by the Associate Project Leader for the LM&OT organization, who has assigned responsibility to the Optics QA engineer to maintain this plan, with the assistance of the NIF QA organization. This Plan governs quality-affecting activities associated with: design; procurement; fabrication; testing and acceptance; handling and storage; and installation of NIF Project optical components into mounts and subassemblies.

  1. Water quality in hard rocks of the Karkonosze National Park (Western Sudetes, SW Poland)

    Science.gov (United States)

    Marszałek, Henryk; Rysiukiewicz, Michał

    2017-12-01

    Long-term regional emissions of air pollutants in the second half of the twentieth century led to strong changes in the quality of surface and groundwater in the Karkonosze Mts. As a result, in the most valuable natural parts of these mountains, protected in the area of the Karkonosze National Park, there was strong deforestation, which assumed the size of an ecological disaster. The various protective activities introduced at the beginning of the 1990s led to the improvement not only of the water quality, but also other ecosystems. Based on the chemical analyses of water sampled in 40 points located in the whole Park, the current state of water quality was assessed. Concentrations of some microelements were higher only in few points compared to the drinking water quality standards, which indicates a significant improvement in water quality.

  2. Revised Methods for Characterizing Stream Habitat in the National Water-Quality Assessment Program

    Science.gov (United States)

    Fitzpatrick, Faith A.; Waite, Ian R.; D'Arconte, Patricia J.; Meador, Michael R.; Maupin, Molly A.; Gurtz, Martin E.

    1998-01-01

    Stream habitat is characterized in the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program as part of an integrated physical, chemical, and biological assessment of the Nation's water quality. The goal of stream habitat characterization is to relate habitat to other physical, chemical, and biological factors that describe water-quality conditions. To accomplish this goal, environmental settings are described at sites selected for water-quality assessment. In addition, spatial and temporal patterns in habitat are examined at local, regional, and national scales. This habitat protocol contains updated methods for evaluating habitat in NAWQA Study Units. Revisions are based on lessons learned after 6 years of applying the original NAWQA habitat protocol to NAWQA Study Unit ecological surveys. Similar to the original protocol, these revised methods for evaluating stream habitat are based on a spatially hierarchical framework that incorporates habitat data at basin, segment, reach, and microhabitat scales. This framework provides a basis for national consistency in collection techniques while allowing flexibility in habitat assessment within individual Study Units. Procedures are described for collecting habitat data at basin and segment scales; these procedures include use of geographic information system data bases, topographic maps, and aerial photographs. Data collected at the reach scale include channel, bank, and riparian characteristics.

  3. Solid Waste and Water Quality Management Models for Sagarmatha National Park and Buffer Zone, Nepal.

    NARCIS (Netherlands)

    Manfredi, Emanuela Chiara; Flury, Bastian; Viviano, Gaetano; Thakuri, Sudeep; Khanal, Sanjay Nath; Jha, Pramod Kumar; Maskey, Ramesh Kumar; Kayastha, Rijan Bhakta; Kafle, Kumud Raj; Bhochhibhoya, Silu; Ghimire, Narayan Prasad; Shrestha, Bharat Babu; Chaudhary, Gyanendra; Giannino, Francesco; Carteni, Fabrizio; Mazzoleni, Stefano; Salerno, Franco

    2010-01-01

    The problem of supporting decision- and policy-makers in managing issues related to solid waste and water quality was addressed within the context of a participatory modeling framework in the Sagarmatha National Park and Buffer Zone in Nepal. We present the main findings of management-oriented

  4. Los Alamos National Laboratory Yucca Mountain Site Characterization Project 1995 quality program status report

    International Nuclear Information System (INIS)

    Bolivar, S.L.

    1996-07-01

    This status report summarizes the activities and accomplishments of the Los Alamos National Laboratory Yucca Mountain Site Characterization Project's (YMP's) quality assurance program for January 1 to September 30, 1995. The report includes major sections on program activities and trend analysis

  5. Nurturing Quality of Higher Education through National Ranking: A Potential Empowerment Model for Developing Countries

    Science.gov (United States)

    Kusumastuti, Dyah; Idrus, Nirwan

    2017-01-01

    This paper reviews the recently introduced National Higher Education ranking system in Indonesia in order to evaluate its potential as a sustainable model to improve the quality of higher education in the country. It is a scaffold towards an established world-universities ranking system that may prove formidable for a developing country. This…

  6. Teacher Compensation and School Quality: New Findings from National and International Data

    Science.gov (United States)

    Zhang, Zhijuan; Verstegen, Deborah A.; Kim, Hoe Ryoung

    2008-01-01

    Are teacher salaries related to school quality in terms of student academic achievement and teacher retention? Are teacher salaries important factors influencing teacher job satisfaction? Is teacher job satisfaction related to retention? This research addressed these questions using international and national data. First, the literature will be…

  7. The national curriculum guidelines of early childhood education: In search of a job to educational quality

    Directory of Open Access Journals (Sweden)

    Alessandra de Carvalho Faria

    2014-08-01

    childhood education. This paper intends to discuss the National Curriculum Guidelines for Early Childhood Education, which define how they should be organized teaching practice, and examine how the activities should be developed in early childhood education institutions, to objectify the holistic development of children in seeking quality care this stage of basic education.

  8. Kenneth W. Kizer on a national quality strategy. Interview by Lori Blades and Patricia A. Cholewka.

    Science.gov (United States)

    Kizer, K W

    2000-01-01

    Kenneth W. Kizer, MD MPH, is president and chief executive officer (CEO) of the National Forum for Health Care Quality Measurement and Reporting (National Quality Forum [NQF]), a not-for-profit membership organization created to develop and implement a national strategy for measuring and reporting healthcare quality. Dr. Kizer previously served as Under Secretary for Health in the U.S. Department of Veterans Affairs (VA) and is widely credited as being the chief architect of and driving force behind the greatest transformation of VA healthcare since its creation in 1946. NQF is a public-private partnership designed to involve all segments of the nation's healthcare system. The organization was proposed as part of the findings of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). Since the release of those findings, leaders from consumer, purchaser, provider, health plan, and health services research organizations, as well as from government, have met to define the mission, structure, and financing of NQF, and staff support has been provided by the United Hospital Fund of New York. NQF is primarily a membership dues- and grant-financed organization and has received significant public and private funding from foundation and corporate grants, including a $2.5-million founding grant from the Robert-Wood Johnson Foundation and a $1-million founding grant from the California Healthcare Foundation. NQF also received initial financial support from The Commonwealth Fund and United Hospital Fund.

  9. Studying the Quality of Democracy: Two Cross-National Measures of Democratic Citizenship

    Science.gov (United States)

    Ledet, Richard

    2016-01-01

    This article provides new cross-national measures of two dimensions of democratic citizenship with great import for the study of democratic quality, expressive participation, and intolerance of diversity. Using data from the 2000-2001 wave of the World Values Survey, the paper present new ways to measure participation and intolerance, as well as a…

  10. Los Alamos National Laboratory Yucca Mountain Site Characterization Project 1995 quality program status report

    Energy Technology Data Exchange (ETDEWEB)

    Bolivar, S.L.

    1996-07-01

    This status report summarizes the activities and accomplishments of the Los Alamos National Laboratory Yucca Mountain Site Characterization Project`s (YMP`s) quality assurance program for January 1 to September 30, 1995. The report includes major sections on program activities and trend analysis.

  11. Early Childhood Educators' Perspectives of the Swedish National Curriculum for Preschool and Quality Work

    Science.gov (United States)

    Brodin, Jane; Renblad, Karin

    2015-01-01

    There is today an increasing global interest in early childhood education, especially with regard to curriculum and quality work. The aim of this article is to study preschool teachers' and child care workers' views on the revised national curriculum for preschool in Sweden (Lpfö 98, rev. 2010), and if the educators perceive that they can conduct…

  12. Los Alamos National Laboratory Yucca Mountain Site Characterization Project: 1991 quality program status report

    International Nuclear Information System (INIS)

    1992-07-01

    This status report summarizes the activities and accomplishments of the Los Alamos National Laboratory (Los Alamos) Yucca Mountain Site Characterization Project's (YMP) quality assurance program for calendar year 1991. The report is divided into three Sections: Program Activities, Verification Activities, and Trend Analysis

  13. Preliminary results of a national quality audit programme in radiotherapy services in Cuba

    International Nuclear Information System (INIS)

    Dominguez Hung, L.; Larrinaga Cortina, E.F.; Campa Menendez, R.; Morales Lopez, J.L.; Garcia Yip, A.F.

    2001-01-01

    The current state of radiotherapy in Cuba has allowed to pass to a superior stage in the process of quality assurance, the establishment of a National Quality Audit Program (PNAC). The National Control Center for Medical Devices, as national regulator entity for the control and supervision of the medical devices of the National Health System, is responsible for the implementation of this program. This paper presents the preliminary results of the execution of the PNAC in teletherapy services with isotopic units of 60 Co. The audits were carried out according to the methodology settled down in the normalized procedure of operation of the PNAC. The physical aspects related with the treatment were audited, such as: the installation and unit's safety, mechanical and dosimetric aspects of the treatment unit and organizational aspects of the institution quality assurance program. Also carried out, in the clinical aspect, verifications of cases type planned by the qualified personnel of the service. The results corresponding to the determination of the reference dose for each institution were compared with those obtained in a postal audit with the International Atomic Energy Agency. These first audits allowed to evaluate the performance of the institutions' program of quality assurance and a feedback for the setting about to the PNAC. (author)

  14. Preliminary results of a national quality audit programme in radiotherapy services in Cuba

    Energy Technology Data Exchange (ETDEWEB)

    Dominguez Hung, L; Larrinaga Cortina, E F [Centro de Control Estatal de Equipos Medicos, Havana (Cuba); Campa Menendez, R [Centro de Proteccion e Higiene de las Radiaciones, Havana (Cuba); Morales Lopez, J L; Garcia Yip, A F [Instituto Nacional de Oncologia y Radiobiologia, Havana (Cuba)

    2001-03-01

    The current state of radiotherapy in Cuba has allowed to pass to a superior stage in the process of quality assurance, the establishment of a National Quality Audit Program (PNAC). The National Control Center for Medical Devices, as national regulator entity for the control and supervision of the medical devices of the National Health System, is responsible for the implementation of this program. This paper presents the preliminary results of the execution of the PNAC in teletherapy services with isotopic units of {sup 60}Co. The audits were carried out according to the methodology settled down in the normalized procedure of operation of the PNAC. The physical aspects related with the treatment were audited, such as: the installation and unit's safety, mechanical and dosimetric aspects of the treatment unit and organizational aspects of the institution quality assurance program. Also carried out, in the clinical aspect, verifications of cases type planned by the qualified personnel of the service. The results corresponding to the determination of the reference dose for each institution were compared with those obtained in a postal audit with the International Atomic Energy Agency. These first audits allowed to evaluate the performance of the institutions' program of quality assurance and a feedback for the setting about to the PNAC. (author)

  15. Comprehensive national database of tree effects on air quality and human health in the United States

    Science.gov (United States)

    Satoshi Hirabayashi; David J. Nowak

    2016-01-01

    Trees remove air pollutants through dry deposition processes depending upon forest structure, meteorology, and air quality that vary across space and time. Employing nationally available forest, weather, air pollution and human population data for 2010, computer simulations were performed for deciduous and evergreen trees with varying leaf area index for rural and...

  16. Hydrologic and water quality monitoring on Turkey Creek watershed, Francis Marion National Forest, SC

    Science.gov (United States)

    D.M. Amatya; T.J. Callahan; A. Radecki-Pawlik; P. Drewes; C. Trettin; W.F. Hansen

    2008-01-01

    The re-initiation of a 7,260 ha forested watershed study on Turkey Creek, a 3rd order stream, within the Francis Marion National forest in South Carolina, completes the development of a multi-scale hydrology and ecosystem monitoring framework in the Atlantic Coastal Plain. Hydrology and water quality monitoring began on the Santee Experimental...

  17. Air Quality Scoping Study for Ash Meadows National Wildlife Refuge, Nevada (EMSI April 2007)

    Energy Technology Data Exchange (ETDEWEB)

    Engelbrecht, Johann; Kavouras, Ilias; Campbell, Dave; Campbell, Scott; Kohl, Steven; Shafer, David

    2007-04-01

    The Desert Research Institute (DRI) is performing a scoping study as part of the U.S.Department of Energy’s Yucca Mountain Environmental Monitoring Systems Initiative (EMSI). The main objective is to obtain baseline air quality information for Yucca Mountain and an area surrounding the Nevada Test Site (NTS). Air quality and meteorological monitoring and sampling equipment housed in a mobile trailer (shelter) is collecting data at seven sites outside the NTS, including Ash Meadows National Wildlife Refuge, Sarcobatus Flat, Beatty, Rachel, Caliente, Pahranagat National Wildlife Refuge, and Crater Flat, and at four sites on the NTS. The trailer is stationed at any one site for approximately eight weeks at a time. Letter reports provide summaries of air quality and meteorological data, on completion of each site’s sampling program.

  18. Development and Application of the Key Technologies for the Quality Control and Inspection of National Geographical Conditions Survey Products

    Science.gov (United States)

    Zhao, Y.; Zhang, L.; Ma, W.; Zhang, P.; Zhao, T.

    2018-04-01

    The First National Geographical Condition Survey is a predecessor task to dynamically master basic situations of the nature, ecology and human activities on the earth's surface and it is the brand-new mapping geographic information engineering. In order to ensure comprehensive, real and accurate survey results and achieve the quality management target which the qualified rate is 100 % and the yield is more than 80 %, it is necessary to carry out the quality control and result inspection for national geographical conditions survey on a national scale. To ensure that achievement quality meets quality target requirements, this paper develops the key technology method of "five-in-one" quality control that is constituted by "quality control system of national geographical condition survey, quality inspection technology system, quality evaluation system, quality inspection information management system and national linked quality control institutions" by aiming at large scale, wide coverage range, more undertaking units, more management levels, technical updating, more production process and obvious regional differences in the national geographical condition survey and combining with novel achievement manifestation, complicated dependency, more special reference data, and large data size. This project fully considering the domestic and foreign related research results and production practice experience, combined with the technology development and the needs of the production, it stipulates the inspection methods and technical requirements of each stage in the quality inspection of the geographical condition survey results, and extends the traditional inspection and acceptance technology, and solves the key technologies that are badly needed in the first national geographic survey.

  19. Establishment of the Auditing National Service of quality to the instrumentation of Nuclear medicine in Cuba

    International Nuclear Information System (INIS)

    Varela C, C.; Diaz B, M.; Lopez B, G.M.; Torres A, L.A.; Coca P, M.A.

    2006-01-01

    Next to the vertiginous development of the technology in the Nuclear Medicine field, the possibility of early diagnosis of pathological processes without anatomical alterations, as well as its application with therapeutic purposes in the cancer treatment has grown. To assure a diagnosis and adapted therapy, it is vital to establish quality guarantee programs to the instrumentation. The State Medical Equipment Control Center (CCEEM), as regulator organ attributed to the Public Health Ministry of Cuba, it has licensed the Service of Quality Audits to the Nuclear medicine services, fulfilling all the technical and legal requirements to such effect. As base of these, the National Protocol for the Quality Control of the Instrumentation in Nuclear Medicine has been implemented, put out in vigour 2 national regulations, and an inter-institutional and multidisciplinary auditor equipment has been licensed. The different followed steps, as well as the realization of the first quality audits, its show not only a better execution of the tests and bigger professionalism of the involved specialists, but an increment in the taking of conscience to apply adequately the quality concepts for achieving a better service to the patient. On the other hand, the necessity of incorporating the clinical aspects to the audits, fomenting an integral harmonized advance of the quality guarantee programs is evidenced. (Author)

  20. Temporal Changes in the Quality of Acute Stroke Care in Five National Audits across Europe

    Directory of Open Access Journals (Sweden)

    Steffi Hillmann

    2015-01-01

    Full Text Available Background. Data on potential variations in delivery of appropriate stroke care over time are scarce. We investigated temporal changes in the quality of acute hospital stroke care across five national audits in Europe over a period of six years. Methods. Data were derived from national stroke audits in Germany, Poland, Scotland, Sweden, and England/Wales/Northern Ireland participating within the European Implementation Score (EIS collaboration. Temporal changes in predefined quality indicators with comparable information between the audits were investigated. Multivariable logistic regression analyses were performed to estimate adherence to quality indicators over time. Results. Between 2004 and 2009, individual data from 542,112 patients treated in 538 centers participating continuously over the study period were included. In most audits, the proportions of patients who were treated on a SU, were screened for dysphagia, and received thrombolytic treatment increased over time and ranged from 2-fold to almost 4-fold increase in patients receiving thrombolytic therapy in 2009 compared to 2004. Conclusions. A general trend towards a better quality of stroke care defined by standardized quality indicators was observed over time. The association between introducing a specific measure and higher adherence over time might indicate that monitoring of stroke care performance contributes to improving quality of care.

  1. Water Quality Conditions Associated with Cattle Grazing and Recreation on National Forest Lands.

    Directory of Open Access Journals (Sweden)

    Leslie M Roche

    Full Text Available There is substantial concern that microbial and nutrient pollution by cattle on public lands degrades water quality, threatening human and ecological health. Given the importance of clean water on multiple-use landscapes, additional research is required to document and examine potential water quality issues across common resource use activities. During the 2011 grazing-recreation season, we conducted a cross sectional survey of water quality conditions associated with cattle grazing and/or recreation on 12 public lands grazing allotments in California. Our specific study objectives were to 1 quantify fecal indicator bacteria (FIB; fecal coliform and E. coli, total nitrogen, nitrate, ammonium, total phosphorus, and soluble-reactive phosphorus concentrations in surface waters; 2 compare results to a water quality regulatory benchmarks, b recommended maximum nutrient concentrations, and c estimates of nutrient background concentrations; and 3 examine relationships between water quality, environmental conditions, cattle grazing, and recreation. Nutrient concentrations observed throughout the grazing-recreation season were at least one order of magnitude below levels of ecological concern, and were similar to U.S. Environmental Protection Agency (USEPA estimates for background water quality conditions in the region. The relative percentage of FIB regulatory benchmark exceedances widely varied under individual regional and national water quality standards. Relative to USEPA's national E. coli FIB benchmarks-the most contemporary and relevant standards for this study-over 90% of the 743 samples collected were below recommended criteria values. FIB concentrations were significantly greater when stream flow was low or stagnant, water was turbid, and when cattle were actively observed at sampling. Recreation sites had the lowest mean FIB, total nitrogen, and soluble-reactive phosphorus concentrations, and there were no significant differences in FIB and

  2. Quality assurance plan for Waste Area Grouping 6 at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    International Nuclear Information System (INIS)

    1994-01-01

    This Quality Assurance Plan (QAP) is concerned with design and construction (Sect. 2) and characterization and monitoring (Sect. 3). The basis for Sect. 2 is the Quality Assurance Plan for the Design and Construction of Waste Area Grouping 6 Closure at Oak Ridge National Laboratory, Oak Ridge, Tennessee, and the basis for Sect. 3 is the Environmental Restoration Quality Program Plan. Combining the two areas into one plan gives a single, overall document that explains the requirements and from which the individual QAPs and quality assurance project plans can be written. The Waste Area Grouping (WAG) 6 QAP establishes the procedures and requirements to be implemented for control of quality-related activities for the WAG 6 project. Quality Assurance (QA) activities are subject to requirements detailed in the Martin Marietta Energy Systems, Inc. (Energy Systems), QA Program and the Environmental Restoration (ER) QA Program, as well as to other quality requirements. These activities may be performed by Energy Systems organizations, subcontractors to Energy Systems, and architect-engineer (A-E) under prime contract to the US Department of Energy (DOE), or a construction manager under prime contract to DOE. This plan specifies the overall Energy Systems quality requirements for the project. The WAG 6 QAP will be supplemented by subproject QAPs that will identify additional requirements pertaining to each subproject

  3. Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

    Science.gov (United States)

    Woo, Russell K; Skarsgard, Erik D

    2015-06-01

    Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. National Health Insurance, Profitability, and Service Quality: Case Study at the Private Hospital in West Java

    Directory of Open Access Journals (Sweden)

    Andriyani Rahmah Fahriati

    2018-02-01

    Full Text Available National health insurance is one of the government programs to facilitate health services for the people. The purpose of this research to determine whether there are effects of National Health Insurance program (JKN on profitability and service quality at Juanda Kuningan Hospital, of West Java. The method using the paired-t-test to analyze the difference between before and after the National Health Insurance program. The result showed that there is a difference in profitability and service quality between pre and post the implementation of national health insurance program. Gross profit margin measured the profitability, net profit margin, return on total assets, and return on equity. This result means that the value of the company's profitability is better when the program JKN yet takes place in the Juanda hospital. While on the service quality variable it is found that the mean value is higher when the JKN program has conducted at the hospital.DOI: 10.15408/etk.v17i1.7064

  5. 40 CFR Appendix P to Part 50 - Interpretation of the Primary and Secondary National Ambient Air Quality Standards for Ozone

    Science.gov (United States)

    2010-07-01

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

  6. 40 CFR Appendix R to Part 50 - Interpretation of the National Ambient Air Quality Standards for Lead

    Science.gov (United States)

    2010-07-01

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

  7. Designing nursing excellence through a National Quality Forum nurse scholar program.

    Science.gov (United States)

    Neumann, Julie A; Brady-Schluttner, Katherine A; Attlesey-Pries, Jacqueline M; Twedell, Diane M

    2010-01-01

    Closing the knowledge gap for current practicing nurses in the Institute of Medicine (IOM) core competencies is critical to providing safe patient care. The National Quality Forum (NQF) nurse scholar program is one organization's journey to close the gap in the IOM core competencies in a large teaching organization. The NQF nurse scholar program is positioned to provide a plan to assist current nurses to accelerate their learning about quality improvement, evidence-based practice, and informatics, 3 of the core competencies identified by the IOM, and focus on application of skills to NQF nurse-sensitive measures. Curriculum outline, educational methodologies, administrative processes, and aims of the project are discussed.

  8. National evaluation of multidisciplinary quality metrics for head and neck cancer.

    Science.gov (United States)

    Cramer, John D; Speedy, Sedona E; Ferris, Robert L; Rademaker, Alfred W; Patel, Urjeet A; Samant, Sandeep

    2017-11-15

    The National Quality Forum has endorsed quality-improvement measures for multiple cancer types that are being developed into actionable tools to improve cancer care. No nationally endorsed quality metrics currently exist for head and neck cancer. The authors identified patients with surgically treated, invasive, head and neck squamous cell carcinoma in the National Cancer Data Base from 2004 to 2014 and compared the rate of adherence to 5 different quality metrics and whether compliance with these quality metrics impacted overall survival. The metrics examined included negative surgical margins, neck dissection lymph node (LN) yield ≥ 18, appropriate adjuvant radiation, appropriate adjuvant chemoradiation, adjuvant therapy within 6 weeks, as well as overall quality. In total, 76,853 eligible patients were identified. There was substantial variability in patient-level adherence, which was 80% for negative surgical margins, 73.1% for neck dissection LN yield, 69% for adjuvant radiation, 42.6% for adjuvant chemoradiation, and 44.5% for adjuvant therapy within 6 weeks. Risk-adjusted Cox proportional-hazard models indicated that all metrics were associated with a reduced risk of death: negative margins (hazard ratio [HR] 0.73; 95% confidence interval [CI], 0.71-0.76), LN yield ≥ 18 (HR, 0.93; 95% CI, 0.89-0.96), adjuvant radiation (HR, 0.67; 95% CI, 0.64-0.70), adjuvant chemoradiation (HR, 0.84; 95% CI, 0.79-0.88), and adjuvant therapy ≤6 weeks (HR, 0.92; 95% CI, 0.89-0.96). Patients who received high-quality care had a 19% reduced adjusted hazard of mortality (HR, 0.81; 95% CI, 0.79-0.83). Five head and neck cancer quality metrics were identified that have substantial variability in adherence and meaningfully impact overall survival. These metrics are appropriate candidates for national adoption. Cancer 2017;123:4372-81. © 2017 American Cancer Society. © 2017 American Cancer Society.

  9. The National Coordinated Research Programme for Air Quality. Another choice for clean air

    International Nuclear Information System (INIS)

    Van Giezen, M.; Havinga, A.; De Boer, H.

    2009-01-01

    On August 1st 2009 the National Coordinated Research Programme for Air quality (NSL in Dutch) entered into operation. This programme must help improve air quality such that it meets the European standards. At the same time the deadlock between environment and space is also solved. A special approach has been chosen for this purpose, which is based on a common interest of the State, provinces and local authorities. It was an intensive and interesting process. The annual monitoring will have to show whether or not the NSL will meet its objectives. [nl

  10. Chemical Reactivity Testing for the National Spent Nuclear Fuel Program. Quality Assurance Project Plan

    International Nuclear Information System (INIS)

    Newsom, H.C.

    1999-01-01

    This quality assurance project plan (QAPjP) summarizes requirements used by Lockheed Martin Energy Systems, Incorporated (LMES) Development Division at Y-12 for conducting chemical reactivity testing of Department of Energy (DOE) owned spent nuclear fuel, sponsored by the National Spent Nuclear Fuel Program (NSNFP). The requirements are based on the NSNFP Statement of Work PRO-007 (Statement of Work for Laboratory Determination of Uranium Hydride Oxidation Reaction Kinetics.) This QAPjP will utilize the quality assurance program at Y-12, QA-101PD, revision 1, and existing implementing procedures for the most part in meeting the NSNFP Statement of Work PRO-007 requirements, exceptions will be noted

  11. Pacific Northwest National Laboratory Apatite Investigation at the 100-NR-2 Quality Assurance Project Plan

    Energy Technology Data Exchange (ETDEWEB)

    Fix, N. J.

    2008-03-28

    This Quality Assurance Project Plan provides the quality assurance requirements and processes that will be followed by staff working on the 100-NR-2 Apatite Project. The U.S. Department of Energy, Fluor Hanford, Inc., Pacific Northwest National Laboratory, and the Washington Department of Ecology agreed that the long-term strategy for groundwater remediation at 100-N would include apatite sequestration as the primary treatment, followed by a secondary treatment. The scope of this project covers the technical support needed before, during, and after treatment of the targeted subsurface environment using a new high-concentration formulation.

  12. [Ecological regionalization of national cotton fiber quality in China using GGE biplot analysis method].

    Science.gov (United States)

    Xu, Nai Yin; Jin, Shi Qiao; Li, Jian

    2017-01-01

    The distinctive regional characteristics of cotton fiber quality in the major cotton-producing areas in China enhance the textile use efficiency of raw cotton yarn by improving fiber quality through ecological regionalization. The "environment vs. trait" GGE biplot analysis method was adopted to explore the interaction between conventional cotton sub-regions and cotton fiber quality traits based on the datasets collected from the national cotton regional trials from 2011 to 2015. The results showed that the major cotton-producing area in China were divided into four fiber quality ecological regions, namely, the "high fiber quality ecological region", the "low micronaire ecological region", the "high fiber strength and micronaire ecological region", and the "moderate fiber quality ecological region". The high fiber quality ecological region was characterized by harmonious development of cotton fiber length, strength, micronaire value and the highest spinning consistency index, and located in the conventional cotton regions in the upper and lower reaches of Yangtze River Valley. The low micronaire value ecological region composed of the northern and south Xinjiang cotton regions was characterized by low micronaire value, relatively lower fiber strength, and relatively high spinning consistency index performance. The high fiber strength and micronaire value ecological region covered the middle reaches of Yangtze River Valley, Nanxiang Basin and Huaibei Plain, and was prominently characterized by high strength and micronaire value, and moderate performance of other traits. The moderate fiber quality ecological region included North China Plain and Loess Plateau cotton growing regions in the Yellow River Valley, and was characterized by moderate or lower performances of all fiber quality traits. This study effectively applied "environment vs. trait" GGE biplot to regionalize cotton fiber quality, which provided a helpful reference for the regiona-lized cotton growing

  13. The national stream quality accounting network: A flux-basedapproach to monitoring the water quality of large rivers

    Science.gov (United States)

    Hooper, R.P.; Aulenbach, Brent T.; Kelly, V.J.

    2001-01-01

    Estimating the annual mass flux at a network of fixed stations is one approach to characterizing water quality of large rivers. The interpretive context provided by annual flux includes identifying source and sink areas for constituents and estimating the loadings to receiving waters, such as reservoirs or the ocean. Since 1995, the US Geological Survey's National Stream Quality Accounting Network (NASQAN) has employed this approach at a network of 39 stations in four of the largest river basins of the USA: The Mississippi, the Columbia, the Colorado and the Rio Grande. In this paper, the design of NASQAN is described and its effectiveness at characterizing the water quality of these rivers is evaluated using data from the first 3 years of operation. A broad range of constituents was measured by NASQAN, including trace organic and inorganic chemicals, major ions, sediment and nutrients. Where possible, a regression model relating concentration to discharge and season was used to interpolate between chemical observations for flux estimation. For water-quality network design, the most important finding from NASQAN was the importance of having a specific objective (that is, estimating annual mass flux) and, from that, an explicitly stated data analysis strategy, namely the use of regression models to interpolate between observations. The use of such models aided in the design of sampling strategy and provided a context for data review. The regression models essentially form null hypotheses for concentration variation that can be evaluated by the observed data. The feedback between network operation and data collection established by the hypothesis tests places the water-quality network on a firm scientific footing.

  14. Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study.

    Science.gov (United States)

    Odhagen, Erik; Sunnergren, Ola; Söderman, Anne-Charlotte Hessén; Thor, Johan; Stalfors, Joacim

    2018-03-24

    Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates. Six ENT centres, all with PTH rates above the Swedish average, participated in the 7-month quality improvement project. Each centre developed improvement plans describing the intended changes in clinical practice. The project's primary outcome variable was the PTH rate. Process indicators, such as surgical technique, were also documented. Data from the QIP centres were compared with a control group of 15 surgical centres in Sweden with similarly high PTH rates. Data from both groups for the 12 months prior to the start of the QIP were compared with data for the 12 months after the QIP. The QIP centres reduced the PTH rate from 12.7 to 7.1% from pre-QIP to follow-up; in the control group, the PTH rate remained unchanged. The QIP centres also exhibited positive changes in related key process indicators, i.e., increasing the use of cold techniques for dissection and haemostasis. The rates of PTH can be reduced with a QIP. A national quality register can be used not only to identify areas for improvement but also to evaluate the impact of subsequent improvement efforts and thereby guide professional development and enhance patient outcomes.

  15. The Role of the Transport System in the National Management of Life Quality

    Directory of Open Access Journals (Sweden)

    Berveno Oksana V.

    2015-11-01

    Full Text Available The aim of the article is to analyze the development prospects of transport system in Ukraine as a lever for national economic development capable of providing a sustainable quality of life and to search for mechanisms of their activation in national development. Transport is one of the leading sectors of material production, it participates in the formation of its branch structure, placement of production capacity and price formation. Through the economic channels the transport industry affects all indicators of life quality creating benefits for economic growth of the region and the country, developing national infrastructure. The transport industry performs a range of services to improve the life quality of the population: providing access to all members of society to socio-economic infrastructure by increasing the degree of transport accessibility, increasing labor force mobility, increasing availability of any objects, simplifying the implementation of many vital processes and expanding opportunities for social interaction. The quality of the social environment formation depends on the operation quality and development level of the transport system. A higher mobility and saving of time as the most important resource of modern time create more opportunities for human development. But the transport system also increases the risk level and risk of human existence because of environmental degradation, technogenity and increasing accident rates. The potential of the transport system development in Ukraine, which, provided the right management decisions, can be implemented as a competitive advantage, should include a favorable geographical position. In order to give the transport development a dynamic nature, it is necessary to combine technological and technical renewal of the industry with the improvement of the state regulation system on the basis of forming innovative transport strategies. It is this approach that not only will allow solving

  16. Isotopic power supplies for space and terrestrial systems: quality assurance by Sandia National Laboratories

    International Nuclear Information System (INIS)

    Hannigan, R.L.; Harnar, R.R.

    1981-09-01

    The Sandia National Laboratories participation in Quality Assurance (QA) programs for Radioisotopic Thermoelectric Generators which have been used in space and terrestrial systems over the past 15 years is summarized. Basic elements of the program are briefly described and recognition of assistance from other Sandia organizations is included. Descriptions of the various systems for which Sandia has had the QA responsibility are also presented. In addition, the outlook for Sandia participation in RTG programs for the next several years is noted

  17. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

    Energy Technology Data Exchange (ETDEWEB)

    Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  18. Quality of physician communication about human papillomavirus vaccine: findings from a national survey.

    Science.gov (United States)

    Gilkey, Melissa B; Malo, Teri L; Shah, Parth D; Hall, Megan E; Brewer, Noel T

    2015-11-01

    Improving the quality of physicians' recommendations for human papillomavirus (HPV) vaccination is critical to addressing low coverage. Thus, we sought to describe HPV vaccine communication practices among primary care physicians. Pediatricians and family physicians (n = 776) completed our national online survey in 2014. We assessed the quality of their HPV vaccine recommendations on strength of endorsement (i.e., saying the vaccine is important), timeliness (recommending it by ages 11-12), consistency (recommending it routinely vs. using a risk-based approach), and urgency (recommending same-day vaccination). A sizeable minority of physicians reported that they do not strongly endorse HPV vaccine (27%) or deliver timely recommendations for girls (26%) or boys (39%). Many physicians (59%) used a risk-based approach to recommending HPV vaccine, and only half (51%) usually recommended same-day vaccination. Overall recommendation quality was lower among physicians who were uncomfortable talking about HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by saying the child was due for HPV vaccine versus giving information or eliciting questions. Many physicians in our national sample reported recommending HPV vaccine inconsistently, behind schedule, or without urgency. These practices likely contribute to under-immunization among adolescents, and may convey ambivalence to parents. As one of the first studies to assess multiple aspects of recommendation quality, these findings can inform the many state and national initiatives that aim to improve communication about HPV vaccine so as to address the persistent underuse of a powerful tool for cancer prevention. ©2015 American Association for Cancer Research.

  19. Clinical Case Registries: Simultaneous Local and National Disease Registries for Population Quality Management

    Science.gov (United States)

    Backus, Lisa I.; Gavrilov, Sergey; Loomis, Timothy P.; Halloran, James P.; Phillips, Barbara R.; Belperio, Pamela S.; Mole, Larry A.

    2009-01-01

    The Department of Veterans Affairs (VA) has a system-wide, patient-centric electronic medical record system (EMR) within which the authors developed the Clinical Case Registries (CCR) to support population-centric delivery and evaluation of VA medical care. To date, the authors have applied the CCR to populations with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Local components use diagnosis codes and laboratory test results to identify patients who may have HIV or HCV and support queries on local care delivery with customizable reports. For each patient in a local registry, key EMR data are transferred via HL7 messaging to a single national registry. From 128 local registry systems, over 60,000 and 320,000 veterans in VA care have been identified as having HIV and HCV, respectively, and entered in the national database. Local and national reports covering demographics, resource usage, quality of care metrics and medication safety issues have been generated. PMID:19717794

  20. Aquatic macroinvertebrates and water quality of Sandia Canyon, Los Alamos National Laboratory, November 1993--October 1994

    Energy Technology Data Exchange (ETDEWEB)

    Cross, S.

    1995-08-01

    The Ecological Studies Team (EST) of ESH-20 at Los Alamos National Laboratory (LANL) has collected samples from the stream within Sandia Canyon since the summer of 1990. These field studies gather water quality measurements and collect aquatic macroinvertebrates from permanent sampling sites. Reports by Bennett (1994) and Cross (1994) discuss previous EST aquatic studies in Sandia Canyon. This report updates and expands those findings. EST collected water quality data and aquatic macroinvertebrates at five permanent stations within the canyon from November 1993 through October 1994. The two upstream stations are located below outfalls that discharge industrial and sanitary waste effluent into the stream, thereby maintaining year-round flow. Some water quality parameters are different at the first three stations from those expected of natural streams in the area, indicating degraded water quality due to effluent discharges. The aquatic habitat at the upper stations has also been degraded by sedimentation and channelization. The macroinvertebrate communities at these stations are characterized by low diversities and unstable communities. In contrast, the two downstream stations appear to be in a zone of recovery, where water quality parameters more closely resemble those found in natural streams of the area. The two lower stations have increased macroinvertebrate diversity and stable communities, further indications of downstream water quality improvement.

  1. Underground Test Area Activity Quality Assurance Plan Nevada National Security Site, Nevada. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    Krenzien, Susan [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States); Farnham, Irene [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2015-06-01

    This Quality Assurance Plan (QAP) provides the overall quality assurance (QA) requirements and general quality practices to be applied to the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Underground Test Area (UGTA) activities. The requirements in this QAP are consistent with DOE Order 414.1D, Change 1, Quality Assurance (DOE, 2013a); U.S. Environmental Protection Agency (EPA) Guidance for Quality Assurance Project Plans for Modeling (EPA, 2002); and EPA Guidance on the Development, Evaluation, and Application of Environmental Models (EPA, 2009). If a participant’s requirement document differs from this QAP, the stricter requirement will take precedence. NNSA/NFO, or designee, must review this QAP every two years. Changes that do not affect the overall scope or requirements will not require an immediate QAP revision but will be incorporated into the next revision cycle after identification. Section 1.0 describes UGTA objectives, participant responsibilities, and administrative and management quality requirements (i.e., training, records, procurement). Section 1.0 also details data management and computer software requirements. Section 2.0 establishes the requirements to ensure newly collected data are valid, existing data uses are appropriate, and environmental-modeling methods are reliable. Section 3.0 provides feedback loops through assessments and reports to management. Section 4.0 provides the framework for corrective actions. Section 5.0 provides references for this document.

  2. Underground Test Area Activity Quality Assurance Plan Nevada National Security Site, Nevada. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Farnham, Irene [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States); Krenzien, Susan [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2012-10-01

    This Quality Assurance Plan (QAP) provides the overall quality assurance (QA) requirements and general quality practices to be applied to the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Underground Test Area (UGTA) activities. The requirements in this QAP are consistent with DOE Order 414.1C, Quality Assurance (DOE, 2005); U.S. Environmental Protection Agency (EPA) Guidance for Quality Assurance Project Plans for Modeling (EPA, 2002); and EPA Guidance on the Development, Evaluation, and Application of Environmental Models (EPA, 2009). NNSA/NSO, or designee, must review this QAP every two years. Changes that do not affect the overall scope or requirements will not require an immediate QAP revision but will be incorporated into the next revision cycle after identification. Section 1.0 describes UGTA objectives, participant responsibilities, and administrative and management quality requirements (i.e., training, records, procurement). Section 1.0 also details data management and computer software requirements. Section 2.0 establishes the requirements to ensure newly collected data are valid, existing data uses are appropriate, and environmental-modeling methods are reliable. Section 3.0 provides feedback loops through assessments and reports to management. Section 4.0 provides the framework for corrective actions. Section 5.0 provides references for this document.

  3. Performance indicators for quality in surgical and laboratory services at Muhimbili National Hospital (MNH) in Tanzania.

    Science.gov (United States)

    Mbembati, Naboth A; Mwangu, Mugwira; Muhondwa, Eustace P Y; Leshabari, Melkizedek M

    2008-04-01

    Muhimbili National Hospital (MNH), a teaching and national referral hospital, is undergoing major reforms to improve the quality of health care. We performed a retrospective descriptive study using a set of performance indicators for the surgical and laboratory services of MNH in years 2001 and 2002, to help monitor and evaluate the impact of reforms on the quality of health care during and after the reform process. Hospital records were reviewed and information recorded for planned and postponed operations, laboratory equipment, reagents, laboratory tests and quality assurance programmes. In the year 2001 a total of 4332 non-emergency operations were planned, 3313 operations were performed and 1019 (23.5%) operations were postponed. In the year 2002, 4301 non-emergency operations were planned, 3046 were performed and 1255 (29%) were postponed. The most common reasons for operation postponement were "time-barred", interference by emergency operations, no show of patients and inoperable anaesthetic machines. Equipment problems and supply and staff shortages together accounted for one quarter of postponements. In the laboratory, a lack of equipment prevented some tests, but quality assurance was performed for most tests. Current surgical services at MNH are inadequate; operating theatres require modern, functioning equipment and adequate supplies of consumables to provide satisfactory care.

  4. 12 Years of the National Quality Award of the Slovak Republic

    Directory of Open Access Journals (Sweden)

    Monika Jurkovičová

    2012-10-01

    Full Text Available The objective of the article is to present twelve years of the National Quality Award of the Slovak Republic, survey results of the awarded organisations and their benefits for the success of the organisation. The basis is previous knowledge of recognition based on the EFQM Excellence Model and CAF Model in the Slovak Republic. The questionnaire survey has been used completed with respondent’s allegation. The aim of the survey was to gain proposals for improvements for the following annual sets of the National Quality Awards of the Slovak Republic to raise quality awareness and competitiveness of Slovak private and public organisations. The following findings were main conclusions. The most effective way of how to approach potential competition participants it to approach them with a direct email information. Expectations of most organisations entering the competition have been met. The quality model implementation and site visit based recommendations were main benefits of participating in the competition that resulted in success and added value in different areas of the organisation and its performance. Organisations that have an experience of at least one year participation in the competition claim its importance. It is also confirmed by the fact that organisations that became winners of its category in the past, backtrack to the competition after three and more years to benchmark their improvements and advancement. The competition is a strong tool that is able to assist an organisation on its journey to success and excellence.

  5. Los Alamos National Laboratory Yucca Mountain Site Characterization Project 1993 Quality Program status report

    International Nuclear Information System (INIS)

    Boliver, S.L.

    1995-05-01

    This status report is for calendar year 1993. It summarizes the annual activities and accomplishments of the Los Alamos National Laboratory (Los Alamos) Yucca Mountain Site Characterization Project (YMP or Project) quality assurance program. By identifying the accomplishments of the quality program, we establish a baseline that will assist in decision making, improve administrative controls and predictability, and allow us to annually identify long term trends and to evaluate improvements. This is the third annual status report (Bolivar, 1992; Bolivar, 1994). This report is divided into two primary sections: Program Activities and Trend Analysis. Under Program Activities, programmatic issues occurring in 1993 are discussed. The goals for 1993 are also listed, followed by a discussion of their status. Lastly, goals for 1994 are identified. The Trend Analysis section is a summary of 1993 quarterly trend reports and provides a good overview of the quality assurance issues of the Los Alamos YMP

  6. Measuring Excellence: A Closer Look at Malcolm Baldrige National Quality Award Winners in the Manufacturing Category

    Directory of Open Access Journals (Sweden)

    Brian Cazzell

    2009-05-01

    Full Text Available The Malcolm Baldrige National Quality Award is the nation’s highest quality award. The application and review process is outlined in this work. The objective of this study was to examine the five previous winners in the Manufacturing category and to establish a firm conclusion about the award’s impact. The impact of the award was examined in several categories including financial performance, market share, and employee productivity. This study explored the accomplishments of each company and compared the common factors they shared with one another. It was found that all five companies experienced tremendous financial growth on average of 100% in either sales or revenue as a result of their dedication to quality which ultimately led to winning the MBNQA.

  7. How and why is aquatic quality changing at Nahanni National Park Reserve, NWT, Canada?

    Science.gov (United States)

    Halliwell, Douglas R; Catto, Steve

    2003-01-01

    Nahanni National Park Reserve is located at southwestern NWT-Yukon border. One of the first UNESCO World Heritage sites, Nahanni lies within Taiga Cordillera and Taiga Shield Ecozones. Base and precious metal mining occurred upstream of Nahanni prior to park establishment. Nahanni waters, sediments, fish, and caribou have naturally elevated metals levels. Baseline water, sediment and fish tissue quality data were collected and analyzed throughout Nahanni during 1988-91 and 1992-97. These two programs characterized how aquatic quality variables are naturally varying in space and time, affected by geology, stream flow, seasonality, and extreme meteorological and geological events. Possible anthropogenic causes of aquatic quality change were examined. Measured values were compared to existing Guidelines and site-specific objectives were established.

  8. Los Alamos National Laboratory Yucca Mountain Site Characterization Project 1993 Quality Program status report

    Energy Technology Data Exchange (ETDEWEB)

    Bolivar, S.L.

    1995-05-01

    This status report is for calendar year 1993. It summarizes the annual activities and accomplishments of the Los Alamos National Laboratory (Los Alamos) Yucca Mountain Site Characterization Project (YMP or Project) quality assurance program. By identifying the accomplishments of the quality program, we establish a baseline that will assist in decision making, improve administrative controls and predictability, and allow us to annually identify long term trends and to evaluate improvements. This is the third annual status report (Bolivar, 1992; Bolivar, 1994). This report is divided into two primary sections: Program Activities and Trend Analysis. Under Program Activities, programmatic issues occurring in 1993 are discussed. The goals for 1993 are also listed, followed by a discussion of their status. Lastly, goals for 1994 are identified. The Trend Analysis section is a summary of 1993 quarterly trend reports and provides a good overview of the quality assurance issues of the Los Alamos YMP.

  9. Successful integration efforts in water quality from the integrated Ocean Observing System Regional Associations and the National Water Quality Monitoring Network

    Science.gov (United States)

    Ragsdale, R.; Vowinkel, E.; Porter, D.; Hamilton, P.; Morrison, R.; Kohut, J.; Connell, B.; Kelsey, H.; Trowbridge, P.

    2011-01-01

    The Integrated Ocean Observing System (IOOS??) Regional Associations and Interagency Partners hosted a water quality workshop in January 2010 to discuss issues of nutrient enrichment and dissolved oxygen depletion (hypoxia), harmful algal blooms (HABs), and beach water quality. In 2007, the National Water Quality Monitoring Council piloted demonstration projects as part of the National Water Quality Monitoring Network (Network) for U.S. Coastal Waters and their Tributaries in three IOOS Regional Associations, and these projects are ongoing. Examples of integrated science-based solutions to water quality issues of major concern from the IOOS regions and Network demonstration projects are explored in this article. These examples illustrate instances where management decisions have benefited from decision-support tools that make use of interoperable data. Gaps, challenges, and outcomes are identified, and a proposal is made for future work toward a multiregional water quality project for beach water quality.

  10. Data analysis considerations for pesticides determined by National Water Quality Laboratory schedule 2437

    Science.gov (United States)

    Shoda, Megan E.; Nowell, Lisa H.; Stone, Wesley W.; Sandstrom, Mark W.; Bexfield, Laura M.

    2018-04-02

    In 2013, the U.S. Geological Survey National Water Quality Laboratory (NWQL) made a new method available for the analysis of pesticides in filtered water samples: laboratory schedule 2437. Schedule 2437 is an improvement on previous analytical methods because it determines the concentrations of 225 fungicides, herbicides, insecticides, and associated degradates in one method at similar or lower concentrations than previously available methods. Additionally, the pesticides included in schedule 2437 were strategically identified in a prioritization analysis that assessed likelihood of occurrence, prevalence of use, and potential toxicity. When the NWQL reports pesticide concentrations for analytes in schedule 2437, the laboratory also provides supplemental information useful to data users for assessing method performance and understanding data quality. That supplemental information is discussed in this report, along with an initial analysis of analytical recovery of pesticides in water-quality samples analyzed by schedule 2437 during 2013–2015. A total of 523 field matrix spike samples and their paired environmental samples and 277 laboratory reagent spike samples were analyzed for this report (1,323 samples total). These samples were collected in the field as part of the U.S. Geological Survey National Water-Quality Assessment groundwater and surface-water studies and as part of the NWQL quality-control program. This report reviews how pesticide samples are processed by the NWQL, addresses how to obtain all the data necessary to interpret pesticide concentrations, explains the circumstances that result in a reporting level change or the occurrence of a raised reporting level, and describes the calculation and assessment of recovery. This report also discusses reasons why a data user might choose to exclude data in an interpretive analysis and outlines the approach used to identify the potential for decreased data quality in the assessment of method recovery. The

  11. Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

    Science.gov (United States)

    Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

    2016-01-01

    Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The

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

    Science.gov (United States)

    Walsh, Stephen Joseph; Meador, Michael R.

    1998-01-01

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

  13. Assessment of sediment quality collected from the Tunku Abdul Rahman National Park, Sabah

    International Nuclear Information System (INIS)

    Mohd Suhaimi Elias; Mohd Suhaimi Hamzah; Shamsiah Abdul Rahman; Siong, Wee Boon; Nazaratul Ashifa Abdullah Salim

    2012-01-01

    Assessment of source and sediment quality was carried out on marine sediments collected from the Tuanku Abdul Rahman National Park. Enrichment factors (EF), pollution load index (PLI) and geo-accumulation index (Igeo) were used to identify the sources of pollution, degree of contamination and sediment quality, respectively. Elemental analyses of marine sediment samples were performed by using the Instrumental Neutron Activation Analysis (INAA). Results from the Tunku Abdul Rahman National Park of Sabah indicated that most of the elements are considered to be from lithological or natural origin with EF values of less than 2 except for As (10 stations), Cr (3 stations), Lu (5 stations), Mg (2 stations), Sb (6 stations) and U (3 stations). For the sediment quality, most of the study area can be categorised as unpolluted for most of the elements (Igeo value < 2) except for As, Cr, Lu, Mg, Sb and U. A few study areas were slightly low contaminated with As, Cr, Lu, Mg, Sb and U. The contamination of As, Cr, Lu, Mg, Sb and U in the study area can be categorised as moderate with Igeo values ranged from 1 to 2. Meanwhile, the results of PLI value for sediment were ranged from 0.93 to 1.47 (PLI < 50) indicating there are not required to perform drastic rectification measures for the screening of the elements in the Tunku Abdul Rahman Park. Overall, assessment of the sediment quality at the Tunku Abdul Rahman National Park showed a few elements such as As, Cr, Lu, Mg, Sb and U were slightly enriched while most of the elements were similar to background values. (author)

  14. The Role of Radiological Protection in Sweden's National Environmental quality Objectives

    International Nuclear Information System (INIS)

    Hubbard, L.; Mjones, L.; Holm, E.

    2004-01-01

    In 1999, the Swedish Parliament adopted fifteen environmental quality objectives, defining the quality of Sweden's environment and of its natural and cultural resources that will insure sustainable growth. In 2001, the government proposed interim targets for each objective, specifying the direction and time scale of the proposed actions. These objectives give Sweden a unique opportunity to define, quantify and achieve an ecologically sustainable environment. One of the national objectives, A Safe Radiation Environment, targets both ionising and non-ionising radiation and states, human health and biological diversity must be protected against the harmful effects of radiation in the environment. The Swedish Radiation Protection Authority (SSI) has the responsibility for formulating and achieving the interim targets for this objective. The targets presently focus on controlling radioactive emissions, limiting exposures to ultraviolet radiation and defining the risks from exposure to electromagnetic fields. Part of SSI's responsibility for the environmental quality objective is to develop a system for monitoring and quantifying progress towards each interim target. Sweden's National Board of Housing, Building and Planning (NBHBP) is responsible for another of the national objectives, A Good Built- Environment. As part of this objective, a special interim target for the indoor environment was approved by Parliament in 2002, which includes a specification for human exposure to radon in indoor air. It states: radon concentrations should be lower than 200 Bq/m3 in schools and pre-schools by the year 2010, and below 200 Bq/m3 in homes by 2020. This substantially raises the level of ambition regarding reducing exposure to indoor radon. The aim of this paper is to briefly summarize the role of radiological protection in Sweden's environmental quality objectives. (Author) 3 refs

  15. Diet quality on meatless days: National Health and Nutrition Examination Survey (NHANES), 2007-2012.

    Science.gov (United States)

    Conrad, Zach; Karlsen, Micaela; Chui, Kenneth; Jahns, Lisa

    2017-06-01

    To compare diet quality scores between adult non-meat eaters and meat eaters, and to compare the consumption of diet components across quintiles of diet quality. Cross-sectional analysis. The Healthy Eating Index-2010 (HEI-2010) and Alternative Healthy Eating Index-2010 (AHEI-2010) were used to assess mean diet quality. Differences in consumption of diet components between quintiles of diet quality were tested using post hoc Wald tests and z tests. The National Health and Nutrition Examination Survey (NHANES), 2007-2012. The sample consisted of 16810 respondents aged≥18 years, including 280 individuals who reported not consuming meat, poultry, game birds or seafood on two non-consecutive days of dietary recall. Dietary data were obtained from one dietary recall per individual. Non-meat eaters had substantially greater HEI-2010 and AHEI-2010 scores than meat eaters (Pempty calories and unsaturated:saturated fatty acids. Mean consumption across AHEI-2010 quintiles demonstrated different (Pempty calories, and increased consumption of nuts and legumes, PUFA and vegetables, as a way to improve overall dietary quality.

  16. National Ignition Facility quality assurance plan for laser materials and optical technology

    International Nuclear Information System (INIS)

    Wolfe, C.R.

    1996-05-01

    Quality achievement is the responsibility of the line organizations of the National Ignition Facility (NIF) Project. This subtier Quality Assurance Plan (QAP) applies to activities of the Laser Materials ampersand Optical Technology (LM ampersand OT) organization and its subcontractors. It responds to the NIF Quality Assurance Program Plan (QAPP, L-15958-2, NIF-95-499) and Department of Energy (DOE) Order 5700.6C. This Plan is organized according to 10 Quality Assurance (QA) criteria and subelements of a management system as outlined in the NIF QAPP. This Plan describes how those QA requirements are met. This Plan is authorized by the Associate Project Leader for the LM ampersand OT organization, who has assigned responsibility to the Optics QA engineer to maintain this plan, with the assistance of the NIF QA organization. This Plan governs quality-affecting activities associated with: design; procurement; fabrication; testing and acceptance; handling and storage; and installation of NIF Project optical components into mounts and subassemblies

  17. Monitoring air quality in Southeast Alaska’s National Parks and Forests: Linking atmospheric pollutants with ecological effects

    Science.gov (United States)

    D. Schirokauer; L. Geiser; A. Bytnerowicz; M. Fenn; K. Dillman

    2014-01-01

    Air quality and air quality related values are important resources to the National Park Service (NPS) units and Wilderness areas in northern Southeast Alaska. Air quality monitoring was prioritized as a high-priority Vital Sign at the Southeast Alaska Network’s (SEAN) Inventory and Monitoring Program’s terrestrial scoping workshop (Derr and Fastie 2006). Air quality...

  18. Water Quality in Big Cypress National Preserve and Everglades National Park - Trends and Spatial Characteristics of Selected Constituents

    Science.gov (United States)

    Miller, Ronald L.; McPherson, Benjamin F.; Sobczak, Robert; Clark, Christine

    2004-01-01

    Seasonal changes in water levels and flows in Big Cypress National Preserve (BICY) and Everglades National Park (EVER) affect water quality. As water levels and flows decline during the dry season, physical, geochemical and biological processes increase the breakdown of organic materials and the build-up of organic waste, nutrients, and other constituents in the remaining surface water. For example, concentrations of total phosphorus in the marsh are less than 0.01 milligram per liter (mg/L) during much of the year. Concentrations can rise briefly above this value during the dry season and occasionally exceed 0.1 mg/L under drought conditions. Long-term changes in water levels, flows, water management, and upstream land use also affect water quality in BICY and EVER, based on analysis of available data (1959-2000). During the 1980's and early 1990's, specific conductance and concentrations of chloride increased in the Taylor Slough and Shark River Slough. Chloride concentrations more than doubled from 1960 to 1990, primarily due to greater canal transport of high dissolved solids into the sloughs. Some apparent long-term trends in sulfate and total phosphorus were likely attributable, at least in part, to high percentages of less-than and zero values and to changes in reporting levels over the period of record. High values in nutrient concentrations were evident during dry periods of the 1980's and were attributable either to increased canal inflows of nutrient-rich water, increased nutrient releases from breakdown of organic bottom sediment, or increased build-up of nutrient waste from concentrations of aquatic biota and wildlife in remaining ponds. Long-term changes in water quality over the period of record are less pronounced in the western Everglades and the Big Cypress Swamp; however, short-term seasonal and drought-related changes are evident. Water quality varies spatially across the region because of natural variations in geology, hydrology, and vegetation

  19. The National Water-Quality Assessment (NAWQA) Program planned monitoring and modeling activities for Texas, 2013–23

    Science.gov (United States)

    Ging, Patricia

    2013-01-01

    The U.S. Geological Survey’s (USGS) National Water-Quality Assessment (NAWQA) Program was established by Congress in 1992 to answer the following question: What is the status of the Nation’s water quality and is it getting better or worse? Since 1992, NAWQA has been a primary source of nationally consistent data and information on the quality of the Nation’s streams and groundwater. Data and information obtained from objective and nationally consistent water-quality monitoring and modeling activities provide answers to where, when, and why the Nation’s water quality is degraded and what can be done to improve and protect it for human and ecosystem needs. For NAWQA’s third decade (2013–23), a new strategic Science Plan has been developed that describes a strategy for building upon and enhancing the USGS’s ongoing assessment of the Nation’s freshwater quality and aquatic ecosystems.

  20. DEVELOPMENT AND APPLICATION OF THE KEY TECHNOLOGIES FOR THE QUALITY CONTROL AND INSPECTION OF NATIONAL GEOGRAPHICAL CONDITIONS SURVEY PRODUCTS

    Directory of Open Access Journals (Sweden)

    Y. Zhao

    2018-04-01

    Full Text Available The First National Geographical Condition Survey is a predecessor task to dynamically master basic situations of the nature, ecology and human activities on the earth’s surface and it is the brand-new mapping geographic information engineering. In order to ensure comprehensive, real and accurate survey results and achieve the quality management target which the qualified rate is 100 % and the yield is more than 80 %, it is necessary to carry out the quality control and result inspection for national geographical conditions survey on a national scale. To ensure that achievement quality meets quality target requirements, this paper develops the key technology method of “five-in-one” quality control that is constituted by “quality control system of national geographical condition survey, quality inspection technology system, quality evaluation system, quality inspection information management system and national linked quality control institutions” by aiming at large scale, wide coverage range, more undertaking units, more management levels, technical updating, more production process and obvious regional differences in the national geographical condition survey and combining with novel achievement manifestation, complicated dependency, more special reference data, and large data size. This project fully considering the domestic and foreign related research results and production practice experience, combined with the technology development and the needs of the production, it stipulates the inspection methods and technical requirements of each stage in the quality inspection of the geographical condition survey results, and extends the traditional inspection and acceptance technology, and solves the key technologies that are badly needed in the first national geographic survey.

  1. A quality-assurance assessment for constituents reported by the National Atmospheric Deposition Program and the National Trends Network

    Science.gov (United States)

    See, R.B.; Schroder, L.J.; Willoughby, T.C.

    1989-01-01

    A continuing quality-assurance program has been operated by the U.S. Geographical Survey to evaluate any bias introduced by routine handling, shipping, and laboratory analyses of wet-deposition samples collected in the National Atmospheric Deposition Program (NADP) and National Trends Network (NTN). Blind-audit samples having a variety of constituent concentrations and values were selected. Only blind-audit samples with constituent concentrations and values less than the 95th-percentile concentration for natural wet-deposition samples were included in the analysis. Of the major ions, there was a significant increase of Ca2+, Mg2+, K+ SO42+ and Cl- in samples handled according to standard protocols and shipped in NADP/NTN sample-collection buckets. For 1979-1987, graphs of smoothed data showing the estimated contaminations in blind-audit samples indicate a decrease in the median concentration and ranges of Ca2+, Mg2+ and SO42- contamination of blind-audit samples shipped in sample-collection buckets. Part of the contamination detected in blind-audit samples can be attributed to contact with the sample-collection bucket and lid; however, additional sources also seem to contaminate the blind-audit sample. Apparent decreases in the magnitude and range of sample contamination may be caused by differences in sample-collection bucket- and lid-washing procedures by the NADP/NTN Central Analytical Laboratory. Although the degree of bias is minimal for most constituents, summaries of the NADP/NTN data base may contain overestimates of Ca2+, Mg2+, Na-, K+, SO42- and Cl- concentrations, and underestimates of H+ concentrations.

  2. National Beef Quality Audit-2011: In-plant survey of targeted carcass characteristics related to quality, quantity, value, and marketing of fed steers and heifers

    Science.gov (United States)

    The National Beef Quality Audit – 2011 (NBQA-2011) assessed the current status of quality and consistency of fed steers and heifers. Beef carcasses (n = 9,802), representing approximately 10 percent of each production lot in 28 beef processing facilities, were selected randomly for the survey. Car...

  3. National Beef Quality Audit-2011: Harvest-floor assessments of targeted characteristics that affect quality and value of cattle, carcasses, and byproducts

    Science.gov (United States)

    The National Beef Quality Audit-2011(NBQA-2011) was conducted to assess targeted characteristics on the harvest floor that affect the quality and value of cattle, carcasses, and byproducts. Survey teams evaluated approximately 18,000 cattle/carcasses between May and November 2011 in 8 beef processin...

  4. 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.

  5. Quality assurance for radon exposure chambers at the National Air and Radiation Environmental Laboratory, Montgomery, Alabama

    Energy Technology Data Exchange (ETDEWEB)

    Semler, M.O.; Sensintaffar, E.L. [National Air and Radiation Environmental Laboratory, Montgomery, AL (United States)

    1993-12-31

    The Office of Radiation and Indoor Air, U.S. Environmental Protection Agency (EPA), operates six radon exposure chambers in its two laboratories, the National Air and Radiation Environmental Laboratory (NAREL) in Montgomery, Alabama, and the Las Vegas Facility, Las Vegas, Nevada. These radon exposure chambers are used to calibrate and test portable radon measuring instruments, test commercial suppliers of radon measurement services through the Radon Measurement Proficiency Program, and expose passive measurement devices to known radon concentrations as part of a quality assurance plan for federal and state studies measuring indoor radon concentrations. Both laboratories participate in national and international intercomparisons for the measurement of radon and are presently working with the National Institute of Standards and Technology (NIST) to receive a certificate of traceability for radon measurements. NAREL has developed an estimate of the total error in its calibration of each chamber`s continuous monitors as part of an internal quality assurance program. This paper discusses the continuous monitors and their calibration for the three chambers located in Montgomery, Alabama, as well as the results of the authors intercomparisons and total error analysis.

  6. The use of quality control performance charts to analyze cesarean delivery rates nationally.

    LENUS (Irish Health Repository)

    Turner, Michael J

    2012-02-01

    OBJECTIVE: To examine the use of quality control performance charts to analyze cesarean rates nationally. METHODS: Information on cesarean rates was obtained for all 19 Irish maternity hospitals receiving state funding in 2009. All women who underwent cesarean delivery of a live or stillborn infant weighing 500 g or more between January 1 and December 31 were included. Deliveries were classified as elective or emergency. Individual hospitals were not identified in the analysis. RESULTS: The mean rates per hospital of elective and emergency cesarean were 12.9+\\/-2.6% (n=9337) and 13.8+\\/-3.0% (n=9989), respectively-giving an overall mean rate of 26.7+\\/-4.2% (n=19326) per hospital. Cesarean rates were normally distributed. Using a quality control performance chart with a cutoff 2 standard deviations from the mean, 1 hospital was above the normal range for both total and elective cesareans, indicating that its pre-labor obstetric practices warrant clinical review. Another hospital had a mean emergency cesarean rate above the normal range, indicating that its labor ward practices warrant review. CONCLUSION: Quality control performance charts can be used to analyze cesarean rates nationally and, thus, to identify hospitals at which obstetric practices should be reviewed.

  7. The quality of our Nation's waters-Nutrients in the Nation's streams and groundwater, 1992-2004

    Science.gov (United States)

    Dubrovsky, N.M.; Burow, K.R.; Clark, G.M.; Gronberg, J.M.; Hamilton, P.A.; Hitt, K.J.; Mueller, D.K.; Munn, M.D.; Nolan, B.T.; Puckett, L.J.; Rupert, M.G.; Short, T.M.; Spahr, N.E.; Sprague, L.A.; Wilber, W.G.

    2010-01-01

    National Findings and Their Implications Although the use of artificial fertilizer has supported increasing food production to meet the needs of a growing population, increases in nutrient loadings from agricultural and, to a lesser extent, urban sources have resulted in nutrient concentrations in many streams and parts of aquifers that exceed standards for protection of human health and (or) aquatic life, often by large margins. Do NAWQA findings substantiate national concerns for aquatic and human health? National Water-Quality Assessment (NAWQA) findings indicate that nutrient concentrations in streams and groundwater in basins with significant agricultural or urban development are substantially greater than naturally occurring or ?background? levels. For example, median concentrations of total nitrogen and phosphorus in agricultural streams are about 6 times greater than background levels. Findings also indicate that concentrations in streams routinely were 2 to 10 times greater than regional nutrient criteria recommended by the U.S. Environmental Protection Agency (USEPA) to protect aquatic life. Such large differences in magnitude suggest that significant reductions in sources of nutrients, as well as greater use of land management strategies to reduce the transport of nutrients to streams, are needed to meet recommended criteria for streams draining areas with significant agricultural and urban development. Nitrate concentrations above the Federal drinking-water standard-or Maximum Contaminant Level (MCL)-of 10 milligrams per liter (mg/L, as nit-ogen) are relatively uncommon in samples from streams used for drinking water or from relatively deep aquifers; the MCL is exceeded, however, in more than 20 percent of shallow (less than 100 feet below the water table) domestic wells in agricultural areas. This finding raises concerns for human health in rural agricultural areas where shallow groundwater is used for domestic supply and may warn of future

  8. Using National Ambient Air Quality Standards for fine particulate matter to assess regional wildland fire smoke and air quality management.

    Science.gov (United States)

    Schweizer, Don; Cisneros, Ricardo; Traina, Samuel; Ghezzehei, Teamrat A; Shaw, Glenn

    2017-10-01

    Wildland fire is an important ecological process in the California Sierra Nevada. Personal accounts from pre-20th century describe a much smokier environment than present day. The policy of suppression beginning in the early 20th century and climate change are contributing to increased megafires. We use a single particulate monitoring site at the wildland urban interface to explore impacts from prescribed, managed, and full suppression wildland fires from 2006 to 2015 producing a contextual assessment of smoke impacts over time at the landscape level. Prescribed fire had little effect on local fine particulate matter (PM 2.5 ) air quality with readings typical of similar non-fire times; hourly and daily good to moderate Air Quality Index (AQI) for PM 2.5 , maximum hourly concentrations 21-103 μg m -3 , and mean concentrations between 7.7 and 13.2 μg m -3 . Hourly and daily AQI was typically good or moderate during managed fires with 3 h and one day reaching unhealthy while the site remained below National Ambient Air Quality Standards (NAAQS), with maximum hourly concentrations 27-244 μg m -3 , and mean concentrations 6.7-11.7 μg m -3 . The large high intensity fire in this area created the highest short term impacts (AQI unhealthy for 4 h and very unhealthy for 1 h), 11 unhealthy for sensitive days, and produced the only annual value (43.9 μg m -3 ) over the NAAQS 98th percentile for PM 2.5 (35 μg m -3 ). Pinehurst remained below the federal standards for PM 2.5 when wildland fire in the local area was managed to 7800 ha (8-22% of the historic burn area). Considering air quality impacts from smoke using the NAAQS at a landscape level over time can give land and air managers a metric for broader evaluation of smoke impacts particularly when assessing ecologically beneficial fire. Allowing managers to control the amount and timing of individual wildland fire emissions can help lessen large smoke impacts to public health from a megafire

  9. Recommendations for Cycle II of National Water-Quality Assessment (NAWQA) Program

    Science.gov (United States)

    ,; Mallard, Gail E.; Armbruster, Jeffrey T.; Broshears, Robert E.; Evenson, Eric J.; Luoma, Samuel N.; Phillips, Patrick J.; Prince, Keith R.

    1999-01-01

    The Planning Team for the U.S. Geological Survey (USGS) National Water-Quality Assessment (NAWQA) Program defines a successful NAWQA Program as one that makes a balanced contribution to study-unit issues, national issues, and to the pursuit of scientific knowledge. Using this criterion, NAWQA has been a success. The program has provided important new knowledge and understanding of scientific processes, and insights into the occurrence and distribution of contaminants that have been key to local and national policy decisions. Most of the basic design characteristics of NAWQA's first decade (1991-2000), hereafter called cycle I) remain appropriate as the program enters its second decade (cycle II) in 2001. In cycle II, the program has the opportunity to build on its successful base and to evolve to take advantage of the knowledge generated in cycle I. In addition to this expected evolution, NAWQA must also make some changes to compensate for the fact that program funding has not kept pace with inflation. An important theme for the second cycle of NAWQA will be the integration of knowledge across scales and across disciplines. The question that drove the NAWQA design in the first cycle was "How is water quality related to land use?" Cycle II will build upon what was learned in cycle I and use land-use and water-quality gradients to identify and understand potential sources of various constituents and the processes affecting transport and fate of those constituents and their effects on receptors. The understanding we gain from applying this approach will be relevant to the interests of policymakers, regulatory agencies, and resource managers.

  10. Northern Great Plains Network water quality monitoring design for tributaries to the Missouri National Recreational River

    Science.gov (United States)

    Rowe, Barbara L.; Wilson, Stephen K.; Yager, Lisa; Wilson, Marcia H.

    2013-01-01

    The National Park Service (NPS) organized more than 270 parks with important natural resources into 32 ecoregional networks to conduct Inventory and Monitoring (I&M) activities for assessment of natural resources within park units. The Missouri National Recreational River (NRR) is among the 13 parks in the NPS Northern Great Plain Network (NGPN). Park managers and NGPN staff identified surface water resources as a high priority vital sign to monitor in park units. The objectives for the Missouri NRR water quality sampling design are to (1) assess the current status and long-term trends of select water quality parameters; and (2) document trends in streamflow at high-priority stream systems. Due to the large size of the Missouri River main stem, the NGPN water quality design for the Missouri NRR focuses on wadeable tributaries within the park unit. To correlate with the NGPN water quality protocols, monitoring of the Missouri NRR consists of measurement of field core parameters including dissolved oxygen, pH, specific conductance, and temperature; and streamflow. The purpose of this document is to discuss factors examined for selection of water quality monitoring on segments of the Missouri River tributaries within the Missouri NRR.Awareness of the complex history of the Missouri NRR aids in the current understanding and direction for designing a monitoring plan. Historical and current monitoring data from agencies and entities were examined to assess potential NGPN monitoring sites. In addition, the U.S. Environmental Protection Agency 303(d) list was examined for the impaired segments on tributaries to the Missouri River main stem. Because major tributaries integrate water quality effects from complex combinations of land use and environmental settings within contributing areas, a 20-mile buffer of the Missouri NRR was used to establish environmental settings that may impact the water quality of tributaries that feed the Missouri River main stem. For selection of

  11. National convention on world homoeopathy day: Enhancing quality of research in homoeopathy

    Directory of Open Access Journals (Sweden)

    Bindu Sharma

    2017-01-01

    Full Text Available A national convention on World Homoeopathy Day was held to commemorate the 262nd birth anniversary of Dr. Samuel Hahnemann on 9th–10th April, 2017 at National Agricultural Science Complex, Pusa, New Delhi, India. The theme of the convention was ‘Enhancing Quality of Research in Homoeopathy’ inspired by the World Health Organization Traditional Medicine Strategy 2014–2023 for achieving Universal Health Coverage. Organised by the Central Council for Research in Homoeopathy, an autonomous research organisation of the Ministry of AYUSH, Government of India, the convention witnessed 11 oral presentations and focused group discussions held in parallel in the main and side hall, respectively. On this occasion, Awards of Excellence such as Lifetime Achievement Award, Best Teacher and Researcher Award, Young Scientist Award and Best Research Paper Award were also given.

  12. Development of statistical and analytical techniques for use in national quality control schemes for steroid hormones

    International Nuclear Information System (INIS)

    Wilson, D.W.; Gaskell, S.J.; Fahmy, D.R.; Joyce, B.G.; Groom, G.V.; Griffiths, K.; Kemp, K.W.; Nix, A.B.J.; Rowlands, R.J.

    1979-01-01

    Adopting the rationale that the improvement of intra-laboratory performance of immunometric assays will enable the assessment of national QC schemes to become more meaningful, the group of participating laboratories has developed statistical and analytical techniques for the improvement of accuracy, precision and monitoring of error for the determination of steroid hormones. These developments are now described and their relevance to NQC schemes discussed. Attention has been focussed on some of the factors necessary for improving standards of quality in immunometric assays and their relevance to laboratories participating in NQC schemes as described. These have included the 'accuracy', precision and robustness of assay procedures as well as improved methods for internal quality control. (Auth.)

  13. Development and status of data quality assurance program at NASA Langley research center: Toward national standards

    Science.gov (United States)

    Hemsch, Michael J.

    1996-01-01

    As part of a continuing effort to re-engineer the wind tunnel testing process, a comprehensive data quality assurance program is being established at NASA Langley Research Center (LaRC). The ultimate goal of the program is routing provision of tunnel-to-tunnel reproducibility with total uncertainty levels acceptable for test and evaluation of civilian transports. The operational elements for reaching such levels of reproducibility are: (1) statistical control, which provides long term measurement uncertainty predictability and a base for continuous improvement, (2) measurement uncertainty prediction, which provides test designs that can meet data quality expectations with the system's predictable variation, and (3) national standards, which provide a means for resolving tunnel-to-tunnel differences. The paper presents the LaRC design for the program and discusses the process of implementation.

  14. A national study of nurse leadership and supports for quality improvement in rural hospitals.

    Science.gov (United States)

    Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer

    2013-01-01

    This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.

  15. Present status of quality assurance system for radiation therapy in the national hospital and sanatorium

    International Nuclear Information System (INIS)

    Uno, Takashi; Itami, Jun; Kotaka, Kikuo; Terui, Takashi

    1994-01-01

    In order to improve the precision of radiation therapy and structure of radiation oncology, the state of quality assurance (QA) system for external radiation therapy in Japanese national hospitals and sanatoriums were investigated, by a questionnaire method. The questionnaire included the equipments, the personnel, and a frequency in quality assurance check of each radiation therapy facilities. The results clarified that real photon energy of megavoltage equipment was measured in only 57% of 58% institutions; frequency of the dose monitor calibration was suboptimal; personnel scale was markedly insufficient; some treatment-related apparatus was inappropriately arranged between institutions. Based on these results, it was considered that the precision of radiation therapy and its QA state could not be improved without personnel sufficiency. In the present situation, we should consider the arrangement of treatment facilities in each area and specialization of radiation therapy between institutions. (author)

  16. Construction quality assurance closure report, Lawrence Livermore National Laboratory Site 300, Pits 1 and 7

    International Nuclear Information System (INIS)

    1993-02-01

    This document presents the Final Construction Quality Assurance (CQA) report for the closure cover system of two mixed, low-level radioactive and hazardous waste landfills (pits) at Site 300. Site 300, operated by the Lawrence Livermore National Laboratory (LLNL), is located in the Altamont Hills, approximately 15 miles southeast of Livermore, California. The purpose of this report is to document the CQA program established to assure that construction is completed in accordance with the design intent and the approved Closure and Post Closure Plans dated May 1989 and revised January 1990 (EPA ID Number: CA 2890090002). Inclusive within the Closure and Post Closure Plan were the CQA Plan and the Technical Specifications for the final cover system. This report contains a complete narrative with photographic documentation of the construction activities and progress, problems encountered and solutions utilized, and third party testing and monitoring results, thus establishing the verification of compliance with the Quality Assurance Plan for the project

  17. Implementation of quality management systems and progress towards accreditation of National Tuberculosis Reference Laboratories in Africa

    Directory of Open Access Journals (Sweden)

    Heidi Albert

    2017-03-01

    Full Text Available Background: Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS and laboratory accreditation are key to improving patient care. Objectives: The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs in the African Region. Method: An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region. Results: A total of 21 laboratories (43.0% had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%, although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing. Barriers to accreditation included lack of training and accreditation programmes. Only 28.6%of NTRLs had developed strategic plans and budgets which included accreditation. Conclusion: Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient

  18. Quality of communication about medicines in United States hospitals: A national retrospective study.

    Science.gov (United States)

    Mullings, Lauren; Sankaranarayanan, Jayashri

    Despite the benefits of improving transitions across care, literature is very limited on inpatient "Communication about Medicines" (ComMed) by staff across United States (U.S.) hospitals. To evaluate ComMed quality variations by hospital characteristics. In a cross-sectional, retrospective study of publicly available U.S. Medicare's Hospital Consumer Assessment of Health Care Plans Survey (HCAHPS) data (January 2013-September 2014), ComMed quality (high = above average/excellent vs. low = average/below average/poor star ratings) of 3125 hospitals were compared across region, rural-urban location, and health information technology (HIT) infrastructure giving providers access to patients' electronic medical records. Multivariate logistic regression analysis was conducted with adjusting for confounders (hospital - bed size, ownership, type, ED services, the number of completed HCAHPS surveys). After adjusting for other characteristics, Midwest versus Western region hospitals (OR = 1.55, 95% CI: 1.21-1.98, p=quality. Hospitals' small bed-size, physician/non-profit ownership, critical-access type, absent ED services, and 100-299 HCAHPS completed surveys were more likely to be associated with high ComMed quality. One of the first national studies found significant variations in ComMed quality across U.S. hospitals by location (high in Midwest and low in Northeast regions and urban areas) and by access to HIT infrastructure (high) after controlling for other hospital characteristics. With this baseline data, hospital providers and policymakers can design, implement, and evaluate service programs with pharmacists and HIT to enhance ComMed quality in the future delivery of patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Assessment of the quality of service provided by a national regulatory institution

    Directory of Open Access Journals (Sweden)

    Adetunji, O.

    2013-05-01

    Full Text Available Government institutions need to assess how well they meet the needs of their customers, and what their customers think about the quality of the services they provide. This is aligned with the Batho Pele principle of the South African government. The SERVQUAL scale, augmented with a qualitative survey, was used to determine how the National Home Builders Registration Council (NHBRC is perceived by its clients, which key factors drive such perceptions, and whether the perceptions are consistent across the different client groups of this regulatory institution. The complementary role of qualitative data in illuminating issues driving quantitative results is highlighted. Service quality scores are computed for the NHBRC. The convergence of opinions of different customer groups was studied using correlation analysis. The significance of service quality perception gaps was tested using the multivariate analysis of variance, and the reliability of the SERVQUAL scale was examined using exploratory factor analysis. It was observed that by improving the feedback mechanism of the NHBRC, their clients customer service quality perceptions could be enhanced.

  20. Impact of National Ambient Air Quality Standards Nonattainment Designations on Particulate Pollution and Health.

    Science.gov (United States)

    Zigler, Corwin M; Choirat, Christine; Dominici, Francesca

    2018-03-01

    Despite dramatic air quality improvement in the United States over the past decades, recent years have brought renewed scrutiny and uncertainty surrounding the effectiveness of specific regulatory programs for continuing to improve air quality and public health outcomes. We employ causal inference methods and a spatial hierarchical regression model to characterize the extent to which a designation of "nonattainment" with the 1997 National Ambient Air Quality Standard for ambient fine particulate matter (PM2.5) in 2005 causally affected ambient PM2.5 and health outcomes among over 10 million Medicare beneficiaries in the Eastern United States in 2009-2012. We found that, on average across all retained study locations, reductions in ambient PM2.5 and Medicare health outcomes could not be conclusively attributed to the nonattainment designations against the backdrop of other regional strategies that impacted the entire Eastern United States. A more targeted principal stratification analysis indicates substantial health impacts of the nonattainment designations among the subset of areas where the designations are estimated to have actually reduced ambient PM2.5 beyond levels achieved by regional measures, with noteworthy reductions in all-cause mortality, chronic obstructive pulmonary disorder, heart failure, ischemic heart disease, and respiratory tract infections. These findings provide targeted evidence of the effectiveness of local control measures after nonattainment designations for the 1997 PM2.5 air quality standard.

  1. Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

    Science.gov (United States)

    Kang, Yu; Meng, Hongdao; Miller, Nancy A

    2011-12-01

    To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

  2. The National Water-Quality Assessment Program Invertebrate Data Analysis System (IDAS) Software: Version 3 (User's Manual)

    National Research Council Canada - National Science Library

    Cuffney, Thomas F

    2003-01-01

    ... as part of the National Water-Quality Assessment Program and stored in the Biological Transactional Database (Bio-TDB). The IDAS software is a stand-alone program for personal computers that run Microsoft...

  3. Trends in surface-water quality at selected National Stream Quality Accounting Network (NASQAN) stations, in Michigan

    Science.gov (United States)

    Syed, Atiq U.; Fogarty, Lisa R.

    2005-01-01

    To demonstrate the value of long-term, water-quality monitoring, the Michigan Department of Environmental Quality (MDEQ), in cooperation with the U.S. Geological Survey (USGS), initiated a study to evaluate potential trends in water-quality constituents for selected National Stream Quality Accounting Network (NASQAN) stations in Michigan. The goal of this study is to assist the MDEQ in evaluating the effectiveness of water-pollution control efforts and the identification of water-quality concerns. The study included a total of nine NASQAN stations in Michigan. Approximately 28 constituents were analyzed for trend tests. Station selection was based on data availability, land-use characteristics, and station priority for the MDEQ Water Chemistry Monitoring Project. Trend analyses were completed using the uncensored Seasonal Kendall Test in the computer program Estimate Trend (ESTREND), a software program for the detection of trends in water-quality data. The parameters chosen for the trend test had (1) at least a 5-year period of record (2) about 5 percent of the observations censored at a single reporting limit, and (3) 40 percent of the values within the beginning one-fifth and ending one-fifth of the selected period. In this study, a negative trend indicates a decrease in concentration of a particular constituent, which generally means an improvement in water quality; whereas a positive trend means an increase in concentration and possible degradation of water quality. The results of the study show an overall improvement in water quality at the Clinton River at Mount Clemens, Manistee River at Manistee, and Pigeon River near Caseville. The detected trend for these stations show decreases in concentrations of various constituents such as nitrogen compounds, conductance, sulfate, fecal coliform bacteria, and fecal streptococci bacteria. The negative trend may indicate an overall improvement in agricultural practices, municipal and industrial wastewater

  4. How the Triangle of Bologna Quality Assurance, a National Legal Framework and Internal Quality Enhancement Supports Institutional Improvement

    Directory of Open Access Journals (Sweden)

    Veronika Kareva

    2017-06-01

    Full Text Available The Republic of Macedonia (RM has been a part of the Bologna process since 2003. The Ministry of Education, law and policy makers and higher education institutions have actively engaged with its main concepts. In parallel with this, since the adoption of the law on higher education in 2008 and the reform of the Accreditation and Evaluation Board, there have been numerous changes and amendments culminating in the fast-tracked adoption of a new law at the beginning of 2015. Some of its solutions created a huge debate among the academic community, other intellectuals and students themselves, resulting in the postponement of that law and a kind of legal vacuum. In such turbulent circumstances, individual higher education institutions had to consider how and to what extent to adopt and develop relevant standards and guidelines, comply with the legal framework and promote good practice. The aim of this paper is to present how these three aspects, Bologna standards and guidelines for Quality Assurance (QA, a national legal framework and an institutional approach are being reflected, merged and implemented at a relatively young higher education institution. It questions the impact of these three elements on each other and how one institution’s drive for improvement is affected. This is done through a qualitative analysis of the three-fold perspectives. The conclusions and recommendations are expected to be of use to policy makers in the country and region as they evaluate how international trends and good practice fit into the socio-economic and political conditions of RM and similar countries. At the same time, it can demonstrate how far institutional quality assurance and progress can be implemented and recognized in the country itself and by some international stakeholders. It can also prove that the South East European University (SEEU is a national leader in this field as RM has no functioning QA evaluation system, while SEEU has managed to

  5. National water summary 1986; Hydrologic events and ground-water quality

    Science.gov (United States)

    Moody, David W.; Carr, Jerry E.; Chase, Edith B.; Paulson, Richard W.

    1988-01-01

    Ground water is one of the most important natural resources of the United States and degradation of its quality could have a major effect on the welfare of the Nation. Currently (1985), ground water is the source of drinking water for 53 percent of the Nation's population and for more than 97 percent of its rural population. It is the source of about 40 percent of the Nation's public water supply, 33 percent of water for irrigation, and 17 percent of freshwater for selfsupplied industries.Ground water also is the source of about 40 percent of the average annual streamflow in the United States, although during long periods of little or no precipitation, ground-water discharges provide nearly all of the base streamflow. This hydraulic connection between aquifers and streams implies that if a persistent pollutant gets into an aquifer, it eventually could discharge into a stream.Information presented in the 1986 National Water Summary clearly shows that the United States has very large amounts of potable ground water available for use. Although naturally occurring constituents, such as nitrate, and human-induced substances, such as synthetic organic chemicals, frequently are detected in ground water, their concentrations usually do not exceed existing Federal or State standards or guidelines for maximum concentrations in drinking water.Troublesome contamination of ground water falls into two basic categories related to the source or sources of the contamination. Locally, high concentrations of a variety of toxic metals, organic chemicals, and petroleum products have been detected in ground water associated with point sources such as wastedisposal sites, storage-tank leaks, and hazardous chemical spills. These types of local problems commonly occur in densely populated urban areas and industrialized areas. Larger, multicounty areas also have been identified where contamination frequently is found in shallow wells. These areas generally are associated with broad

  6. Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective.

    Science.gov (United States)

    Moore, Laura J; Moore, Frederick A; Todd, S Rob; Jones, Stephen L; Turner, Krista L; Bass, Barbara L

    2010-07-01

    To document the incidence, mortality rate, and risk factors for sepsis and septic shock compared with pulmonary embolism and myocardial infarction in the general-surgery population. Retrospective review. American College of Surgeons National Surgical Quality Improvement Program institutions. General-surgery patients in the 2005-2007 National Surgical Quality Improvement Program data set. Incidence, mortality rate, and risk factors for sepsis and septic shock. Of 363 897 general-surgery patients, sepsis occurred in 8350 (2.3%), septic shock in 5977 (1.6%), pulmonary embolism in 1078 (0.3%), and myocardial infarction in 615 (0.2%). Thirty-day mortality rates for each of the groups were as follows: 5.4% for sepsis, 33.7% for septic shock, 9.1% for pulmonary embolism, and 32.0% for myocardial infarction. The septic-shock group had a greater percentage of patients older than 60 years (no sepsis, 40.2%; sepsis, 51.7%; and septic shock, 70.3%; P surgery resulted in more cases of sepsis (4.5%) and septic shock (4.9%) than did elective surgery (sepsis, 2.0%; septic shock, 1.2%) (P surgery, and the presence of any comorbidity. This study emphasizes the need for early recognition of patients at risk via aggressive screening and the rapid implementation of evidence-based guidelines.

  7. General introduction for the “National field manual for the collection of water-quality data”

    Science.gov (United States)

    ,

    2018-02-28

    BackgroundAs part of its mission, the U.S. Geological Survey (USGS) collects data to assess the quality of our Nation’s water resources. A high degree of reliability and standardization of these data are paramount to fulfilling this mission. Documentation of nationally accepted methods used by USGS personnel serves to maintain consistency and technical quality in data-collection activities. “The National Field Manual for the Collection of Water-Quality Data” (NFM) provides documented guidelines and protocols for USGS field personnel who collect water-quality data. The NFM provides detailed, comprehensive, and citable procedures for monitoring the quality of surface water and groundwater. Topics in the NFM include (1) methods and protocols for sampling water resources, (2) methods for processing samples for analysis of water quality, (3) methods for measuring field parameters, and (4) specialized procedures, such as sampling water for low levels of mercury and organic wastewater chemicals, measuring biological indicators, and sampling bottom sediment for chemistry. Personnel who collect water-quality data for national USGS programs and projects, including projects supported by USGS cooperative programs, are mandated to use protocols provided in the NFM per USGS Office of Water Quality Technical Memorandum 2002.13. Formal training, for example, as provided in the USGS class, “Field Water-Quality Methods for Groundwater and Surface Water,” and field apprenticeships supplement the guidance provided in the NFM and ensure that the data collected are high quality, accurate, and scientifically defensible.

  8. 40 CFR 50.11 - National primary and secondary ambient air quality standards for oxides of nitrogen (with...

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false National primary and secondary ambient air quality standards for oxides of nitrogen (with nitrogen dioxide as the indicator). 50.11 Section 50.11 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL...

  9. Water quality study at the Congaree Swamp National monument of Myers Creek, Reeves Creek and Toms Creek. Technical report

    International Nuclear Information System (INIS)

    Rikard, M.

    1991-11-01

    The Congaree Swamp National Monument is one of the last significant near virgin tracts of bottom land hardwood forests in the Southeast United States. The study documents a water quality monitoring program on Myers Creek, Reeves Creek and Toms Creek. Basic water quality parameters were analyzed. High levels of aluminum and iron were found, and recommendations were made for further monitoring

  10. Quality control of calibration system for area monitors at National Laboratory of Metrology from Ionizing Radiations (LNMRI)

    International Nuclear Information System (INIS)

    Ramos, M.M.O.; Freitas, L.C. de

    1992-01-01

    The quality control of equipment used in calibration from the National Laboratory of Metrology on Ionizing Radiations is presented, with results of standard measure systems and irradiation system. Tables and graphics with the quality of systems are also shown. (C.G.C.)

  11. Photometric Assessment of Night Sky Quality over Chaco Culture National Historical Park

    Science.gov (United States)

    Hung, Li-Wei; Duriscoe, Dan M.; White, Jeremy M.; Meadows, Bob; Anderson, Sharolyn J.

    2018-06-01

    The US National Park Service (NPS) characterizes night sky conditions over Chaco Culture National Historical Park using measurements in the park and satellite data. The park is located near the geographic center of the San Juan Basin of northwestern New Mexico and the adjacent Four Corners state. In the park, we capture a series of night sky images in V-band using our mobile camera system on nine nights from 2001 to 2016 at four sites. We perform absolute photometric calibration and determine the image placement to obtain multiple 45-million-pixel mosaic images of the entire night sky. We also model the regional night sky conditions in and around the park based on 2016 VIIRS satellite data. The average zenith brightness is 21.5 mag/arcsec2, and the whole sky is only ~16% brighter than the natural conditions. The faintest stars visible to naked eyes have magnitude of approximately 7.0, reaching the sensitivity limit of human eyes. The main impacts to Chaco’s night sky quality are the light domes from Albuquerque, Rio Rancho, Farmington, Bloomfield, Gallup, Santa Fe, Grants, and Crown Point. A few of these light domes exceed the natural brightness of the Milky Way. Additionally, glare sources from oil and gas development sites are visible along the north and east horizons. Overall, the night sky quality at Chaco Culture National Historical Park is very good. The park preserves to a large extent the natural illumination cycles, providing a refuge for crepuscular and nocturnal species. During clear and dark nights, visitors have an opportunity to see the Milky Way from nearly horizon to horizon, complete constellations, and faint astronomical objects and natural sources of light such as the Andromeda Galaxy, zodiacal light, and airglow.

  12. Chemical quality of water and bottom sediment, Stillwater National Wildlife Refuge, Lahontan Valley, Nevada

    Science.gov (United States)

    Thodal, Carl E.

    2017-12-28

    The U.S. Geological Survey, in cooperation with the U.S. Fish and Wildlife Service collected data on water and bottom-sediment chemistry to be used to evaluate a new water rights acquisition program designed to enhance wetland habitat in Stillwater National Wildlife Refuge and in Lahontan Valley, Churchill County, Nevada. The area supports habitat critical to the feeding and resting of migratory birds travelling the Pacific Flyway. Information about how water rights acquisitions may affect the quality of water delivered to the wetlands is needed by stakeholders and Stillwater National Wildlife Refuge managers in order to evaluate the effectiveness of this approach to wetlands management. A network of six sites on waterways that deliver the majority of water to Refuge wetlands was established to monitor the quality of streamflow and bottom sediment. Each site was visited every 4 to 6 weeks and selected water-quality field parameters were measured when flowing water was present. Water samples were collected at varying frequencies and analyzed for major ions, silica, and organic carbon, and for selected species of nitrogen and phosphorus, trace elements, pharmaceuticals, and other trace organic compounds. Bottom-sediment samples were collected for analysis of selected trace elements.Dissolved-solids concentrations exceeded the recommended criterion for protection of aquatic life (500 milligrams per liter) in 33 of 62 filtered water samples. The maximum arsenic criterion (340 micrograms per liter) was exceeded twice and the continuous criterion was exceeded seven times. Criteria protecting aquatic life from continuous exposure to aluminum, cadmium, lead, and mercury (87, 0.72, 2.5, and 0.77 micrograms per liter, respectively) were exceeded only once in filtered samples (27, 40, 32, and 36 samples, respectively). Mercury was the only trace element analyzed in bottom-sediment samples to exceed the published probable effect concentration (1,060 micrograms per kilogram).

  13. 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.

  14. Field methods and quality-assurance plan for water-quality activities and water-level measurements, U.S. Geological Survey, Idaho National Laboratory, Idaho

    Science.gov (United States)

    Bartholomay, Roy C.; Maimer, Neil V.; Wehnke, Amy J.

    2014-01-01

    Water-quality activities and water-level measurements by the personnel of the U.S. Geological Survey (USGS) Idaho National Laboratory (INL) Project Office coincide with the USGS mission of appraising the quantity and quality of the Nation’s water resources. The activities are carried out in cooperation with the U.S. Department of Energy (DOE) Idaho Operations Office. Results of the water-quality and hydraulic head investigations are presented in various USGS publications or in refereed scientific journals and the data are stored in the National Water Information System (NWIS) database. The results of the studies are used by researchers, regulatory and managerial agencies, and interested civic groups. In the broadest sense, quality assurance refers to doing the job right the first time. It includes the functions of planning for products, review and acceptance of the products, and an audit designed to evaluate the system that produces the products. Quality control and quality assurance differ in that quality control ensures that things are done correctly given the “state-of-the-art” technology, and quality assurance ensures that quality control is maintained within specified limits.

  15. Field Methods and Quality-Assurance Plan for Quality-of-Water Activities, U.S. Geological Survey, Idaho National Laboratory, Idaho

    Science.gov (United States)

    Knobel, LeRoy L.; Tucker, Betty J.; Rousseau, Joseph P.

    2008-01-01

    Water-quality activities conducted by the staff of the U.S. Geological Survey (USGS) Idaho National Laboratory (INL) Project Office coincide with the USGS mission of appraising the quantity and quality of the Nation's water resources. The activities are conducted in cooperation with the U.S. Department of Energy's (DOE) Idaho Operations Office. Results of the water-quality investigations are presented in various USGS publications or in refereed scientific journals. The results of the studies are highly regarded, and they are used with confidence by researchers, regulatory and managerial agencies, and interested civic groups. In its broadest sense, quality assurance refers to doing the job right the first time. It includes the functions of planning for products, review and acceptance of the products, and an audit designed to evaluate the system that produces the products. Quality control and quality assurance differ in that quality control ensures that things are done correctly given the 'state-of-the-art' technology, and quality assurance ensures that quality control is maintained within specified limits.

  16. Strengthening of national capacity in implementation of antimalarial drug quality assurance in Thailand.

    Science.gov (United States)

    Vijaykadga, Saowanit; Cholpol, Sawat; Sitthimongkol, Saipin; Pawaphutanan, Anusorn; Pinyoratanachot, Arunya; Rojanawatsirivet, Chaiporn; Kovithvattanapong, Rojana; Thimasarn, Krongthong

    2006-01-01

    Substandard and counterfeit pharmaceutical products, including antimalarial drugs, appear to be widespread internationally and affect both the developing and developed countries. The aim of the study was to investigate the quality of antimalarial drugs, ie, artesunate (ART), chloroquine (CHL), mefloquine (MEF), quinine (QUI), sulfadoxine/pyrimethamine (S/P) and tetracycline (TT) obtained from the government sector and private pharmacies in 4 Thai provinces: Mae Hong Son, Kanchanaburi, Ranong, and Chanthaburi. Three hundred sixty-nine samples of 6 antimalarial drugs from 27 government hospitals, 27 malaria clinics, and 53 drugstores, were collected. Drug quality was assessed by simple disintegration test and semi-quantitative thin-layer chromatography in each province; 10% passed, 100% failed and doubtful samples were sent to be verified by high performance liquid chromatography (HPLC) at the Thai National Drug Analysis Laboratory, (NL). Fifteen point four percent of ART, 11.1% of CHL and 29.4% of QUI were substandard. Based on the finding, drug regulatory authorities in the country took appropriate action against violators to ensure that antimalarial drugs consumed by malaria patients are of good quality.

  17. Air quality investigations of the Sandia National Laboratories Sol se Mete Aerial Cable Facility

    International Nuclear Information System (INIS)

    Gutman, W.M.; Silver, R.J.

    1994-12-01

    The air quality implications of the test and evaluation activities at the Sandia National Laboratories Sol se Mete Aerial Cable Facility are examined. All facets of the activity that affect air quality are considered. Air contaminants produced directly include exhaust products of rocket motors used to accelerate test articles, dust and gas from chemical explosives, and exhaust gases from electricity generators in the test arenas. Air contaminants produced indirectly include fugitive dust and exhaust contaminants from vehicles used to transport personnel and material to the test area, and effluents produced by equipment used to heat the project buildings. Both the ongoing program and the proposed changes in the program are considered. Using a reliable estimate of th maximum annual testing level, the quantities of contaminants released by project activities ar computed either from known characteristics of test items or from EPA-approved emission factors Atmospheric concentrations of air contaminants are predicted using EPA dispersion models. The predicted quantities and concentrations are evaluated in relation to Federal, New Mexico, an Bernalillo County air quality regulations and the human health and safety standards of the American Conference of Governmental Industrial Hygienists

  18. Real-time water quality monitoring at a Great Lakes National Park

    Science.gov (United States)

    Byappanahalli, Muruleedhara; Nevers, Meredith; Shively, Dawn; Spoljaric, Ashley; Otto, Christopher

    2018-01-01

    Quantitative polymerase chain reaction (qPCR) was used by the USEPA to establish new recreational water quality criteria in 2012 using the indicator bacteria enterococci. The application of this method has been limited, but resource managers are interested in more timely monitoring results. In this study, we evaluated the efficacy of qPCR as a rapid, alternative method to the time-consuming membrane filtration (MF) method for monitoring water at select beaches and rivers of Sleeping Bear Dunes National Lakeshore in Empire, MI. Water samples were collected from four locations (Esch Road Beach, Otter Creek, Platte Point Bay, and Platte River outlet) in 2014 and analyzed for culture-based (MF) and non-culture-based (i.e., qPCR) endpoints using Escherichia coli and enterococci bacteria. The MF and qPCR enterococci results were significantly, positively correlated overall (r = 0.686, p Water quality standard exceedances based on enterococci levels by qPCR were lower than by MF method: 3 and 16, respectively. Based on our findings, we conclude that qPCR may be a viable alternative to the culture-based method for monitoring water quality on public lands. Rapid, same-day results are achievable by the qPCR method, which greatly improves protection of the public from water-related illnesses.

  19. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan part 2 mappings for the ASC software quality engineering practices, version 2.0.

    Energy Technology Data Exchange (ETDEWEB)

    Heaphy, Robert; Sturtevant, Judith E.; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR001.3.2 and CPR001.3.6 and to a Department of Energy document, ''ASCI Software Quality Engineering: Goals, Principles, and Guidelines''. This document also identifies ASC management and software project teams' responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  20. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1 : ASC software quality engineering practices version 1.0.

    Energy Technology Data Exchange (ETDEWEB)

    Minana, Molly A.; Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Forsythe, Christi A.; Schofield, Joseph Richard, Jr.; Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2005-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in DOE/AL Quality Criteria (QC-1) as conformance to customer requirements and expectations. This quality plan defines the ASC program software quality practices and provides mappings of these practices to the SNL Corporate Process Requirements (CPR 1.3.2 and CPR 1.3.6) and the Department of Energy (DOE) document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines (GP&G). This quality plan identifies ASC management and software project teams' responsibilities for cost-effective software engineering quality practices. The SNL ASC Software Quality Plan establishes the signatories commitment to improving software products by applying cost-effective software engineering quality practices. This document explains the project teams opportunities for tailoring and implementing the practices; enumerates the practices that compose the development of SNL ASC's software products; and includes a sample assessment checklist that was developed based upon the practices in this document.

  1. Assessment of national dosimetry quality audits results for teletherapy machines from 1989 to 2015.

    Science.gov (United States)

    Muhammad, Wazir; Ullah, Asad; Mahmood, Khalid; Matiullah

    2016-01-01

    The purpose of this study was to ensure accuracy in radiation dose delivery, external dosimetry quality audit has an equal importance with routine dosimetry performed at clinics. To do so, dosimetry quality audit was organized by the Secondary Standard Dosimetry Laboratory (SSDL) of Pakistan Institute of Nuclear Science and Technology (PINSTECH) at the national level to investigate and minimize uncertainties involved in the measurement of absorbed dose, and to improve the accuracy of dose measurement at different radiotherapy hospitals. A total of 181 dosimetry quality audits (i.e., 102 of Co-60 and 79 of linear accelerators) for teletherapy units installed at 22 different sites were performed from 1989 to 2015. The percent deviation between users’ calculated/stated dose and evaluated dose (in the result of on-site dosimetry visits) were calculated and the results were analyzed with respect to the limits of ± 2.5% (ICRU "optimal model") ± 3.0% (IAEA on-site dosimetry visits limit) and ± 5.0% (ICRU minimal or "lowest acceptable" model). The results showed that out of 181 total on-site dosimetry visits, 20.44%, 16.02%, and 4.42% were out of acceptable limits of ± 2.5% ± 3.0%, and ± 5.0%, respectively. The importance of a proper ongoing quality assurance program, recommendations of the followed protocols, and properly calibrated thermometers, pressure gauges, and humidity meters at radiotherapy hospitals are essential in maintaining consistency and uniformity of absorbed dose measurements for precision in dose delivery.

  2. Quality-assurance plan and field methods for quality-of-water activities, U.S. Geological Survey, Idaho National Engineering Laboratory, Idaho

    International Nuclear Information System (INIS)

    Mann, L.J.

    1996-10-01

    Water-quality activities at the Idaho National Engineering Laboratory (INEL) Project Office are part of the US Geological Survey's (USGS) Water Resources Division (WRD) mission of appraising the quantity and quality of the Nation's water resources. The purpose of the Quality Assurance Plan (QAP) for water-quality activities performed by the INEL Project Office is to maintain and improve the quality of technical products, and to provide a formal standardization, documentation, and review of the activities that lead to these products. The principles of this plan are as follows: (1) water-quality programs will be planned in a competent manner and activities will be monitored for compliance with stated objectives and approaches; (2) field, laboratory, and office activities will be performed in a conscientious and professional manner in accordance with specified WRD practices and procedures by qualified and experienced employees who are well trained and supervised, if or when, WRD practices and procedures are inadequate, data will be collected in a manner that its quality will be documented; (3) all water-quality activities will be reviewed for completeness, reliability, credibility, and conformance to specified standards and guidelines; (4) a record of actions will be kept to document the activity and the assigned responsibility; (5) remedial action will be taken to correct activities that are deficient

  3. National environmental policy act disclosure of air quality impacts for prescribed fire projects in national forests in the Pacific Southwest Region

    Science.gov (United States)

    Suraj Ahuja; Laurie Perrot

    2008-01-01

    A key purpose of the National Environmental Policy Act (NEPA) is to “promote effortswhich will prevent or eliminate damage to the environment and biosphere and stimulate thehealth and welfare of man” (NEPA, Sec 2). The Council on Environmental Quality states “theNEPA process is intended to help public officials make decisions that...

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

    Science.gov (United States)

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

    2004-01-01

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

  5. Readmission After Craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis.

    Science.gov (United States)

    Dasenbrock, Hormuzdiyar H; Yan, Sandra C; Smith, Timothy R; Valdes, Pablo A; Gormley, William B; Claus, Elizabeth B; Dunn, Ian F

    2017-04-01

    Although readmission has become a common quality indicator, few national studies have examined this metric in patients undergoing cranial surgery. To utilize the prospective National Surgical Quality Improvement Program 2011-2013 registry to evaluate the predictors of unplanned 30-d readmission and postdischarge mortality after cranial tumor resection. Multivariable logistic regression was applied to screen predictors, which included patient age, sex, tumor location and histology, American Society of Anesthesiologists class, functional status, comorbidities, and complications from the index hospitalization. Of the 9565 patients included, 10.7% (n = 1026) had an unplanned readmission. Independent predictors of unplanned readmission were male sex, infratentorial location, American Society of Anesthesiologists class 3 designation, dependent functional status, a bleeding disorder, and morbid obesity (all P ≤ .03). Readmission was not associated with operative time, length of hospitalization, discharge disposition, or complications from the index admission. The most common reasons for readmission were surgical site infections (17.0%), infectious complications (11.0%), venous thromboembolism (10.0%), and seizures (9.4%). The 30-d mortality rate was 3.2% (n = 367), of which the majority (69.7%, n = 223) occurred postdischarge. Independent predictors of postdischarge mortality were greater age, metastatic histology, dependent functional status, hypertension, discharge to institutional care, and postdischarge neurological or cardiopulmonary complications (all P Readmissions were common after cranial tumor resection and often attributable to new postdischarge complications rather than exacerbations of complications from the initial hospitalization. Moreover, the majority of 30-d deaths occurred after discharge from the index hospitalization. The preponderance of postdischarge mortality and complications requiring readmission highlights the importance of posthospitalization

  6. A contemporary analysis of Fournier gangrene using the National Surgical Quality Improvement Program.

    Science.gov (United States)

    Kim, Stanley Y; Dupree, James M; Le, Brian V; Kim, Dae Y; Zhao, Lee C; Kundu, Shilajit D

    2015-05-01

    To determine a nationwide contemporary description of surgical Fournier gangrene (FG) and necrotizing fasciitis of the genitalia (NFG) outcomes because historically reported mortality rates for FG and NFG are based on small single-institution studies from the 1980s and the 1990s. The National Surgical Quality Improvement Program is a risk-adjusted surgical database used by nearly 400 hospitals nationwide, which tracks preoperative, intraoperative, and 30-day postoperative clinical variables. Data are extracted from patient charts by an independent surgical clinical reviewer at each hospital. Using the National Surgical Quality Improvement Program data from 2005 to 2009, we calculated 30-day mortality rates and identified preoperative factors associated with increased mortality. A total of 650 patients were identified with surgery for FG or NFG. Fourteen patients with do not resuscitate orders placed preoperatively were excluded from analyses. For the remaining 636 patients, the overall 30-day mortality was 10.1% (64 of 636). Fifty-seven percent of patients (360 of 636) were men, 70% (446 of 636) were white, and 13% (81 of 636) were African American. Multivariate logistic regression indicated that increased age (odds ratio [OR], 1.041; P = .004), body mass index (OR, 1.045; P <.001), and preoperative white blood cell count (OR, 1.061; P = .001), and decreased platelet count (OR, 0.993; P <.001) were all associated with increased risk of death. We determined a surgical mortality rate for FG-NFG of 10.1%. This rate is about half of historically published estimates and similar to recent studies. The lower rate may indicate improvements in therapy. Increased age, body mass index, and white blood cell count, and decreased platelet count were all associated with an increased risk of 30-day mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Implementation of the quality assurance programmes for radiotherapy at the national level

    International Nuclear Information System (INIS)

    Jaervinen, H.

    1997-01-01

    In Finland, the general principles and objectives of the QA are being more and more incorporated in the basic curricula of radiotherapy professionals: radiotherapists, radiation technologists (nurses), and the physicists, in particular. The medical physicists are identified as an independent specialty which, after the general studies in physics requires a special examination and five years practicing in various aspects of radiotherapy clinical work. Specific meetings organized both occasionally and regularly by national societies, hospitals and the authorities collect together different specialists in the field, thus providing opportunities for continuous up-keeping of knowledge and the exchange of experiences in QA. The Finnish Centre for Radiation and nuclear Safety (STUK), operating under the Ministry of Social Affairs and Health, is the national authority for radiation protection covering all fields of the application of radiation. Besides its supervisory role, i.e. to control that the safety of various applications meets the requirements et by legislation, considerable amount of the resources are devoted to research in support of the supervisory activities. For radiotherapy, the leading principle is to ensure the safety of patients, personnel and the public, the good accuracy of the dose to the patient being one of the main objectives. In essence, this leading principle manifests itself through the maintenance of standards, measurement techniques and calibration services traceable to the international measurement system, and through the legal inspections as well as independent reviews and measurements to assess the QA systems of hospitals (i.e. through Dosimetry Audits or Quality Audits)

  8. Modelling air quality according to INSPIRE data specifications, ISO standards and national regulations

    Directory of Open Access Journals (Sweden)

    Pachelski Wojciech

    2017-12-01

    Full Text Available Protection of the environment is an activity of many institutions, organizations and communities from global to regional and local scales. Any activity in this area needs structured database records, using advanced methodology, given, among others, in INSPIRE documents, ISO standards of 19100 series, and national regulations. The goal of this paper is to analyse both the legal provisions related to the air quality and also data sources associated with the prevention of air pollution. Furthermore, the UML application schema of the spatial data related to the air protection is proposed, for the use by urban planners. Also, the overview of the methodology of geographic information is given, including the Unified Modelling Language (UML, as well as the basic concepts of conceptual models within the INSPIRE project. The study is based on the relevant literature and documents, as well as on the expert knowledge gained through urban planning practice, as well as on the analysis of the spatial planning regulations. The UML application schema for different aspects related to the air protection, as presented in this paper, is an example of how to use the methodology also in other fields of the environment protection. Spatial planners know how to improve the air quality, but in the present state of law they often suffer from the lack of planning tools for real actions. In the spatial planners work an important issue are data that allow a thorough analysis of the area.

  9. An evaluation of the readability of drinking water quality reports: a national assessment.

    Science.gov (United States)

    Roy, Siddhartha; Phetxumphou, Katherine; Dietrich, Andrea M; Estabrooks, Paul A; You, Wen; Davy, Brenda M

    2015-09-01

    The United States Environmental Protection Agency mandates that community water systems (or water utilities) provide annual consumer confidence reports (CCRs)--water quality reports--to their consumers. These reports encapsulate information regarding sources of water, detected contaminants, regulatory compliance, and educational material. These reports have excellent potential for providing the public with accurate information on the safety of tap water, but there is a lack of research on the degree to which the information can be understood by a large proportion of the population. This study evaluated the readability of a nationally representative sample of 30 CCRs, released between 2011 and 2013. Readability (or 'comprehension difficulty') was evaluated using Flesch-Kincaid readability tests. The analysis revealed that CCRs were written at the 11th-14th grade level, which is well above the recommended 6th-7th grade level for public health communications. The CCR readability ease was found to be equivalent to that of the Harvard Law Review journal. These findings expose a wide chasm that exists between current water quality reports and their effectiveness toward being understandable to US residents. Suggestions for reorienting language and scientific information in CCRs to be easily comprehensible to the public are offered.

  10. Performance management excellence among the Malcolm Baldrige National Quality Award Winners in Health Care.

    Science.gov (United States)

    Duarte, Neville T; Goodson, Jane R; Arnold, Edwin W

    2013-01-01

    When carefully constructed, performance management systems can help health care organizations direct their efforts toward strategic goals, high performance, and continuous improvement needed to ensure high-quality patient care and cost control. The effective management of performance is an integral component in hospital and health care systems that are recognized for excellence by the Malcolm Baldrige National Quality Award in Health Care. Using the framework in the 2011-2012 Health Care Criteria for Performance Excellence, this article identifies the best practices in performance management demonstrated by 15 Baldrige recipients. The results show that all of the recipients base their performance management systems on strategic goals, outcomes, or competencies that cascade from the organizational to the individual level. At the individual level, each hospital or health system reinforces the strategic direction with performance evaluations of leaders and employees, including the governing board, based on key outcomes and competencies. Leader evaluations consistently include feedback from internal and external stakeholders, creating a culture of information sharing and performance improvement. The hospitals or health care systems also align their reward systems to promote high performance by emphasizing merit and recognition for contributions. Best practices can provide a guide for leaders in other health systems in developing high-performance work systems.

  11. Quality management at Argonne National Laboratory: Status, accomplishments, and lessons learned

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-06-01

    In April 1992, Argonne National Laboratory (ANL) launched the implementation of quality management (QM) as an initiative of the Laboratory Director. The goal of the program is to seek ways of improving Laboratory performance and effectiveness by drawing from the realm of experiences in the global total quality management movement. The Argonne QM initiative began with fact finding and formulating a strategy for implementation; the emphasis is that the underlying principles of QM should be an integral part of how the Laboratory is managed and operated. A primary theme that has guided the Argonne QM initiative is to consider only those practices that offer the potential for real improvement, make sense, fit the culture, and would be credible to the broad population. In October 1993, the Laboratory began to pilot a targeted set of QM activities selected to produce outcomes important to the Laboratory--strengthening the customer focus, improving work processes, enhancing employee involvement and satisfaction, and institutionalizing QM. This report describes the results of the just-concluded QM development and demonstration phase in terms of detailed strategies, accomplishments, and lessons learned. These results are offered as evidence to support the conclusion that the Argonne QM initiative has achieved value-added results and credibility and is well positioned to support future deployment across the entire Laboratory as an integrated management initiative. Recommendations for follow-on actions to implement future deployment are provided separately.

  12. Quality assurance of chemical ingredient classification for the National Drug File - Reference Terminology.

    Science.gov (United States)

    Zheng, Ling; Yumak, Hasan; Chen, Ling; Ochs, Christopher; Geller, James; Kapusnik-Uner, Joan; Perl, Yehoshua

    2017-09-01

    The National Drug File - Reference Terminology (NDF-RT) is a large and complex drug terminology consisting of several classification hierarchies on top of an extensive collection of drug concepts. These hierarchies provide important information about clinical drugs, e.g., their chemical ingredients, mechanisms of action, dosage form and physiological effects. Within NDF-RT such information is represented using tens of thousands of roles connecting drugs to classifications. In previous studies, we have introduced various kinds of Abstraction Networks to summarize the content and structure of terminologies in order to facilitate their visual comprehension, and support quality assurance of terminologies. However, these previous kinds of Abstraction Networks are not appropriate for summarizing the NDF-RT classification hierarchies, due to its unique structure. In this paper, we present the novel Ingredient Abstraction Network (IAbN) to summarize, visualize and support the audit of NDF-RT's Chemical Ingredients hierarchy and its associated drugs. A common theme in our quality assurance framework is to use characterizations of sets of concepts, revealed by the Abstraction Network structure, to capture concepts, the modeling of which is more complex than for other concepts. For the IAbN, we characterize drug ingredient concepts as more complex if they belong to IAbN groups with multiple parent groups. We show that such concepts have a statistically significantly higher rate of errors than a control sample and identify two especially common patterns of errors. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Student Assessment of Quality of Access at the National Open University of Nigeria (NOUN

    Directory of Open Access Journals (Sweden)

    Juliet Obhajajie Inegbedion

    2016-12-01

    Full Text Available This paper presents a study conducted by Inegbedion, Adu and Ofulue from the National Open University of Nigeria. The study focused on the quality of access (admission and registration at NOUN from a student perspective. A survey design was used for the study while a multi-stage sampling technique was used to select the sample size. All the 78,555 registered students in all the 61 Study Centres of the University at the time of the study formed the population; out of which 3,060 students were sampled. The questionnaire instrument is the Institutional Internal QA Tools and Instrument developed by the African Council for Distance Education (ACDE as a regulatory mechanism. The data collected were analyzed using simple statistics. The result showed that 66% of the students confirmed that NOUN has published clear policies on the admission and registration of students. About 29.1% of the students were not satisfied with the transparency of the admission process. In conclusion, the study revealed high quality of access and some deficiencies in website and Internet connectivity.

  14. Transuranic waste examination quality assurance at the Idaho National Engineering Laboratory

    International Nuclear Information System (INIS)

    Bower, J.M.

    1987-01-01

    Since 1954, defense-generated transuranic (TRU) waste has been received at the Radioactive Waste Management Complex (RWMC) at the Idaho National Engineering Laboratory (INEL). A major objective of the Department of Energy (DOE) Nuclear Waste Management Programs is the proper management of the defense-generated TRU waste. The Stored Waste Examination Pilot Plant (SWEPP) is providing nondestructive examination and assay of retrievably stored contact handled TRU waste in order to certify it to the Waste Isolation Pilot Plant Waste Acceptance Crtieria (WIPP-WAC). SWEPP's capabilities for certifying contact handled waste containers include weighing, real-time radiographic examination, fissile material assay examination, container integrity examination, radiological surveys and labeling of waste containers. These processes involve not only instrument accuracy but also a wide range of technician interpretation from moderate on the assay to 100% on the radiograph. This, therefore, requires a variety of quality assurance techniques to ensure that the examinations and certifications are being performed correctly. The purpose of this paper is to discuss the methods utilized by SWEPP for checking on the examination process and to ensure that waste certifications are being properly performed. Included is the application of the quality assurance techniques to each examination system, the management of the data generated by the examination, and the verifications to ensure accurate certification. 1 ref

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

    Science.gov (United States)

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

    2010-01-01

    In 1991, the U.S. Congress established the U.S. Geological Survey (USGS) National Water-Quality Assessment (NAWQA) Program to develop long-term, nationally consistent information on the quality of the Nation's streams and groundwater. Congress recognized the critical need for this information to support scientifically sound management, regulatory, and policy decisions concerning the increasingly stressed water resources of the Nation. The long-term goals of NAWQA are to: (1) assess the status of water-quality conditions in the United States, (2) evaluate long-term trends in water-quality conditions, and (3) link status and trends with an understanding of the natural and human factors that affect water quality. These goals are national in scale, include both surface water and groundwater, and include consideration of water quality in relation to both human uses and aquatic ecosystems. Since 1991, NAWQA assessments and findings have fostered and supported major improvements in the availability and use of unbiased scientific information for decisionmaking, resource management, and planning at all levels of government. These improvements have enabled agencies and stakeholders to cost-effectively address a wide range of water-quality issues related to natural and human influences on the quality of water and potential effects on aquatic ecosystems and human health (http://water.usgs.gov/nawqa/xrel.pdf). NAWQA, like all USGS programs, provides policy relevant information that serves as a scientific basis for decisionmaking related to resource management, protection, and restoration. The information is freely available to all levels of government, nongovernmental organizations, industry, academia, and the public, and is readily accessible on the NAWQA Web site and other diverse formats to serve the needs of the water-resource community at different technical levels. Water-quality conditions in streams and groundwater are described in more than 1,700 publications (available

  16. NOAA's National Air Quality Prediction and Development of Aerosol and Atmospheric Composition Prediction Components for NGGPS

    Science.gov (United States)

    Stajner, I.; McQueen, J.; Lee, P.; Stein, A. F.; Wilczak, J. M.; Upadhayay, S.; daSilva, A.; Lu, C. H.; Grell, G. A.; Pierce, R. B.

    2017-12-01

    NOAA's operational air quality predictions of ozone, fine particulate matter (PM2.5) and wildfire smoke over the United States and airborne dust over the contiguous 48 states are distributed at http://airquality.weather.gov. The National Air Quality Forecast Capability (NAQFC) providing these predictions was updated in June 2017. Ozone and PM2.5 predictions are now produced using the system linking the Community Multiscale Air Quality model (CMAQ) version 5.0.2 with meteorological inputs from the North American Mesoscale Forecast System (NAM) version 4. Predictions of PM2.5 include intermittent dust emissions and wildfire emissions from an updated version of BlueSky system. For the latter, the CMAQ system is initialized by rerunning it over the previous 24 hours to include wildfire emissions at the time when they were observed from the satellites. Post processing to reduce the bias in PM2.5 prediction was updated using the Kalman filter analog (KFAN) technique. Dust related aerosol species at the CMAQ domain lateral boundaries now come from the NEMS Global Aerosol Component (NGAC) v2 predictions. Further development of NAQFC includes testing of CMAQ predictions to 72 hours, Canadian fire emissions data from Environment and Climate Change Canada (ECCC) and the KFAN technique to reduce bias in ozone predictions. NOAA is developing the Next Generation Global Predictions System (NGGPS) with an aerosol and gaseous atmospheric composition component to improve and integrate aerosol and ozone predictions and evaluate their impacts on physics, data assimilation and weather prediction. Efforts are underway to improve cloud microphysics, investigate aerosol effects and include representations of atmospheric composition of varying complexity into NGGPS: from the operational ozone parameterization, GOCART aerosols, with simplified ozone chemistry, to CMAQ chemistry with aerosol modules. We will present progress on community building, planning and development of NGGPS.

  17. Diet quality of cancer survivors and noncancer individuals: Results from a national survey.

    Science.gov (United States)

    Zhang, Fang Fang; Liu, Shanshan; John, Esther M; Must, Aviva; Demark-Wahnefried, Wendy

    2015-12-01

    Patterns of poor nutritional intake may exacerbate the elevated morbidity experienced by cancer survivors. It remains unclear whether cancer survivors adhere to existing dietary guidelines and whether survivors' diets differ from those of individuals without cancer over the long term. The authors evaluated dietary intake and quality in 1533 adult cancer survivors who participated in the National Health and Nutrition Examination Survey from 1999 to 2010 compared with dietary intake and quality in 3075 individuals who had no history of cancer and were matched to the cancer survivors by age, sex, and race/ethnicity. Dietary intake was assessed using 24-hour dietary recalls. The 2010 Healthy Eating Index (HEI-2010) was used to evaluate diet quality. The mean ± standard deviation HEI-2010 total score was 47.2 ± 0.5 in the cancer survivors and 48.3 ± 0.4 in the noncancer group (P = .03). Compared with the noncancer group, cancer survivors had a significantly lower score for empty calories (13.6 vs 14.4; P = .001), which corresponded to worse adherence to dietary intake of calories from solid fats, alcohol, and added sugars. Cancer survivors also had significantly lower dietary intake of fiber than the noncancer group (15.0 vs 15.9 g per day; P = .02). In relation to recommended intake, survivors' mean dietary intake of vitamin D, vitamin E, potassium, fiber, and calcium was 31%, 47%, 55%, 60%, and 73%, respectively; whereas their mean dietary intake of saturated fat and sodium was 112% and 133%, respectively, of the recommended intake. Cancer survivors had poor adherence to the US Department of Agriculture 2010 Dietary Guidelines for Americans, and their intake patterns were worse than those in the general population for empty calories and fiber. © 2015 American Cancer Society.

  18. Water quality and pollution status of Chambal river in National Chambal Sanctuary, Madhya Pradesh.

    Science.gov (United States)

    Saksena, D N; Garg, R K; Rao, R J

    2008-09-01

    The physico-chemical characteristics of Chambal river water in National Chambal sanctuary (Madhya Pradesh) have been studied. The stretch of Chambal river contained in the National Chambal sanctuary (located at 25 degrees 23'-26 degrees 52'N, 76 degrees 28'-79 degrees 15'E) is extending up to 600 km downstream from Kota (Rajasthan) to the confluence of the Chambal with Yamuna river (Etawah). The river flow in Madhya Pradesh spans up to approximately 400 km. Three sampling stations viz., Station A--near Palighat, district Sheopurkalan, Station B--near Rajghat, district Morena and Station C--near Baraighat, district Bhind were established for the collection of water samples during April, 2003 to March, 2004. The water quality parameters namely transparency (12.12-110 cm), colour (transparent-very turbid), turbidity (1-178 TNU), electrical conductivity (145.60-884 microS cm(-1)), total dissolved solids (260-500 mgl(-1)), pH (7.60-9.33), dissolved oxygen (4.86-14.59 mgl(-1)), free carbon dioxide (0-16.5 mgl(-1)), total alkalinity (70-290 mgl(-1)), total hardness (42-140 mgl(-1)), chloride (15.62-80.94 mgl(-1)), nitrate (0.008-0.025 mgl(-1)), nitrite (0.002-0.022 mgl(-1)), sulphate (3.50-45 mgl(-1)), phosphate (0.004-0.050 mgl(-1)), silicate (2.80-13.80 mgl(-1)), biochemical oxygen demand (0.60-5.67 mgl(-1)), chemical oxygen demand (2.40-26.80 mgl(-1)), ammonia (nil-0.56 mgl(-1)), sodium (14.30-54.40 mgl(-1)) and potassium (2.10 mgl(-1)-6.30 mgl(-1)) reflects on the pristine nature of the river in National Chambal sanctuary. On the basis of various parameters studied, Chambal river in this stretch can be placed under the category of oligosaprobic. The water quality analysis, indicated that the riverwater in the sanctuary area is pollution free and can serve as a good habitat for many aquatic animals including endangered species.

  19. Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012.

    Science.gov (United States)

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-03-11

    Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to 'top hospital', best hospital', and 'hospital quality', as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by advertising on Google or Twitter and using social media interactively with consumers looking

  20. Quality in Cross-Border Higher Education and Challenges for the Internationalization of National Quality Assurance Agencies in the Asia-Pacific Region: The Taiwanese Experience

    Science.gov (United States)

    Hou, Angela Yung-chi

    2014-01-01

    Cross-border higher education has created a need to build capacity -- particularly in the internationalization dimension -- for national quality assurance agencies to evaluate cross-border education provided by foreign educational providers, or jointly by local and foreign institutions. This is quickly becoming a key issue in the Asia-Pacific…

  1. National smokefree law in New Zealand improves air quality inside bars, pubs and restaurants

    Directory of Open Access Journals (Sweden)

    Näthe Jenny

    2007-05-01

    Full Text Available Abstract Background: We aimed to: (i assess compliance with a new smokefree law in a range of hospitality settings; and (ii to assess the impact of the new law by measuring air quality and making comparisons with air quality in outdoor smoking areas and with international data from hospitality settings. Methods: We included 34 pubs, restaurants and bars, 10 transportation settings, nine other indoor settings, six outdoor smoking areas of bars and restaurants, and six other outdoor settings. These were selected using a mix of random, convenience and purposeful sampling. The number of lit cigarettes among occupants at defined time points in each venue was observed and a portable real-time aerosol monitor was used to measure fine particulate levels (PM2.5. Results: No smoking was observed during the data collection periods among over 3785 people present in the indoor venues, nor in any of the transportation settings. The levels of fine particulates were relatively low inside the bars, pubs and restaurants in the urban and rural settings (mean 30-minute level = 16 μg/m3 for 34 venues; range of mean levels for each category: 13 μg/m3 to 22 μg/m3. The results for other smokefree indoor settings (shops, offices etc and for smokefree transportation settings (eg, buses, trains, etc were even lower. However, some "outdoor" smoking areas attached to bars/restaurants had high levels of fine particulates, especially those that were partly enclosed (eg, up to a 30-minute mean value of 182 μg/m3 and a peak of maximum value of 284 μg/m3. The latter are far above WHO guideline levels for 24-hour exposure (ie, 25μg/m3. Conclusion: There was very high compliance with the new national smokefree law and this was also reflected by the relatively good indoor air quality in hospitality settings (compared to the "outdoor" smoking areas and the comparable settings in countries that permit indoor smoking. Nevertheless, adopting enhanced regulations (as used in

  2. National smokefree law in New Zealand improves air quality inside bars, pubs and restaurants.

    Science.gov (United States)

    Wilson, Nick; Edwards, Richard; Maher, Anthony; Näthe, Jenny; Jalali, Rafed

    2007-05-18

    We aimed to: (i) assess compliance with a new smokefree law in a range of hospitality settings; and (ii) to assess the impact of the new law by measuring air quality and making comparisons with air quality in outdoor smoking areas and with international data from hospitality settings. We included 34 pubs, restaurants and bars, 10 transportation settings, nine other indoor settings, six outdoor smoking areas of bars and restaurants, and six other outdoor settings. These were selected using a mix of random, convenience and purposeful sampling. The number of lit cigarettes among occupants at defined time points in each venue was observed and a portable real-time aerosol monitor was used to measure fine particulate levels (PM2.5). No smoking was observed during the data collection periods among over 3785 people present in the indoor venues, nor in any of the transportation settings. The levels of fine particulates were relatively low inside the bars, pubs and restaurants in the urban and rural settings (mean 30-minute level = 16 microg/m3 for 34 venues; range of mean levels for each category: 13 microg/m3 to 22 microg/m3). The results for other smokefree indoor settings (shops, offices etc) and for smokefree transportation settings (eg, buses, trains, etc) were even lower. However, some "outdoor" smoking areas attached to bars/restaurants had high levels of fine particulates, especially those that were partly enclosed (eg, up to a 30-minute mean value of 182 microg/m3 and a peak of maximum value of 284 microg/m3). The latter are far above WHO guideline levels for 24-hour exposure (ie, 25 microg/m3). There was very high compliance with the new national smokefree law and this was also reflected by the relatively good indoor air quality in hospitality settings (compared to the "outdoor" smoking areas and the comparable settings in countries that permit indoor smoking). Nevertheless, adopting enhanced regulations (as used in various US and Canadian jurisdictions) may be

  3. Underground Test Area Fiscal Year 2012 Annual Quality Assurance Report Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Farnham, Irene [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States); Marutzky, Sam [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2013-01-01

    This report is mandated by the Underground Test Area (UGTA) Quality Assurance Project Plan (QAPP) and identifies the UGTA quality assurance (QA) activities for fiscal year (FY) 2012. All UGTA organizations—U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO); Desert Research Institute (DRI); Lawrence Livermore National Laboratory (LLNL); Los Alamos National Laboratory (LANL); Navarro-Intera, LLC (N-I); National Security Technologies, LLC (NSTec); and the U.S. Geological Survey (USGS)—conducted QA activities in FY 2012. The activities included conducting assessments, identifying findings and completing corrective actions, evaluating laboratory performance, revising the QAPP, and publishing documents. In addition, processes and procedures were developed to address deficiencies identified in the FY 2011 QAPP gap analysis.

  4. Underground Test Area Fiscal Year 2013 Annual Quality Assurance Report Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Krenzien, Susan [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States); Marutzky, Sam [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2014-01-01

    This report is required by the Underground Test Area (UGTA) Quality Assurance Plan (QAP) and identifies the UGTA quality assurance (QA) activities for fiscal year (FY) 2013. All UGTA organizations—U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office (NNSA/NFO); Desert Research Institute (DRI); Lawrence Livermore National Laboratory (LLNL); Los Alamos National Laboratory (LANL); Navarro-Intera, LLC (N-I); National Security Technologies, LLC (NSTec); and the U.S. Geological Survey (USGS)—conducted QA activities in FY 2013. The activities included conducting assessments, identifying findings and completing corrective actions, evaluating laboratory performance, and publishing documents. In addition, integrated UGTA required reading and corrective action tracking was instituted.

  5. Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012

    Science.gov (United States)

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-01-01

    Objectives Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. Setting and design A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to ‘top hospital’, best hospital’, and ‘hospital quality’, as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. Primary outcome measures (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. Results National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Conclusions Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by

  6. 40 CFR Appendix I to Part 50 - Interpretation of the 8-Hour Primary and Secondary National Ambient Air Quality Standards for Ozone

    Science.gov (United States)

    2010-07-01

    ... Secondary National Ambient Air Quality Standards for Ozone 1. General. This appendix explains the data.... Primary and Secondary Ambient Air Quality Standards for Ozone. 2.1 Data Reporting and Handling Conventions... and Secondary National Ambient Air Quality Standards for Ozone I Appendix I to Part 50 Protection of...

  7. National Economic Development Procedures Manual - Recreation. Volume 4. Evaluating Changes in the Quality of the Recreation Experience

    Science.gov (United States)

    1991-07-31

    harvesting and road building in two national forests. The case study sites were the Siuslaw National Forest near Corvallis, Oregon, and the Porcupine ...million would accrue to recreational and commercial anglers from the clearcutting alternative. For the Porcupine - Hyalite Wilderness Study Area in Montana...impact environmental factors (e.g., available habitat, hunting area, or size of elk herds ), and ultimately those quality factors of the recreation

  8. The assessment of khorramabad River water quality with National Sanitation Foundation Water Quality Index and Zoning by GIS

    Directory of Open Access Journals (Sweden)

    abdolrahim Yusefzadeh

    2014-03-01

    Full Text Available Background : Rivers are a fraction of flowing waters in the worlds and one of the important sources of water for different consumptions such as agricultural, drinking and industrial uses. The aim of this study was to assess water quality of the Khorramrood River in Khorramabad by NSFWQI index. Materials and Methods: In this cross-sectional study, quality parameters needed for NASWQI index calculation such as BOD5, dissolved oxygen (DO, total nitrate, fecal coliform, pH, total phosphate, temperature, turbidity and total suspended solids content were measured for six months (from July to December 2012using standard methods at six selected stations. The river zoning conducted by GIS software. Results: According to the results obtained through this study, the highest and the lowest water quality value was observed in stations 1 and 6 with NSFWQI indexes 82 water with good quality, 42 water with bad quality, respectively. With moving toward last station (from 1 to 6 station water pollution increased. Conclusion: Results of the study indicated that water quality index NSFWQI is a good index to identify the effect of polluter sources on the river water. Based on the average of the index NSFWQI, water quality in station one was good, in the second, third and fourth stations were mediocre and the fifth and sixth stations had bad quality. These results allow to make decisions about monitoring and controlling water pollution sources, as well as provide different efficient uses of it by relevant authorities.

  9. Food safety and quality through radiation technology: its implications to national security

    Energy Technology Data Exchange (ETDEWEB)

    Lanuza, Luvimina G.

    2012-08-15

    The increasing consumption of ready-to-eat meals necessitates a review of its quality and safety. Food irradiation is a technology that would allow the food product to be free from pathogenic organisms while maintaining its fresh-like taste and appearance. The paper evaluated the effectiveness of food irradiation in maintaining the quality and safety of ready-to-eat meals using the three criteria: microbiological, nutritional and acceptability. Chicken adobo was chosen as a representative ready-to-eat meat. Primary data was collected through experimental and non-experimental methods using irradiated and non-irradiated chicken adobo. Irradiation was carried out at the Multipurpose Irradiation Facility of the Philippine Nuclear Research Institute using a radiation dose of 4 kGy at an irradiation temperature of 29.9-32.1 degree centigrade. Experimental data were gathered through laboratory analyses. Nutritional analyses (protein and Vitamin B{sub 1}) as well as microbiological analyses (E. Coli) were conducted at Day 1, Day 7 and Day 15 stored at -4 degree centigrade after irradiation. The non-experimental data were gathered by means of acceptability questionnaires which made use of a modified Likert scale of 1 to 4. This made the respondents rate the food attributes (color, odor, flavor, texture, juiciness) and overall acceptability during the sensory evaluation of both Sample A (irradiated) and Sample B (non-irradiated). There were two sets of respondents, the professional and non-professional sector. The laboratory-scale study revealed that the application of gamma irradiation of a dose of 4 kGy at an irradiation temperature range of 29.9 to 32.1 degree centigrade to packed ready-to-eat chicken adobo was found to be an effective treatment for eliminating the E.coli pathogen even up to Day 15 stored at -4 degree centigrade after irradiation. The protein and Vitamin B{sub 1} contents of the food sample were not significantly affected and results of the acceptability

  10. Food safety and quality through radiation technology: its implications to national security

    International Nuclear Information System (INIS)

    Lanuza, Luvimina G.

    2012-08-01

    The increasing consumption of ready-to-eat meals necessitates a review of its quality and safety. Food irradiation is a technology that would allow the food product to be free from pathogenic organisms while maintaining its fresh-like taste and appearance. The paper evaluated the effectiveness of food irradiation in maintaining the quality and safety of ready-to-eat meals using the three criteria: microbiological, nutritional and acceptability. Chicken adobo was chosen as a representative ready-to-eat meat. Primary data was collected through experimental and non-experimental methods using irradiated and non-irradiated chicken adobo. Irradiation was carried out at the Multipurpose Irradiation Facility of the Philippine Nuclear Research Institute using a radiation dose of 4 kGy at an irradiation temperature of 29.9-32.1 degree centigrade. Experimental data were gathered through laboratory analyses. Nutritional analyses (protein and Vitamin B 1 ) as well as microbiological analyses (E. Coli) were conducted at Day 1, Day 7 and Day 15 stored at -4 degree centigrade after irradiation. The non-experimental data were gathered by means of acceptability questionnaires which made use of a modified Likert scale of 1 to 4. This made the respondents rate the food attributes (color, odor, flavor, texture, juiciness) and overall acceptability during the sensory evaluation of both Sample A (irradiated) and Sample B (non-irradiated). There were two sets of respondents, the professional and non-professional sector. The laboratory-scale study revealed that the application of gamma irradiation of a dose of 4 kGy at an irradiation temperature range of 29.9 to 32.1 degree centigrade to packed ready-to-eat chicken adobo was found to be an effective treatment for eliminating the E.coli pathogen even up to Day 15 stored at -4 degree centigrade after irradiation. The protein and Vitamin B 1 contents of the food sample were not significantly affected and results of the acceptability tests

  11. Nation

    DEFF Research Database (Denmark)

    Østergaard, Uffe

    2014-01-01

    Nation er et gammelt begreb, som kommer af det latinske ord for fødsel, natio. Nationalisme bygger på forestillingen om, at mennesker har én og kun én national identitet og har ret til deres egen nationalstat. Ordet og forestillingen er kun godt 200 år gammel, og i 1900-tallet har ideologien bredt...

  12. The development of national quality performance standards for disposable absorbent products for adult incontinence.

    Science.gov (United States)

    Muller, Nancy; McInnis, Elaine

    2013-09-01

    Disposable absorbent products are widely used in inpatient care settings and in the community to manage adult urinary and fecal incontinence, but few product standards exist to help guide their production or optimal use. Increasing costs and reduced revenues have caused a number of states to evaluate absorbent product use among persons who receive care at home with the assistance of the Medicaid Waiver Program, further increasing concerns about the lack of product performance standards. To address these issues, the National Association For Continence (NAFC) formed a council of experts and key stakeholders with the objective of establishing national, independent quality performance standards for disposable absorbent products provided by states to Waiver Program recipients. The Council consisted of representatives from five purposefully selected states, technical directors from six nonwoven product manufacturers, an officer of the nonwoven manufactures trade association, a delegate from an academic nursing program and professional societies, a family caregiver, and a patient representative. Following a consensus method and guidelines for use, nine specific recommendations were developed, posted for public comment, and further refined. Final recommendations for product performance assessment include: rewet rate (a measure of a product's ability to withstand multiple incontinent episodes between changes), rate of acquisition (a measure of the speed at which urine is drawn away from the skin by a product, product retention capacity (a measure of a product's capacity to hold fluid without rewetting the skin), sizing options, absorbency levels, product safety, closure technology, breathable zones (a measure of the air permeability across a textile-like fabric at a controlled differential pressure), and elasticity. The Council also set values for and recommended four quantifiable parameters, and the testing methodology associated with each, to help consumers and states

  13. Evaluation of data quality at the National Cancer Registry of Ukraine.

    Science.gov (United States)

    Ryzhov, Anton; Bray, Freddie; Ferlay, Jacques; Fedorenko, Zoya; Goulak, Liudmyla; Gorokh, Yevgeniy; Soumkina, Olena; Znaor, Ariana

    2018-04-01

    Cancer notification has been mandatory in Ukraine since 1953, with the National Cancer Registry of Ukraine (NCRU) established in 1996. The aim of this study was to provide a comprehensive evaluation of the data quality at the NCRU. Qualitative and semi-quantitative methods were used to assess the comparability, completeness, validity and timeliness of cancer incidence data from the NCRU for the period 2002-2012. Cancer registration procedures at the NCRU are in accordance with international standards and recommendations. Semi-quantitative methods suggested the NCRU's data was reasonably complete, although decreases in age-specific incidence and mortality rates in the elderly indicated some missing cases at older ages. The proportion of microscopically-verified cases increased from 73.6% in 2002 to 82.3% in 2012, with death-certificate-only (DCO) proportions stable at around 0.1% and unknown stage recorded in 9.6% of male and 7.5% of female solid tumours. Timeliness was considered acceptable, with reporting >99% complete within a turn-around time of 15 months. While timely reporting of national data reflects the advantages of a mandatory data collection system, a low DCO% and observed age-specific declines suggest possible underreporting of incidence and mortality data, particularly at older ages. Overall, the evaluation indicates that the data are reasonably comparable and thus may be used to describe the magnitude of the cancer burden in Ukraine. Given its central role in monitoring and evaluation of cancer control activities, ensuring the sustainability of NCRU operations throughout the process of healthcare system reform is of utmost importance. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Severe Gastrointestinal Haemorrhage: Summary of a National Quality of Care Study with Focus on Radiological Services

    International Nuclear Information System (INIS)

    McPherson, Simon J.; Sinclair, Martin T.; Smith, Neil C. E.

    2017-01-01

    Purpose of StudyTo identify the remediable factors in the quality of care provided to patients with severe gastrointestinal (GI) bleeding.MethodAll hospital admissions in the first four months of 2013 with ICD10 coding for GI bleeding who received a transfusion of 4 units or more of blood. Up to five cases/hospital randomly selected for structured case note peer review. National availability of GI bleeding services data derived from organisational questionnaire completed by all hospitals.Results4563/29,796 (15.3%) of GI bleeds received 4 or more units of blood with a mortality rate of 20.2% compared to 7.3% without blood transfusion. 30.8% of GI bleeds received a blood transfusion. 32% (60/185) of hospitals admitting acute GI bleeds lacked 24/7 endoscopy. 26% (48/185) had on-site embolisation 24/7 with a further 34% (64/185) accessing embolisation by transfer within a validated formal network. Blood product use was inappropriate in 20% (84/426). Improved management, principally earlier senior gastroenterologist review and/or endoscopy, would have reduced blood product use in 25% (113/457). 14.5% (90/618) had a CT scan which identified the site of bleeding in 32% (29/90). 7.8% (36/459) underwent an Interventional Radiology (IR) procedure but a further 6.3% (21/33) should have had IR. 6% (36/586) underwent surgery with 21/36 for uncontrolled bleeding. In 20/35 IR was not considered despite the majority being suitable for IR. Overall 44% (210/476) received an acceptable standard of care according to peer review.Conclusions26 recommendations were made to improve the quality of care in GI bleeding, with six principle recommendations.

  15. Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes.

    Science.gov (United States)

    Daigle, Christopher R; Brethauer, Stacy A; Tu, Chao; Petrick, Anthony T; Morton, John M; Schauer, Philip R; Aminian, Ali

    2018-01-12

    National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health. To quantify the impact of specific bariatric surgery complications on key clinical outcomes. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated. In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality. This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery

  16. Health assessment using aqua-quality indicators of alpine streams (Khunjerab National Park), Gilgit, Pakistan.

    Science.gov (United States)

    Ali, Salar; Gao, Junfeng; Begum, Farida; Rasool, Atta; Ismail, Muhammad; Cai, Yongjiu; Ali, Shaukat; Ali, Shujaat

    2017-02-01

    This preliminary research was conducted to evaluate the alpine stream health by using water quality as an indicator in Khunjerab National park of the Karakoram ranges located in Pak-China boarder Pakistan having altitude of 3660 m. This study investigated the stream health in the context of the presence or absence of sensitive species, their diversity, and their taxa richness. The water and macroinvertebrate samples were collected from 17 different locations from upstream and downstream of the river by using random sampling method. Macroinvertebrate samples were obtained using kick net (500-μm mesh size) and hand-picking method (NYSDEC). A total of 710 counts including 41 families of macroinvertebrates were recorded comprising of 7 orders including: Ephemeroptera (46%) being the most dominant group, Plecoptera (33%), Trichoptera (5%), Chironomidae (Diptera) (14%), Heteroptera (1%), and Coleoptera (1%). Ephemeroptera, Trichoptera, and Plecoptera (EPT) were found in abundance at the main source, Qarchanai, Dhee, and Tourqeen Nullah, as compared to the other locations of the stream. The most dominant macroinvertebrate was Ephemeroptera whose relative abundance is Pi = 0.49 by using the Shannon index. However, different statistical tools, including principal component analysis (PCA), cluster analysis (CA), ANOVA, and linear regression model, show a strong correlation between water quality and macroinvertebrates. The overall results of the biological indicators showed better ecological health at downstream compared to upstream. This study will provide basic information and understanding about the macroinvertebrates for future researchers, and the data will be helpful for upcoming research programs on alpine streams for the discovery and occurrences of macroinvertebrates and associated fauna.

  17. Severe Gastrointestinal Haemorrhage: Summary of a National Quality of Care Study with Focus on Radiological Services

    Energy Technology Data Exchange (ETDEWEB)

    McPherson, Simon J., E-mail: simon.mcpherson@nhs.net, E-mail: smcpherson@ncepod.org.uk [Leeds Teaching Hospitals Trust, Department of Radiology (United Kingdom); Sinclair, Martin T.; Smith, Neil C. E. [NCEPOD (National Confidential Enquiry into Patient Outcome and Death) (United Kingdom)

    2017-02-15

    Purpose of StudyTo identify the remediable factors in the quality of care provided to patients with severe gastrointestinal (GI) bleeding.MethodAll hospital admissions in the first four months of 2013 with ICD10 coding for GI bleeding who received a transfusion of 4 units or more of blood. Up to five cases/hospital randomly selected for structured case note peer review. National availability of GI bleeding services data derived from organisational questionnaire completed by all hospitals.Results4563/29,796 (15.3%) of GI bleeds received 4 or more units of blood with a mortality rate of 20.2% compared to 7.3% without blood transfusion. 30.8% of GI bleeds received a blood transfusion. 32% (60/185) of hospitals admitting acute GI bleeds lacked 24/7 endoscopy. 26% (48/185) had on-site embolisation 24/7 with a further 34% (64/185) accessing embolisation by transfer within a validated formal network. Blood product use was inappropriate in 20% (84/426). Improved management, principally earlier senior gastroenterologist review and/or endoscopy, would have reduced blood product use in 25% (113/457). 14.5% (90/618) had a CT scan which identified the site of bleeding in 32% (29/90). 7.8% (36/459) underwent an Interventional Radiology (IR) procedure but a further 6.3% (21/33) should have had IR. 6% (36/586) underwent surgery with 21/36 for uncontrolled bleeding. In 20/35 IR was not considered despite the majority being suitable for IR. Overall 44% (210/476) received an acceptable standard of care according to peer review.Conclusions26 recommendations were made to improve the quality of care in GI bleeding, with six principle recommendations.

  18. Quality Improvement and Performance Management Benefits of Public Health Accreditation: National Evaluation Findings.

    Science.gov (United States)

    Siegfried, Alexa; Heffernan, Megan; Kennedy, Mallory; Meit, Michael

    To identify the quality improvement (QI) and performance management benefits reported by public health departments as a result of participating in the national, voluntary program for public health accreditation implemented by the Public Health Accreditation Board (PHAB). We gathered quantitative data via Web-based surveys of all applicant and accredited public health departments when they completed 3 different milestones in the PHAB accreditation process. Leadership from 324 unique state, local, and tribal public health departments in the United States. Public health departments that have achieved PHAB accreditation reported the following QI and performance management benefits: improved awareness and focus on QI efforts; increased QI training among staff; perceived increases in QI knowledge among staff; implemented new QI strategies; implemented strategies to evaluate effectiveness and quality; used information from QI processes to inform decision making; and perceived achievement of a QI culture. The reported implementation of QI strategies and use of information from QI processes to inform decision making was greater among recently accredited health departments than among health departments that had registered their intent to apply but not yet undergone the PHAB accreditation process. Respondents from health departments that had been accredited for 1 year reported higher levels of staff QI training and perceived increases in QI knowledge than those that were recently accredited. PHAB accreditation has stimulated QI and performance management activities within public health departments. Health departments that pursue PHAB accreditation are likely to report immediate increases in QI and performance management activities as a result of undergoing the PHAB accreditation process, and these benefits are likely to be reported at a higher level, even 1 year after the accreditation decision.

  19. Diet Quality of Cancer Survivors and Non-Cancer Individuals: Results from a National Survey

    Science.gov (United States)

    Zhang, Fang Fang; Liu, Shanshan; John, Esther; Must, Aviva; Demark-Wahnefried, Wendy

    2015-01-01

    Background Patterns of poor nutritional intake may exacerbate elevated morbidity experienced by cancer survivors. It remains unclear whether cancer survivors adhere to existing dietary guidelines, and whether survivors’ diet differs from individuals without cancer long-term. Methods We evaluated dietary intake and quality in 1,533 adult cancer survivors in the National Health and Nutrition Examination Survey (NHANES) 1999–2010 and compared that to 3,075 individuals without a history of cancer who were matched to cancer survivors by age, gender, and race/ethnicity. Dietary intake was assessed using 24-hour dietary recalls. The Healthy Eating Index (HEI)-2010 was used to evaluate diet quality. Results The mean HEI-2010 total score was 47.2 (SD=0.5) in cancer survivors and 48.3 (SD=0.4) in non-cancer individuals (p=0.03). Compared to non-cancer individuals, cancer survivors had a significantly lower score of empty calories (13.6 vs. 14.4, p=0.001), which corresponds to worse adherence to dietary intake of calories from solid fats, alcohol and added sugars. Cancer survivors also had a significantly lower dietary intake of fiber than non-cancer individuals (15.0 vs. 15.9 grams/day, p=0.02). Survivors’ mean dietary intakes of vitamin D, vitamin E, potassium, fiber, and calcium were 31%, 47%, 55%, 60%, and 73% in relation to the recommended intake whereas the mean dietary intake of saturated fat and sodium was 112% and 133% of the recommended intake. Conclusions Cancer survivors had a poor adherence to the 2010 Dietary Guidelines for Americans, and their intake patterns were worse than those in the general population for empty calories and fiber. PMID:26624564

  20. Quality of malaria case management in Malawi: results from a nationally representative health facility survey.

    Science.gov (United States)

    Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

    2014-01-01

    Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. In April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have

  1. Quality indicators for discarding blood in the National Blood Center, Kuala Lumpur

    Directory of Open Access Journals (Sweden)

    Mohammed Morish

    2012-01-01

    Full Text Available Background and Objective: The implementation of quality system and continuous evaluation of all activities of the Blood Transfusion Services (BTS can help to achieve the maximum quantity and quality of safe blood. Optimizing blood collection and processing would reduce the rate of discard and improve the efficiency of the BTS. The objective of this study is to determine the rate of discard of blood and blood component and identify its reasons at the National Blood Centre (NBC, Kuala Lumpur, during the year of 2007 in order to introduce appropriate intervention. Study Designs and Methods: Data on the number of discarded whole blood units and its components, reasons for discard, and the number of blood components processed as well as the number of collected blood units were obtained from the Blood Bank Information System - NBC database. These were analyzed. Results: The total number of blood units collected in 2007 was 171169 from which 390636 units of components were prepared. The total number of discarded whole blood units and its components was 8968 (2.3%. Platelet concentrate recorded the highest of discard at 6% (3909 followed by whole blood at 3.7% (647, fresh frozen plasma (FFP at 2.5% (2839, and cryoprecipitate at 2% (620. The rate of discarded packed red blood cells RBCs, plasma aphaeresis, and PLT aphaeresis was less than 1% at 0.6% (902, 0.6% (37, and 0.29% (14, respectively. RBC contamination of PLT and plasma were the major cause of discard at 40% (3558. Other causes include leakage (26% - 2306, lipemia (25% - 2208, and underweight (4% - 353. Conclusion: Good donor selection, training and evaluation of the staff, as well as implementation of automation will help to improve processes and output of BTS. This would reduce discard of blood components and wastage caused by non conformance.

  2. Mobile Tourism Guide in the Context of Thai National Parks: The Effects of Mobile Design Qualities in TAM2

    Directory of Open Access Journals (Sweden)

    Trakulmaykee Numtip

    2014-01-01

    Full Text Available This study aims to predict the level of international tourists’ intention to use MTG in the context of Thai national parks, and investigates the roles of mobile design qualities (content quality, appearance quality, and interaction quality through perceived usefulness and perceived ease-of-use on intention. The mixed-method via exploratory sequential design is conducted this study. The qualitative approach is started in the first stage then quantitative approach is employed to analyze the large sample size. This study extends the TAM2 with mobile design qualities. The results shows the high level of international tourist’ intention to use MTG. It indicates that the international tourists will intent to the mobile tourism guide (MTG, if the MTG is provided for them. The direct factors of tourists’ intention are perceived usefulness, perceived ease-of-use, mobile content quality and mobile appearance quality. The most direct effect is mobile content quality. The qualities of content and appearance have the positive roles on perceived usefulness, while the qualities of appearance and interaction have the indirect effects through perceived ease-of-use on tourists’ intention. The proposed model provides the body of knowledge in the context of MTG, especially the factors of international tourists’ intention to use MTG.

  3. Does litigation increase or decrease health care quality?: a national study of negligence claims against nursing homes.

    Science.gov (United States)

    Stevenson, David G; Spittal, Matthew J; Studdert, David M

    2013-05-01

    The tort system is supposed to help improve the quality and safety of health care, but whether it actually does so is controversial. Most previous studies modeling the effect of negligence litigation on quality of care are ecologic. To assess whether the experience of being sued and incurring litigation costs affects the quality of care subsequently delivered in nursing homes. We linked information on 6471 negligence claims brought against 1514 nursing homes between 1998 and 2010 to indicators of nursing home quality drawn from 2 US national datasets (Online Survey, Certification, and Reporting system; Minimum Data Set Quality Measure/Indicator Reports). At the facility level, we tested for associations between 9 quality measures and 3 variables indicating the nursing homes' litigation experience in the preceding 12-18 months (total indemnity payments; total indemnity payments plus administrative costs; ≥ 1 paid claims vs. none). The analyses adjusted for quality at baseline, case-mix, ownership, occupancy, year, and facility and state random effects. Nearly all combinations of the 3 litigation exposure measures and 9 quality measures--27 models in all--showed an inverse relationship between litigation costs and quality. However, only a few of these associations were statistically significant, and the effect sizes were very small. For example, a doubling of indemnity payments was associated with a 1.1% increase in the number of deficiencies and a 2.2% increase in pressure ulcer rates. Tort litigation does not increase the quality performance of nursing homes, and may decrease it slightly.

  4. Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System.

    Science.gov (United States)

    Moreno-Casbas, María Teresa; Alonso-Poncelas, Emma; Gómez-García, Teresa; Martínez-Madrid, María José; Escobar-Aguilar, Gema

    2018-03-19

    To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  5. Water quality and quantity of selected springs and seeps along the Colorado River corridor, Utah and Arizona: Arches National Park, Canyonlands National Park, Glen Canyon National Recreation Area, and Grand Canyon National Park, 1997-98

    Science.gov (United States)

    Taylor, Howard E.; Spence, John R.; Antweiler, Ronald C.; Berghoff, Kevin; Plowman, Terry I.; Peart, Dale B.; Roth, David A.

    2004-01-01

    The U.S. Geological Survey, in cooperation with the National Park Service conducted an intensive assessment of selected springs along the Colorado River Corridor in Arches National Park, Canyonlands National Park, Glen Canyon National Recreation Area, and Grand Canyon National Park in 1997 and 1998, for the purpose of measuring and evaluating the water quality and quantity of the resource. This study was conducted to establish baseline data for the future evaluation of possible effects from recreational use and climate change. Selected springs and seeps were visited over a study period from 1997 to 1998, during which, discharge and on-site chemical measurements were made at selected springs and seeps, and samples were collected for subsequent chemical laboratory analysis. This interdisciplinary study also includes simultaneous studies of flora and fauna, measured and sampled coincidently at the same sites. Samples collected during this study were transported to U.S. Geological Survey laboratories in Boulder, Colorado, where analyses were performed using state-of-the-art laboratory technology. The location of the selected springs and seeps, elevation, geology, aspect, and onsite measurements including temperature, discharge, dissolved oxygen, pH, and specific conductance, were recorded. Laboratory analyses include determinations for alkalinity, aluminum, ammonium (nitrogen), antimony, arsenic, barium, beryllium, bismuth, boron, bromide, cadmium, calcium, cerium, cesium, chloride, chromium, cobalt, copper, dissolved inorganic carbon, dissolved organic carbon, dysprosium, erbium, europium, fluoride, gadolinium, holmium, iodine, iron, lanthanum, lead, lithium, lutetium, magnesium, manganese, mercury, molybdenum, neodymium, nickel, nitrate (nitrogen), nitrite (nitrogen), phosphate, phosphorus, potassium, praseodymium, rhenium, rubidium, samarium, selenium, silica, silver, sodium, strontium, sulfate, tellurium, terbium, thallium, thorium, thulium, tin, titanium, tungsten

  6. The air quality impacts of road closures associated with the 2004 Democratic National Convention in Boston

    Directory of Open Access Journals (Sweden)

    Clougherty Jane E

    2006-05-01

    Full Text Available Abstract Background The Democratic National Convention (DNC in Boston, Massachusetts in 2004 provided an opportunity to evaluate the impacts of a localized and short-term but potentially significant change in traffic patterns on air quality, and to determine the optimal monitoring approach to address events of this nature. It was anticipated that the road closures associated with the DNC would both influence the overall air pollution level and the distribution of concentrations across the city, through shifts in traffic patterns. Methods To capture these effects, we placed passive nitrogen dioxide badges at 40 sites around metropolitan Boston before, during, and after the DNC, with the goal of capturing the array of hypothesized impacts. In addition, we continuously measured elemental carbon at three sites, and gathered continuous air pollution data from US EPA fixed-site monitors and traffic count data from the Massachusetts Highway Department. Results There were significant reductions in traffic volume on the highway with closures north of Boston, with relatively little change along other highways, indicating a more isolated traffic reduction rather than an across-the-board decrease. For our nitrogen dioxide samples, while there was a relatively small change in mean concentrations, there was significant heterogeneity across sites, which corresponded with our a priori classifications of road segments. The median ratio of nitrogen dioxide concentrations during the DNC relative to non-DNC sampling periods was 0.58 at sites with hypothesized traffic reductions, versus 0.88 for sites with no changes hypothesized and 1.15 for sites with hypothesized traffic increases. Continuous monitors measured slightly lower concentrations of elemental carbon and nitrogen dioxide during road closure periods at monitors proximate to closed highway segments, but not for PM2.5 or further from major highways. Conclusion We conclude that there was a small but

  7. [Internal quality control of the blood products in the Lomé National Blood Transfusion Centre].

    Science.gov (United States)

    Fétéké, L; Mawussi, K; Lakté, P; Kuéviakoe, I M; Haudrechy, D; Ségbéna, A Y

    2008-07-01

    Evaluate the conformity of blood red cells units prepared in the Lomé CNTS with European norms concerning volume, haemoglobin content and haematocrite. Measure the conservation of the haemostatic properties and the rate of haemostasis factors V and VIII in the fresh frozen plasma. Measure the rate of residual cells in the plasma. In the year 2006, from March 1st to April 15th, we analysed the quality of 135 units of whole blood, red blood cells (RBC) and plasma from blood donors in the Lomé National Blood Transfusion Centre. The quality control had concerned: the volume of whole blood units; the volume, the haemoglobin content and the haematocrite of red blood cells units; the volume, the prothrombin rate, the cephalin with activator time (TCA), the rate of haemostasis factors V and VIII and the number of residual cells (red cells, leucocytes and platelets) in the plasma. Among the 135 units of whole blood which were controlled, 50.57% were in conformity with the norms concerning the volume. The red blood cells units were in conformity with norms concerning their volume, their haemoglobin content and their haematocrite respectively in 21.48%, 80.75% and 20% of the cases. The volume of 75.56% of the plasma units controlled were conform with the norm. All of the plasma units were conform with the norm concerning the number of residual platelets while the number of residual red blood cells and leucocytes were conform respectively in 80.74% and 60%. The percentage of conformity concerning the prothrombin rate, the TCA, the coagulation factor V and the factor VIII were respectively 66.67; 97.78; 48.89 and 47.4 before freezing, and 54.81; 88.14; 64.44; 84.44 a month after freezing. To improve the quality of the new blood products of the Lomé CNTS, some correctives actions must be applied concerning the adequate volume of blood which must be collected from the donors, the position of the blood bags in during the centrifugation and the volume of plasma which must be

  8. Dynamic factor analysis of groundwater quality trends in an agricultural area adjacent to Everglades National Park

    Science.gov (United States)

    Muñoz-Carpena, R.; Ritter, A.; Li, Y. C.

    2005-11-01

    The extensive eastern boundary of Everglades National Park (ENP) in south Florida (USA) is subject to one of the most expensive and ambitious environmental restoration projects in history. Understanding and predicting the water quality interactions between the shallow aquifer and surface water is a key component in meeting current environmental regulations and fine-tuning ENP wetland restoration while still maintaining flood protection for the adjacent developed areas. Dynamic factor analysis (DFA), a recent technique for the study of multivariate non-stationary time-series, was applied to study fluctuations in groundwater quality in the area. More than two years of hydrological and water quality time series (rainfall; water table depth; and soil, ground and surface water concentrations of N-NO 3-, N-NH 4+, P-PO 43-, Total P, F -and Cl -) from a small agricultural watershed adjacent to the ENP were selected for the study. The unexplained variability required for determining the concentration of each chemical in the 16 wells was greatly reduced by including in the analysis some of the observed time series as explanatory variables (rainfall, water table depth, and soil and canal water chemical concentration). DFA results showed that groundwater concentration of three of the agrochemical species studied (N-NO 3-, P-PO 43-and Total P) were affected by the same explanatory variables (water table depth, enriched topsoil, and occurrence of a leaching rainfall event, in order of decreasing relative importance). This indicates that leaching by rainfall is the main mechanism explaining concentration peaks in groundwater. In the case of N-NH 4+, in addition to leaching, groundwater concentration is governed by lateral exchange with canals. F -and Cl - are mainly affected by periods of dilution by rainfall recharge, and by exchange with the canals. The unstructured nature of the common trends found suggests that these are related to the complex spatially and temporally varying

  9. Design of Cycle 3 of the National Water-Quality Assessment Program, 2013-23: Part 2: Science plan for improved water-quality information and management

    Science.gov (United States)

    Rowe, Gary L.; Belitz, Kenneth; Demas, Charlie R.; Essaid, Hedeff I.; Gilliom, Robert J.; Hamilton, Pixie A.; Hoos, Anne B.; Lee, Casey J.; Munn, Mark D.; Wolock, David W.

    2013-01-01

    This report presents a science strategy for the third decade of the National Water-Quality Assessment (NAWQA) Program, which since 1991, has been responsible for providing nationally consistent information on the quality of the Nation's streams and groundwater; how water quality is changing over time; and the major natural and human factors that affect current water quality conditions and trends. The strategy is based on an extensive evaluation of the accomplishments of NAWQA over its first two decades, the current status of water-quality monitoring activities by USGS and its partners, and an updated analysis of stakeholder priorities. The plan is designed to address priority issues and national needs identified by NAWQA stakeholders and the National Research Council (2012) irrespective of budget constraints. This plan describes four major goals for the third decade (Cycle 3), the approaches for monitoring, modeling, and scientific studies, key partnerships required to achieve these goals, and products and outcomes that will result from planned assessment activities. The science plan for 2013–2023 is a comprehensive approach to meet stakeholder priorities for: (1) rebuilding NAWQA monitoring networks for streams, rivers, and groundwater, and (2) upgrading models used to extrapolate and forecast changes in water-quality and stream ecosystem condition in response to changing climate and land use. The Cycle 3 plan continues approaches that have been central to the Program’s long-term success, but adjusts monitoring intensities and study designs to address critical information needs and identified data gaps. Restoration of diminished monitoring networks and new directions in modeling and interpretative studies address growing and evolving public and stakeholder needs for water-quality information and improved management, particularly in the face of increasing challenges related to population growth, increasing demands for water, and changing land use and climate

  10. Evaluation of the causal framework used for setting national ambient air quality standards.

    Science.gov (United States)

    Goodman, Julie E; Prueitt, Robyn L; Sax, Sonja N; Bailey, Lisa A; Rhomberg, Lorenz R

    2013-11-01

    Abstract A scientifically sound assessment of the potential hazards associated with a substance requires a systematic, objective and transparent evaluation of the weight of evidence (WoE) for causality of health effects. We critically evaluated the current WoE framework for causal determination used in the United States Environmental Protection Agency's (EPA's) assessments of the scientific data on air pollutants for the National Ambient Air Quality Standards (NAAQS) review process, including its methods for literature searches; study selection, evaluation and integration; and causal judgments. The causal framework used in recent NAAQS evaluations has many valuable features, but it could be more explicit in some cases, and some features are missing that should be included in every WoE evaluation. Because of this, it has not always been applied consistently in evaluations of causality, leading to conclusions that are not always supported by the overall WoE, as we demonstrate using EPA's ozone Integrated Science Assessment as a case study. We propose additions to the NAAQS causal framework based on best practices gleaned from a previously conducted survey of available WoE frameworks. A revision of the NAAQS causal framework so that it more closely aligns with these best practices and the full and consistent application of the framework will improve future assessments of the potential health effects of criteria air pollutants by making the assessments more thorough, transparent, and scientifically sound.

  11. Construction quality assurance for Pit 6 landfill closure, Lawrence Livermore National Laboratory, Site 300

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-10-30

    Golder Construction Services, Inc. (GCS), under contract to the Regents of the University of California, Lawrence Livermore National Laboratory (LLNL), provided the construction quality assurance (CQA) observation and testing during the construction of the Site 300, Pit 6 landfill closure cover. The cap construction was performed as a CERCLA non-time-critical removal action from June 2 to August 29, 1997. the project site is located 18 miles east of Livermore on Tesla Road and approximately 10 miles southwest of Tracy on Corral Hollow Road in San Joaquin County, California. This report certifies that the LLNL, Site 300, Pit 6, Landfill Closure was constructed in accordance with the construction specifications and design drawings. This report documents construction activities and CQA monitoring and testing for construction of the Pit 6 Landfill Closure. Golder Associates, Inc. of Oakland, California was the design engineering firm responsible for preparation of the drawings and specifications. CQA services were provided by GCS, of Roseville, California, under supervision of a California registered civil Engineer.

  12. Quality of life and psychological health indicators in the national social life, health, and aging project.

    Science.gov (United States)

    Shiovitz-Ezra, Sharon; Leitsch, Sara; Graber, Jessica; Karraker, Amelia

    2009-11-01

    The National Social Life, Health, and Aging Project (NSHAP) measures seven indicators of quality of life (QoL) and psychological health. The measures used for happiness, self-esteem, depression, and loneliness are well established in the literature. Conversely, measures of anxiety, stress, and self-reported emotional health were modified for their use in this unique project. The purpose of this paper is to provide (a) an overview of NSHAP's QoL assessment and (b) evidence for the adequacy of the modified measures. First, we examined the psychometric properties of the modified measures. Second, the established QoL measures were used to examine the concurrent validity of the modified measures. Finally, gender- and age-group differences were examined for each modified measure. The anxiety index exhibited good internal reliability and concurrent validity. Consistent with the literature, a single-factor structure best fit the data. Stress was satisfactory in terms of concurrent validity but with only fair internal consistency. Self-reported emotional health exhibited good concurrent validity and moderate external validity. The modified indices used in NSHAP tended to exhibit good internal reliability and concurrent validity. These measures can confidently be used in the exploration of QoL and psychological health in later life and its many correlates.

  13. Evaluation of the quality of the mammography study in the radio-diagnostic service of the National Cancer Institute

    International Nuclear Information System (INIS)

    Rubio Laverde, Alba Lucia; Pineros Petersen, Marion; Betancourt Gil, Claudia

    2003-01-01

    The development of mammography quality control programs at radiology services has had an important progress in the last decades, mainly in developed countries. Although breast cancer is one of the leading causes of cancer mortality and incidence in Colombia, quality control programs for mammography screening are just beginning to be considered. This article describes the results of a baseline evaluation aimed at establishing a quality control program at the Radiology Unit of the National Cancer Institute, in Colombia. The mammography equipment, the film processing, and all main physical parameters were checked and compared to international standards. Quality of the image in 301 mammographic X-ray plates was evaluated. In order to implement a good quality control program, the need for acquiring essential instruments, improving physical facilities and starting a continuous training program is imperative

  14. Water quality data collected by the the National Estuarine Research Reserve System's System-wide Monitoring Program (NERRS SWMP), 1996 - 1998 (NODC Accession 0000789)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Estuarine Research Reserve System's System-wide Monitoring Program (NERRS SWMP) collected water quality data in 22 reserves in the United States and...

  15. Water quality, meteorological, and nutrient data collected by the the National Estuarine Research Reserve System's System-wide Monitoring Program (NERRS SWMP), 1994 - 2005 (NODC Accession 0019215)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Estuarine Research Reserve System's System-wide Monitoring Program (NERRS SWMP) collected water quality, meteorological, and nutrient data in 25...

  16. Methods to characterize environmental settings of stream and groundwater sampling sites for National Water-Quality Assessment

    Science.gov (United States)

    Nakagaki, Naomi; Hitt, Kerie J.; Price, Curtis V.; Falcone, James A.

    2012-01-01

    Characterization of natural and anthropogenic features that define the environmental settings of sampling sites for streams and groundwater, including drainage basins and groundwater study areas, is an essential component of water-quality and ecological investigations being conducted as part of the U.S. Geological Survey's National Water-Quality Assessment program. Quantitative characterization of environmental settings, combined with physical, chemical, and biological data collected at sampling sites, contributes to understanding the status of, and influences on, water-quality and ecological conditions. To support studies for the National Water-Quality Assessment program, a geographic information system (GIS) was used to develop a standard set of methods to consistently characterize the sites, drainage basins, and groundwater study areas across the nation. This report describes three methods used for characterization-simple overlay, area-weighted areal interpolation, and land-cover-weighted areal interpolation-and their appropriate applications to geographic analyses that have different objectives and data constraints. In addition, this document records the GIS thematic datasets that are used for the Program's national design and data analyses.

  17. National Profiles of Classroom Quality and Family Involvement: A Multilevel Examination of Proximal Influences on Head Start Children's School Readiness

    Science.gov (United States)

    Bulotsky-Shearer, Rebecca J.; Wen, Xiaoli; Faria, Ann-Marie; Hahs-Vaughn, Debbie L.; Korfmacher, Jon

    2012-01-01

    Guided by a developmental and ecological model, the study employed latent profile analysis to identify a multilevel typology of family involvement and Head Start classroom quality. Using the nationally representative Head Start Family and Child Experiences Survey (FACES 1997; N = 1870), six multilevel latent profiles were estimated, characterized…

  18. 78 FR 30863 - Judges Panel of the Malcolm Baldrige National Quality Award and Board of Overseers of the Malcolm...

    Science.gov (United States)

    2013-05-23

    ... Standards and Technology and from the Chair of the Judges Panel of the Malcolm Baldrige National Quality... with balanced representation from U.S. service, manufacturing, nonprofit, education, and health care... issues of manufacturing companies, service companies, small businesses, health care providers, and...

  19. How does a quality audits work in national harmonization of activity measurement over nuclear medicine measurement in Cuba

    International Nuclear Information System (INIS)

    Varela, C.

    2006-01-01

    The National Control Center for Medical Devices (CCEEM) is a regulatory agency, belongs to the Cuban Ministry of Public Heath. It works to guarantee the safety and effectiveness of medical devices used into the National Health System (NHS) and the patient, and user protection. Quality Control assures that particular aspect will be satisfied, so since several years ago a national programme for the quality control of nuclear medicine instruments has been organized and established. A service was created in order to control periodically the state of the instrumentation in all the nuclear medicine departments, it is making annual quality control audits and participating in comparisons exercises organises by CCEEM. 3 comparisons exercises with CENTIS and services of NHS were made and eleven nuclear medicine departments were audited in order to perform a practical evaluation of this service, giving the two new regulations and general instructions to dose administration. The objects of the present work is shows, by those results, how does a quality audits work in National Harmonization of Activity Measurement over Nuclear Medicine Measurement in Cuba

  20. Intersection of Re-Designated National League for Nursing Centers of Excellence(TM) and Quality in Nursing Education

    Science.gov (United States)

    Merriam, Deborah

    2013-01-01

    Nursing education is challenged to meet a growing demand for nurses, while substantiating the quality of the educational experience as well as the achievement of desired student outcomes. The National League for Nursing (NLN) Centers of Excellence (COE) in Nursing Education(TM) program represents high performing nursing schools which utilize…

  1. Accreditation Role of the National Universities Commission and the Quality of the Educational Inputs into Nigerian University System

    Science.gov (United States)

    Ibijola; Yinka, Elizabeth

    2014-01-01

    The Accreditation role of the National Universities Commission (NUC) and the quality of the educational inputs into Nigerian university system was investigated in this work, using a descriptive research of survey design. The population consisted of public Universities in South-West, Nigeria. The sample was made up of 300 subjects, consisting of 50…

  2. National phantoms bank for the service of nuclear medicine in Cuba. Utility for the quality control of the instrumentation

    International Nuclear Information System (INIS)

    Varela C, C.; Diaz B, M.; Lopez B, G.M.

    2006-01-01

    Although, most of the applications in Nuclear Medicine have diagnostic ends, its going enlarging considerably the therapeutic applications. So that the diagnostic accuracy or the therapy effectiveness have not been affected, it becomes indispensable the quality control of the instrumentation, independently of its technological complexity and/or its exploitation period. Before the real lack of phantoms in the institutions, it was created a bank that puts to disposition of all the institutions, the existent phantoms in the country, and those that are going acquired, centralized by the State Control of Medical Equipment Center (CCEEM) and with Web access in its place www.eqmed.sld.cu. Having like base the elaboration of the National Protocol for the Quality Control of the Instrumentation in Nuclear Medicine that keeps in mind the international normative and the own existent conditions, were dictated and established two national regulations and its are being carried out the first audits to the instrumentation quality. These have evidenced the partial realization of the established quality controls in the services, the necessity to make aware as for the fulfillment of the criteria and quality concepts for the instrumentation, as well as the necessity to increase the phantoms number to the bank to guarantee the fulfillment of the Quality Control Programs. (Author)

  3. Growing Exports by Signaling Product Quality: Trade Competition and the Cross-National Diffusion of ISO 9000 Quality Standards

    Science.gov (United States)

    Cao, Xun; Prakash, Aseem

    2011-01-01

    Trade policy is an important topic in global public policy. It is recognized that trade is hampered when buyers have incomplete information about the offered products, a problem accentuated in the international markets by the physical and cultural distances between buyers and sellers. Buyers look for proxies to assess product quality, and…

  4. Quality of Best Possible Medication History upon Admission to Hospital: Comparison of Nurses and Pharmacy Students and Consideration of National Quality Indicators.

    Science.gov (United States)

    Sproul, Ashley; Goodine, Carole; Moore, David; McLeod, Amy; Gordon, Jacqueline; Digby, Jennifer; Stoica, George

    2018-01-01

    Medication reconciliation at transitions of care increases patient safety. Collection of an accurate best possible medication history (BPMH) on admission is a key step. National quality indicators are used as surrogate markers for BPMH quality, but no literature on their accuracy exists. Obtaining a high-quality BPMH is often labour- and resource-intensive. Pharmacy students are now being assigned to obtain BPMHs, as a cost-effective means to increase BPMH completion, despite limited information to support the quality of BPMHs obtained by students relative to other health care professionals. To determine whether the national quality indicator of using more than one source to complete a BPMH is a true marker of quality and to assess whether BPMHs obtained by pharmacy students were of quality equal to those obtained by nurses. This prospective trial compared BPMHs for the same group of patients collected by nurses and by trained pharmacy students in the emergency departments of 2 sites within a large health network over a 2-month period (July and August 2016). Discrepancies between the 2 versions were identified by a pharmacist, who determined which party (nurse, pharmacy student, or both) had made an error. A panel of experts reviewed the errors and ranked their severity. BPMHs were prepared for a total of 40 patients. Those prepared by nurses were more likely to contain an error than those prepared by pharmacy students (171 versus 43 errors, p = 0.006). There was a nonsignificant trend toward less severe errors in BPMHs completed by pharmacy students. There was no significant difference in the mean number of errors in relation to the specified quality indicator (mean of 2.7 errors for BPMHs prepared from 1 source versus 4.8 errors for BPMHs prepared from ≥ 2 sources, p = 0.08). The surrogate marker (number of BPMH sources) may not reflect BPMH quality. However, it appears that BPMHs prepared by pharmacy students had fewer errors and were of similar quality (in

  5. Current discharge management of acute coronary syndromes: baseline results from a national quality improvement initiative.

    Science.gov (United States)

    Wai, A; Pulver, L K; Oliver, K; Thompson, A

    2012-05-01

    Evidence-practice gaps exist in the continuum of care for patients with acute coronary syndromes (ACS), particularly at hospital discharge. We aimed to describe the methodology and baseline results of the Discharge Management of Acute Coronary Syndromes (DMACS) project, focusing on the prescription of guideline-recommended medications, referral to cardiac rehabilitation and communication between the hospital, patient and their primary healthcare professionals. DMACS employed Drug Use Evaluation methodology involving data collection, evaluation and feedback, and targeted educational interventions. Adult patients with ACS discharged during a 4-month period were eligible to participate. Data were collected (maximum 50 patients) at each site through an inpatient medical record review, a general practitioner (GP) postal/fax survey conducted 14 days post discharge and a patient telephone survey 3 months post discharge. Forty-nine hospitals participated in the audit recruiting 1545 patients. At discharge, 57% of patients were prescribed a combination of antiplatelet agent(s), beta-blocker, statin and angiotensin-converting enzyme inhibitor and/or angiotensin II-antagonist. At 3 months post discharge, 48% of patients reported using the same combination. Some 67% of patients recalled being referred to cardiac rehabilitation; of these, 33% had completed the programme. In total, 83% of patients had a documented ACS management plan at discharge. Of these, 90% included a medication list, 56% a chest pain action plan and 54% risk factor modification advice. Overall, 65% of GPs rated the quality of information received in the discharge summary as 'very good' to 'excellent'. The findings of our baseline audit showed that despite the robust evidence base and availability of national guidelines, the management of patients with ACS can be improved. These findings will inform a multifaceted intervention strategy to improve adherence to guidelines for the discharge management of

  6. Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program.

    Science.gov (United States)

    Liu, Jason B; Berian, Julia R; Ban, Kristen A; Liu, Yaoming; Cohen, Mark E; Angelos, Peter; Matthews, Jeffrey B; Hoyt, David B; Hall, Bruce L; Ko, Clifford Y

    2017-09-01

    To determine whether concurrently performed operations are associated with an increased risk for adverse events. Concurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown. Using American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix. There were 1430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic surgery (n = 393 [13.7%]), otolaryngology (n = 470 [11.2%]), and neurosurgery (n = 2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n = 2059/12,010 [17.1%]). Unadjusted rates of DSM (9.0% vs 7.1%; P < 0.001), reoperation (3.6% vs 2.7%; P < 0.001), and readmission (6.9% vs 5.1%; P < 0.001) were greater in the concurrent operation cohort versus the non-concurrent. After propensity score matching and risk-adjustment, there was no significant association of concurrence with DSM (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.96-1.21), reoperation (OR 1.16; 95% CI 0.96-1.40), or readmission (OR 1.14; 95% CI 0.99-1.29). In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.

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

    Science.gov (United States)

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

    1993-01-01

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

  8. The Eighth Annual NASA/Contractors Conference and 1991 National Symposium on Quality and Productivity: Extending the boundaries of total quality management

    Science.gov (United States)

    Templeton, Geoffrey B. (Editor); Stewart, Lynne M. (Editor); Still, William T. (Editor)

    1992-01-01

    The Eighth Annual NASA/Contractors Conference and 1991 National Symposium on Quality and Productivity provided a forum to exchange knowledge and experiences in these areas of continuous improvement. The more than 1,100 attendees from government, industry, academia, community groups, and the international arena had a chance to learn about methods, tools, and strategies for excellence and to discuss continuous improvement strategies, successes, and failures. This event, linked via satellite to concurrent conferences hosted by the NASA Goddard Space Flight Center in Greenbelt, Maryland, and Martin Marietta Astronautics Group in Denver, Colorado, also explored extending the boundaries of Total Quality Management to include partnerships for quality within communities and encouraged examination, evaluation, and change to incorporate the principles of continuous improvement.

  9. The First National Report Card on Quality of Health Care in America

    National Research Council Canada - National Science Library

    2004-01-01

    How good is the quality of health care in America? To answer this question Elizabeth McGlynn led a team of experts in the largest and most comprehensive examination ever conducted of health care quality in the United States...

  10. Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies.

    Science.gov (United States)

    Bohl, Daniel D; Basques, Bryce A; Golinvaux, Nicholas S; Baumgaertner, Michael R; Grauer, Jonathan N

    2014-06-01

    National databases are being used with increasing frequency to conduct orthopaedic research. However, there are important differences in these databases, which could result in different answers to similar questions; this important potential limitation pertaining to database research in orthopaedic surgery has not been adequately explored. The purpose of this study was to explore the interdatabase reliability of two commonly used national databases, the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP), in terms of (1) demographics; (2) comorbidities; and (3) adverse events. In addition, using the NSQIP database, we identified (4) adverse events that had a higher prevalence after rather than before discharge, which has important implications for interpretation of studies conducted in the NIS. A retrospective cohort study of patients undergoing operative stabilization of transcervical and intertrochanteric hip fractures during 2009 to 2011 was performed in the NIS and NSQIP. Totals of 122,712 and 5021 patients were included from the NIS and NSQIP, respectively. Age, sex, fracture type, and lengths of stay were compared. Comorbidities common to both databases were compared in terms of more or less than twofold difference between the two databases. Similar comparisons were made for adverse events. Finally, adverse events that had a greater postdischarge prevalence were identified from the NSQIP database. Tests for statistical difference were thought to be of little value given the large sample size and the resulting fact that statistical differences would have been identified even for small, clinically inconsequential differences resulting from the associated high power. Because it is of greater clinical importance to focus on the magnitude of differences, the databases were compared by absolute differences. Demographics and hospital lengths of stay were not different between the two databases. In terms of comorbidities

  11. Implementation of imaging of the national protocol for quality control in planning systems

    International Nuclear Information System (INIS)

    Caudepon Moreno, F.; Martin-Viera cueto, J. A.; Bodineau gil, C.; Benitez Villegas, E. M.; Casado Villalon, F. J.; Moreno Sainz, C.

    2011-01-01

    Quality control of the planning system (SP) plays a key role in quality assurance schemes that include all stages of the radiotherapy process.In this work we focus on the evidence detailing the ''Protocol for quality control in therapy planning systems with ionizing radiation of the SEFM in ''anatomical data acquisition (DA).

  12. Preliminary results of the national program of audit of quality in radiotherapy services in the Republic of Cuba

    International Nuclear Information System (INIS)

    Dominguez Hung, Lourdes; Larrinaga Cortina, Eduardo F.; Morales Lopez, Jorge L.; Garcia Yip, Fernando; Campa Menendez, Raudel

    2001-01-01

    The current state of the radiotherapy in Cuba has allowed to pass to a superior stage, the establishment of a National Quality Audit Program (PNAC). The National Control Center for Medical Devices as national regulator entity for the control and supervision of the medical devices of the National Health System is the responsible for it implementation. This paper presents the preliminary results of the execution of the PNAC in teletherapy services with isotopic units of 60 Co. The audits were carried out according to the methodology settled down in the normalized procedure of operation of the PNAC. The physical aspects related with the treatment were audit, such as: the installation and unit's security, treatment unit's mechanical and dosimetric aspects and organizational aspects of the institution quality assurance program. Also were carried out, in the clinical aspect, verifications of cases type planned by the qualified personnel of the service. The results corresponding to the determination of the reference dose for each institution were compared with those obtained in a postal audit with the International Atomic Energy Agency. These first audits allowed to evaluate the performance of the institution's program of quality assurance and a feedback for the setting about to the PNAC. (author)

  13. Quality assurance plan for the molten salt reactor experiment Remediation Project at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    International Nuclear Information System (INIS)

    1998-02-01

    This Quality Assurance Plan (QAP) identifies and describes the systems utilized by Molten Salt Reactor Experiment (MSRE) Remediation Project personnel to implement the requirements and associated applicable guidance contained in the Quality Program Description, Y/QD-15 Rev. 2 (Martin Marietta Energy Systems, Inc., 1995) and Environmental Management and Enrichment Facilities Work Smart Standards. This QAP defines the quality assurance (QA) requirements applicable to all activities and operations in and directly pertinent to the MSRE Remediation Project. This QAP will be periodically reviewed, revised, and approved as necessary. This QAP identifies and describes the QA activities and procedures implemented by the various Oak Ridge National Laboratory support organizations and personnel to provide confidence that these activities meet the requirements of this project. Specific support organization (Division) quality requirements, including the degree of implementation of each, are contained in the appendixes of this plan

  14. A Proposed Framework for Applying the National Standards of Quality Assurance in Higher Education in Sudan from the Teaching Staff’s Perspective - Faculties of Business Administration

    Directory of Open Access Journals (Sweden)

    Alfatih Alamin Elfaki

    2017-08-01

    Full Text Available This study aimed to clarify the importance of having national standards and their role in achieving quality, as well as establishing a framework for the actual application of national standards in quality assurance so as to achieve quality in higher education institutions. The researchers  followed a descriptive analytical method to achieve the objectives of the study and developed a questionnaire covering primary and secondary variables that have a role in the design of specific models to help in applying the national standards by the Sudanese universities. The questionnaire included one dependent variable; the effective application of national standards of quality assurance in higher education institutions, and the four main variables (independent are: the national standards of quality assurance in higher education in Sudan, the standard of quality assurance, the standard of teaching and learning and the standard of scientific research and publication. The study revealed a number of conclusions: there were statistically significant differences in the extent of familiarity with the  national quality assurance standards in Sudan according to the academic rank of the  faculty members; there were also significant differences in the extent of compliance with the  national quality assurance standards in Sudan according to the academic rank of the faculty members; there was full agreement between the national standards for quality assurance in Sudan and the international standards for quality assurance; and  there were statistically significant differences in that the absence of specific models would have a negative impact on effective application of national standards of quality assurance in higher education in Sudan, according to the academic rank of the faculty members. Keywords: Quality, The program, Standards, University, Total quality management.

  15. National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan.

    Science.gov (United States)

    Virdun, Claudia; Luckett, Tim; Lorenz, Karl A; Phillips, Jane

    2018-06-01

    The importance of measuring the quality of end-of-life care provision is undisputed, but determining how best to achieve this is yet to be confirmed. This study sought to identify and describe national end-of-life care quality indicators and supporting policies used by countries leading in their end-of-life care provision. A systematic environmental scan that included a web search to identify relevant national policies and indicators; hand searching for additional materials; information from experts listed for the top 10 (n=15) countries ranked in the 'quality of care' category of the 2015 Quality of Death Index study; and snowballing from Index experts. Ten countries (66%) have national policy support for end-of-life care measurement, five have national indicator sets, with two indicator sets suitable for all service providers. No countries mandate indicator use, and there is limited evidence of consumer engagement in development of indicators. Two thirds of the 128 identified indicators are outcomes measures (62%), and 38% are process measures. Most indicators pertain to symptom management (38%), social care (32%) or care delivery (27%). Measurement of end-of-life care quality varies globally and rarely covers all care domains or service providers. There is a need to reduce duplication of indicator development, involve consumers, consider all care providers and ensure measurable and relevant indicators to improve end-of-life care experiences for patients and families. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Physical aspects of quality assurance in nuclear medicine and radiotherapy, regulatory approach of the National Nuclear Safety Center

    International Nuclear Information System (INIS)

    Gonzalez C, D.; Fuente P, A. de la; Quevedo G, J.R.; Lopez F, Y.; Varela C, C.

    2006-01-01

    The physical aspects of the quality guarantee in Nuclear Medicine and Radiotherapy its are of cardinal importance to guarantee the quality of the diagnoses and treatments that are carried out to the patients in this type of services. The OIEA, the OMS and other scientific and professional organizations have contributed significantly to the elaboration of recommendations, Protocols, etc. applicable in the quality control programs and safety of the Nuclear Medicine and Radiotherapy departments. In spite of the great effort developed in this sense the Installation of the programs of quality control and safety of the Nuclear Medicine and Radiotherapy departments can fail if the same ones are not based in three decisive elements that are: the existence of national regulations, the existence of the infrastructure required for it and the existence of enough qualified personnel to develop this programs. The present work shows the regulatory focus that on this topic, it has followed the National Center of Nuclear Safety of Cuba (CNSN). The same left of strengthen all the existent Synergies in the different organizations of the country and it went in two fundamental directions: installation of the regulatory requirements that govern this activity and the Authorization of a Cuban Entity, specialized in carrying out audits to the quality control and safety programs of the Nuclear Medicine and Radiotherapy departments. After 4 work years in this direction, the results confirm the validity of the experience developed by the CNSN, at the moment all the services of Nuclear Medicine and Radiotherapy of Cuba possess quality control and safety programs, these programs are annually Auditing by an Authorized entity by the CNSN and the Inspectors of the Regulatory Authority, control, during the inspections, the one execution of the established requirements in the national regulations. The work developed so far can serve, modestly, of reference to others countries of Latin America that

  17. National waste terminal storage repository in a bedded salt formation for spent unreprocessed fuel. Quality assurance program for licensing

    International Nuclear Information System (INIS)

    1978-12-01

    A National Waste Terminal Storage Repository, in bedded salt, for spent unreprocessed fuel is the subject of a conceptual design project which began in January 1977. This volume presents a preliminary quality assurance program to guide the license applicant in developing a detailed program that will be compatible with anticipated National Waste Terminal Storage (NWTSR2) contracting arrangements and provide the documentation required by regulatory bodies. This QA program is designed to provide confidence that the quality-related activities pertaining to safety-related structures, systems, and components will be identified and controlled. Specific responsibilities for quality-related activities are documented and assigned to personnel and organizations for the major phases of facility design and construction. These responsibilities encompass a broad range of activities and are addressed in this preliminary program. The quality assurance program elements are organized and discussed herein as follows: (1) quality assurance during design and construction; (2) the applicant (DOE); (3) siting contractor; (4) architect/engineer; (5) project field management; and (6) operations contractor

  18. Quality of Artemisinin-Containing Antimalarials in Tanzania's Private Sector--Results from a Nationally Representative Outlet Survey.

    Science.gov (United States)

    Act Consortium Drug Quality Project Team And The Impact Study Team

    2015-06-01

    Ensuring that artemisinin-containing antimalarials (ACAs) are of good quality is a key component of effective malaria treatment. There are concerns that a high proportion of ACAs are falsified or substandard, though estimates are rarely based on representative data. During a nationally representative survey in Tanzania, ACAs were purchased from private retail drug outlets, and the active pharmaceutical ingredient (API) was measured. All 1,737 ACAs contained the labeled artemisinin derivative, with 4.1% being outside the 85-115% artemisinin API range defined as acceptable quality. World Health Organization (WHO) prequalified drugs had 0.1 times the odds of being poor quality compared with non-prequalified ACAs for the artemisinin component. When partner components of combination therapies were also considered, 12.1% were outside the acceptable API range, and WHO prequalified ACAs had 0.04 times the odds of being poor quality. Although the prevalence of poor quality ACAs was lower than reported elsewhere, the minority of samples found to be substandard is a cause for concern. Improvements in quality could be achieved by increasing the predominance of WHO prequalified products in the market. Continued monitoring of quality standards is essential. © The American Society of Tropical Medicine and Hygiene.

  19. Pilot for the Australian Breast Device Registry (ABDR): a national opt-out clinical quality registry for breast device surgery.

    Science.gov (United States)

    Hopper, Ingrid; Best, Renee L; McNeil, John J; Mulvany, Catherine M; Moore, Colin C M; Elder, Elisabeth; Pase, Marie; Cooter, Rodney D; Evans, Sue M

    2017-12-28

    To establish a pilot clinical quality registry (CQR) to monitor the quality of care and device performance for breast device surgery in Australia. All patients having breast device surgery from contributing hospitals in Australia. A literature review was performed which identified quality indicators for breast device surgery. A pilot CQR was established in 2011 to capture prospective data on breast device surgery. An interim Steering Committee and Management Committee were established to provide clinical governance, and guide quality indicator selection. The registry's minimum dataset was formulated in consultation with stakeholder groups; potential quality indicators were assessed in terms of (1) importance and relevance, (2) usability, (3) feasibility to collect and (4) scientific validity. Data collection was by a two-sided paper-based form with manual data entry. Seven sites were recruited, including one public hospital, four private hospitals and two day surgeries. Patients were recruited and opt-out consent used. The pilot breast device registry provides high-quality population-based data. It provides a model for developing a national CQR for breast devices; its minimum dataset and quality indicators reflect the opinions of the broad range of stakeholders. It is easily scalable, and has formed the basis for other international surgical groups establishing similar registries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Quality Teaching in Addressing Student Achievement: A Comparative Study between National Board Certified Teachers and Other Teachers on the Kentucky Core Content Test Results

    Science.gov (United States)

    Buecker, Harrie Lynne

    2010-01-01

    This dissertation focused on the link between quality teaching and its potential impact on student achievement. National Board Certification is used to represent quality teaching and student achievement is measured by the Kentucky Core Content Test. Data were gathered on the reading and mathematics scores of students of National Board Teachers who…

  1. Summary and evaluation of pesticides in field blanks collected for the National Water-Quality Assessment Program, 1992-95

    Science.gov (United States)

    Martin, Jeffrey D.; Gilliom, Robert J.; Schertz, Terry L.

    1999-01-01

    Field blanks are quality-control samples used to assess contamination in environmental water samples. Contamination is the unintentional introduction of a chemical (pesticides in this instance) into an environmental water sample from sources such as inadequately cleaned equipment, dirty hands, dust, rain, or fumes. Contamination causes a positive bias in analytical measurements that may need to be considered in the analysis and interpretation of the environmental data. Estimates of pesticide contamination in environmental water samples collected for the National Water-Quality Assessment (NAWQA) Program are used to qualify, where needed, interpretations of the occurrence and distribution of pesticides in the surface and ground waters of the United States.

  2. Does litigation increase or decrease health care quality? A national study of negligence claims against nursing homes

    Science.gov (United States)

    Stevenson, David G.; Spittal, Matthew J.; Studdert, David M.

    2016-01-01

    Background The tort system is supposed to help improve the quality and safety of health care, but whether it actually does so is controversial. Most previous studies modeling the effect of negligence litigation on quality of care are ecologic. Objective To assess whether the experience of being sued and incurring litigation costs affects the quality of care subsequently delivered in nursing homes. Research Design, Subjects, Measures We linked information on 6,471 negligence claims brought against 1,514 nursing homes between 1998 and 2010 to indicators of nursing home quality drawn from two U.S. national datasets (Online Survey, Certification, and Reporting system; Minimum Data Set Quality Measure/Indicator Reports). At the facility level, we tested for associations between 9 quality measures and 3 variables indicating the nursing homes’ litigation experience in the preceding 12–18 months (total indemnity payments; total indemnity payments plus administrative costs; ≥1 paid claims vs. none). The analyses adjusted for quality at baseline, case-mix, ownership, occupancy, year, and facility and state random effects. Results Nearly all combinations of the 3 litigation exposure measures and 9 quality measures—27 models in all—showed an inverse relationship between litigation costs and quality. However only a few of these associations were statistically significant, and the effect sizes were very small. For example, a doubling of indemnity payments was associated with a 1.1% increase in the number of deficiencies and a 2.2% increase in pressure ulcer rates. Conclusions Tort litigation does not increase the quality performance of nursing homes, and may decrease it slightly. PMID:23552438

  3. Effects of equipment performance on data quality from the National Atmospheric Deposition Program/National Trends Network and the Mercury Deposition Network

    Science.gov (United States)

    Wetherbee, Gregory A.; Rhodes, Mark F.

    2013-01-01

    The U.S. Geological Survey Branch of Quality Systems operates the Precipitation Chemistry Quality Assurance project (PCQA) to provide independent, external quality-assurance for the National Atmospheric Deposition Program (NADP). NADP is composed of five monitoring networks that measure the chemical composition of precipitation and ambient air. PCQA and the NADP Program Office completed five short-term studies to investigate the effects of equipment performance with respect to the National Trends Network (NTN) and Mercury Deposition Network (MDN) data quality: sample evaporation from NTN collectors; sample volume and mercury loss from MDN collectors; mercury adsorption to MDN collector glassware, grid-type precipitation sensors for precipitation collectors, and the effects of an NTN collector wind shield on sample catch efficiency. Sample-volume evaporation from an NTN Aerochem Metrics (ACM) collector ranged between 1.1–33 percent with a median of 4.7 percent. The results suggest that weekly NTN sample evaporation is small relative to sample volume. MDN sample evaporation occurs predominantly in western and southern regions of the United States (U.S.) and more frequently with modified ACM collectors than with N-CON Systems Inc. collectors due to differences in airflow through the collectors. Variations in mercury concentrations, measured to be as high as 47.5 percent per week with a median of 5 percent, are associated with MDN sample-volume loss. Small amounts of mercury are also lost from MDN samples by adsorption to collector glassware irrespective of collector type. MDN 11-grid sensors were found to open collectors sooner, keep them open longer, and cause fewer lid cycles than NTN 7-grid sensors. Wind shielding an NTN ACM collector resulted in collection of larger quantities of precipitation while also preserving sample integrity.

  4. Proxy and patient reports of health-related quality of life in a national cancer survey.

    Science.gov (United States)

    Roydhouse, Jessica K; Gutman, Roee; Keating, Nancy L; Mor, Vincent; Wilson, Ira B

    2018-01-05

    Proxy respondents are frequently used in surveys, including those assessing health-related quality of life (HRQOL). In cancer, most research involving proxies has been undertaken with paired proxy-patient populations, where proxy responses are compared to patient responses for the same individual. In these populations, proxy-patient differences are small and suggest proxy underestimation of patient HRQOL. In practice, however, proxy responses will only be used when patient responses are not available. The difference between proxy and patient reports of patient HRQOL where patients are not able to report for themselves in cancer is not known. The objective of this study was to evaluate the difference between patient and proxy reports of patient HRQOL in a large national cancer survey, and determine if this difference could be mitigated by adjusting for clinical and sociodemographic information about patients. Data were from the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Patients or their proxies were recruited within 3-6 months of diagnosis with lung or colorectal cancer. HRQOL was measured using the SF-12 mental and physical composite scales. Differences of ½ SD (=5 points) were considered clinically significant. The primary independent variable was proxy status. Linear regression models were used to adjust for patient sociodemographic and clinical covariates, including cancer stage, patient age and education, and patient co-morbidities. Of 6471 respondents, 1011 (16%) were proxies. Before adjustment, average proxy-reported scores were lower for both physical (-6.7 points, 95% CI -7.4 to -5.9) and mental (-6 points, 95% CI -6.7 to -5.2) health. Proxy-reported scores remained lower after adjustment (physical: -5.8 points, -6.6 to -5; mental: -5.8 points, -6.6 to 5). Proxy-patient score differences remained clinically and statistically significant, even after adjustment for sociodemographic and clinical variables. Proxy-reported outcome scores

  5. Development, enhancement, and evaluation of aircraft measurement techniques for national ambient air quality standard criteria pollutants

    Science.gov (United States)

    Brent, Lacey Cluff

    The atmospheric contaminants most harmful to human health are designated Criteria Pollutants. To help Maryland attain the national ambient air quality standards (NAAQS) for Criteria Pollutants, and to improve our fundamental understanding of atmospheric chemistry, I conducted aircraft measurements in the Regional Atmospheric Measurement Modeling Prediction Program (RAMMPP). These data are used to evaluate model simulations and satellite observations. I developed techniques for improving airborne observation of two NAAQS pollutants, particulate matter (PM) and nitrogen dioxide (NO2). While structure and composition of organic aerosol are important for understanding PM formation, the molecular speciation of organic ambient aerosol remains largely unknown. The spatial distribution of reactive nitrogen is likewise poorly constrained. To examine water-soluble organic aerosol (WSOA) during an air pollution episode, I designed and implemented a shrouded aerosol inlet system to collect PM onto quartz fiber filters from a Cessna 402 research aircraft. Inlet evaluation conducted during a side-by-side flight with the NASA P3 demonstrated agreement to within 30%. An ion chromatographic mass spectrometric method developed using the NIST Standard Reference Material (SRM) 1649b Urban Dust, as a surrogate material resulted in acidic class separation and resolution of at least 34 organic acids; detection limits approach pg/g concentrations. Analysis of aircraft filter samples resulted in detection of 8 inorganic species and 16 organic acids of which 12 were quantified. Aged, re-circulated metropolitan air showed a greater number of dicarboxylic acids compared to air recently transported from the west. While the NAAQS for NO2 is rarely exceeded, it is a precursor molecule for ozone, America's most recalcitrant pollutant. Using cavity ringdown spectroscopy employing a light emitting diode (LED), I measured vertical profiles of NO2 (surface to 2.5 km) west (upwind) of the Baltimore

  6. Assessment Report Sandia National Laboratories Fuel Cycle Technologies Quality Assurance Evaluation of FY15 SNL FCT M2 Milestone Deliverables

    Energy Technology Data Exchange (ETDEWEB)

    Appel, Gordon John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-05-01

    Sandia National Laboratories (SNL) Fuel Cycle Technologies (FCT) program activities are conducted in accordance with FCT Quality Assurance Program Document (FCT-QAPD) requirements. The FCT-QAPD interfaces with SNL approved Quality Assurance Program Description (SNL-QAPD) as explained in the Sandia National Laboratories QA Program Interface Document for FCT Activities (Interface Document). This plan describes SNL's FY16 assessment of SNL's FY15 FCT M2 milestone deliverable's compliance with program QA requirements, including SNL R&A requirements. The assessment is intended to confirm that SNL's FY15 milestone deliverables contain the appropriate authenticated review documentation and that there is a copy marked with SNL R&A numbers.

  7. Assessment Report Sandia National Laboratories Fuel Cycle Technologies Quality Assurance Evaluation of FY15 SNL FCT M2 Milestone Deliverables

    International Nuclear Information System (INIS)

    Appel, Gordon John

    2016-01-01

    Sandia National Laboratories (SNL) Fuel Cycle Technologies (FCT) program activities are conducted in accordance with FCT Quality Assurance Program Document (FCT-QAPD) requirements. The FCT-QAPD interfaces with SNL approved Quality Assurance Program Description (SNL-QAPD) as explained in the Sandia National Laboratories QA Program Interface Document for FCT Activities (Interface Document). This plan describes SNL's FY16 assessment of SNL's FY15 FCT M2 milestone deliverable's compliance with program QA requirements, including SNL R&A requirements. The assessment is intended to confirm that SNL's FY15 milestone deliverables contain the appropriate authenticated review documentation and that there is a copy marked with SNL R&A numbers.

  8. Measuring patent quality and national technological capacity in cross-country comparison

    OpenAIRE

    Boeing, Philipp; Müller, Elisabeth

    2016-01-01

    China recently surpassed the USA as the greatest global source of patent applications. However, without internationally comparable measures of patent quality it remains questionable whether China's patent expansion constitutes the rise of a new technological superpower. Our novel quality index is based on citations from international search reports and provides internationally comparable, quality-adjusted figures for applications made under the Patent Cooperation Treaty (PCT). We show that Ch...

  9. An Overview of Food Patterns and Diet Quality in Qatar: Findings from the National Household Income Expenditure Survey

    OpenAIRE

    Akram, Hammad

    2017-01-01

    Abstract Introduction Availability of accurate data pertaining to a population’s dietary patterns and associated health outcomes is critical for proper development and implementation of related policies. This article is a first attempt to share the food patterns, amounts and diet quality among households (HH) in Qatar. Methods Data from the 2012-2013 Qatar National Household Income and Expenditure Survey (HIES) was used. This cross-sectional survey included 3723 HH (1826 Qatar...

  10. An Overview of Food Patterns and Diet Quality in Qatar: Findings from the National Household Income Expenditure Survey

    OpenAIRE

    Al-Thani, Mohammed; Al-Thani, Al-Anoud; Al-Mahdi, Nasser; Al-Kareem, Hefzi; Barakat, Darine; Al-Chetachi, Walaa; Tawfik, Afaf; Akram, Hammad

    2017-01-01

    Introduction Availability of accurate data pertaining to a population?s dietary patterns and associated health outcomes is critical for proper development and implementation of related policies. This article is a first?attempt to share the food patterns, amounts and diet quality among households (HH) in Qatar. Methods Data from the 2012-2013 Qatar National Household Income and Expenditure Survey (HIES) was used. This cross-sectional survey included 3723 HH (1826 Qatari HH and 1897 non-Qatari ...

  11. Cultural and Technical Evaluation of Heating Alternatives to Improve Indoor Air Quality on the Navajo Nation

    Science.gov (United States)

    In the Navajo Nation it is estimated that 62% of households use wood as their primary means of heating1. A 2010 study by the U.S. Geological Survey (USGS) and Diné College found that in Shiprock, NM, the largest town in the Navajo Nation (pop. = 8,300)2, heating is often w...

  12. The Supplemental Nutrition Assistance Program and dietary quality among US adults: findings from a nationally representative survey.

    Science.gov (United States)

    Nguyen, Binh T; Shuval, Kerem; Njike, Valentine Y; Katz, David L

    2014-09-01

    To examine the association of the Supplemental Nutrition Assistance Program (SNAP) and diet quality among low-income adults. We examined US nationally representative data from the National Health and Nutrition Examination Surveys 2003-2004, 2005-2006, 2007-2008, and 2009-2010. The data were analyzed from October 7, 2013, to March 1, 2014. The analytic sample consisted of 4211 low-income adults aged 20 to 64 years, of whom 1830 participate in SNAP. We adhered to the National Cancer Institute method in calculating the Healthy Eating Index 2010 and other dietary indicators, such as empty calorie intake. Bivariate and multivariable regression was used to compare SNAP participants and income-eligible nonparticipants among the full sample and subsamples of age, sex, race/ethnicity, and food insecurity. Compared with low-income nonparticipants, adjusted analyses reveal that SNAP participants had lower dietary quality scores overall (42.58 vs 44.36, P≤.0001) and lower scores for fruits and vegetables, seafood and plant proteins (1.55 vs 1.77, P≤.0022), and empty calories (9.03 vs 9.90, P≤.0001), but they exhibited comparable scores on whole grain, refined grain, total dairy, total protein, fatty acid, and sodium intakes. The association between SNAP participation and lower dietary quality was statistically significant among women, Hispanics, young adults, and individuals who were food secure. Our analyses suggest that SNAP participants have lower dietary quality than their income-eligible nonparticipant counterparts. Although SNAP has an important role in providing nutrition assistance to eligible low-income individuals, interventions are warranted to improve the dietary quality of participants. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  13. The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards.

    Science.gov (United States)

    Twigg, Diane E; Duffield, Christine; Evans, Gemma

    2013-09-01

    The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting these standards and improving the quality of patient care. Several of the standards are influenced by nursing interventions, which incorporate any direct-care treatment that the nurse performs for a patient that may be nurse or physician initiated. The ability for nurses to undertake these interventions is influenced by the hours of care available, the skill mix of the nursing workforce and the environment in which they practice. Taking into consideration the predicted nursing shortages, the challenge to successfully implement the National Safety and Quality Health Service Standards will be great. This paper examines the role of nursing in the delivery of the National Standards, analyses the evidence with regard to nursing-sensitive outcomes and discusses the implications for health service decision makers and policy.

  14. Rating the quality of the landscape of Sierra de las Quijadas National Park, Province of San Luis, Argentina

    International Nuclear Information System (INIS)

    Maero, I.; Rivarola, D.; Tognelli, G.

    2007-01-01

    The National Park Sierra de las Quijadas is located to 120 km to the northwest of the Province of San Luis, Argentina. The study area is of 24,000 hectares, that correspond to 32 % of the total surface, this surface covers the totality with the Potrero de la Aguada and the next zones, the same one was selected because it conforms at the present time the zone of greater frequency of visitors within the Park. The objective of this work is centered in the obtaining of the Total Quality of the Landscape, having compared the demand of beauty to the rest of the other natural resources, to be able to make proposals to improve the Plan of Handling that takes ahead the Administration of National Parks. The used Methodology is the described one by Cendrero et. al. (1987), it is an indirect valuation that is carried out through the components of the landscape and allows to determine the Intrinsic Visual Quality and the Fragility of each one of the Environmental Units in which the park is divided. This analysis allowed to determine 2 Total Qualities of Landscape, that have been mapped using aerial photography equipment and materials and SIG, with field control. This investigation is developed within the Project of Investigation Geology of the Neogeno and Cuaternario of the Mountain range of San Luis, Faculty of Sciences Physical, Mathematics and Natural - National University of San Luis, Argentina. (author)

  15. Early Surgical Site Infection Following Tissue Expander Breast Reconstruction with or without Acellular Dermal Matrix: National Benchmarking Using National Surgical Quality Improvement Program

    Directory of Open Access Journals (Sweden)

    Sebastian Winocour

    2015-03-01

    Full Text Available BackgroundSurgical site infections (SSIs result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR. This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP.MethodsWomen who underwent ITEBR with/without acellular dermal matrix (ADM were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed.Results12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4% patients nationwide excluding our institution, with lower rates observed at our institution (1.9%. Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5% compared to non-ADM patients (3.2%, P=0.005, and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00. A multivariable analysis of all institutions identified age ≥50 years (odds ratio [OR], 1.4; confidence interval [CI], 1.1-1.7, body mass index ≥30 kg/m2 vs. 4.25 hours (OR, 1.9; CI, 1.5-2.4 as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2-1.1, although this difference was not statistically significant (P=0.07.ConclusionsThe 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution.

  16. Quality of after-hours primary care in The Netherlands: adherence to national guidelines

    NARCIS (Netherlands)

    Willekens, M.; Giesen, P.H.J.; Plat, E.; Mokkink, H.G.A.; Burgers, J.S.; Grol, R.P.T.M.

    2011-01-01

    OBJECTIVE: To assess the quality of after-hours clinical care as delivered by general practitioner (GP) cooperatives in The Netherlands. METHODS: A cross-sectional analysis was undertaken of patient health records of five GP cooperatives during 1 year. We used quality indicators derived from

  17. The quality report of national ever-awarded health websites in Taiwan.

    Science.gov (United States)

    Fang, Li-Ping; Chang, Polun

    2009-01-01

    The Ministry of Health in Taiwan has promoted the award campaign to assure the health web information since 2002. The 98 ever-awarded web sites were reexamined with the new set of quality indicators in 2007. The results show that the overall quality only at an acceptance level and much work needs to be done in credibility and site interaction.

  18. NATIONAL EXPOSURE RESEARCH LABORATORY (NERL) INTEGRATED INFORMATOIN AND QUALITY MANAGEMENT PLAN TRAINING

    Science.gov (United States)

    The success of the NERL quality system relies on participation by all managers and staff. This training was developed for the purpose of communicating the basic features of the quality system in a convenient and efficient manner. The total time to complete a review of all five ...

  19. 75 FR 80801 - National Advisory Committee on Institutional Quality and Integrity (NACIQI) Meeting

    Science.gov (United States)

    2010-12-23

    ... of ``quality assurance,'' ``continuous improvement,'' and ``compliance,'' as well as tension between... and quality improvement process. There are also disparities between compliance with regulation and accreditation via peer review, as well as varying roles and interests of Federal and State entities...

  20. Through Deming's Eyes: A Cross-National Analysis of Quality Assurance Policies in Higher Education.

    Science.gov (United States)

    Dill, David D.

    1995-01-01

    Efforts to improve the quality of academic programs in the United Kingdom, United States, and Netherlands have followed three general approaches: the logic of competitive markets; application of incentives; and professional self-regulation. Strengths and weaknesses of these approaches for improving academic quality are examined through the lens of…

  1. Analysis of chemistry textbook content and national science education standards in terms of air quality-related learning goals

    Science.gov (United States)

    Naughton, Wendy

    In this study's Phase One, representatives of nine municipal agencies involved in air quality education were interviewed and interview transcripts were analyzed for themes related to what citizens need to know or be able to do regarding air quality concerns. Based on these themes, eight air quality Learning Goal Sets were generated and validated via peer and member checks. In Phase Two, six college-level, liberal-arts chemistry textbooks and the National Science Education Standards (NSES) were analyzed for congruence with Phase One learning goals. Major categories of desired citizen understandings highlighted in agency interviews concerned air pollution sources, impact, detection, and transport. Identified cognitive skills focused on information-gathering and -evaluating skills, enabling informed decision-making. A content match was found between textbooks and air quality learning goals, but most textbooks fail to address learning goals that remediate citizen misconceptions and inabilities---particularly those with a "personal experience" focus. A partial match between NSES and air quality learning goals was attributed to differing foci: Researcher-derived learning goals deal specifically with air quality, while NSES focus is on "fundamental science concepts," not "many science topics." Analysis of findings within a situated cognition framework suggests implications for instruction and NSES revision.

  2. Quality Assurance and Improvement in Head and Neck Cancer Surgery: From Clinical Trials to National Healthcare Initiatives.

    Science.gov (United States)

    Simon, Christian; Caballero, Carmela

    2018-05-24

    It is without question in the best interest of our patients, if we can identify ways to improve the quality of care we deliver to them. Great progress has been made within the last 25 years in terms of development and implementation of quality-assurance (QA) platforms and quality improvement programs for surgery in general, and within this context for head and neck surgery. As of now, we have successfully identified process indicators that impact outcome of our patients and the quality of care we deliver as surgeons. We have developed risk calculators to determine the risk for complications of individual surgical patients. We have created perioperative guidelines for complex head and neck procedures. We have in Europe and North America created audit registries that can gather and analyze data from institutions across the world to better understand which processes need change to obtain good outcomes and improve quality of care. QA platforms can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit directly from such initiatives on a global level.

  3. National survey provides average power quality profiles for different customer groups

    International Nuclear Information System (INIS)

    Hughes, B.; Chan, J.

    1996-01-01

    A three year survey, beginning in 1991, was conducted by the Canadian Electrical Association to study the levels of power quality that exist in Canada, and to determine ways to increase utility expertise in making power quality measurements. Twenty-two utilities across Canada were involved, with a total of 550 sites being monitored, including residential and commercial customers. Power disturbances, power outages and power quality were recorded for each site. To create a group average power quality plot, the transient disturbance activity for each site was normalized to a per channel, per month basis and then divided into a grid. Results showed that the average power quality provided by Canadian utilities was very good. Almost all the electrical disturbance within a customer premises were created and stayed within those premises. Disturbances were generally beyond utility control. Utilities could, however, reduce the amount of time the steady-state voltage exceeds the CSA normal voltage upper limit. 5 figs

  4. The skill-divide in job quality: a cross-national analysis of 28 countries.

    Science.gov (United States)

    Stier, Haya

    2015-01-01

    This study focuses on the skill divide in job quality and the role of social institutions in structuring the relation of workers' qualifications to the attributes of their jobs. Four measures of job quality are examined: job security, job achievement, job content and work schedule flexibility. The study is based on the 2005 ISSP module on work orientations and encompasses 28 countries. Obtained through multilevel modeling, the findings show that low-skilled workers are disadvantaged in all aspects of job quality. However, skill inequality in the quality of employment depends on countries' characteristics, with declining inequality in countries at higher levels of technological development and to some extent also in times of technological growth. At times of high unemployment, skill disparities in job security widen while on other measures of job quality they decline. Under high market regulation, the low skilled enjoy better job security but on other measures, skill inequalities increase. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. The National Network of State Perinatal Quality Collaboratives: A Growing Movement to Improve Maternal and Infant Health.

    Science.gov (United States)

    Henderson, Zsakeba T; Ernst, Kelly; Simpson, Kathleen Rice; Berns, Scott; Suchdev, Danielle B; Main, Elliott; McCaffrey, Martin; Lee, Karyn; Rouse, Tara Bristol; Olson, Christine K

    2018-03-01

    State Perinatal Quality Collaboratives (PQCs) are networks of multidisciplinary teams working to improve maternal and infant health outcomes. To address the shared needs across state PQCs and enable collaboration, Centers for Disease Control and Prevention (CDC), in partnership with March of Dimes and perinatal quality improvement experts from across the country, supported the development and launch of the National Network of Perinatal Quality Collaboratives (NNPQC). This process included assessing the status of PQCs in this country and identifying the needs and resources that would be most useful to support PQC development. National representatives from 48 states gathered for the first meeting of the NNPQC to share best practices for making measurable improvements in maternal and infant health. The number of state PQCs has grown considerably over the past decade, with an active PQC or a PQC in development in almost every state. However, PQCs have some common challenges that need to be addressed. After its successful launch, the NNPQC is positioned to ensure that every state PQC has access to key tools and resources that build capacity to actively improve maternal and infant health outcomes and healthcare quality.

  6. What is the radiotherapy quality control program (PQRT) of the National Cancer Institute - Rio de Janeiro/Brazil?

    Energy Technology Data Exchange (ETDEWEB)

    Campos de Araujo, A.M.; Viegas, C.C.B.; Salomon de Souza, R. [Instituto Nacional de Cancer, Praca Cruz Vermelha No. 23, Centro 20230-130, Rio de Janeiro (Brazil)]. e-mail: amcampos@inca.gov.br; tld@inca.gov.br; salomon@inca.gov.br

    2004-07-01

    The National Cancer Institute (INCA) Quality Program in Radiotherapy (PQRT) started in 1999 as a 3 years pilot program with only 33 participant institutions. Due to its positive results, it has been integrated to the permanent INCA programs and its activities extended to all the radiotherapy services where patients from the National Health System (SUS) are treated. They are about 150 services (90% of all the available Brazilian radiotherapy services). The PQRT activities objective is to allow that radiotherapeutic treatments can be carried out just like planned, according to international quality and safety standards. The PQRT main activities are: on-site quality control audits, postal TLD audits in reference and non-reference conditions, training and development of research projects. The on-site quality control audits have already evaluated 75 teletherapy units (37 Co-60 and 38 linear accelerators), performing dosimetric, electrical, mechanical and safety tests. The Postal TLD audits used, till 2002, for the 33 participants, the International Atomic Energy Agency (IAEA) system for reference conditions. Five audits have been performed with this simple system. Since 2003, the PQRT postal TLD audit program is using its own system, developed for reference and non-reference conditions. This new system has been already applied to 58 beams (18 Co-60 and 40 linacs). In total, in reference conditions, PQRT has performed 400 audits in reference conditions (190 Co-60 and 210 linacs). Eighteen courses attended to the participants, covering their main practical problems. In parallel, some research studies have been carried out.

  7. What is the radiotherapy quality control program (PQRT) of the National Cancer Institute - Rio de Janeiro/Brazil?

    International Nuclear Information System (INIS)

    Campos de Araujo, A.M.; Viegas, C.C.B.; Salomon de Souza, R.

    2004-01-01

    The National Cancer Institute (INCA) Quality Program in Radiotherapy (PQRT) started in 1999 as a 3 years pilot program with only 33 participant institutions. Due to its positive results, it has been integrated to the permanent INCA programs and its activities extended to all the radiotherapy services where patients from the National Health System (SUS) are treated. They are about 150 services (90% of all the available Brazilian radiotherapy services). The PQRT activities objective is to allow that radiotherapeutic treatments can be carried out just like planned, according to international quality and safety standards. The PQRT main activities are: on-site quality control audits, postal TLD audits in reference and non-reference conditions, training and development of research projects. The on-site quality control audits have already evaluated 75 teletherapy units (37 Co-60 and 38 linear accelerators), performing dosimetric, electrical, mechanical and safety tests. The Postal TLD audits used, till 2002, for the 33 participants, the International Atomic Energy Agency (IAEA) system for reference conditions. Five audits have been performed with this simple system. Since 2003, the PQRT postal TLD audit program is using its own system, developed for reference and non-reference conditions. This new system has been already applied to 58 beams (18 Co-60 and 40 linacs). In total, in reference conditions, PQRT has performed 400 audits in reference conditions (190 Co-60 and 210 linacs). Eighteen courses attended to the participants, covering their main practical problems. In parallel, some research studies have been carried out

  8. Dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine.

    Science.gov (United States)

    Evans, E Whitney; Lipton, Richard B; Peterlin, B Lee; Raynor, Hollie A; Thomas, J Graham; O'Leary, Kevin C; Pavlovic, Jelena; Wing, Rena R; Bond, Dale S

    2015-04-01

    The role of diet in migraine is not well understood. We sought to characterize usual dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine. We also examined whether the relationship between migraine and diet differs by weight status. In this analysis, women with migraine or severe headache status was determined by questionnaire for 3069 women, ages 20-50 years, who participated in the National Health and Nutrition Examination Study, 1999-2004. Women who experienced severe headaches or migraines were classified as migraine for the purposes of this analysis. Dietary intake patterns (micro- and macronutrient intake and eating frequency) and diet quality, measured by the Healthy Eating Index, 2005, were determined using one 24-hour dietary recall. Dietary intake patterns did not significantly differ between women with and without migraine. Normal weight women with migraine had significantly lower diet quality (Healthy Eating Index, 2005 total scores) than women without migraine (52.5 ± 0.9 vs. 45.9 ± 1.0; P quality differs by migraine status in normal weight women. Prospective analyses are needed to establish how diet relates to migraine onset, characteristics, and clinical features in individuals of varying weight status. © 2015 American Headache Society.

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  10. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5

    Directory of Open Access Journals (Sweden)

    Armstrong David

    2006-11-01

    Full Text Available Abstract Background The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF, data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics. Methods We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country. Characteristics of practices were also obtained. QOF and census data were available for 8480 practices. Results The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model. Conclusion Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.

  11. Association between sleep quality and C-reactive protein: results from national health and nutrition examination survey, 2005-2008.

    Directory of Open Access Journals (Sweden)

    Rong Liu

    Full Text Available OBJECTIVE: Our objective was to explore the association between poor sleep quality and hs_CRP in an adult U.S. population. METHODS: This study focused on 9,317 participants in the National Health and Nutrition Examination Survey (NHANES from 2005-2008 who were aged 20-85 years, completed a sleep disorder questionnaire, and had available information on serum hs_CRP. Sleep quality was classified into three categories (good, moderate, poor based on the responses of participants to the NHANES sleep disorder questionnaire. High CRP was defined as hs-CRP >1 md/dL. Linear regression model was applied to investigate the association between poor sleep quality and log-transformed hs_CRP. And logistic regression model was fitted to evaluate the association between sleep quality and the risk of high CRP. RESULTS: Females were more likely to report poor sleep quality than males (26% vs. 19%, p<0.0001. Each sleep disorder was significantly associated with increased hs_CRP and correlative to other sleep disorders. In fully-adjusted linear regression model, poor sleep quality was significantly associated with elevated hs_CRP (log transformed among the overall sample and in females only (β = 0.10, se = 0.03, p<0.01 and β = 0.13, se = 0.04, p<0.01, respectively. In fully-adjusted logistics regression model, poor sleep quality was linked with risk of high CRP(OR: 1.42, 95%CI: 1.15-1.76 in overall sample and OR: 1.59, 95%CI: 1.18-2.14 in females, respectively. CONCLUSION: We found that poor sleep quality was independently associated with elevated hs_CRP in females but not in males in a U.S. adult population.

  12. 77 FR 69795 - Malcolm Baldrige National Quality Award Board of Overseers

    Science.gov (United States)

    2012-11-21

    ... Award. The agenda will include: Report from the Judges' Panel, Baldrige Performance Excellence Program (BPEP) Update, Baldrige Program Business Plan Status Report, Baldrige Performance Excellence Criteria..., Baldrige Performance Excellence Program, National Institute of Standards and Technology, 100 Bureau Drive...

  13. Quality

    International Nuclear Information System (INIS)

    Burnett, N.; Jeffries, J.; Mach, J.; Robson, M.; Pajot, D.; Harrigan, J.; Lebsack, T.; Mullen, D.; Rat, F.; Theys, P.

    1993-01-01

    What is quality? How do you achieve it? How do you keep it once you have got it. The answer for industry at large is the three-step hierarchy of quality control, quality assurance and Total quality Management. An overview is given of the history of quality movement, illustrated with examples from Schlumberger operations, as well as the oil industry's approach to quality. An introduction of the Schlumberger's quality-associated ClientLink program is presented. 15 figs., 4 ills., 16 refs

  14. Quality indicators for the hospital transfusion chain : A national survey conducted in 100 dutch hospitals

    NARCIS (Netherlands)

    Zijlker-Jansen, Pauline Y.; Janssen, M. P.; van Tilborgh-de Jong, A. J W; Schipperus, M. R.; Wiersum-Osselton, J. C.

    2015-01-01

    Background: The 2011 Dutch Blood Transfusion Guideline for hospitals incorporates seven internal quality indicators for evaluation of the hospital transfusion chain. The indicators aim to measure guideline compliance as shown by the instatement of a hospital transfusion committee and transfusion

  15. Reliability testing across the Environmental Quality Index and national environmental indices.

    Science.gov (United States)

    One challenge in environmental epidemiology is the exploration of cumulative environmental exposure across multiple domains (e.g. air, water, land). The Environmental Quality Index (EQI), created by the U.S. EPA, uses principle component analyses combining environmental domains (...

  16. Underground Test Area Fiscal Year 2014 Annual Quality Assurance Report Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Krenzien, Susan

    2015-01-01

    This report is required by the Underground Test Area (UGTA) Quality Assurance Plan (QAP) and identifies the UGTA quality assurance (QA) activities from October 1, 2013, through September 30, 2014 (fiscal year [FY] 2014). All UGTA organizations—U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office (NNSA/NFO); Desert Research Institute (DRI); Lawrence Livermore National Laboratory (LLNL); Los Alamos National Laboratory (LANL); National Security Technologies, LLC (NSTec); Navarro-Intera, LLC (N-I); and the U.S. Geological Survey (USGS)—conducted QA activities in FY 2014. The activities included conducting oversight assessments for QAP compliance, identifying findings and completing corrective actions, evaluating laboratory performance, and publishing documents. UGTA Activity participants conducted 25 assessments on topics including safe operations, QAP compliance, activity planning, and sampling. These assessments are summarized in Section 2.0. Corrective actions tracked in FY 2014 are presented in Appendix A. Laboratory performance was evaluated based on three approaches: (1) established performance evaluation programs (PEPs), (2) interlaboratory comparisons, or (3) data review. The results of the laboratory performance evaluations, and interlaboratory comparison results are summarized in Section 4.0. The UGTA Activity published three public documents and a variety of other publications in FY 2014. The titles, dates, and main authors are identified in Section 5.0. The Contract Managers, Corrective Action Unit (CAU) Leads, Preemptive Review (PER) Committee members, and Topical Committee members are listed by name and organization in Section 6.0. Other activities that affected UGTA quality are discussed in Section 7.0. Section 8.0 provides the FY 2014 UGTA QA program conclusions, and Section 9.0 lists the references not identified in Section 5.0.

  17. State of progress of the national data base for the quality of air

    International Nuclear Information System (INIS)

    Vidal, J.P.; Daubon, P.

    1991-01-01

    A new air quality data base have been created in France with the aim to collect all the air quality measuring results and provide information for synthesis and research. The main hardware equipment have been implemented in October 1990 but the practical application of the data bank is heavily relied to harmonization and standardization of the control equipment, files structures, measuring characteristics and communication systems for the various measuring networks

  18. NATIONAL AND INTERNATIONAL PERSPECTIVES ON THE QUALITY OF ACCOUNTING INFORMATION38

    OpenAIRE

    Assist. Alina Rusu

    2012-01-01

    The primary objective of general purpose financial reporting is to provide high-quality financial information about the reporting entity, useful for economic decision making. Qualitative characteristics of financial statements are the basic attributes that make sense of usefulness of accounting information. In the normalization and accounting doctrine, criteria for defining the concept of quality of accounting information are not identical, their selection and ranking being different. Our res...

  19. Sleep quality in long haul truck drivers: A study on Iranian national data.

    Science.gov (United States)

    Sadeghniiat-Haghighi, Khosro; Yazdi, Zohreh; Kazemifar, Amir-Mohammad

    2016-08-01

    Iran has a high rate of road traffic accidents. Poor quality of sleep brings about loss of attention, which is an important cause of road traffic accidents particularly in monotonous roads. The causes of poor quality of sleep in occupational drivers are multifactorial. The objective of the present study was to assess the prevalence of poor sleep quality among occupational drivers with rotating work schedules and analyze its different risk factors. 2200 professional long-haul truck drivers who had been referred to the Occupational Health Clinic for routine education course were invited. We obtained data from eight provinces from various parts of Iran during 2012-2013. Data were collected using a questionnaire including questions about demographic and job characteristics. Pittsburg Sleep Quality Index (PSQI) was used to assess drivers' sleep quality. Mean working (driving) time was (9.3±2.5) hours daily and (55.5 ± 18.29) hours weekly. About 23.5% of the drivers reported history of smoking, 14.5% had low job satisfaction and 60% had irregular work schedule. 16.4% of drivers had an accidents leading to injury during the past five years. The mean PSQI score was 4.2 ± 2.7; 54% had a PSQI>5 (poor quality of sleep). Multivariate logistic regression showed that smoking, job satisfaction, history of accidents, shift work and work hours per day were the most important risk factors for poor sleep quality. Results obtained from the current study showed a high prevalence of poor quality of sleep among professional drivers. It warrants more attention to this significant problem using some measures to improve working conditions in professional drivers, as well as health promotion interventions.

  20. A Challenge Facing the Malaysian Pharmaceutical Sector: Quality and Affordability of the National Medications

    OpenAIRE

    Abubaker Abdellah; Noordin MI; Shade AM Khalifa; Rafdzah Zaki; Ahmad S Sulaiman; Ali Abdellah; Hesham R El-Seedi

    2016-01-01

    Background: Enhancing public satisfaction of the quality and affordability of medicines is an important task in health services. Objective: This study was intended to assess the trust and acceptance of public concerning quality and affordability of locally manufactured medicines in Malaysia. Methodology: A cross sectional study was performed, and a validated Likert scale questionnaire was used in this study. The results were analyzed using the statistical Package for Social Sciences (SPSS) so...

  1. National Survey on Internal Quality Control for HbA(1c) Analytical Instruments in 331 Hospital Laboratories of China.

    Science.gov (United States)

    Zeng, Rong; Wang, Wei; Zhao, Haijian; Fei, Yang; Wang, Zhiguo

    2015-01-01

    The narrow gap of HbA1 value of mass fraction between "normal" (control of inter-assay standardization, assay precision, and trueness. This survey was initiated to obtain knowledge of the current situation of internal quality control (IQC) practice for HbA(1c) in China and find out the most appropriate quality specifications. Data of IQC for HbA(1c) in 331 institutions participating in the national proficiency testing (PT) programs in China were evaluated using four levels of quality specifications, and the percentages of laboratories meeting the quality requirement were calculated to find out the most appropriate quality specifications for control materials of HbA(1c) in China. The IQC data varied vastly among 331 clinical laboratories in China. The measurement of control materials covered a wide range from 4.52% to 12.24% (inter-quartile range) and there were significant differences among the CVs of different methods, including LPLC, CE-HPLC, AC-HPLC, immunoturbidimetry, and others. Among the four main methods, CE-HPLC and AC-HPLC achieved a better precision. As we can see, the performance of laboratories for HbA(1c) has yet to be improved. Clinical laboratories in China should improve their performance with a stricter imprecision criteria.

  2. National Survey on Internal Quality Control Practice for Lipid Parameters in Laboratories of China from 2014 to 2016.

    Science.gov (United States)

    Ye, Yuanyuan; Wang, Wei; Zhao, Haijian; He, Falin; Zhong, Kun; Yuan, Shuai; Wang, Zhiguo

    2017-09-01

    To investigate the situation of Internal Quality Control (IQC) practice for total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol from 2014 to 2016 in laboratories in China and provide improvement measurements. A web-based External Quality Assessment (EQA) system was used to collect IQC data of lipid parameters in laboratories which continuously participated in the national EQA programs in China from 2014 to 2016. Pass rate of the coefficients of variation (CVs) of two level quality controls in four lipid parameters were calculated according to six quality specifications for precision to evaluate the current status of precision level of the four lipid parameters and their change over time in China. 533, 512, 504, and 466 laboratories continuously reported the data of level one for total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol, and 212, 210, 208 and 198 laboratories reported the level two, respectively. The percentage of laboratories meeting the quality specification varied based on different criteria. Non-significant change can be found in the pass rate of CVs over time. The number of laboratories using a closed system increased over time, but still only accounted for a small proportion. There is no significant difference in the pass rate of CVs between closed and open systems. Triglycerides currently have a fairly good performance in China. While the performance of laboratories on total cholesterol, HDL-cholesterol and LDL-cholesterol has yet to be improved.

  3. Assessing the relationship between healthcare market competition and medical care quality under Taiwan's National Health Insurance programme.

    Science.gov (United States)

    Liao, Chih-Hsien; Lu, Ning; Tang, Chao-Hsiun; Chang, Hui-Chih; Huang, Kuo-Cherh

    2018-06-04

    There is still significant uncertainty as to whether market competition raises or lowers clinical quality in publicly funded healthcare systems. We attempted to assess the effects of market competition on inpatient care quality of stroke patients in a retrospective study of the universal single-payer health insurance system in Taiwan. In this 11-year population-based study, we conducted a pooled time-series cross-sectional analysis with a fixed-effects model and the Hausman test approach by utilizing two nationwide datasets: the National Health Insurance Research Database and the National Hospital and Services Survey in Taiwan. Patients who were admitted to a hospital for ischemic or hemorrhagic stroke were enrolled. After excluding patients with a previous history of stroke and those with different types of stroke, 247 379 ischemic and 79 741 hemorrhagic stroke patients were included in our analysis. Four outcome indicators were applied: the in-hospital mortality rate, 30-day post-operative complication rate, 14-day re-admission rate and 30-day re-admission rate. Market competition exerted a negative or negligible effect on the medical care quality of stroke patients. Compared to hospitals located in a highly competitive market, in-hospital mortality rates for hemorrhagic stroke patients were significantly lower in moderately (β = -0.05, P markets (β = -0.05, P market competition on the quality of care of ischemic stroke patients was insignificant. Simply fostering market competition might not achieve the objective of improving the quality of health care. Other health policy actions need to be contemplated.

  4. Don't forget the posters! Quality and content variables associated with accepted abstracts at a national trauma meeting.

    Science.gov (United States)

    Dossett, Lesly A; Fox, Erin E; del Junco, Deborah J; Zaydfudim, Victor; Kauffmann, Rondi; Shelton, Julia; Wang, Weiwei; Cioffi, William G; Holcomb, John B; Cotton, Bryan A

    2012-05-01

    As a primary venue for presenting research results, abstracts selected for presentation at national meetings should be of the highest scientific merit and research quality. It is uncertain to what degree this is achieved as the methodological quality of abstracts submitted to national surgical meetings has not been previously described. The objective of this study was to evaluate abstracts presented at a leading trauma meeting for methodological quality. All abstracts accepted for the 2009 American Association for the Surgery of Trauma meeting were reviewed and scored for methodological quality based on 10 criteria (scores, 0-10; 10 being the highest). Criteria were based on nationally published methodology guidelines. Two independent reviewers who were blinded to institution, region, and author reviewed each abstract. A total of 187 abstracts were accepted for presentation (67 oral and 120 posters). The most frequent clinical topics were shock/transfusion (23%), abdomen (12%), and nervous system (11%). Shock/transfusion abstracts were more common in the oral presentations (31% vs. 19%; p = 0.06). Abstracts from the northeast and south regions were the most common in both oral (26% and 29%) and posters (25% and 24%). Basic science accounted for 12% of accepted studies, while 51% were clinical and 28% were health services/outcomes. Only 8% of abstracts presented randomized data and only 11% reported null findings. Overall abstract scores ranged from 3 to 10 (median, 7; mean, 7.4). Abstracts selected for poster presentation had an overall higher score than those selected for oral presentation (7.4 ± 1.7 vs. 6.8 ± 1.7; p = 0.02). Although oral presentations traditionally receive the most attention and interest, the methodological quality of abstracts accepted for poster presentation equals (and sometimes exceeds) that of oral abstracts. Attendees of these national meetings should reconsider their time spent in viewing and visiting these poster sessions as with the

  5. Quality of care at ART clinic in Shashamanne referral hospital, West Arsi zone, Oromina National Regional State, South Ethiopia

    Directory of Open Access Journals (Sweden)

    Melese Belayneh

    2017-01-01

    Full Text Available Background Low income nations like Ethiopia, which are heavily affected by HIV pandemic, health system needs to provide comprehensive services for escalating numbers of HIV positive patients. While demand is increasing, resources are not expanding at desirable rates to meet these demands. This leads to the risk of running poor quality antiretroviral therapy in resource limited health facilities. However, there is paucity of research based evidences on the quality of health services in the country in general, and on anti retroviral therapy in particular. Objective To assess quality of care at antiretroviral therapy clinic in Shashamanne Referral Hospital. Method A cross‐sectional study was conducted in Shashamanne Referral hospital from May 30 to June 30,2017.The study population were selected people living with HIV, antiretroviral therapy clinics and health care workers in antiretroviral therapy clinics during the study period. Stratified sampling method was used to identify study population. Interviewer administered questionnaire was employed among 204 patients to assess their satisfaction. Medical records review check list was used to get vital information from documents of 354 patients. Interview guide was also used to assess providers’ view on services. Data were entered by using SPSS version 20 and analyzed using descriptive, bivariate and multivariate techniques. Ethical clearance was obtained from Jimma University College of Public Health and Medical Sciences. Results Resources required for implementation of antiretroviral therapy wee available as per recommendation by the national Guideline. However, scarcity of some OIs and ARV drugs and absence of a few laboratory services seen in the hospital. HIV/AIDS care given in line with national guidelines but study revealed that only 42.7% of clients eligible for isoniazid preventive therapy actually taken it. Average mean satisfaction score of patients was 2.51 and significant

  6. Effects of stock use and backpackers on water quality in wilderness in Sequoia and Kings Canyon National Parks, USA

    Science.gov (United States)

    Clow, David W.; Forrester, Harrison; Miller, Benjamin; Roop, Heidi; Sickman, James O.; Ryu, Hodon; Santo Domingo, Jorge

    2013-01-01

    During 2010-2011, a study was conducted in Sequoia and Kings Canyon National Parks (SEKI) to evaluate the influence of pack animals (stock) and backpackers on water quality in wilderness lakes and streams. The study had three main components: (1) a synoptic survey of water quality in wilderness areas of the parks, (2) paired water-quality sampling above and below several areas with differing types and amounts of visitor use, and (3) intensive monitoring at six sites to document temporal variations in water quality. Data from the synoptic water-quality survey indicated that wilderness lakes and streams are dilute and have low nutrient and Escherichia coli (E. coli) concentrations. The synoptic survey sites were categorized as minimal use, backpacker use, or mixed use (stock and backpackers), depending on the most prevalent type of use upstream from the sampling locations. Sites with mixed use tended to have higher concentrations of most constituents (including E.coli) than those categorized as minimal-use (p≤0.05); concentrations at backpacker-use sites were intermediate. Data from paired-site sampling indicated that E.coli, total coliform, and particulate phosphorus concentrations were greater in streams downstream from mixed-use areas than upstream from those areas (p≤0.05). Paired-site data also indicated few statistically significant differences in nutrient, E. coli, or total coliform concentrations in streams upstream and downstream from backpacker-use areas. The intensive-monitoring data indicated that nutrient and E. coli concentrations normally were low, except during storms, when notable increases in concentrations of E.coli, nutrients, dissolved organic carbon, and turbidity occurred. In summary, results from this study indicate that water quality in SEKI wilderness generally is good, except during storms; and visitor use appears to have a small, but statistically significant influence on stream water quality.

  7. Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Joshua Montroy

    Full Text Available The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery.A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR and 95% confidence intervals (CI.Eleven articles reporting on 35 health care institutions were included. Nine (82% of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72-0.91, deep (pRR 0.82; 95% CI0.64-1.05 and organ space (pRR 1.15; 95% CI 0.96-1.37 infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39-0.77; deep pRR 0.61, 95% CI 0.50-0.75, and organ space pRR 0.60, 95% CI 0.50-0.71. Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program.These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.

  8. 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.

  9. Comparative analysis of quality control tests on computed tomography in accordance with national and international laws

    International Nuclear Information System (INIS)

    Ramos, Fernando S.; Vasconcelos, Rebeca S.; Goncalves, Marcel S.; Oliveira, Marcus V.L. de

    2014-01-01

    The objective of this study is to perform a comparative analysis between the Brazilian legislation and internationals protocols, with respect to the quality control tests for computerized tomography. We used 07 references, published from 1998-2012: the Protocolo Brasileiro - Portaria 453/98 SVS/MS and the Guia de Radiodiagnostico Medico da ANVISA; Quality Assurance Programme for Computed Tomography: Diagnostic and Therapy Applications of the IAEA; European Protocol - European Guidelines on Quality Criteria for Computed Tomography of the EUR No. 16262 EN; Radiation Protection No. 162 - Criteria for Acceptability of Medical Radiology, Nuclear Medicine and Radiotherapy of the European Commission; the Protocols of Control de Calidad en Radiodiagnostico IAEA / ARCAL XLIX; and the Protocolo Espanol de Control de Calidad en Radiodignostico. The comparative analysis of these legislations was based on aspects of tolerance / limit, frequency and objectives of the recommended tests. Were found 18 tests in the Brazilian legislation. The tests were grouped according to their nature (dosimetric tests / exposure and geometric tests and image quality tests). Among the evaluated protocols was identified divergence between tests contained in the documents and the criteria of assessment set out in this work. It is clear, moreover, that for certain documents are not observed tolerances, well-defined methodologies and even frequency of testing. We conclude that the current legislation in Brazil differs in certain respects from international protocols analyzed, although this has a great numbers of quality control tests. However, it is necessary that the Brazilian legislation takes into account technological advances presented to time

  10. The aquatic real-time monitoring network; in-situ optical sensors for monitoring the nation's water quality

    Science.gov (United States)

    Pellerin, Brian A.; Bergamaschi, Brian A.; Murdoch, Peter S.; Downing, Bryan D.; Saraceno, John Franco; Aiken, George R.; Striegl, Robert G.

    2011-01-01

    Floods, hurricanes, and longer-term changes in climate and land use can have profound effects on water quality due to shifts in hydrologic flow paths, water residence time, precipitation patterns, connectivity between rivers and uplands, and many other factors. In order to understand and respond to changes in hydrology and water quality, resource managers and policy makers have a need for accurate and early indicators, as well as the ability to assess possible mechanisms and likely outcomes. In-situ optical sensors-those making continuous measurements of constituents by absorbance or fluorescence properties in the environment at timescales of minutes to years-have a long history in oceanography for developing highly resolved concentrations and fluxes, but are not commonly used in freshwater systems. The United States Geological Survey (USGS) has developed the Aquatic Real-Time Monitoring Network, with high-resolution optical data collection for organic carbon, nutrients, and sediment in large coastal rivers, along with continuous measurements of discharge, water temperature, and dissolved inorganic carbon. The collecting of continuous water-quality data in the Nation?s waterways has revealed temporal trends and spatial patterns in constituents that traditional sampling approaches fail to capture, and will serve a critical role in monitoring, assessment and decision-making in a rapidly changing landscape.

  11. The hazardous priority substances in Italy: National rules and environmental quality standard in marine environment

    International Nuclear Information System (INIS)

    Maggi, Chiara; Onorati, Fulvio; Lamberti, Claudia Virno; Cicero, Anna Maria

    2008-01-01

    Article number 16 of the Water Framework Directive (Directive 2000/60/EC) lays down the community strategy for establishment of harmonised quality standards for the priority substances and other substances posing a significant risk to the aquatic environment. In order to achieve the protection objectives of the Directive 2000/60/EC, the Italian Ministry of the Environment proposed the quality standards for surface water, sediments and biota related to the priority substances listed in the decision No. 2455/2001/EC of the European Parliament and of the Council of November 20 (2001) [Decision N. 2455/2001/EC of the European Parliament and of the Council of 20 November 2001. The list of priority substances in the field of water policy and amending Directive 2000/60/EC. Official Journal of the European Communities, 15.12.2001, p. 5]. Particularly, for the protection of the marine environment, the proposed Italian rules state that, from 1 January 2021, the concentrations of the hazardous priority substances in Italian marine and lagoon waters must be near the natural background for natural substances, like metals, and near zero for the anthropogenic one. According to Directive 2000/60/EC, the Italian Ministry of Environment issued in 2003 Decree 367 in which has derived 160 Environmental Quality Standard (EQS) for water and 27 Environmental Quality Objective (EQO) for sediment of marine coastal area, lagoons and coastal ponds. Biota quality standards have still to be fixed. The paper illustrates the criteria applied for the definition of the quality standards and some comments are presented

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

    Science.gov (United States)

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

    2010-09-01

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

  13. 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.

  14. Producing National Ignition Facility (NIF)-quality beams on the Nova and Beamlet lasers

    International Nuclear Information System (INIS)

    Widmayer, C.C.; Auerbach, J.M.; Ehrlich, R.B.

    1996-08-01

    The Nova and Beamlet lasers were used to simulate the beam propagation conditions that will be encountered during the National Ignition Facility operation. Perturbation theory predicts that there is a 5mm scale length propagation mode that experiences large nonlinear power growth. This mode was observed in the tests. Further tests have confirmed that this mode can be suppressed with improved spatial filtering

  15. Air Quality at Devils Postpile National Monument, Sierra Nevada Mountains, California, USA

    Science.gov (United States)

    Joel D. Burley; Andrzej Bytnerowicz; Monica Buhler; Barbara Zielinska; Donald Schweizer; Ricardo Cisneros; Susan Schilling; Jennifer Chapman Varela; Mark McDaniel; Michelle Horn; Deanna Dulen

    2016-01-01

    Ambient concentrations of O3, PM2.5, NH3, NO, NO2, HNO3, SO2 and VOCs were measured at Devils Postpile National Monument (DEPO) during the summer seasons of 2013 and 2014. The measurements were impacted by the Aspen and Rim Fires in...

  16. Higher Education for National Development: Quality Assurance and Fostering Global Competencies

    Science.gov (United States)

    Magzan, Masa; Aleksic-Maslac, Karmela

    2011-01-01

    Responding to the impact of globalization on delivering education and the increasing need to adapt to the needs of economic and social life, higher education institutions (HEI) effectiveness is depending on the use of technology and contribution to national development. While increasing access to higher education remains to be an important…

  17. Survival As a Quality Metric of Cancer Care: Use of the National Cancer Data Base to Assess Hospital Performance.

    Science.gov (United States)

    Shulman, Lawrence N; Palis, Bryan E; McCabe, Ryan; Mallin, Kathy; Loomis, Ashley; Winchester, David; McKellar, Daniel

    2018-01-01

    Survival is considered an important indicator of the quality of cancer care, but the validity of different methodologies to measure comparative survival rates is less well understood. We explored whether the National Cancer Data Base (NCDB) could serve as a source of unadjusted and risk-adjusted cancer survival data and whether these data could be used as quality indicators for individual hospitals or in the aggregate by hospital type. The NCDB, an aggregate of > 1,500 hospital cancer registries, was queried to analyze unadjusted and risk-adjusted hazards of death for patients with stage III breast cancer (n = 116,787) and stage IIIB or IV non-small-cell lung cancer (n = 252,392). Data were analyzed at the individual hospital level and by hospital type. At the hospital level, after risk adjustment, few hospitals had comparative risk-adjusted survival rates that were statistically better or worse. By hospital type, National Cancer Institute-designated comprehensive cancer centers had risk-adjusted survival ratios that were statistically significantly better than those of academic cancer centers and community hospitals. Using the NCDB as the data source, survival rates for patients with stage III breast cancer and stage IIIB or IV non-small-cell lung cancer were statistically better at National Cancer Institute-designated comprehensive cancer centers when compared with other hospital types. Compared with academic hospitals, risk-adjusted survival was lower in community hospitals. At the individual hospital level, after risk adjustment, few hospitals were shown to have statistically better or worse survival, suggesting that, using NCDB data, survival may not be a good metric to determine relative quality of cancer care at this level.

  18. National survey on internal quality control for tumour markers in clinical laboratories in China.

    Science.gov (United States)

    Wang, Wei; Zhong, Kun; Yuan, Shuai; He, Falin; Du, Yuxuan; Hu, Zhehui; Wang, Zhiguo

    2018-06-15

    This survey was initiated to obtain knowledge on the current situation of internal quality control (IQC) practice for tumour markers (TMs) in China. Additionally, we tried to acquire the most appropriate quality specifications. This survey was a current status survey. The IQC information had been collected via online questionnaires. All of 1821 clinical laboratories which participated in the 2016 TMs external quality assessment (EQA) programme had been enrolled. The imprecision evaluation criteria were the minimal, desirable, and optimal allowable imprecisions based on biological variations, and 1/3 total allowable error (TEa) and 1/4 TEa. A total of 1628 laboratories answered the questionnaires (89%). The coefficients of variation (CVs) of the IQC of participant laboratories varied greatly from 1% (5 th percentile) to 13% (95 th percentile). More than 82% (82 - 91%) of participant laboratories two types of CVs met 1/3 TEa except for CA 19-9. The percentiles of current CVs were smaller than cumulative CVs. A number of 1240 laboratories (76%) reported their principles and systems used. The electrochemiluminescence was the most used principle (45%) and had the smallest CVs. The performance of laboratories for TMs IQC has yet to be improved. On the basis of the obtained results, 1/3 TEa would be realistic and attainable quality specification for TMs IQC for clinical laboratories in China.

  19. How Students Rate the Quality Service Climate on Campus. National Research Report, 2012

    Science.gov (United States)

    Noel-Levitz, Inc, 2012

    2012-01-01

    How satisfied are students with the service they receive--and how important is it to them? This report documents significant strides that colleges and universities have made in recent years to improve service quality and their overall campus climate, yet also finds that campuses still have room for improvement. A few highlights: (1) While progress…

  20. How Students Rate the Quality Service Climate on Campus. National Research Report, 2011

    Science.gov (United States)

    Noel-Levitz, Inc, 2011

    2011-01-01

    How satisfied are students with the service they receive--and how important is it to them? This report documents significant strides that colleges and universities have made in recent years to improve service quality and their overall campus climate, yet also finds that campuses still have room for improvement. A few highlights: (1) While progress…

  1. Planning of and System for the Dutch National Cooperative Programme for Air Quality

    International Nuclear Information System (INIS)

    2006-06-01

    In order to deal with the emission problem of particulates and NO2 in the Netherlands in the coming five year a new program to improve the air quality in the Netherlands will be set up and implemented (NSL, abbreviated in Dutch) [nl

  2. QUALITY ASSURANCE IN CONTINUING ADULT EDUCATION: FROM THE EUROPEAN TO THE NATIONAL LEVEL

    Directory of Open Access Journals (Sweden)

    Nina Aniskina

    2015-11-01

    Full Text Available The paper is devoted to the process of formation of competences professional, social, and personal as a component of the process of continuing adult education. The quality assurance model for this process is presented considering the international and Russian experience.

  3. Performance Evaluation of the United Nations Environment Programme Air Quality Monitoring Unit

    Science.gov (United States)

    A request for technical collaboration between the UNEP and the US EPA resulted in the establishment of a MCRADA. The purpose of this agreement was to evaluate an air quality monitoring system (referred to as the UNEP pod) developed by the UNEP for use in environmental situations ...

  4. Playing language games: higher education quality dynamics in Dutch national policies since 1985

    NARCIS (Netherlands)

    Weenink, Kasja; Aarts, Noelle; Jacobs, Sandra

    2017-01-01

    Higher education quality is a vague, ambiguous, multiple, and essentially contested concept. Quality’s contested character involves endless disputes about its proper use which makes it problematic to handle in governmental policies. Wittgenstein’s notion of language games is used to understand how,

  5. A national survey of rice ( Oryza sativa L.) grain quality in Sierra ...

    African Journals Online (AJOL)

    As Sierra Leone approaches self-sufficiency in rice, against a backdrop of agricultural commercialization, the dynamics of the rice grain production and consumption will increasingly be driven by the quality of grains demanded by consumers to be produced by farmers and marketed by traders in the open market.

  6. Continuous water-quality monitoring to improve lake management at Lake Mattamuskeet National Wildlife Refuge

    Science.gov (United States)

    Michelle Moorman; Tom Augspurger

    2016-01-01

    The U.S. Fish and Wildlife Service has partnered with U.S. Geological Survey to establish 2 continuous water-quality monitoring stations at Lake Mattamuskeet. Stations on the east and west side of the lake measure water level, clarity, dissolved oxygen, pH, temperature, salinity, and conductivity.

  7. Evaluating the quality of sampling frames used in European cross-national surveys

    NARCIS (Netherlands)

    Maineri, A.M.; Scherpenzeel, A.; Bristle, Johanna; Pflüger, Senta-Melissa; Butt, Sarah; Zins, Stefan; Emery, Tom; Luijkx, R.

    This report addresses the quality of the population registers which are currently being used as sampling frames in countries participating in the four cross-European surveys cooperating in SERISS: the European Social Survey (ESS), the European Values Study (EVS), the Gender and Generations Program

  8. Cross-national differences in job quality among low-skilled young workers in Europe

    NARCIS (Netherlands)

    Grip, A. de; Wolbers, M.H.J.

    2006-01-01

    Purpose - The purpose of this paper is to analyse the extent to which the quality of the jobs of low-skilled young workers is affected by the structure of education and training systems in various European countries. It focuses on the differences between countries providing fairly general education

  9. Cross-national differences in job quality among low-skilled young workers in Europe

    NARCIS (Netherlands)

    de Grip, A.; Wolbers, M.H.J.

    2006-01-01

    Purpose – The purpose of this paper is to analyse the extent to which the quality of the jobs of low-skilled young workers is affected by the structure of education and training systems in various European countries. It focuses on the differences between countries providing fairly general education

  10. 75 FR 18788 - Malcolm Baldrige National Quality Award Panel of Judges

    Science.gov (United States)

    2010-04-13

    ... prominent in the fields of quality, innovation, and performance management and appointed by the Secretary of... amended by Section 5(c) of the Government in the Sunshine Act, Public Law 94-409. The meeting, which... of these data as compared to the Award criteria in order to recommend Award recipients, may be closed...

  11. Sleep quality in long haul truck drivers: A study on Iranian national data

    Directory of Open Access Journals (Sweden)

    Khosro Sadeghniiat-Haghighi

    2016-08-01

    Conclusion: Results obtained from the current study showed a high prevalence of poor quality of sleep among professional drivers. It warrants more attention to this significant problem using some measures to improve working conditions in professional drivers, as well as health promotion interventions.

  12. Poor quality data challenges conclusion and decision making: timely analysis of measles confirmed and suspected cases line list in Southern Nations Nationalities and People's Region, Ethiopia.

    Science.gov (United States)

    Endriyas, Misganu; Solomon, Tarekegn; Belayhun, Bekele; Mekonnen, Emebet

    2018-02-12

    Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available. Timely analysis of measles surveillance data is crucial for epidemic control and can show disease control program status. Therefore, this study aimed to show vaccination status and delay in seeking health care using surveillance data. A retrospective study was carried out in Southern Nations Nationalities and People's Region (SNNPR), Ethiopia. We reviewed 2132 records from measles surveillance line list data from July 2013 to January 2014. Descriptive statistics were performed using SPSS 20 for Windows. From a total of 2132 confirmed and suspected measles cases, 1319 (61.9%), had at least one dose of measles containing vaccine; the rest 398 (18.7%) and 415 (19.5%) were unvaccinated and had unknown status respectively. About two fifth, 846 (39.7%), cases visited health facilities within 48 h of onset of clinical signs/symptoms with a median of 2.0 days, IQR (1.0, 3.0). Majority of the measles cases were vaccinated with at least one dose of measles containing vaccine and vaccination data or vaccine potency at lower level was unclear. Delay in seeking healthcare was noted as only about two fifth of cases visited health facilities within 48 h of clinical manifestation. Vaccination and surveillance data quality and factors associated with delay in seeking health care should be investigated.

  13. Synthesis of thirty years of surface water quality and aquatic biota data in Shenandoah National Park: Collaboration between the US Geological Survey and the National Park Service

    Science.gov (United States)

    Rice, Karen C.; Jastram, John D.; Wofford, John E.B.; Schaberl, James P.

    2014-01-01

    The eastern United States has been the recipient of acidic atmospheric deposition (hereinafter, “acid rain”) for many decades. Deleterious effects of acid rain on natural resources have been well documented for surface water (e.g., Likens et al. 1996; Stoddard et al. 2001), soils (Bailey et al. 2005), forest health (Long et al. 2009), and habitat suitability for stream biota (Baker et al. 1993). Shenandoah National Park (SNP) is located in northern and central Virginia and consists of a long, narrow strip of land straddling the Blue Ridge Mountains (Figure 1). The park’s elevated topography and location downwind of the Ohio River valley, where many acidic emissions to the atmosphere are generated (NSTC 2005), have made it a target for acid rain. Characterizing the link between air quality and water quality as related to acid rain, contaminants, soil conditions, and forest health is a high priority for research and monitoring in SNP. The US Geological Survey (USGS) and SNP have had a long history of collaboration on documenting acid rain effects on the park’s natural resources, starting in 1985 and continuing to the present (Lynch and Dise 1985; Rice et al. 2001, 2004, 2005, 2007; Deviney et al. 2006, 2012; Jastram et al. 2013).

  14. [Promoting directives of the Quality Law of the Spanish National Health System: Computer-interpretable clinical practice guidelines].

    Science.gov (United States)

    González-Ferrer, Arturo; Valcárcel, María Ángel

    2018-04-01

    The Cohesion and Quality Act of the National Health System promotes the use of new technologies to make it possible for health professionals put the scientific evidence into practice. In order to do this, there are technological tools, known as of computer-interpretable guidelines, which can help achieve this goal from an innovation perspective. They can be adopted using an iterative process, having a great initial potential as an educational tool, of quality and safety of the patient, in the decision making and, optionally, can be integrated with the electronic medical history, once they are rigorously validated. This article presents updates on these tools, reviews international projects, and personal experiences in which they have demonstrated their value, and highlights the advantages, risks, and limitations they present from a clinical point of view. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  15. The application of national and international guidelines in the assessment of the radiological quality of drinking water

    International Nuclear Information System (INIS)

    Cooper, M.B.

    1998-01-01

    Full text: The World Health Organisation has developed international guidelines for drinking water quality which define acceptable levels of contaminants including radionuclides. These guidelines were the basis for the recent Australian water quality guidelines developed by the National Health and Medical Research Council in conjunction with the Agriculture and Resource Management Council of Australia and New Zealand. This paper highlights some of the practical problems in applying the guidelines in the assessment of groundwater supplies in Australia where the radium content of the water may be significant and the presence of other dissolved minerals can create difficulties in the analytical procedures. Generally, screening methods are based on the determination of gross alpha and beta radioactivity and the limitations of these techniques are discussed. The issue is also addressed as to the appropriate actions in the event of guideline values for specific radionuclides being exceeded

  16. Quality Control in the Dosimetric System of the Personnel Dosimetry Service of the Spanish National Health Service

    Energy Technology Data Exchange (ETDEWEB)

    Casal, E.; Gil, J.A.; Roig, F.; Soriano, A. [Valencia (Spain)

    1999-07-01

    The main operating and quality control procedures implemented at the Centro Nacional de Dosimetria (CND) of the Spanish National Health Service to ensure the acceptance of the dosimetry service are described. The operating procedures are routinely performed at every step, since the dosemeters are received from the manufacturer until the doses are assigned to the dosimetric history and their main aim is to ensure the traceability of the doses. They make use of control and background dosemeters and frequent cross reference (automatic and manual) of different sources of data. The control procedures are performed at the end of each monthly process to detect possible errors or systematic bias in the dosimetry service and include analysis of the measurements of quality control dosemeters irradiated at the CND's laboratory and randomly read. The results of this analysis since 1996 are presented. (author)

  17. Using Maslow's pyramid and the national database of nursing quality indicators(R) to attain a healthier work environment.

    Science.gov (United States)

    Groff-Paris, Lisa; Terhaar, Mary

    2010-12-07

    The strongest predictor of nurse job dissatisfaction and intent to leave is that of stress in the practice environment. Good communication, control over practice, decision making at the bedside, teamwork, and nurse empowerment have been found to increase nurse satisfaction and decrease turnover. In this article we share our experience of developing a rapid-design process to change the approach to performance improvement so as to increase engagement, empowerment, effectiveness, and the quality of the professional practice environment. Meal and non-meal breaks were identified as the target area for improvement. Qualitative and quantitative data support the success of this project. We begin this article with a review of literature related to work environment and retention and a presentation of the frameworks used to improve the work environment, specifically Maslow's theory of the Hierarchy of Inborn Needs and the National Database of Nursing Quality Indicators Survey. We then describe our performance improvement project and share our conclusion and recommendations.

  18. Real-Time Water Quality Monitoring and Habitat Assessment in theSan Luis National Wildlife Refuge

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, Nigel W.T.; Hanlon, Jeremy S.; Burns, Josephine R.; Stromayer, Karl A.K.; Jordan, Brandon M.; Ennis, Mike J.; Woolington,Dennis W.

    2005-08-28

    The project report describes a two year experiment to control wetland drainage to the San Joaquin River of California from the San Luis National Wildlife Refuge using a decision support system for real-time water quality management. This system required the installation and operation of one inlet and three drainage flow and water quality monitoring stations which allowed a simple mass balance model to be developed of the seasonally managed wetlands in the study area. Remote sensing methods were developed to document long-term trends in wetland moist soil vegetation and soil salinity in response to management options such as delaying the initiation of seasonal wetland drainage. These environmental management tools provide wetland managers with some of the tools necessary to improve salinity conditions in the San Joaquin River and improve compliance with State mandated salinity objectives without inflicting long-term harm on the wild fowl habitat resource.

  19. Quality Control in the Dosimetric System of the Personnel Dosimetry Service of the Spanish National Health Service

    International Nuclear Information System (INIS)

    Casal, E.; Gil, J.A.; Roig, F.; Soriano, A.

    1999-01-01

    The main operating and quality control procedures implemented at the Centro Nacional de Dosimetria (CND) of the Spanish National Health Service to ensure the acceptance of the dosimetry service are described. The operating procedures are routinely performed at every step, since the dosemeters are received from the manufacturer until the doses are assigned to the dosimetric history and their main aim is to ensure the traceability of the doses. They make use of control and background dosemeters and frequent cross reference (automatic and manual) of different sources of data. The control procedures are performed at the end of each monthly process to detect possible errors or systematic bias in the dosimetry service and include analysis of the measurements of quality control dosemeters irradiated at the CND's laboratory and randomly read. The results of this analysis since 1996 are presented. (author)

  20. Los Alamos National Laboratory Yucca Mountain Site Characterization Project 1992 quality program status report

    International Nuclear Information System (INIS)

    Bolivar, S.L.; Burningham, A.; Chavez, P.

    1994-03-01

    This status report summarizes the activities and accomplishments of the Los Alamos Yucca Mountain Site Characterization Project's quality assurance program for calendar year 1992. The report includes major sections on Program Activities and Trend Analysis. Program Activities are discussed periodically at quality meetings. The most significant issue addressed in 1992 has been the timely revision of quality administrative procedures. The procedure revision process was streamlined from 55 steps to 7. The number of forms in procedures was reduced by 38%, and the text reduced by 29%. This allowed revision in 1992 of almost half of all implementing procedures. The time necessary to complete the revision process (for a procedure) was reduced from 11 months to 3 months. Other accomplishments include the relaxation of unnecessarily strict training requirements, requiring quality assurance reviews only from affected organizations, and in general simplifying work processes. All members of the YMP received training to the new Orientation class Eleven other training classed were held. Investigators submitted 971 records to the Project and only 37 were rejected. The software program has 115 programs approved for quality-affecting work. The Project Office conducted 3 audits and 1 survey of Los Alamos activities. We conducted 14 audits and 4 surveys. Eight corrective action reports were closed, leaving only one open. Internally, 22 deficiencies were recognized. This is a decrease from 65 in 1991. Since each deficiency requires about 2 man weeks to resolve, the savings are significant. Problems with writing acceptable deficiency reports have essentially disappeared. Trend reports for 1992 were examined and are summarized herein. Three adverse trends have been closed; one remaining adverse trend will be closed when the affected procedures are revised. The number of deficiencies issued to Los Alamos compared to other participants is minimal

  1. ER-E2 regulation. Implementation of the national protocol for quality control of instrumentation in nuclear medicine

    International Nuclear Information System (INIS)

    2015-01-01

    The purpose of this regulation is the adoption and enforcement of the 'Protocol National Quality Control Instrumentation in Nuclear Medicine'; as well as the establishment of an annual program of external audits, which take place on CCEEM, in order to verify compliance with the established considerations into protocols. It is applicable to all entities within the NHS who perform the practice of nuclear medicine in Cuba, both for use 'in vitro' and 'in vivo'.

  2. Automated damage test facilities for materials development and production optic quality assurance at Lawrence Livermore National Laboratory

    International Nuclear Information System (INIS)

    Battersby, C.; Dickson, R.; Jennings, R.; Kimmons, J.; Kozlowski, M. R.; Maricle, S.; Mouser, R.; Runkel, M.; Schwartz, S.; Sheehan, L. M.; Weinzapfel, C.

    1998-01-01

    The Laser Program at LLNL has developed automated facilities for damage testing optics up to 1 meter in diameter. The systems were developed to characterize the statistical distribution of localized damage performance across large-aperture National Ignition Facility optics. Full aperture testing is a key component of the quality assurance program for several of the optical components. The primary damage testing methods used are R:1 mapping and raster scanning. Automation of these test methods was required to meet the optics manufacturing schedule. The automated activities include control and diagnosis of the damage-test laser beam as well as detection and characterization of damage events

  3. Dentistry in Taiwan, Republic of China: National health insurance reforms, illegal dentistry and peer review quality control

    DEFF Research Database (Denmark)

    Moore, R.; Shiau, Y.Y.

    1999-01-01

    licensure. Their popularity and price advantage has maintained a political base that affects policy decisions. Health care reforms of March, 1995 with a comprehensive national health insurance, as well as ambitious plans for systematic peer review quality control of dentists' work are unique health care......The dental health care system in Taiwan, Republic of China is described in terms of demographics, structure, context of treatment and historical development of the dental health care payment system. A notable characteristic of the system is the existence of trade dentists, who operate without...... developments worthy of the attention of health care policy makers in other countries who are studying health care reform processes...

  4. Quality control of secondary standards and calibration systems, therapy level, of National Laboratory of Metrology from Ionizing Radiations (LNMRI)

    International Nuclear Information System (INIS)

    Cecatti, E.R.; Freitas, L.C. de

    1992-01-01

    The results of quality control program of secondary standards, therapy level, and the calibration system of clinical dosemeters were analysed from 1984, when a change in the laboratory installation occurred and new standards were obtained. The national and the international intercomparisons were emphasised. The results for graphite wall chambers were compared, observing a maximum variation of about 0,6%. In the case of Delrin (TK01) wall chambers, the maximum variation was 1,7%. The results of post intercomparisons with thermoluminescent dosemeters have presented derivations lesser than 1%, securing the standards consistence at LNMRI with the international metrological system. (C.G.C.)

  5. Will the circle be unbroken: a history of the U.S. National Ambient Air Quality Standards.

    Science.gov (United States)

    Bachmann, John

    2007-06-01

    In celebration of the 100th anniversary of the Air & Waste Management Association, this review examines the history of air quality management (AQM) in the United States over the last century, with an emphasis on the ambient standards programs established by the landmark 1970 Clean Air Act (CAA) Amendments. The current CAA system is a hybrid of several distinct air pollution control philosophies, including the recursive or circular system driven by ambient standards. Although this evolving system has resulted in tremendous improvements in air quality, it has been far from perfect in terms of timeliness and effectiveness. The paper looks at several periods in the history of the U.S. program, including: (1) 1900-1970, spanning the early smoke abatement and smog control programs, the first federal involvement, and the development of a hybrid AQM approach in the 1970 CAA; (2) 1971-1976, when the first National Ambient Air Quality Standards (NAAQS) were set and implemented; (3) 1977-1993, a period of the first revisions to the standards, new CAA Amendments, delays in implementation and decision-making, and key science/policy/legislative developments that would alter both the focus and scale of air pollution programs and how they are implemented; and (4) 1993-2006, the second and third wave of NAAQS revisions and their implementation in the context of the 1990 CAA. This discussion examines where NAAQS have helped drive implementation programs and how improvements in both effects and air quality/control sciences influenced policy and legislation to enhance the effectiveness of the system over time. The review concludes with a look toward the future of AQM, emphasizing challenges and ways to meet them. The most significant of these is the need to make more efficient progress toward air quality goals, while adjusting the system to address the growing intersections between air quality management and climate change.

  6. Aquatic macroinvertebrates and water quality of Sandia Canyon, Los Alamos National Laboratory, December 1992--October 1993. Status report

    International Nuclear Information System (INIS)

    Cross, S.

    1994-09-01

    In the summer of 1990, an accidental spill from the TA-3 Power Plant Environment Tank released more than 3,785 liters of sulfuric acid into upper Sandia Canyon. The Biological Resource Evaluation Team (BRET) of EM-8 at Los Alamos National Laboratory (LANL) has collected aquatic samples from the stream within Sandia Canyon since then. These field studies gather water quality measurements and collect macroinvertebrates from permanent sampling sites. An earlier report by Bennett (1994) discusses previous BRET aquatic studies in Sandia Canyon. This report updates and expands Bennett's initial findings. During 1993, BRET collected water quality data and aquatic macroinvertebrates at five permanent stations within the canyon. The substrates of the upper three stations are largely sands and silts while the substrates of the two lower stations are largely rock and cobbles. The two upstream stations are located near outfalls that discharge industrial and sanitary waste effluent. The third station is within a natural cattail marsh, approximately 0.4 km (0.25 mi) downstream from Stations SC1 and SC2. Water quality parameters are slightly different at these first three stations from those expected of natural streams, suggesting slightly degraded water quality. Correspondingly, the macroinvertebrate communities at these stations are characterized by low diversities and poorly-developed community structures. The two downstream stations appear to be in a zone of recovery, where water quality parameters more closely resemble those found in natural streams of the area. Macroinvertebrate diversity increases and community structure becomes more complex at the two lower stations, which are further indications of improved water quality downstream

  7. Sleep Quality of Call Handlers Employed in International Call Centers in National Capital Region of Delhi, India.

    Science.gov (United States)

    Raja, J D; Bhasin, S K

    2016-10-01

    Call center sector in India is a relatively new and fast growing industry driving employment and growth in modern India today. Most international call centers in National Capital Region (NCR) of Delhi operate at odd work hours corresponding to a time suitable fortheir international customers. The sleep quality of call handlers employed in these call centers is in jeopardy owing to their altered sleep schedule. To assess the sleep quality and determine its independent predictors among call handlers employed in international call centers in NCR of Delhi. A cross-sectional questionnaire-based study was conducted on 375 call handlers aged 18-39 years employed in international call centers in NCR of Delhi. Sleep quality was assessed using Athens Insomnia scale along with a pre-tested, structured questionnaire. The mean age of respondents was 24.6 (SD 2.4) years. 78% of participants were male. 83.5% of respondents were unmarried. 44.3% of call handlers were cigarette smokers. Physical ailments were reported by 37% call handlers. 77.6% of call handlers had somesuspicion of insomnia or suspected insomnia; the rest had no sleep problem. Smoking, poor social support, heavy workload, lack of relaxation facility at office, and prolonged travel time to office were independent predictors of sleep quality (pSafeguarding their health becomes an occupational health challenge to public health specialists.

  8. Water quality status and trends in agriculture dominated headwaters; a national monitoring network for assessing the effectiveness of national and European manure legislation in The Netherlands

    Science.gov (United States)

    Rozemeijer, J.; Klein, J.

    2016-12-01

    Large nutrient losses to groundwater and surface waters are a major drawback of the highly productive agricultural sector in The Netherlands. The resulting high nutrient concentrations in water resources threaten their ecological, industrial, and recreational functions. To mitigate eutrophication problems, legislation on nutrient application in agriculture was enforced in 1986 in The Netherlands. The objective of this study was to evaluate this manure policy by assessing the water quality status and trends in agriculture dominated headwaters. We used datasets from 5 agricultural test catchments and from 167 existing monitoring locations in agricultural headwaters. Trend analysis for these locations showed a fast reduction of nutrient concentrations after the enforcement of the manure legislation (median slopes of -0.55 mg/L per decade for total nitrogen (N-tot) and -0.020 mg/L per decade for total phosphorus (P-tot)). Still, up to 76% of the selected locations currently do not comply with either the environmental quality standards (EQSs) for nitrogen (N-tot) or phosphorus (P-tot). This indicates that further improvement of agricultural water quality is needed. We observed that weather-related variations in nutrient concentrations strongly influence the compliance testing results, both for individual locations and for the aggregated results at the national scale. Another important finding is that testing compliance for nutrients based on summer average concentrations may underestimate the agricultural impact on ecosystem health. The focus on summer concentrations does not account for the environmental impact of high winter loads from agricultural headwaters towards downstream water bodies.

  9. Perioperative Temperature Measurement Considerations Relevant to Reporting Requirements for National Quality Programs Using Data From Anesthesia Information Management Systems.

    Science.gov (United States)

    Epstein, Richard H; Dexter, Franklin; Hofer, Ira S; Rodriguez, Luis I; Schwenk, Eric S; Maga, Joni M; Hindman, Bradley J

    2018-02-01

    Perioperative hypothermia may increase the incidences of wound infection, blood loss, transfusion, and cardiac morbidity. US national quality programs for perioperative normothermia specify the presence of at least 1 "body temperature" ≥35.5°C during the interval from 30 minutes before to 15 minutes after the anesthesia end time. Using data from 4 academic hospitals, we evaluated timing and measurement considerations relevant to the current requirements to guide hospitals wishing to report perioperative temperature measures using electronic data sources. Anesthesia information management system databases from 4 hospitals were queried to obtain intraoperative temperatures and intervals to the anesthesia end time from discontinuation of temperature monitoring, end of surgery, and extubation. Inclusion criteria included age >16 years, use of a tracheal tube or supraglottic airway, and case duration ≥60 minutes. The end-of-case temperature was determined as the maximum intraoperative temperature recorded within 30 minutes before the anesthesia end time (ie, the temperature that would be used for reporting purposes). The fractions of cases with intervals >30 minutes between the last intraoperative temperature and the anesthesia end time were determined. Among the hospitals, averages (binned by quarters) of 34.5% to 59.5% of cases had intraoperative temperature monitoring discontinued >30 minutes before the anesthesia end time. Even if temperature measurement had been continued until extubation, averages of 5.9% to 20.8% of cases would have exceeded the allowed 30-minute window. Averages of 8.9% to 21.3% of cases had end-of-case intraoperative temperatures <35.5°C (ie, a quality measure failure). Because of timing considerations, a substantial fraction of cases would have been ineligible to use the end-of-case intraoperative temperature for national quality program reporting. Thus, retrieval of postanesthesia care unit temperatures would have been necessary. A

  10. Water-Quality Data for Selected National Park Units, Southern and Central Arizona and West-Central New Mexico, Water Years 2003 and 2004

    National Research Council Canada - National Science Library

    Brown, James G

    2005-01-01

    In 1992 the National Park Service began a Level 1 Water Quality Data Inventory program to make available to park managers the water-resource information with which to best manage each park and plan for the future...

  11. Quality Assurance in the National Tests of English: Investigating What Makes Reading Difficult

    Directory of Open Access Journals (Sweden)

    Angela Hasselgreen

    2017-09-01

    Full Text Available This article presents a piece of research, conducted in order to validate the claims made in test results, concerning what it means – in terms of reading ability – to be placed at a particular mastery level. It will consider the question of what makes reading tasks difficult, and whether data from the National Tests of English (NTE supports the progression of subskills/reading operations as presented in the mastery level descriptors, which are the basis of test results

  12. Quality of environmental disclosure by multi-national oil companies: a corporate governance perspective

    OpenAIRE

    Babatunde, A.

    2005-01-01

    Over the past few years, concern about the issue of environmental sustainability\\ud has increased considerably. Closely linked to this concern is the growing disquiet\\ud over the increasing pervasiveness of multi-national companies, especially oil\\ud companies, in shaping global politics and economics. Consequently, increased\\ud awareness about the environment has led to calls for better management of global\\ud resources and for ways in which to make the corporations that benefit the most\\ud ...

  13. Linkage of the National Health Interview Survey to air quality data

    OpenAIRE

    Parker, JD; Kravets, N; Woodruff, TJ

    2012-01-01

    Objective This report describes the linkage between the National Health Interview Survey (NHIS) and air monitoring data from the U.S. Environmental Protection Agency (EPA). There have been few linkages of these data sources, partly because of restrictions on releasing geographic detail from NHIS on public-use files in order to protect participant confidentiality. Methods Pollution exposures for NHIS respondents were calculated by averaging the annual average exposure estimates from EPA air mo...

  14. Results of a national quality audit programme for radiotherapy centers in Iran

    International Nuclear Information System (INIS)

    Solimanian, A.; Ghafoori, M.

    1998-01-01

    The SSDL of Iran has established a quality audit programme for radiotherapy centers in the country. Most of the radiotherapy departments are now audited annually by the SSDL dosimetry team. During the site visits, beam characteristics of the teletherapy units are determined or tested. This report presents the results of the on-site output measurements conducted during the period 1985-1996 and demonstrates the role of traceability of absorbed dose to water determinations in hospitals to the SSDL standard. (author)

  15. INFLUENCE OF THE FREEZING PROCESS ON NATIONAL QUALITY FLOUR PRODUCTS (OSSETIAN PIES

    Directory of Open Access Journals (Sweden)

    I. U. Kusova

    2014-01-01

    Full Text Available Summary. Satisfying the taste preferences of the main engine of people food. Abundance and diversity of varieties of products provided by the manufacturer to the consumer market, is a consequence of the increasing diversity of taste preferences. Along with the expansion of the range of bakery products, improve the quality and nutritional value, the main task is to preserve the manufacturers of products in a fresh state. To preserve freshness, extend shelf life without deterioration of organoleptic properties of bakery products is the most appropriate way to freeze them. This article determines the dynamics of the freezing process, depending on the kind of filling and semi-finished (raw blanks, blanks after proofing, baking blanks after partial or fully finished products and the relationship with the quality of products. The highest quality of frozen semi-finished products is achieved when subjected to freeze after partial baking the preform (50 % availability. The article shows that the freezing of products with filling blanks based on a change in his cheese lipid fractions decreased total lipid content due to their partial migration in the test portion of the blank, and there is some increase of peroxide and acid number. Similar changes occur during freezing most of the filling. In the case of freezing of products subjected to partial baking, lipid changes are less significant.

  16. Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO research database

    Directory of Open Access Journals (Sweden)

    Aiello Bowles Erin J

    2012-04-01

    Full Text Available Abstract Background Common measures of surgical quality are 30-day morbidity and mortality, which poorly describe breast cancer surgical quality with extremely low morbidity and mortality rates. Several national quality programs have collected additional surgical quality measures; however, program participation is voluntary and results may not be generalizable to all surgeons. We developed the Breast Cancer Surgical Outcomes (BRCASO database to capture meaningful breast cancer surgical quality measures among a non-voluntary sample, and study variation in these measures across providers, facilities, and health plans. This paper describes our study protocol, data collection methods, and summarizes the strengths and limitations of these data. Methods We included 4524 women ≥18 years diagnosed with breast cancer between 2003-2008. All women with initial breast cancer surgery performed by a surgeon employed at the University of Vermont or three Cancer Research Network (CRN health plans were eligible for inclusion. From the CRN institutions, we collected electronic administrative data including tumor registry information, Current Procedure Terminology codes for breast cancer surgeries, surgeons, surgical facilities, and patient demographics. We supplemented electronic data with medical record abstraction to collect additional pathology and surgery detail. All data were manually abstracted at the University of Vermont. Results The CRN institutions pre-filled 30% (22 out of 72 of elements using electronic data. The remaining elements, including detailed pathology margin status and breast and lymph node surgeries, required chart abstraction. The mean age was 61 years (range 20-98 years; 70% of women were diagnosed with invasive ductal carcinoma, 20% with ductal carcinoma in situ, and 10% with invasive lobular carcinoma. Conclusions The BRCASO database is one of the largest, multi-site research resources of meaningful breast cancer surgical quality data

  17. EVALUATING THE EFFECTS OF THE IMPLEMENTATION OF IRAN NATIONAL QUALITY AWARD NEW MODEL (INQA IN IRANIAN ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Mahmoud Zamani

    2014-09-01

    Full Text Available The aim of this study is to examine the effectiveness of the Iran National Quality Award new model (INQA in corporations that have implemented this model in Iran. This research aims to reveal the effects of implementation of Iran National Quality Award (INQA New Model on seven dimensions of the Iranian companies which indeed are seven core factors of this model, i.e. Management & leadership, People, Processes, Resources, Customer & consumer results, Environment & community results, and Performance results. A mail survey was conducted on a simple random sample of 210 organizations that have achieved certification or appreciation during the implementation of INQA model in four rounds. 400 questionnaires were randomly distributed and 392 complete and correct questionnaires were returned. Descriptive and inferential statistics were employed to analyze the data.Results indicated that the highest positive impact of INQA New Model on the improvement of organizational performance of the surveyed organizations was on customers' area. Performance results, leadership and management, processes improvement, environment and society results, and finally better utilization of organizational resources were respectively other areas which are affected mostly. Also, this study found no significant relationship between the implementation of this model and the improvement of employees' conditions in the surveyed organizations.

  18. Spatial assessment of water quality in the vicinity of Lake Alice National Wildlife Refuge, Upper Devils Lake Basin, North Dakota.

    Science.gov (United States)

    Vandeberg, Gregory S; Dixon, Cami S; Vose, Brian; Fisher, Mark R

    2015-02-01

    Runoff from concentrated animal feeding operations and croplands in the Upper Devils Lake Basin (Towner and Ramsey Counties), North Dakota, has the potential to impact the water quality and wildlife of the Lake Alice National Wildlife Refuge. Water samples were collected at eight locations upstream and downstream of the refuge, beginning in June 2007 through March 2011, to identify the spatial distribution of water quality parameters and assess the potential impacts from the upstream land use practices. Geographic Information Systems, statistical analysis, and regulatory standards were used to differentiate between sample locations, and identify potential impacts to water quality for the refuge based on 20 chemical constituents. Kruskal-Wallis analysis of variance (ANOVA) showed significant differences between sample locations based on boron, calcium, Escherichia coli, phosphorus, aluminum, manganese, and nickel. Hierarchical agglomerative cluster analysis of these constituents identified four distinct water quality groupings in the study area. Furthermore, this study found a significant positive correlation between the nutrient measures of nitrate-nitrite and total Kjeldahl nitrogen, and the percentage of concentrated animal feeding operation nutrient management areas using the non-parametric Spearman rho method. Significant correlations were also noted between total organic carbon and nearness to concentrated animal feeding operations. Finally, dissolved oxygen, pH, sulfate, E. coli, total phosphorus, nitrate-nitrite, and aluminum exceeded state of North Dakota and/or US Environmental Protection Agency water quality standards and/or guidelines. Elevated concentrations of phosphorus, nitrate-nitrite, and E. coli from upstream sources likely have the greatest potential impact on the Lake Alice Refuge.

  19. A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).

    Science.gov (United States)

    Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S

    2014-12-01

    A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system. Published by Elsevier Inc.

  20. Lake and bulk sampling chemistry, NADP, and IMPROVE air quality data analysis on the Bridger-Teton National Forest (USFS Region 4)

    Science.gov (United States)

    Jill Grenon; Terry Svalberg; Ted Porwoll; Mark Story

    2010-01-01

    Air quality monitoring data from several programs in and around the Bridger-Teton (B-T) National Forest - National Atmospheric Deposition Program (NADP), longterm lake monitoring, long-term bulk precipitation monitoring (both snow and rain), and Interagency Monitoring of Protected Visual Environments (IMPROVE) - were analyzed in this report. Trends were analyzed using...

  1. Linking agricultural crop management and air quality models for regional to national-scale nitrogen assessments

    Science.gov (United States)

    Cooter, E. J.; Bash, J. O.; Benson, V.; Ran, L.

    2012-10-01

    While nitrogen (N) is an essential element for life, human population growth and demands for energy, transportation and food can lead to excess nitrogen in the environment. A modeling framework is described and implemented to promote a more integrated, process-based and system-level approach to the estimation of ammonia (NH3) emissions which result from the application of inorganic nitrogen fertilizers to agricultural soils in the United States. The United States Department of Agriculture (USDA) Environmental Policy Integrated Climate (EPIC) model is used to simulate plant demand-driven fertilizer applications to commercial cropland throughout the continental US. This information is coupled with a process-based air quality model to produce continental-scale NH3 emission estimates. Regional cropland NH3 emissions are driven by the timing and amount of inorganic NH3 fertilizer applied, soil processes, local meteorology, and ambient air concentrations. Initial fertilizer application often occurs when crops are planted. A state-level evaluation of EPIC-simulated, cumulative planted area compares well with similar USDA reported estimates. EPIC-annual, inorganic fertilizer application amounts also agree well with reported spatial patterns produced by others, but domain-wide the EPIC values are biased about 6% low. Preliminary application of the integrated fertilizer application and air quality modeling system produces a modified geospatial pattern of seasonal NH3 emissions that improves current simulations of observed atmospheric particle nitrate concentrations. This modeling framework provides a more dynamic, flexible, and spatially and temporally resolved estimate of NH3 emissions than previous factor-based NH3 inventories, and will facilitate evaluation of alternative nitrogen and air quality policy and adaptation strategies associated with future climate and land use changes.

  2. Mapping of the image quality in myocardial scintigraphy: A national study

    International Nuclear Information System (INIS)

    Ohlson, Maria; Gustafsson, Agnetha; Gretarsdottir, Jakobina; Olsson, Eva; Johansson, Lena

    2008-04-01

    The aim of this study was to make a survey over the physical parameters and how they affect the image quality and the final diagnosis for myocardial perfusion SPECT in Sweden. Another aim was to evaluate the need for standardized acquisition and processing protocols for myocardial perfusion SPECT. All thirty nuclear medicine departments in Sweden that perform myocardial perfusion SPECT participated in the study. A thorax heart phantom was used to simulate two patients. All studies were acquired and processed with the parameters used clinically in each hospital respectively. A quantitative and a qualitative evaluation were performed. At each hospital, the local nuclear medicine physician interpreted the images as if they were true patient images. There are great differences in the acquiring and processing parameters used in myocardial perfusion SPECT studies in Sweden. The image quality varies greatly for the different hospital but was approved for the majority of the hospitals. Images from two hospitals were considered to be too poor to be diagnosed. The interpretations of the local nuclear medicine physicians differ but the majority has reported an adequate diagnosis. One third of the hospitals have reported false positive defects. All steps in the chain from the acquisition to the evaluation of the medicine physician must be performed with high quality. The determinative factors are the noise reduction filter, the orientation of the slices in the heart and the judgement of the local medicine physician. The acquiring and processing parameters proposed by EANM should be used. The hospitals are also recommended to investigate in the time and resources available, in order to educate all staff involved in the evaluation of myocardial studies

  3. Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry

    NARCIS (Netherlands)

    Berrevoets, Marvin Ah; ten Oever, Jaap; Sprong, Tom; van Hest, Reinier M.; Groothuis, Ingeborg; van Heijl, Inger; Schouten, Jeroen A.; Hulscher, Marlies E.; Kullberg, Bart-Jan

    2017-01-01

    The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of

  4. What Is the Best Way to Measure Surgical Quality? Comparing the American College of Surgeons National Surgical Quality Improvement Program versus Traditional Morbidity and Mortality Conferences.

    Science.gov (United States)

    Zhang, Jacques X; Song, Diana; Bedford, Julie; Bucevska, Marija; Courtemanche, Douglas J; Arneja, Jugpal S

    2016-04-01

    Morbidity and mortality conferences have played a traditional role in tracking complications. Recently, the American College of Surgeons National Surgical Quality Improvement Program Pediatrics (ACS NSQIP-P) has gained popularity as a risk-adjusted means of addressing quality assurance. The purpose of this article is to report an analysis of the two methodologies used within pediatric plastic surgery to determine the best way to manage quality. ACS NSQIP-P and morbidity and mortality data were extracted for 2012 and 2013 at a quaternary care institution. Overall complication rates were compared statistically, segregated by type and severity, followed by a subset comparison of ACS NSQIP-P-eligible cases only. Concordance and discordance rates between the two methodologies were determined. One thousand two hundred sixty-one operations were performed in the study period. Only 51.4 percent of cases were ACS NSQIP-P eligible. The overall complication rates of ACS NSQIP-P (6.62 percent) and morbidity and mortality conferences (6.11 percent) were similar (p = 0.662). Comparing for only ACS NSQIP-P-eligible cases also yielded a similar rate (6.62 percent versus 5.71 percent; p = 0.503). Although different complications are tracked, the concordance rate for morbidity and mortality and ACS NSQIP-P was 35.1 percent and 32.5 percent, respectively. The ACS NSQIP-P database is able to accurately track complication rates similarly to morbidity and mortality conferences, although it samples only half of all procedures. Although both systems offer value, limitations exist, such as differences in definitions and purpose. Because of the rigor of the ACS NSQIP-P, we recommend that it be expanded to include currently excluded cases and an extension of the study interval.

  5. Nonattainment of national ambient air quality standards: implications for energy policy

    Energy Technology Data Exchange (ETDEWEB)

    Garvey, D.B.; Streets, D.G.; Kotecki, R.; Senew, M.

    1979-10-01

    In accordance with the 1977 Clean Air Act Amendments, EPA established regulations governing new and existing sources of emissions in areas where the NAAQS are being exceeded. These requirements may constrain the implementation of a national energy policy to increase the use of coal in utilities and industries. The states designated the nonattainment areas and prepared State Implementation Plans, outlining strategies for attaining the standards by the deadline of December 31, 1982. This report contains maps of nonattainment areas for all pollutants and summaries of the attainment strategies for those pollutants most likely to affect fossil-fueled energy development - SO/sub 2/, TSP, and NO/sub x/. The review of SIPs indicates that attainment of SO/sub 2/ standards should be relatively easy. Attainment of TSP standards may be more difficult since point sources are already well controlled and further reductions in emissions will require controls on fugitive sources. NO/sub x/ nonattainment is currently limited to three small areas. The report also contains an examination of emission limitations in nonattainment areas and a national assessment of the potential constraints of nonattainment on energy development in 1985 to 1990. The assessment concludes that constraints on projected new coal-fired utilities should not be significant. Constraints on expanded industrial coal use from TSP nonattainment may be significant but the effects of SO/sub 2/ nonattainment should be limited.

  6. The Use of Quality Benchmarking in Assessing Web Resources for the Dermatology Virtual Branch Library of the National electronic Library for Health (NeLH)

    OpenAIRE

    Boulos, MN Kamel; Roudsari, AV; Gordon, C; Gray, JA Muir

    2001-01-01

    Background In 1998, the U.K. National Health Service Information for Health Strategy proposed the implementation of a National electronic Library for Health to provide clinicians, healthcare managers and planners, patients and the public with easy, round the clock access to high quality, up-to-date electronic information on health and healthcare. The Virtual Branch Libraries are among the most important components of the National electronic Library for Health . They aim at creating online kno...

  7. A fresh look at road salt: aquatic toxicity and water-quality impacts on local, regional, and national scales.

    Science.gov (United States)

    Corsi, Steven R; Graczyk, David J; Geis, Steven W; Booth, Nathaniel L; Richards, Kevin D

    2010-10-01

    A new perspective on the severity of aquatic toxicity impact of road salt was gained by a focused research effort directed at winter runoff periods. Dramatic impacts were observed on local, regional, and national scales. Locally, samples from 7 of 13 Milwaukee, Wisconsin area streams exhibited toxicity in Ceriodaphnia dubia and Pimephales promelas bioassays during road-salt runoff. Another Milwaukee stream was sampled from 1996 to 2008 with 72% of 37 samples exhibiting toxicity in chronic bioassays and 43% in acute bioassays. The maximum chloride concentration was 7730 mg/L. Regionally, in southeast Wisconsin, continuous specific conductance was monitored as a chloride surrogate in 11 watersheds with urban land use from 6.0 to 100%. Elevated specific conductance was observed between November and April at all sites, with continuing effects between May and October at sites with the highest specific conductance. Specific conductance was measured as high as 30,800 μS/cm (Cl = 11,200 mg/L). Chloride concentrations exceeded U.S. Environmental Protection Agency (USEPA) acute (860 mg/L) and chronic (230 mg/L) water-quality criteria at 55 and 100% of monitored sites, respectively. Nationally, U.S. Geological Survey historical data were examined for 13 northern and 4 southern metropolitan areas. Chloride concentrations exceeded USEPA water-quality criteria at 55% (chronic) and 25% (acute) of the 168 monitoring locations in northern metropolitan areas from November to April. Only 16% (chronic) and 1% (acute) of sites exceeded criteria from May to October. At southern sites, very few samples exceeded chronic water-quality criteria, and no samples exceeded acute criteria.

  8. Advances in public health accreditation readiness and quality improvement: evaluation findings from the National Public Health Improvement Initiative.

    Science.gov (United States)

    McLees, Anita W; Thomas, Craig W; Nawaz, Saira; Young, Andrea C; Rider, Nikki; Davis, Mary

    2014-01-01

    Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). Evaluate the extent to which NPHII awardees have achieved program goals. NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. NPHII performance improvement managers or principal investigators. Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

  9. Sexual Quality of Life and Aging: A Prospective Study of a Nationally Representative Sample.

    Science.gov (United States)

    Forbes, Miriam K; Eaton, Nicholas R; Krueger, Robert F

    2017-02-01

    Unlike other life domains, sexual quality of life (SQoL) has a negative relationship with age. This study disentangled the effect of age in this relationship from confounding sociocultural influences (e.g., the period of time in which data were collected, and cohort differences) and aimed to understand the roles of other sexual domains (i.e., frequency, perceived control, thought and effort invested in sex, and number of sexual partners). We analyzed data from the longitudinal Midlife in the United States study (n = 6,278; age range 20-93), which were collected between 1995 and 2013. Repeated measures linear mixed-effects models showed that age was the most robust time-related predictor of declining SQoL. However, after the sexual domains were included in the model, age had a positive relationship with SQoL and older adults' SQoL was differentially influenced by the quality-not quantity-of sex. When partnership characteristics were included in the model, age was no longer related to SQoL. These findings suggest that aging may be associated with the acquisition of skills and strategies that can buffer age-related declines in SQoL, particularly in the context of a positive relationship. We summarize these findings as sexual wisdom.

  10. Improving quality in national reference laboratories: The role of SLMTA and mentorship

    Directory of Open Access Journals (Sweden)

    Rosemary A. Audu

    2014-09-01

    Full Text Available Background: The Nigerian Institute of Medical Research houses two reference laboratories: the virology and tuberculosis laboratories. Both were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA programme. Objective: To describe the impact of SLMTA and discuss factors affecting the results, with an emphasis on mentorship. Methods: The SLMTA programme was implemented from April 2010 through November 2012. Participants attended three workshops and executed quality improvement projects; laboratory auditors evaluated performance using a standard checklist. The virology laboratory did not receive mentorship; however, the tuberculosis laboratory had an international mentor who visited the laboratory four times during the programme, spending two to four weeks embedded within the laboratory during each visit. Results: There was an overall improvement in the performance of both laboratories, with the virology laboratory increasing 13% (from 80% at baseline to 93% at exit audit and the tuberculosis laboratory increasing 29% (from 66% to 95%. These scores were maintained nine months later at the surveillance audit. Conclusion: The SLMTA programme resulted in improved and sustained quality management performance for both laboratories. Mentoring was a possible factor in the substantial improvement made by the tuberculosis laboratory and should be considered in order to augment the training received from the SLMTA workshops.

  11. The Role of Higher Education in National Quality Infrastructure Policy-Making

    Directory of Open Access Journals (Sweden)

    Jelena Ruso

    2017-05-01

    Full Text Available The aim of the paper is to raise awareness of the importance of the policy makers’ knowledge and expertise about quality infrastructure (QI for the successful policy-making. This article, which addresses the role of higher education in Serbian quality infrastructure policy-making, is an analysis of QI related contents of higher education institution curriculum. The target institutions are public faculties from whose official websites the data were collected. Depending on the keywords, the analysis was performed in order to classify the faculties into three categories. After reviewing the 307 subject titles and descriptions of undergraduate courses, the results show that the concepts of QI are widely recognized as an important and popular topic. The analysis of the QI adoption and diffusion indicates that although some of the faculties might be ‘leaders’ in a particular dimension, they still do not necessarily fall into the ‘leader’ category. JEL Classification:I21, I23, H54, L15

  12. The Strategic Study of National Quality Award through Business Excellence Model - The IBM, Panasonic and E.SUN Bank Cases in Taiwan

    Directory of Open Access Journals (Sweden)

    Jang-Ruey Tzeng

    2009-10-01

    Full Text Available Quality is a dignity to a country and also masterpiece and bedrock for the development of a country. To recover economical prosperity immediately right from the II world war, Japan founded Demin Quality Award to encourage the improvement of quality and promote the whole scale of competence core for enterprises in 1951. All the products produced by Japan are entirely favoured by the customers around the world during the period of 1975. The Japanese made automobiles, electronics and appliances are inexpensive and competitive enough to sluggish the economy growth of USA. To counter the serious threats and regain the advantage of the market, the United States finally founded Malcolm Baldrige National Quality Award, MBNQA to provide a series of standards for excellence performance in 1987. European Excellence Award was set up by the European Foundation for Quality Management, EFQM for advancing the superiority of tech development in 1991. Among the developing countries, there is no exception can be made for the emerging countries, especially in area of Aisa. Taiwan is the first country in Asia to establish Taiwan National Quality Award, TNQA in 1990 to represent the great honour of quality, also the first national quality award in this area. As the candidate with the great potential to be developed country in this region, not only Taiwan is struggling to advance its technology, but also promote the quality issues by quality related policies of government. Therefore, this paper is to examine the process of involvement in the promotion to Taiwan National Quality Award for three different enterprises, the 1assessment of various dimension in company through spot visit by judges of TNQA, and the analysis of interview record from the superior executives for the further research and introductive contribution of this award. Conclusively, this paper is trying to draw the overview of how to improve the excellence of quality in the practice of business

  13. A Lebanese dietary pattern promotes better diet quality among older adults: findings from a national cross-sectional study.

    Science.gov (United States)

    Jomaa, Lamis; Hwalla, Nahla; Itani, Leila; Chamieh, Marie Claire; Mehio-Sibai, Abla; Naja, Farah

    2016-04-19

    Proper nutrition is critical for healthy aging and maintaining functional independence. Limited research has been done on the assessment of dietary patterns of older adults and their association with diet quality indices. This study was conducted to identify, characterize, and evaluate the dietary patterns and diet quality of older adults in Lebanon, a middle-income country undergoing nutrition transition. A cross-sectional population-based study was conducted on a nationally representative sample of community-dwelling older adults aged >50 years (n = 525). Socio-demographic, anthropometric, and lifestyle variables were collected through interviews, and dietary intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Five commonly used diet quality indices (DQIs) were calculated, including the Alternative Healthy Eating Index (AHEI), the alternate Mediterranean diet score (aMed), the Dietary Approach to Stop Hypertension (DASH) style diet score, and the Lebanese Mediterranean Diet index. Dietary patterns (DPs) were derived using exploratory factor analysis. Associations of identified DPs with energy, energy-adjusted nutrients, and DQIs were evaluated by Pearson's correlations. Multiple linear regression analyses were used to examine correlates of DPs. Three DPs were derived: Lebanese, Western, and High Protein/Alcohol patterns. The Lebanese pattern had highest correlations with fiber, folate, vitamin C, and all five DQIs. The Western was positively associated with energy and sodium and was inversely correlated with fiber, most vitamins, and a number of DQIs, namely AHEI, aMED, and DASH-style diet score. Highest correlations with intakes of proteins and fat were observed for the High Protein/Alcohol pattern. The Lebanese pattern was associated with female gender, education, nonsmoking and physical activity, whereas the Western pattern was associated with adverse health behaviors, including smoking, skipping breakfast, and physical inactivity

  14. Summary of oceanographic and water-quality measurements near the Blackwater National Wildlife Refuge, Maryland, 2011

    Science.gov (United States)

    Ganju, Neil K.; Dickhudt, Patrick J.; Montgomery, Ellyn T.; Brennand, Patrick; Derby, R. Kyle; Brooks, Thomas W.; Guntenspergen, Glenn R.; Martini, Marinna A.; Borden, Jonathan; Baldwin, Sandra M.

    2012-01-01

    Suspended-sediment transport is a critical element governing the geomorphology of tidal marshes. Marshes rely on both organic material and inorganic sediment deposition to maintain their elevation relative to sea level. In wetlands near the Blackwater National Wildlife Refuge, Maryland, portions of the salt marsh have been subsiding relative to sea level since the early 20th century. Other portions of the marsh have been successful at maintaining elevation. The U.S. Geological Survey performed observational deployments to measure suspended-sediment concentration in the tidal channels in order to understand the magnitude of suspended-sediment concentrations, the sediment-transport mechanisms, and differences between two marsh areas, one that subsided and one that maintained elevation. We deployed optical turbidity sensors and acoustic velocity meters at multiple sites over two periods in 2011. This report presents the time-series of oceanographic data collected during those field studies, including velocity, depth, turbidity, salinity, water temperature, and pH.

  15. Experience with the european quality assurance guidelines for digital mammography systems in a national screening programme

    International Nuclear Information System (INIS)

    McCullagh, J.; Keavey, E.; Egan, G.; Phelan, N.

    2013-01-01

    The transition to a fully digital breast screening programme, utilising three different full-field digital mammography (FFDM) systems has presented many challenges to the implementation of the European guidelines for physico-technical quality assurance (QA) testing. An analysis of the QA results collected from the FFDM systems in the screening programme over a 2-y period indicates that the three different systems have similar QA performances. Generally, the same tests were failed by all systems and failure rates were low. The findings provide some assurance that the QA guidelines are being correctly implemented. They also suggest that there is more scope for the development of the relevance of the guidelines with respect to modern FFDM systems. This study has also shown that a summary review of the QA data can be achieved by simple organisation of the QA data storage and by automation of data query and retrieval using commonly available software. (authors)

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

    Science.gov (United States)

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

    2018-06-01

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

  17. A national quality incentive scheme to reduce antibiotic overuse in hospitals: evaluation of perceptions and impact.

    Science.gov (United States)

    Islam, J; Ashiru-Oredope, D; Budd, E; Howard, P; Walker, A S; Hopkins, S; Llewelyn, M J

    2018-02-28

    In 2016/2017, a financially linked antibiotic prescribing quality improvement initiative Commissioning for Quality and Innovation (AMR-CQUIN) was introduced across acute hospitals in England. This aimed for >1% reductions in DDDs/1000 admissions of total antibiotics, piperacillin/tazobactam and carbapenems compared with 2013/2014 and improved review of empirical antibiotic prescriptions. To assess perceptions of staff leading antimicrobial stewardship activity regarding the AMR-CQUIN, the investments made by hospitals to achieve it and how these related to achieving reductions in antibiotic use. We invited antimicrobial stewardship leads at acute hospitals across England to complete a web-based survey. Antibiotic prescribing data were downloaded from the PHE Antimicrobial Resistance Local Indicators resource. Responses were received from 116/155 (75%) acute hospitals. Owing to yearly increases in antibiotic use, most trusts needed to make >5% reductions in antibiotic consumption to achieve the AMR-CQUIN goal of 1% reduction. Additional funding was made available at 23/113 (20%) trusts and, in 18 (78%), this was trend for increased antibiotic use reversed in 2016/2017. In 2014/2015, year-on-year changes were +3.7% (IQR -0.8%, +8.4%), +9.4% (+0.2%, +19.5%) and +5.8% (-6.2%, +18.2%) for total antibiotics, piperacillin/tazobactam and carbapenems, respectively, and +0.1% (-5.4%, +4.0%), -4.8% (-16.9%, +3.2%) and -8.0% (-20.2%, +4.0%) in 2016/2017. Hospitals where staff believed they could reduce antibiotic use were more likely to do so (P < 0.001). Introducing the AMR-CQUIN was associated with a reduction in antibiotic use. For individual hospitals, achieving the AMR-CQUIN was associated with favourable perceptions of staff and not availability of funding.

  18. Water quality and aquatic communities of upland wetlands, Cumberland Island National Seashore, Georgia, April 1999 to July 2000

    Science.gov (United States)

    Frick, Elizabeth A.; Gregory, M. Brian; Calhoun, Daniel L.; Hopkins, Evelyn H.

    2002-01-01

    Cumberland Island is the southernmost and largest barrier island along the coast of Georgia. The island contains about 2,500 acres of freshwater wetlands that are located in a variety of physical settings, have a wide range of hydroperiods, and are influenced to varying degrees by surface and ground water, rainwater, and seawater. In 1999-2000, the U.S. Geological Survey, in cooperation with the National Park Service, conducted a water-quality study of Cumberland Island National Seashore to document and interpret the quality of a representative subset of surface- and ground-water resources for management of the seashore's natural resources. As part of this study, historical ground-water, surface-water, and ecological studies conducted on Cumberland Island also were summarized. Surface-water samples from six wetland areas located in the upland area of Cumberland Island were collected quarterly from April 1999 to March 2000 and analyzed for major ions, nutrients, trace elements, and field water-quality constituents including specific conductance, pH, temperature, dissolved oxygen, alkalinity, tannin and lignin, and turbidity. In addition, water temperature and specific conductance were recorded continuously from two wetland areas located near the mean high-tide mark on the Atlantic Ocean beaches from April 1999 to July 2000. Fish and invertebrate communities from six wetlands were sampled during April and December 1999. The microbial quality of the near-shore Atlantic Ocean was assessed in seawater samples collected for 5 consecutive days in April 1999 at five beaches near campgrounds where most recreational water contact occurs. Ground-water samples were collected from the Upper Floridan aquifer in April 1999 and from the surficial aquifer in April 2000 at 11 permanent wells and 4 temporary wells (drive points), and were analyzed for major ions, nutrients, trace elements, and field water-quality constituents (conductivity, pH, temperature, dissolved oxygen, and

  19. Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap.

    Science.gov (United States)

    Kidanto, Hussein Lesio; Wangwe, Peter; Kilewo, Charles D; Nystrom, Lennarth; Lindmark, Gunnila

    2012-11-21

    Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania. The prevalence of eclampsia in MNH is high (≈6%) with the majority of cases arriving after start of convulsions. In 2004-2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania after implementation of recommendations of a previous audit. A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH) guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001), urine for albumin test (61% vs. 99%; P=0.001), proper use of partogram to monitor labour (75% vs. 95%; P=0.003), treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001), Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005), full blood count (28% vs. 93%; P=0.001), serum urea and creatinine (44% vs. 86%; P=0.001), liver enzymes (4.0% vs. 86%; P=0.001), and specialist review within 2 hours of

  20. Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap

    Directory of Open Access Journals (Sweden)

    Kidanto Hussein

    2012-11-01

    Full Text Available Abstract Background Criteria-based audits (CBA have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania. Objective The prevalence of eclampsia in MNH is high (≈6% with the majority of cases arriving after start of convulsions. In 2004–2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base. A criteria-based audit (CBA was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH, Dar es Salaam, Tanzania after implementation of recommendations of a previous audit. Methods A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. Results There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001, urine for albumin test (61% vs. 99%; P=0.001, proper use of partogram to monitor labour (75% vs. 95%; P=0.003, treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001, Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005, full blood count (28% vs. 93%; P=0.001, serum urea and creatinine (44% vs. 86%; P=0.001, liver enzymes (4.0% vs

  1. A direct sensitivity approach to predict hourly ozone resulting from compliance with the National Ambient Air Quality Standard.

    Science.gov (United States)

    Simon, Heather; Baker, Kirk R; Akhtar, Farhan; Napelenok, Sergey L; Possiel, Norm; Wells, Benjamin; Timin, Brian

    2013-03-05

    In setting primary ambient air quality standards, the EPA's responsibility under the law is to establish standards that protect public health. As part of the current review of the ozone National Ambient Air Quality Standard (NAAQS), the US EPA evaluated the health exposure and risks associated with ambient ozone pollution using a statistical approach to adjust recent air quality to simulate just meeting the current standard level, without specifying emission control strategies. One drawback of this purely statistical concentration rollback approach is that it does not take into account spatial and temporal heterogeneity of ozone response to emissions changes. The application of the higher-order decoupled direct method (HDDM) in the community multiscale air quality (CMAQ) model is discussed here to provide an example of a methodology that could incorporate this variability into the risk assessment analyses. Because this approach includes a full representation of the chemical production and physical transport of ozone in the atmosphere, it does not require assumed background concentrations, which have been applied to constrain estimates from past statistical techniques. The CMAQ-HDDM adjustment approach is extended to measured ozone concentrations by determining typical sensitivities at each monitor location and hour of the day based on a linear relationship between first-order sensitivities and hourly ozone values. This approach is demonstrated by modeling ozone responses for monitor locations in Detroit and Charlotte to domain-wide reductions in anthropogenic NOx and VOCs emissions. As seen in previous studies, ozone response calculated using HDDM compared well to brute-force emissions changes up to approximately a 50% reduction in emissions. A new stepwise approach is developed here to apply this method to emissions reductions beyond 50% allowing for the simulation of more stringent reductions in ozone concentrations. Compared to previous rollback methods, this

  2. National indicators for quality of drug therapy in older persons: the Swedish experience from the first 10 years.

    Science.gov (United States)

    Fastbom, Johan; Johnell, Kristina

    2015-03-01

    Inappropriate drug use is an important health problem in elderly persons. Beginning with the Beers' criteria in the early 1990s, explicit criteria have been extensively used to measure and improve quality of drug use in older people. This article describes the Swedish indicators for quality of drug therapy in the elderly, introduced in 2004 and updated in 2010. These indicators were designed to be applied to people aged 75 years and over, regardless of residence and other characteristics. The indicators are divided into drug specific, covering choice, indication and dosage of drugs, polypharmacy, drug-drug interactions (DDIs), drug use in decreased renal function and in some symptoms; and diagnosis specific, covering the rational, irrational and hazardous drug use in common disorders in elderly people. During the 10 years since introduction, the Swedish indicators have several applications. They form the basis for recommendations for drug therapy in older people, are implemented in prescribing supports and drug utilisation reviews, are used in national benchmarking of the quality of Swedish healthcare and have contributed to initiatives from pensioner organisations. The indicators have also been used in several pharmacoepidemiological studies. Since 2005, there have been signs of improvement of the quality of drug prescribing to elderly persons in Sweden. For example, the prescribing of drugs that should be avoided in older persons decreased by 36 % between 2006 and 2012 in persons aged 80 years and older. Similarly, drug combinations that may cause DDIs decreased by 26 % and antipsychotics by 41 %. The indicators have likely contributed to this.

  3. Loop Ileostomy Closure as an Overnight Procedure: Institutional Comparison With the National Surgical Quality Improvement Project Data Set.

    Science.gov (United States)

    Berger, Nicholas G; Chou, Raymond; Toy, Elliot S; Ludwig, Kirk A; Ridolfi, Timothy J; Peterson, Carrie Y

    2017-08-01

    Enhanced recovery pathways have decreased length of stay after colorectal surgery. Loop ileostomy closure remains a challenge, because patients experience high readmission rates, and validation of enhanced recovery pathways has not been demonstrated. This study examined a protocol whereby patients were discharged on the first postoperative day and instructed to advance their diet at home with close telephone follow-up. The hypothesis was that patients can be safely discharged the day after loop closure, leading to shorter length of stay without increased rates of readmission or complications. Patients undergoing loop ileostomy closure were queried from the American College of Surgeons National Surgical Quality Improvement Project and compared with a single institution (2012-2015). Length of stay, 30-day readmission, and 30-day morbidity data were analyzed. The study was conducted at a tertiary university department. The study includes 1602 patients: 1517 from the National Surgical Quality Improvement Project database and 85 from a single institution. Length of stay and readmission rates were measured. Median length of stay was less at the single institution compared with control (2 vs 4 d; p < 0.001). Thirty-day readmission (15.3% vs 10.4%; p = 0.15) and overall 30-day complications (15.3% vs 16.7%; p = 0.73) were similar between cohorts. Estimated adjusted length of stay was less in the single institution (2.93 vs 5.58 d; p < 0.0001). There was no difference in the odds of readmission (p = 0.22). The main limitations of this study include its retrospective nature and limitations of the National Surgical Quality Improvement Program database. Next-day discharge with protocoled diet advancement and telephone follow-up is acceptable after loop ileostomy closure. Patients can benefit from decreased length of stay without an increase in readmission or complications. This has the potential to change the practice of postoperative management of loop ileostomy closure, as

  4. Associations between water quality, Pasteurella multocida, and avian cholera at Sacramento National Wildlife Refuge

    Science.gov (United States)

    Lehr, M.A.; Botzler, R.G.; Samuel, M.D.; Shadduck, D.J.

    2005-01-01

    We studied patterns in avian cholera mortality, the presence of Pasteurella multocida in the water or sediment, and water chemistry characteristics in 10 wetlands at the Sacramento National Wildlife Refuge Complex (California, USA), an area of recurrent avian cholera epizootics, during the winters of 1997 and 1998. Avian cholera outbreaks (a?Y50 dead birds) occurred on two wetlands during the winter of 1997, but no P. multocida were recovered from 390 water and 390 sediment samples from any of the 10 wetlands. No mortality events were observed on study wetlands during the winter of 1998; however, P. multocida was recovered from water and sediment samples in six of the 10 study wetlands. The pH levels were higher for wetlands experiencing outbreaks during the winter of 1997 than for nonoutbreak wetlands, and aluminum concentrations were higher in wetlands from which P. multocida were recovered during the winter of 1998. Water chemistry parameters (calcium, magnesium, sodium, and dissolved protein) previously linked with P. multocida and avian cholera mortality were not associated with the occurrence of avian cholera outbreaks or the presence of P. multocida in our study wetlands. Overall, we found no evidence to support the hypothesis that wetland characteristics facilitate the presence of P. multocida and, thereby, allow some wetlands to serve as long-term sources (reservoirs) for P. multocida.

  5. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

    Science.gov (United States)

    Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F

    2015-01-01

    Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, pquality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the need to intensify client education and balanced

  6. Voyageurs National Park: Water-level regulation and effects on water quality and aquatic biology

    Science.gov (United States)

    Christensen, Victoria G.; Maki, Ryan P.; LeDuc, Jaime F.

    2018-01-01

    Following dam installations in the remote Rainy Lake Basin during the early 1900s, water-level fluctuations were considered extreme (1914–1949) compared to more natural conditions. In 1949, the International Joint Commission (IJC), which sets rules governing dam operation on waters shared by the United States and Canada, established the first rule curves to regulate water levels on these waterbodies. However, rule curves established prior to 2000 were determined to be detrimental to the ecosystem. Therefore, the IJC implemented an order in 2000 to change rule curves and to restore a more natural water regime. After 2000, measured chlorophyll-a concentrations in the two most eutrophic water bodies decreased whereas concentrations in oligotrophic lakes did not show significant water-quality differences. Fish mercury data were inconclusive, due to the variation in water levels and fish mercury concentrations, but can be used by the IJC as part of a long term data set.

  7. Assessing organisational culture for quality and safety improvement: a national survey of tools and tool use.

    Science.gov (United States)

    Mannion, R; Konteh, F H; Davies, H T O

    2009-04-01

    There is growing international interest in managing organisational culture as a lever for healthcare improvement. This has prompted a practical need to understand what instruments and tools exist for assessing cultures in healthcare contexts. The present study was undertaken to determine the culture assessment tools being used in the English NHS and assess their fitness for purpose. Postal questionnaire survey of clinical governance leads in 275 English NHS organisations, with a response rate of 77%. A third of the organisations were currently using a culture assessment instrument to support their clinical governance activity. Although we found a high degree of satisfaction with existing instruments, in terms of ease of use and relevance, there is an immediate practical need to develop new and better bespoke culture assessment tools to bridge the gap between the cultural domains covered by extant instruments and the broader range of concerns of clinical governance managers. There is growing interest in understanding and shaping local cultures in healthcare, which is not yet matched by widespread use of available instruments. Even though extant tools cover many of the most important cultural attributes identified by clinical governance managers, the over-riding focus of tools in use is on safety rather than a holistic assessment of the dimensions of healthcare quality and performance.

  8. 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.

  9. Comparative analysis of national and state publications on the quality control of radiation diagnosis

    International Nuclear Information System (INIS)

    Francisco, Michel F.F.; Souza, Danilo L.M.; Oliveira, Caio V.; Cabete, Henrique V.; Cruz, Livia C.; Pires, Silvio R.; Freitas, Marcelo B.; Medeiros, Regina B.

    2016-01-01

    Taking into account that there are several standards for Quality Control in diagnostic radiology, the purpose of this research was to carry out an overview of Brazilian regulatory publications. The sample was composed by Ordinance 453/98, resolutions SS-625 (SP), SES/MG Number 5177, 002/DIVS/SES (SC) and ANVISA guide. Differences and similarities in the tests, nomenclatures, periodicity and performance parameters were evaluated. It was identified that SS-625 was one of the first publications in the area, proposing standards and indicating reference levels. ANVISA guide describes the procedures for performing the tests established in Ordinance 453. The 002/DIVS/SES included digital imaging systems and provides more restrictive performance standards in some tests when compared other publications. ES/MG Number 5177 describes some tests in mammography equipment, not defined in other publications. We conclude that there is no standardization in the nomenclature or in the performance and frequency of the tests, seeking greater scope and updating. (author)

  10. National Beef Quality Audit-2000: survey of targeted cattle and carcass characteristics related to quality, quantity, and value of fed steers and heifers.

    Science.gov (United States)

    McKenna, D R; Roebert, D L; Bates, P K; Schmidt, T B; Hale, D S; Griffin, D B; Savell, J W; Brooks, J C; Morgan, J B; Montgomery, T H; Belk, K E; Smith, G C

    2002-05-01

    The National Beef Quality Audit-2000 was conducted to assess the current status ofthe quality and consistency of U.S. fed steers and heifers. Between May and November 2000, survey teams assessed hide condition (n = 43,415 cattle for color, brands, mud/manure), bruises (n = 43,595 carcasses), offal and carcass condemnation (n = 8,588 cattle), and carcass quality and yield information (n = 9,396 carcasses) in 30 U.S. beef packing plants. Hide colors were black (45.1%), red (31.0%), yellow (8.0%), Holstein (5.7%), gray (4.0%), white (3.2%), brown (1.7%), and brindle (1.3%). Brand frequencies were no (49.3%), one (46.2%), and two or more (4.4%), and brands were located on the butt (36.3%), side (13.7%), and shoulder (3.6%). Most cattle had no (18.0%) or a small amount (55.8%) of mud/manure on their hides, and they had no (77.3%) horns. Most carcasses (53.3%) were not bruised, 30.9% had one bruise, and 15.8% had multiple bruises. Bruise location and incidence were round (14.9%), loin (25.9%), rib (19.4%), chuck (28.2%), and brisket, flank, and plate (11.6%). Condemnation item and incidence were liver (30.3%), lungs (13.8%), tripe (11.6%), heads (6.2%), tongues (7.0%), and carcasses (0.1%). Carcass evaluation revealed these traits and frequencies: steer (67.9%), heifer (31.8%), and bullock (0.3%) sex-classes; dark-cutters (2.3%); A (96.6%), B (2.5%), and C or older (0.9%) overall maturities; and native (90.1%), dairy-type (6.9%), and Bos indicus (3.0%) breed-types. Mean USDA yield grade traits were USDA yield grade (3.0), carcass weight (356.9 kg), adjusted fat thickness (1.2 cm), longissimus muscle area (84.5 cm2), and kidney, pelvic, and heart fat (2.4%). USDA yield grades were Yield Grade 1 (12.2%), Yield Grade 2 (37.4%), Yield Grade 3 (38.6%), Yield Grade 4 (10.4%), and Yield Grade 5 (1.3%). Mean USDA quality grade traits were USDA quality grade (Select85), marbling score (Small23), overall maturity (A66), lean maturity (A65), and skeletal maturity (A67). Marbling

  11. The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

    Science.gov (United States)

    Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P

    2012-01-01

    The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project.

  12. [The National Database of the Regional Collaborative Rheumatic Centers as a tool for clinical epidemiology and quality assessment in rheumatology].

    Science.gov (United States)

    Zink, Angela; Huscher, Dörte; Listing, Joachim

    2003-01-01

    The national database of the German Collaborative Arthritis Centres is a well-established tool for the observation and assessment of health care delivery to patients with rheumatic diseases in Germany. The discussion of variations in treatment practices contributes to the internal quality assessment in the participating arthritis centres. This documentation has shown deficits in primary health care including late referral to a rheumatologist, undertreatment with disease-modifying drugs and complementary therapies. In rheumatology, there is a trend towards early, intensive medical treatment including combination therapy. The frequency and length of inpatient hospital and rehabilitation treatments is decreasing, while active physiotherapy in outpatient care has been increased. Specific deficits have been identified concerning the provision of occupational therapy services and patient education.

  13. Validation Study for the Brief Measure of Quality of Life and Quality of Care: A Questionnaire for the National Random Sampling Hospital Survey.

    Science.gov (United States)

    Shimizu, Megumi; Fujisawa, Daisuke; Kurihara, Miho; Sato, Kazuki; Morita, Tatsuya; Kato, Masashi; Miyashita, Mitsunori

    2017-08-01

    To monitor quality of life (QOL) for patients with cancer in a large population-based survey, we developed a short QOL and quality-of-care (QOC) questionnaire. To determine the validity and reliability of this new questionnaire for evaluating QOL in patients with cancer. Outpatients and inpatients at National Cancer Center Hospital East were administered a questionnaire, including the following items-the short QOL and QOC questionnaire (physical distress, pain, emotional distress, walk burden, and need for help with self-care; perceived general health status; and satisfaction with medical care and treatment by doctor, communication with doctor, support by health-care staff other than doctor, care for physical symptoms such as pain, and psychological care), the Functional Assessment of Cancer Therapy-General (FACT-G), the Cancer Care Evaluation Scale (CCES) for patients, and demographic and medical data. We then readministered the short QOL and QOC questionnaire. In total, 329 outpatients and 239 inpatients completed the survey (response rates: 80% and 90%, respectively). Total Cronbach α for the short QOL and QOC questionnaire was 0.83 for outpatients and 0.82 for inpatients. Items of the questionnaire correlated with cancer-specific measurements, FACT-G, and CCES. Intraclass correlation coefficients for all items of the questionnaire were 0.79 and 0.89 in each setting. Items of QOL and QOC did not correlate with each other. The validity and reliability of the short QOL and QOC questionnaire appear sufficient. This questionnaire enables continuous monitoring of patient QOL in large population-based surveys.

  14. Expression of Geochemical Controls on Water Quality in Loch Vale, Rocky Mountain National Park

    Science.gov (United States)

    Podzorski, H.; Navarre-Sitchler, A.; Stets, E.; Clow, D. W.

    2017-12-01

    Relationships between concentrations of rock weathering products and discharge provide insight into the interactions between climate and solute dynamics. This concentration-discharge (C-Q) relationship is especially interesting in high alpine regions, due to their susceptibility to changes in the timing and magnitude of snowmelt. Previous studies looking at C-Q relationships have concluded that concentrations of conservative solutes remain relatively constant as discharge varies; however, these results may be due to relatively small sample sizes, especially at higher discharge values. Using water chemistry data collected regularly by the U.S. Geological Survey from Loch Vale, a high-elevation catchment in Rocky Mountain National Park, C-Q relationships were examined to determine possible geochemical controls on stream solute concentrations. A record of over 20 years of C-Q data resulted in a pattern that shows little variation in conservative solute concentrations during base flow and larger variations in concentrations around peak discharge. This observed pattern is consistent with accumulation of solutes in pore water during base flow, which are then flushed out and diluted by snowmelt. Further evidence of this flushing out mechanism is found in patterns of hysteresis that are present in annual C-Q relationships. Before peak discharge, concentrations of weathering products are higher than after peak discharge at similar values of discharge. Based on these observations, we hypothesize that the geochemical processes controlling stream chemistry vary by season. During the winter, solute concentrations are transport-limited due to slow subsurface flushing resulting in concentrations that are effectively constant and close to equilibrium. During the spring and summer, concentrations drop sharply after peak discharge due to a combination of dilution and reaction-limited processes under conditions with faster subsurface flow and continued snowmelt. This study provides

  15. Taking up national safety alerts to improve patient safety in hospitals: The perspective of healthcare quality and risk managers.

    Science.gov (United States)

    Pfeiffer, Yvonne; Schwappach, David

    2016-01-01

    National safety alert systems publish relevant information to improve patient safety in hospitals. However, the information has to be transformed into local action to have an effect on patient safety. We studied three research questions: How do Swiss healthcare quality and risk managers (qm/rm(1)) see their own role in learning from safety alerts issued by the Swiss national voluntary reporting and analysis system? What are their attitudes towards and evaluations of the alerts, and which types of improvement actions were fostered by the safety alerts? A survey was developed and applied to Swiss healthcare risk and quality managers, with a response rate of 39 % (n=116). Descriptive statistics are presented. The qm/rm disseminate and communicate with a broad variety of professional groups about the alerts. While most respondents felt that they should know the alerts and their contents, only a part of them felt responsible for driving organizational change based on the recommendations. However, most respondents used safety alerts to back up their own patient safety goals. The alerts were evaluated positively on various dimensions such as usefulness and were considered as standards of good practice by the majority of the respondents. A range of organizational responses was applied, with disseminating information being the most common. An active role is related to using safety alerts for backing up own patient safety goals. To support an active role of qm/rm in their hospital's learning from safety alerts, appropriate organizational structures should be developed. Furthermore, they could be given special information or training to act as an information hub on the issues discussed in the alerts. Copyright © 2016. Published by Elsevier GmbH.

  16. Assessment of the Dutch National Air Quality Plan 2004; Beoordeling van het Nationaal Luchtkwaliteitsplan 2004

    Energy Technology Data Exchange (ETDEWEB)

    Beck, J.P.; Buringh, E.; Wieringa, K.

    2005-02-01

    The Dutch government expects that targets for the reduction of emission of particulates and nitrogen dioxide can not be reached in time. Therefore, the Netherlands is obliged to draft a plan of actions in order to realize those targets within the period that has been agreed upon in the context of the European Union air quality policy. The present plan of action has been assessed by the Netherlands Environmental Assessment Agency (MNP) with regard to the feasibility of the boundary values and the preconditions for action plans as formulated by the European Committee. Also, the plan has been assessed for the prevention or limitation of health effects and the Dutch position with regard to particulates. [Dutch] Het luchtbeleid heeft als doelstelling dat op lange termijn de gezondheidsrisico's en de effecten op ecosystemen en biodiversiteit moeten dalen tot een verwaarloosbaar niveau. Daartoe zijn in Europees verband normen voor de luchtkwaliteit vastgesteld. Nederland verwacht dat met het vastgestelde beleid niet tijdig aan de grenswaarden voor fijn stof en stikstofdioxide zal worden voldaan. Hierdoor is Nederland verplicht om een actieplan op te stellen. De uitvoering ervan zal er toe moeten leiden dat Nederland alsnog de doelen binnen de gestelde termijn haalt. Het Milieu- en Natuurplanbureau (MNP) van het RIVM heeft het actieplan getoetst aan de haalbaarheid van grenswaarden en aan de voorwaarden die door de Europese Commissie voor actieplannen zijn opgesteld. Daarnaast is het plan beoordeeld in het perspectief van de doelstelling van de richtlijn: het voorkomen of verminderen van gezondheidseffecten. Tenslotte geeft de evaluatie aanknopingspunten voor het herijken van de Nederlandse positie in de fijnstofproblematiek.

  17. The role of providers in implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative: Fresenius Medical Care North America perspective.

    Science.gov (United States)

    Lazarus, J M; Wick, G; Borella, L

    1999-01-01

    This is a brief review of the history of utilization of quality indicators by a major dialysis provider and how those indicators have been modified in response to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI). Fresenius Medical Care North America (FMCNA) has monitored adequacy of dialysis, anemia management, and nutrition therapy for a number of years, using a self-directed continuous quality improvement program. FMCNA supports the NKF-DOQI Guidelines and has used the DOQI as it continues to enhance its patient quality care program. Specific goals and action thresholds of that program are delineated.

  18. Socioeconomic Status and Age Variations in Health-Related Quality of Life: Results From the National Health Measurement Study

    Science.gov (United States)

    Cherepanov, Dasha; Palta, Mari; Dunham, Nancy Cross; Feeny, David; Fryback, Dennis G.

    2009-01-01

    Objectives We examine whether multiple health-related quality of life (HRQoL) measures are stratified by socioeconomic status (SES) and age in the United States. Methods Data are from the 2005/2006 National Health Measurement Study, a telephone survey of a nationally representative sample of U.S. adults. We plot mean HRQoL scores by SES within age groups. Regression analyses test whether education, income, and assets each have independent associations with three “preference-based” HRQoL measures and self-rated health (SRH). We test whether these associations vary by age. Results There are SES disparities in HRQoL and SRH among adults in the United States at all age groups. Income differentials in HRQoL are strong across current adult age cohorts, except the 75–89 age cohort. Education and assets have statistically significant but weaker associations with HRQoL. All three SES measures are associated with SRH (net of each other) at every age group. Those in the lowest income and education groups in the 35–44 age cohort have worse HRQoL and SRH than those in higher SES groups in the 65+ age cohort. Discussion Significant improvements in HRQoL at the population level will only be possible if we improve the HRQoL of people at the lowest end of the socioeconomic distribution. PMID:19307286

  19. Work life and patient safety culture in Canadian healthcare: connecting the quality dots using national accreditation results.

    Science.gov (United States)

    Mitchell, Jonathan I

    2012-01-01

    Fostering quality work life is paramount to building a strong patient safety culture in healthcare organizations. Data from two patient safety culture and work-life questionnaires used for Accreditation Canada's national program were analyzed. Strong team leadership was reported in that units were doing a good job of identifying, assessing and managing risks to patients. Seventy-one percent of respondents gave their unit a positive overall grade on patient safety, and 79% of respondents felt that they could often do their best-quality work in their job. However, healthcare workers felt that they did not have enough time to do their jobs adequately and indicated that co-workers were cutting corners in patient care in order to save time. This article discusses engaging both senior leadership and the entire organization in the change process, ensuring supervisory support, and using performance measures to focus organizational efforts on key priorities all as improvement strategies relevant to these findings. These strategies can be used by organizations across sectors and jurisdictions and by healthcare leaders to positively affect work life and patient safety.

  20. Groundwater quality monitoring well installation for Waste Area Grouping 3 at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    International Nuclear Information System (INIS)

    Mortimore, J.A.; Ebers, M.L.

    1994-09-01

    This report documents the drilling and installation of 15 groundwater quality monitoring (GQM) wells on the perimeter of Waste Area Grouping (WAG) 3. WAG 3 is located in Melton Valley, approximately 3,000 ft west of the west gate of Oak Ridge National Laboratory, and consists of an estimated 22 acres. The subject site contains three solid waste management units: the Contractors' Landfill, the Closed Scrap Metal Area, and Solid Waste Storage Area 3. The wells at WAG 3 were drilled and developed between September 1987 and August 1990. These wells were installed to characterize and assess the WAG in accordance with applicable Department of Energy, state, and Environmental Protection Agency regulatory requirements. The wells at WAG 3 were drilled with auger or air rotary rigs. Depending upon the hydrogeologic conditions present at each proposed well location, one of four basic installation methods was utilized. The purpose of the well installation program was to install GQM wells for groundwater characterization at WAG 3. Data packages produced during installation activities by the ERCE hydrogeologists are an important product of the program. These packages document the well drilling, installation, and development activities and provide valuable data for well sampling and WAG characterization. The forms contained in the packages include predrilling and postdrilling checklists, drilling and construction logs, development and hydraulic conductivity records, and quality control-related documents

  1. Groundwater quality monitoring well installation for Waste Area Grouping 17 at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    International Nuclear Information System (INIS)

    Mortimore, J.A.; Ebers, M.L.

    1994-09-01

    This report documents the drilling and installation of groundwater quality monitoring (GQM) wells on the perimeter of Waste Area Grouping (WAG) 17. WAG 17 is composed of approximately 23 acres and is located in Bethel Valley about 3,100 ft east of the Oak Ridge National Laboratory (ORNL) main plant area. The facilities in WAG 17 constitute the ORNL Services Area and include the shipping and receiving departments, machine shops, carpenter shops, paint shops, lead burning facilities, tritium facility, and the materials storage area. The wells at WAG 17 were drilled and developed between November 1989 and April 1990. These wells were installed to characterize and assess the WAG in accordance with applicable Department of Energy, state, and Environmental Protection Agency regulatory requirements. The purpose of the well installation program was to install GQM wells for groundwater characterization at WAG 17. Data packages produced during installation activities by the ERCE hydrogeologists are an important product of the program. These packages document the well drilling, installation, and development activities and provide valuable data for well sampling and WAG 17 characterization. The forms contained in the packages include predrilling and postdrilling checklists, drilling and construction logs, development and hydraulic conductivity records, and quality control-related documents

  2. Medical clerks in a national university hospital: improving the quality of medical care with a focus on spinal surgery.

    Science.gov (United States)

    Kobayashi, Kazuyoshi; Ando, Kei; Noda, Makiko; Ishiguro, Naoki; Imagama, Shiro

    2018-02-01

    In our institution, which is a national university hospital, medical clerks were introduced in 2009 to improve the doctor's working environment. Seventeen clerks were assigned to 9 separate departments and the work content differed greatly among departments, but sufficient professional work was not done efficiently. The purpose of this study is to investigate the effects of the work of medical clerks on improvement of medical quality in recent years. In 2011, we established a central clerk desk on our outpatient floor to improve efficiency and centralize the clerk work. Since 2013, periodic education of clerks on spine disease has been provided by spine doctors, and this has facilitated sharing of information on spinal surgery from diagnosis to surgical treatment. This has allowed medical clerks to ask patients questions, leading to more efficient medical treatment and a potential reduction of doctors' work. In 2016, a revision of the insurance system by the Ministry of Health, Labour and Welfare of Japan increased the amount of medical work that clerks can perform, and it became possible to increase the number of medical clerks. Currently, we have 30 medical clerks, and this has allowed establishment of new clerk desks in other departments to handle patients. A training curriculum will be developed to reduce the burden on doctors further and to improve the quality of medical treatment.

  3. Quality management and accreditation of research tissue banks: experience of the National Center for Tumor Diseases (NCT) Heidelberg.

    Science.gov (United States)

    Herpel, Esther; Röcken, Christoph; Manke, Heike; Schirmacher, Peter; Flechtenmacher, Christa

    2010-12-01

    Tissue banks are key resource and technology platforms in biomedical research that address the molecular pathogenesis of diseases as well as disease prevention, diagnosis, and treatment. Due to the central role of tissue banks in standardized collection, storage, and distribution of human tissues and their derivatives, quality management and its external assessment is becoming increasingly relevant for the maintenance, acceptance, and funding of tissue banks. Little experience exists regarding formalized external evaluation of tissue banks, especially regarding certification and accreditation. Based on the accreditation of the National Center of Tumor Diseases (NCT) tissue bank in Heidelberg (Germany), criteria, requirements, processes, and implications were compiled and evaluated. Accreditation formally approved professional competence and performance of the tissue bank in all steps involved in tissue collection, storage, handling as well as macroscopic and histologic examination and final (exit) examination of the tissue and transfer supervised by board-certified competent histopathologists. Thereby, accreditation provides a comprehensive measure to evaluate and document the quality standard of tissue research banks and may play a significant role in the future assessment of tissue banks. Furthermore, accreditation may support harmonization and standardization of tissue banking for biomedical research purposes.

  4. Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

    Science.gov (United States)

    Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

    2018-03-31

    To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

  5. Modelling relationships between lichen bioindicators, air quality and climate on a national scale: Results from the UK OPAL air survey

    International Nuclear Information System (INIS)

    Seed, Lindsay; Wolseley, Pat; Gosling, Laura; Davies, Linda; Power, Sally A.

    2013-01-01

    Air pollution has many negative effects on the natural environment, from changes in plant growth patterns to loss of ecosystem function. This study uses citizen science to investigate national-scale patterns in the distribution and abundance of selected lichen species on tree trunks and branches, and to relate these to air pollution and climate. Volunteers collected data for nine lichen indicators on 19,334 deciduous trees. Submitted data provided information on species-level patterns, and were used to derive composite lichen indices. Multiple linear regression and ANCOVA were used to model the relationships between lichen response variables on Quercus spp. and pollution, climate and location. The study demonstrated significant relationships between patterns in indicator lichens and levels of N- and S-containing pollutants on trunks and twigs. The derived lichen indices show great potential as a tool to provide information on local, site-specific levels of air quality. -- Highlights: •Data on presence and abundance of selected lichens were collected by members of the public. •Indicator species and indices were modelled against air pollution and climate data. •Lichens and indices show significant relationships with nitrogenous air pollution. •Lichen indices are useful tools for providing information on local air quality. -- Data on selected lichen taxa collected by members of the public in England is used to show the relationship of indicator taxa and pollution indices to air pollution and climate data

  6. Groundwater quality monitoring well installation for Waste Area Grouping 5 at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    International Nuclear Information System (INIS)

    Mortimore, J.A.; Ebers, M.L.

    1994-09-01

    This report documents the drilling and installation of 22 groundwater quality monitoring (GQM) wells on the perimeter of Waste Area Grouping (WAG) 5. WAG 5 is located south of the Oak Ridge National Laboratory main plant area in Melton Valley and includes 33 solid waste management units. The wells at WAG 5 were drilled and developed between July 1987 and March 1990. These wells were installed to characterize and assess the WAG in accordance with applicable Department of Energy, state, and Environmental Protection Agency regulatory requirements. The purpose of the well installation program was to install GQM wells for groundwater characterization at WAG 5. Data packages produced during installation activities by the ERCE hydrogeologists are an important product of the program. These packages document the well drilling, installation, and development activities and provide valuable data for well sampling and WAG characterization. The forms contained in the packages include predrilling and postdrilling checklists, drilling and construction logs, development and hydraulic conductivity records, and quality control-related documents

  7. Groundwater quality monitoring well installation for Waste Area Grouping 4 at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    International Nuclear Information System (INIS)

    Mortimore, J.A.

    1994-09-01

    This report documents the drilling and installation of 15 groundwater quality monitoring (GQM) wells on the perimeter of Waste Area Grouping (WAG) 4. WAG 4 is comprised of about 27 acres located in Melton Valley approximately 2700 ft southwest of the Oak Ridge National Laboratory main plant. It contains three inactive solid waste management units: (1) the abandoned intermediate level liquid waste transfer line located along the WAG's northwestern boundary, (2) the experimental pilot pit area, and (3) SWSA 4, the largest unit in the WAG. The wells at WAG 4 were drilled and developed between September 1987 and October 1990. These wells were installed to characterize and assess the WAG in accordance with applicable Department of Energy (DOE), state, and Environmental Protection Agency regulatory requirements. The wells at WAG 4 were drilled with auger or air rotary rigs. Depending on the hydrogeologic conditions present at each proposed well location, one of four basic installation methods was utilized. The purpose of the well installation program was to install GQM wells for groundwater characterization at WAG 4. Data packages produced during installation activities by the ERCE hydrogeologists are an important product of the program. These packages document the well drilling, installation, and development activities and provide valuable data for well sampling and WAG characterization. The forms contained in the packages include predrilling and postdrilling checklists, drilling and construction logs, development and hydraulic conductivity records, and quality control-related documents

  8. Relationship between dietary quality, tinnitus and hearing level: data from the national health and nutrition examination survey, 1999-2002.

    Science.gov (United States)

    Spankovich, Christopher; Bishop, Charles; Johnson, Mary Frances; Elkins, Alex; Su, Dan; Lobarinas, Edward; Le Prell, Colleen G

    2017-10-01

    To examine the relationship between the healthy eating index (HEI), a measure of dietary quality based on United States Department of Agriculture recommendations and report of tinnitus. This cross-sectional analysis was based on HEI data and report of tinnitus. Data for adults between 20 and 69 years of age were drawn from the National Health and Nutrition Examination Survey (NHANES), 1999-2002. The NHANES is a programme of studies, to assess the health and nutritional status of adults and children in the United States. Two thousand one hundred and seventy-six participants were included in the analytic sample. Of the sample, 21.1% reported tinnitus within the past year and 11.7% reported persistent tinnitus, defined as tinnitus experienced at least monthly or greater. Controlling for age, sex, race/ethnicity, diabetes, noise exposure and smoking status, we found that with healthier diet (poorer vs. better HEI) there was decreased odds of reported persistent tinnitus [odds ratio (OR); 0.67; 95% confidence interval (CI) 0.45-0.98; p = 0.03]. The current findings support a possible relationship between healthier diet quality and reported persistent tinnitus.

  9. A reconnaissance of the effects of a forest fire on water quality in Kings Canyon National Park, California

    Science.gov (United States)

    Hoffman, Ray J.; Ferreira, Rodger F.

    1976-01-01

    Following two forest fires in the Roaring River drainage basin, Kings Canyon National Park, Calif., water samples were collected from May to July 1974 to determine water-quality changes resulting from the fires. Field measurements included alkalinity , pH, specific conductance, temperature, and discharge. Samples were analyzed in the laboratory for major dissolved chemical constituents, selected plant nutrients, trace metals, suspended sediment, total organic carbon, and seston. Periphytic algae and benthic invertebrate samples were collected. A noticeable increase in the concentration of nitrogen was found in Roaring River immediately downstream from the Moraine Creek fire. The increase in the concentration of inorganic nitrogen compounds, however, was not great enough to pose a serious threat to the aquatic ecosystem. High total organic nitrogen concentrations may have been due, in part, to factors other than the effect of fire. The results of other water-quality measurements were typical of dilute Sierra Nevada streams and indicate that Roaring River was not adversely affected by the fires. (Woodard-USGS)

  10. Pesticides in streams of the United States : initial results from the National Water-Quality Assessment Program

    Science.gov (United States)

    Larson, Steven J.; Gilliom, Robert J.; Capel, Paul D.

    1999-01-01

    Water samples from 58 rivers and streams across the United States were analyzed for pesticides as part of the National Water-Quality Assessment Program of the U.S. Geological Survey. The sampling sites represent 37 diverse agricultural basins, 11 urban basins, and 10 basins with mixed land use. Forty-six pesticides and pesticide degradation products were analyzed in approximately 2,200 samples collected from 1992 to 1995. The target compounds account for approximately 70 percent of national agricultural use in terms of the mass of pesticides applied annually. All the target compounds were detected in one or more samples. Herbicides generally were detected more frequently and at higher concentrations than insecticides. Nationally, 11 herbicides, 1 herbicide degradation product, and 3 insecticides were detected in more than 10 percent of samples. The number of target compounds detected at each site ranged from 7 to 37. The herbicides atrazine, metolachlor, prometon, and simazine were detected most frequently; among the insecticides, carbaryl, chlorpyrifos, and diazinon were detected the most frequently. Distinct differences in pesticide occurrence were observed in streams draining the various agricultural settings. Relatively high levels of several herbicides occurred as seasonal pulses in corn-growing areas. Several insecticides were frequently detected in areas where the dominant crops consist of orchards and vegetables. The number of pesticides detected and their concentrations were lower in wheat-growing areas than in most other agricultural areas. In most urban areas, the herbicides prometon and simazine and the insecticides carbaryl, chlorpyrifos, diazinon, and malathion were commonly detected. Concentrations of pesticides rarely exceeded standards and criteria established for drinking water, but some pesticides commonly exceeded criteria established for the protection of aquatic life.

  11. An Overview of Food Patterns and Diet Quality in Qatar: Findings from the National Household Income Expenditure Survey.

    Science.gov (United States)

    Al-Thani, Mohammed; Al-Thani, Al-Anoud; Al-Mahdi, Nasser; Al-Kareem, Hefzi; Barakat, Darine; Al-Chetachi, Walaa; Tawfik, Afaf; Akram, Hammad

    2017-05-15

    Availability of accurate data pertaining to a population's dietary patterns and associated health outcomes is critical for proper development and implementation of related policies. This article is a first attempt to share the food patterns, amounts and diet quality among households (HH) in Qatar. Data from the 2012-2013 Qatar National Household Income and Expenditure Survey (HIES) was used. This cross-sectional survey included 3723 HH (1826 Qatari HH and 1897 non-Qatari HH). Dietary data on monthly amounts food items available at HH according to the nationality was used. The food items were expressed in terms of grams per capita per day and aggregated into groups to examine the food patterns, energy, and adequacy. The overall average amount of purchased food at HH in Qatar was 1885 g/capita/day. Qatari HH purchased more food (2118 g/capita/day) versus non-Qataris (1373 g/capita/day); however, the percentages of the amounts purchased by food types were similar among both nationalities. Average daily energy (kcal) per capita was almost double among Qatari HH (4275 kcal) vs. non-Qatari HH (2424 kcal). The food items under subsidy program for Qatari citizens provided 1753 kcal/capita/day and accounted for 41% of total daily energy. Proteins (29.2), fats (39.2), sodium (3.3), and vitamin C (32.5) had higher than recommended levels of nutrient density (grams per 1000 kcal). Calcium (227), vitamin A (302.3), fiber (2.0), and carbohydrates (132.6) had lower than recommended levels of nutrient energy density (g/1000 kcal). The study predicts unhealthy dietary habits among HH in Qatar and provides useful information for policy makers and healthcare community.

  12. Quality of prostate cancer screening information on the websites of nationally recognized cancer centers and health organizations.

    Science.gov (United States)

    Manole, Bogdan-Alexandru; Wakefield, Daniel V; Dove, Austin P; Dulaney, Caleb R; Marcrom, Samuel R; Schwartz, David L; Farmer, Michael R

    2017-12-24

    The purpose of this study was to survey the accessibility and quality of prostate-specific antigen (PSA) screening information from National Cancer Institute (NCI) cancer center and public health organization Web sites. We surveyed the December 1, 2016, version of all 63 NCI-designated cancer center public Web sites and 5 major online clearinghouses from allied public/private organizations (cancer.gov, cancer.org, PCF.org, USPSTF.org, and CDC.gov). Web sites were analyzed according to a 50-item list of validated health care information quality measures. Web sites were graded by 2 blinded reviewers. Interrater agreement was confirmed by Cohen kappa coefficient. Ninety percent of Web sites addressed PSA screening. Cancer center sites covered 45% of topics surveyed, whereas organization Web sites addressed 70%. All organizational Web pages addressed the possibility of false-positive screening results; 41% of cancer center Web pages did not. Forty percent of cancer center Web pages also did not discuss next steps if a PSA test was positive. Only 6% of cancer center Web pages were rated by our reviewers as "superior" (eg, addressing >75% of the surveyed topics) versus 20% of organizational Web pages. Interrater agreement between our reviewers was high (kappa coefficient = 0.602). NCI-designated cancer center Web sites publish lower quality public information about PSA screening than sites run by major allied organizations. Nonetheless, information and communication deficiencies were observed across all surveyed sites. In an age of increasing patient consumerism, prospective prostate cancer patients would benefit from improved online PSA screening information from provider and advocacy organizations. Validated cancer patient Web educational standards remain an important, understudied priority. Copyright © 2018. Published by Elsevier Inc.

  13. A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan.

    Science.gov (United States)

    El-Jardali, Fadi; Fadlallah, Racha

    2017-08-16

    Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking

  14. The use of quality benchmarking in assessing web resources for the dermatology virtual branch library of the National electronic Library for Health (NeLH).

    Science.gov (United States)

    Kamel Boulos, M N; Roudsari, A V; Gordon, C; Muir Gray, J A

    2001-01-01

    In 1998, the U.K. National Health Service Information for Health Strategy proposed the implementation of a National electronic Library for Health to provide clinicians, healthcare managers and planners, patients and the public with easy, round the clock access to high quality, up-to-date electronic information on health and healthcare. The Virtual Branch Libraries are among the most important components of the National electronic Library for Health. They aim at creating online knowledge based communities, each concerned with some specific clinical and other health-related topics. This study is about the envisaged Dermatology Virtual Branch Libraries of the National electronic Library for Health. It aims at selecting suitable dermatology Web resources for inclusion in the forthcoming Virtual Branch Libraries after establishing preliminary quality benchmarking rules for this task. Psoriasis, being a common dermatological condition, has been chosen as a starting point. Because quality is a principal concern of the National electronic Library for Health, the study includes a review of the major quality benchmarking systems available today for assessing health-related Web sites. The methodology of developing a quality benchmarking system has been also reviewed. Aided by metasearch Web tools, candidate resources were hand-selected in light of the reviewed benchmarking systems and specific criteria set by the authors. Over 90 professional and patient-oriented Web resources on psoriasis and dermatology in general are suggested for inclusion in the forthcoming Dermatology Virtual Branch Libraries. The idea of an all-in knowledge-hallmarking instrument for the National electronic Library for Health is also proposed based on the reviewed quality benchmarking systems. Skilled, methodical, organized human reviewing, selection and filtering based on well-defined quality appraisal criteria seems likely to be the key ingredient in the envisaged National electronic Library for

  15. Source apportionment analysis of air pollutants using CMAQ/BFM for national air quality management policy over Republic of Korea.

    Science.gov (United States)

    Moon, N.; Kim, S.; Seo, J.; Lee, Y. J.

    2017-12-01

    Recently, the Korean government is focusing on solving air pollution problem such as fine particulate matter and ozone. Korea has high population density and concentrated industrial complex in its limited land space. For better air quality management, it is important to understand source and contribution relation to target pollutant. The air quality analysis representing the mutual contribution among the local regions enables to understand the substantive state of the air quality of a region in association with neighboring regions. Under this background, the source apportionment of PM10, PM2.5, O3, NO2, SO2 using WRF and CMAQ/BFM was analyzed over Korea and BFM was applied to mobile, area and point sources in each local government. The contribution rate from neighboring region showed different pattern for each pollutant. In case of primary pollutants such as NO2, SO2, local source contribution is dominant, on the other hand secondary pollutants case especially O3, contribution from neighboring region is higher than that from source region itself. Local source contribution to PM10 showed 20-25% and the contribution rate to O3 has big difference with different meteorological condition year after year. From this study, we tried to estimate the conversion rate between source (NOx, VOC, SO2, NH3, PMC, PM2.5, CO) and concentration (PM10, PM2.5, O3, NO2, SO2,) by regional group over Korea. The result can contribute to the decision-making process of important national planning related to large-scale industrial developments and energy supply policies (eg., operations of coal-fired power plants and diesel cars) and emission control plan, where many controversies and concerns are currently concentrated among local governments in Korea. With this kind of approach, various environmental and social problems related to air quality can also be identified early so that a sustainable and environmentally sound plan can be established by providing data infrastructures to be utilized

  16. Vegetation Diversity Quality in Mountainous Forest of Ranu Regulo Lake Area, Bromo Tengger Semeru National Park, East Java

    Directory of Open Access Journals (Sweden)

    Jehan Ramdani Hariyati

    2012-01-01

    Full Text Available Aim of this research was to study vegetation diversity quality in mountainous forest of Ranu Regulo Lake area in Bromo Tengger Semeru National Park (TNBTS, East Java. Field observation was carried out by vegetation analysis using sampling plots of 25x25 m2 for trees, 5x5 m2 for poles, 1x1 m2 for ground surface plants. Community structure of each lake side was determined by calculating vegetation's density, basal area, frequency, important value and stratification of species. While vegetations diversity was estimated by taxa richness, Shannon-Wiener diversity index, and rate of endemism. Each lake side forests were compared by Morisita community similarity index. Data were tabulated by Microsoft Excel 2007. The result showed that based on existed vegetation, mountainous forest surrounding Ranu Regulo Lake consisted of four ecosystems, i.e. heterogenic mountainous forest, pine forest, acacia forest and bushes. Bushes Area has two types of population, edelweiss and Eupatorium odoratum invaded area. Vegetation diversity quality in heterogenic mountainous forest of Ranu Regulo TNBTS was the highest, indicated by its multi-stratification to B stratum trees of 20-30m high. Heterogenic mountainous forest’s formation was Acer laurinum and Acmena accuminatissima for trees, Chyatea for poles. Taxa richness was found 59 species and 30 families, while the others were found below 28 species and 17 families. Diversity Index of heterogenic mountainous forest is the highest among others for trees is 2.31 and 3.24 for poles and second in bushes (H=3.10 after edelweiss ecosystem (H=3.39. Highest rate of endemism reached 100% for trees in heterogenic mountainous forest, 87% for poles in edelweiss area and 89% for bushes also in heterogenic mountainous forest. Trees, poles and herbs most similarity community showed by pine and acacia forest. Based on those five characters, vegetation diversity quality in Ranu Regulo Lake area was medium for heterogenic mountainous

  17. USDA's National Food and Nutrient Analysis Program (NFNAP) produces high-quality data for USDA food composition databases: Two decades of collaboration.

    Science.gov (United States)

    Haytowitz, David B; Pehrsson, Pamela R

    2018-01-01

    For nearly 20years, the National Food and Nutrient Analysis Program (NFNAP) has expanded and improved the quantity and quality of data in US Department of Agriculture's (USDA) food composition databases (FCDB) through the collection and analysis of nationally representative food samples. NFNAP employs statistically valid sampling plans, the Key Foods approach to identify and prioritize foods and nutrients, comprehensive quality control protocols, and analytical oversight to generate new and updated analytical data for food components. NFNAP has allowed the Nutrient Data Laboratory to keep up with the dynamic US food supply and emerging scientific research. Recently generated results for nationally representative food samples show marked changes compared to previous database values for selected nutrients. Monitoring changes in the composition of foods is critical in keeping FCDB up-to-date, so that they remain a vital tool in assessing the nutrient intake of national populations, as well as for providing dietary advice. Published by Elsevier Ltd.

  18. Evaluation of quality assurance/quality control data collected by the U.S. Geological Survey for water-quality activities at the Idaho National Engineering and Environmental Laboratory, Idaho, 1994 through 1995

    International Nuclear Information System (INIS)

    Williams, L.M.

    1997-03-01

    More than 4,000 water samples were collected by the US Geological Survey (USGS) from 179 monitoring sites for the water-quality monitoring program at the Idaho National Engineering Laboratory from 1994 through 1995. Approximately 500 of the water samples were replicate or blank samples collected for the quality assurance/quality control program. Analyses were performed to determine the concentrations of major ions, nutrients, trace elements, gross radioactivity and radionuclides, total organic carbon, and volatile organic compounds in the samples. To evaluate the precision of field and laboratory methods, analytical results of the replicate pairs of samples were compared statistically for equivalence on the basis of the precision associated with each result. In all, the statistical comparison of the data indicated that 95% of the replicate pairs were equivalent. Within the major ion analyses, 97% were equivalent; nutrients, 88%; trace elements, 95%; gross radioactivity and radionuclides, 93%; and organic constituents, 98%. Ninety percent or more of the analytical results for each constituent were equivalent, except for nitrite, orthophosphate, phosphorus, aluminum, iron, strontium-90, and total organic carbon

  19. Calibrations and evaluation of the quality assurance during 1999 at the National Laboratory for ionising radiation; Kalibrerings- och normalieverksamheten vid Riksmaetplats 06 under 1999

    Energy Technology Data Exchange (ETDEWEB)

    Grindborg, Jan-Erik; Israelsson, Karl-Erik; Kylloenen, Jan-Erik; Samuelson, Goeran

    2000-06-01

    The Swedish Radiation Protection Institute is the National Laboratory for the dosimetric quantities kerma, absorbed dose and dose equivalent. The activity is based on established calibration procedures and a quality assurance program for the used standards. This report gives a brief summary of the calibrations performed during 1999 and a more detailed description and analysis of the quality assurance during this year. The report makes it easier to draw conclusions about the long-term stability and possible malfunctions.

  20. Quality of health care of atopic eczema in Germany: results of the national health care study AtopicHealth.

    Science.gov (United States)

    Langenbruch, A; Radtke, M; Franzke, N; Ring, J; Foelster-Holst, R; Augustin, M

    2014-06-01

    The successful treatment of atopic eczema (AE) should result in the improvement of both physical symptoms and patient's quality of life (QoL). This study was conducted using a sample of dermatologists throughout Germany. This is due to dermatologists being the main health care providers of AE. Obtaining reliable data on quality of care of AE from both the patient's and the physician's perspective. This cross-sectional study assessed: the individual clinical history; dermatology-specific QoL (DLQI); state of health (EQ-5d-VAS); treatments; burden caused by disease and treatment; patient-defined treatment benefit (PBI). Data from 1678 adult patients (60.5% female, mean age: 38.4 ± 15.9) were analysed. The most frequently used treatments during the last five years were emollients (90.4%) and topical corticosteroids (85.5%). In this study, 75.8% of the patients felt only moderately or not at all impaired by their treatment. The mean DLQI (0 = minimum-30 = maximum QoL impairment) was 8.5 ± 6.5. The EQ-5d-VAS (100 = best possible) was 63.6 ± 22.0 on average. 26.6% reported suffering 'often' or 'every night' from sleeplessness due to severe itching. Mean PBI was 2.4 ± 1.1 (4 = maximum benefit). This study provides first data on the health care of adults with AE in Germany at a national level and reveals the need for a more effective care. Whereas most patients consider their treatment-related burden as low, the daily burden of the disease seems to be high: one third reports sleeplessness due to itching which indicates insufficient therapeutic regimes in these cases. A better implementation of the German national guideline for AE and a systematic analysis of the difficulties causing its limited effects is needed. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

  1. Pediatric сlinic of Odessa National Medical University: the quality of emergency medical care for children

    Directory of Open Access Journals (Sweden)

    E.A. Starets

    2017-04-01

    Full Text Available Background. The purpose of the article is to discuss the issue of improving the quality of emergency care for children with the most common diseases. Materials and methods. The quality of medical care includes 6 characteristics: 1 effectiveness — evidencebased health care results in improved health outcomes; 2 relevancy: health care is delivered in a manner that maximizes resource use and avoids wasting and provided in a setting where skills and resources are appropriate to medical need; 3 accessibility: health care is provided timely, reasonable and affordable; 4 acceptability/patient-centered: health care provided takes into account the preferences and aspirations of individual service users; 5 equity: health care provided does not vary in quality because of personal characteristics or socioeconomic status; 6 safety: health care provided minimizes risks and harm to service users and providers. Results. The Intensive Care Unit (ICU started working in the Pediatric Clinic of the Odessa National Medical University on February 1, 2017. The main task of ICU is the treatment of children with emergency conditions (who needs monitoring of breathing and cardiac activity, oxygen therapy, large-volume rehydration therapy, etc. The patients admit to the ICU according the results of triage. Triage is the process of rapidly screening of sick children soon after their addmission to hospital and in ICU, in order to identify those with emergency signs — obstruc-ted breathing or severe respiratory distress; central cyanosis; signs of shock; signs of severe dehydration; those with priority signs — very high temperature, severe pallor, respiratory distress etc. The local guidelines for the most common diseases in children have been developed in the Pediatric Clinic. These local guidelines are based on: 1 modern national guidelines; 2 WHO: Pocket book of hospital care for children: guidelines for the management of common childhood illnesses (2013; clinical

  2. Quality assurance in CT: implementation of the updated national diagnostic reference levels using an automated CT dose monitoring system.

    Science.gov (United States)

    Appel, E; Kröpil, P; Bethge, O T; Aissa, J; Thomas, C; Antoch, G; Boos, J

    2018-03-20

    To evaluate the implementation of the updated computed tomography (CT) diagnostic reference levels (DRLs) from the German Federal Office for Radiation Protection into clinical routine using an automatic CT dose monitoring system. CT radiation exposure was analysed before and after implementing the updated national DRLs into routine clinical work in 2016. After the implementation process, institutional CT protocols were mapped to the anatomical regions for which DRLs were provided. Systematically, protocols that exceeded the thresholds were optimised and analysed in detail. The CT radiation output parameters analysed were volumetric CT dose index (CTDIvol) and dose-length product (DLP). Three radiologists evaluated subjective image quality using a three-point Likert scale. The study included 94,258 CT series (from 27,103 CT examinations) in adult patients performed in 2016. When averaged over all body regions with available DRL, institutional CTDIvol/DLP values were always below the DRLs (65.2±32.9%/67.3±41.5% initially; 59.4±32%/60.5±39.9% after optimisation). Values exceeding the national DRLs were found for pelvis (n=268; CTDIvol 107.7±65.7%/DLP 106.3±79.3%), lumbar spine (n=91; 160.8±74.7%/175.2±104.1%), and facial bones (n=527; 108±39%/152.7±75.7%). After optimisation, CTDIvol and DLP were 87.9±73%/87.8±80.8% for the pelvis, 67.8±33.2%/74.5±50.6% for the lumbar spine and 95.1±45.8%/133.3±74.6% for the viscerocranium. An automatic CT dose monitoring system enabled not only comprehensive monitoring of a DRL implementation process but can also help to optimise radiation exposure. Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  3. Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan.

    Science.gov (United States)

    Huang, C-J; Hu, H-T; Fan, Y-C; Liao, Y-M; Tsai, P-S

    2010-04-01

    This study investigated the associations of breakfast skipping with obesity and health-related quality of life (QOL). We also tested the hypothesis that there is a dose-dependent relationship between frequency of breakfast consumption and prevalence of obesity. This cross-section study used a national representative sample (n=15 340) from the 2005 Taiwan National Health Interview Survey. Breakfast skippers were defined as those who ate breakfast about once a week or less often and those who never ate breakfast. Individuals were classified as 'obese' if their body mass index was >or=27. Health-related QOL was assessed using the Medical Outcome Studies 36-Item Short-Form (SF-36) Health Survey. Logistic regression was used to examine the odds ratio of obesity and associated 95% confidence intervals (CIs) in breakfast skippers compared with breakfast eaters. Multivariable logistic regression modeling was used to adjust all risk estimates for covariates. The unadjusted odds ratio of obesity in breakfast skippers was 1.23 (95% CI: 1.06, 1.43). The odds of developing obesity for breakfast skippers was 1.34 (95% CI: 1.15, 1.56) controlling for age, sex, marital status, educational level, monthly income, smoking, alcohol, betel nut chewing and exercise habit. The Cochran-Armitage trend test revealed that the prevalence rate of obesity decreased as the frequency of breakfast consumption increased (P=0.005). Breakfast skippers had significantly worse health-related QOL than breakfast eaters (Pbreakfast skippers had significantly lower scores in 5 out of 8 domain scores of the SF-36, namely general health perceptions (Pmental health (Pbreakfast eating in obesity prevention.

  4. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    Directory of Open Access Journals (Sweden)

    Darko Gvozdanovi_

    2007-09-01

    Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

  5. Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District.

    Science.gov (United States)

    Nsiah-Boateng, Eric; Aikins, Moses; Asenso-Boadi, Francis; Andoh-Adjei, Francis-Xavier

    2016-09-01

    Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial access to health care for all residents. This article analyzed claims reimbursement data of the NHIS to assess the value of the benefit package to the insured and responsiveness of the service to the financial needs of health services providers. Medical claims data reported between January 1, 2010, and December 31, 2014, were retrieved from the database of Ashiedu Keteke District Office of the National Health Insurance Authority. The incurred claims ratio, promptness of claims settlements, and claims adjustment rate were analyzed over the 5-year period. In all, 644,663 medical claims with a cost of Ghana cedi (GHS) 11.8 million (US $3.1 million) were reported over the study period. The ratio of claims cost to contributions paid increased from 4.3 to 7.2 over the 2011-2013 period, and dropped to 5.0 in 2014. The proportion of claims settled beyond 90 days also increased from 26% to 100% between 2011 and 2014. Generally, the amount of claims adjusted was low; however, it increased consistently from 1% to about 4% over the 2011-2014 period. The reasons for claims adjustments included provision of services to ineligible members, overbilling of services, and misapplication of diagnosis related groups. There is increased value of the NHIS benefit package to subscribers; however, the scheme's responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Benchmarking by HbA1c in a national diabetes quality register--does measurement bias matter?

    Science.gov (United States)

    Carlsen, Siri; Thue, Geir; Cooper, John Graham; Røraas, Thomas; Gøransson, Lasse Gunnar; Løvaas, Karianne; Sandberg, Sverre

    2015-08-01

    Bias in HbA1c measurement could give a wrong impression of the standard of care when benchmarking diabetes care. The aim of this study was to evaluate how measurement bias in HbA1c results may influence the benchmarking process performed by a national diabetes register. Using data from 2012 from the Norwegian Diabetes Register for Adults, we included HbA1c results from 3584 patients with type 1 diabetes attending 13 hospital clinics, and 1366 patients with type 2 diabetes attending 18 GP offices. Correction factors for HbA1c were obtained by comparing the results of the hospital laboratories'/GP offices' external quality assurance scheme with the target value from a reference method. Compared with the uncorrected yearly median HbA1c values for hospital clinics and GP offices, EQA corrected HbA1c values were within ±0.2% (2 mmol/mol) for all but one hospital clinic whose value was reduced by 0.4% (4 mmol/mol). Three hospital clinics reduced the proportion of patients with poor glycemic control, one by 9% and two by 4%. For most participants in our study, correcting for measurement bias had little effect on the yearly median HbA1c value or the percentage of patients achieving glycemic goals. However, at three hospital clinics correcting for measurement bias had an important effect on HbA1c benchmarking results especially with regard to percentages of patients achieving glycemic targets. The analytical quality of HbA1c should be taken into account when comparing benchmarking results.

  7. Health related quality of life in patients with type 2 diabetes mellitus in Iran: a national survey.

    Directory of Open Access Journals (Sweden)

    Mehdi Javanbakht

    Full Text Available INTRODUCTION: The aim of this study was to measure health-related quality of life (HRQoL in Iranian people with Type 2 Diabetes Mellitus using two different measures and examines which socio-demographic and diabetes-related characteristics are associated with better quality of life based on a nationally distributed sample. METHODS: A multi-stage cluster sampling method was used to select 3472 subjects as a part of Iranian surveillance of risk factors of non-communicable disease (ISRFNCD. EuroQol-5 Dimensions questionnaire (EQ-5D and Visual Analog Scale (VAS were employed to measure HRQoL. Binary logistic and Tobit regression models were used to investigate factors associated with EQ-5D results. RESULTS: The mean age of subjects was 59.4 years (SD = 11.7, 61.3% were female and had 8.08 years (SD = 6.7 known duration of diabetes. The patients reported "some or extreme problems" most frequently in Pain/Discomfort (69.3% and Anxiety/Depression (56.6% dimensions of EQ-5D. The mean EQ-5D and VAS score were 0.70 (95% CI 0.69-0.71 and 56.8 (95% CI 56.15-57.5 respectively. Female gender, lower education, unemployment, long duration of diabetes, diabetes-related hospitalization in past years and having nephropathy and lower extremity lesions were associated with higher probabilities of reporting "some or extreme problems" in most dimensions of EQ-5D in binary logistic regression models. The same factors in addition to retinopathy were significantly associated with lower levels of HRQoL in Tobit regression analysis too. CONCLUSIONS: The study findings indicate that patients with diabetes in Iran suffer from relatively poor HRQoL. Therefore much more attention should be paid to main determinants of HRQoL to identify and implement appropriate policies for achieving better management of diabetes and ultimately improving the quality of life of diabetic patients in this region.

  8. Sources of information used to support quality use of medicines: findings from a national survey of nurse practitioners in Australia.

    Science.gov (United States)

    Buckley, Thomas; Stasa, Helen; Cashin, Andrew; Stuart, Meg; Dunn, Sandra V

    2015-02-01

    The purpose of this study was to investigate the sources, both print and electronic formats, which Australian nurse practitioners (NPs) currently use to obtain information regarding quality use of medicines (QUM). An additional aim was to document NPs' preferences for continuing education in relation to QUM. A national electronic survey of Australian NPs was conducted in 2007 and again in 2010. Eighty percent of respondents accessed information on QUM from professional literature, which may include scholarly journal articles, reports, and independent publications. There was a decrease in the percentage of respondents who obtained information from drug industry representatives. NPs prefer to receive medicines information in an electronic form, rather than a paper-based version, and over the time period more NPs are utilizing electronic sources rather than paper. These findings provide important insights into medical information products for the developers who may be able to use these results to ensure that their products meet the needs of NP clinicians. Additionally, the finding that NPs prefer to receive their continuing information related to medicines in electronic format, but also highly value conference proceedings, may help to inform future planning of NP education needs in relation to QUM. ©2014 American Association of Nurse Practitioners.

  9. Molecular Approach to Microbiological Examination of Water Quality in the Grand Bay National Estuarine Research Reserve (NERR) in Mississippi, USA.

    Science.gov (United States)

    Kishinhi, Stephen S; Tchounwou, Paul B; Farah, Ibrahim O

    2013-01-01

    Grand Bay National Estuarine Research Reserve (NERR) is an important ecosystem in the Mississippi Gulf Coast. It serves as important nursery areas for juveniles of many species of fish. The bay is also used for fishing, crabbing, oyster togging, boating as well as recreation. Like in other aquatic environments, this bay may be contaminated by microorganisms including pathogenic bacteria. The objective of this study was to evaluate the microbiological quality of water in the Grand Bay NERR and determine the levels and potential source(s) of human fecal pollution. To achieve this goal, water samples were collected aseptically every month in Bayou Heron, Bayou Cumbest, Point Aux Chenes Bay and Bangs Lake. Enterococci were concentrated from water samples by membrane filtration according to the methodology outlined in USEPA Method 1600. After incubation, DNA was extracted from bacteria colonies on the membrane filters by using QIAamp DNA extraction kit. Water samples were also tested for the presence of traditional indicator bacteria including: heterotrophic plate count, total coliforms, fecal coliforms, and Enterococcus bacteria. The marker esp gene was detected in one site of Bayou Cumbest, an area where human populations reside. Data from this study indicates higher concentrations of indicator bacteria compared to the recommended acceptable levels. Presence of esp marker and high numbers of indicator bacteria suggest a public health concern for shellfish and water contact activities. Hence, control strategies should be developed and implemented to prevent further contamination of the Grand bay NERR waters.

  10. Outcomes of operations for benign foregut disease in elderly patients: a National Surgical Quality Improvement Program database analysis.

    Science.gov (United States)

    Molena, Daniela; Mungo, Benedetto; Stem, Miloslawa; Feinberg, Richard L; Lidor, Anne O

    2014-08-01

    The development of minimally invasive operative techniques and improvement in postoperative care has made surgery a viable option to a greater number of elderly patients. Our objective was to evaluate the outcomes of laparoscopic and open foregut operation in relation to the patient age. Patients who underwent gastric fundoplication, paraesophageal hernia repair, and Heller myotomy were identified via the National Surgical Quality Improvement Program (NSQIP) database (2005-2011). Patient characteristics and outcomes were compared between five age groups (group I: ≤65 years, II: 65-69 years; III: 70-74 years; IV: 75-79 years; and V: ≥80 years). Multivariable logistic regression analysis was used to predict the impact of age and operative approach on the studied outcomes. A total of 19,388 patients were identified. Advanced age was associated with increased rate of 30-day mortality, overall morbidity, serious morbidity, and extended length of stay, regardless of the operative approach. After we adjusted for other variables, advanced age was associated with increased odds of 30-day mortality compared with patients <65 years (III: odds ratio 2.70, 95% confidence interval 1.34-5.44, P = .01; IV: 2.80, 1.35-5.81, P = .01; V: 6.12, 3.41-10.99, P < .001). Surgery for benign foregut disease in elderly patients carries a burden of mortality and morbidity that needs to be acknowledged. Copyright © 2014 Mosby, Inc. All rights reserved.

  11. Tailoring the operative approach for appendicitis to the patient: a prediction model from national surgical quality improvement program data.

    Science.gov (United States)

    Senekjian, Lara; Nirula, Raminder

    2013-01-01

    Laparoscopic appendectomy (LA) is increasingly being performed in the United States, despite controversy about differences in infectious complication rates compared with open appendectomy (OA). Subpopulations exist in which infectious complication rates, both surgical site and organ space, differ with respect to LA compared with OA. All appendectomies in the National Surgical Quality Improvement Program database were analyzed with respect to surgical site infection (SSI) and organ space infection (OSI). Multivariate logistic regression analysis identified independent predictors of SSI or OSI. Probabilities of SSI or OSI were determined for subpopulations to identify when LA was superior to OA. From 2005 to 2009, there were 61,830 appendectomies performed (77.5% LA), of which 9,998 (16.2%) were complicated (58.7% LA). The risk of SSI was considerably lower for LA in both noncomplicated and complicated appendicitis. Across all ages, body mass index, renal function, and WBCs, LA was associated with a lower probability of SSI. The risk of OSI was considerably greater for LA in both noncomplicated and complicated appendicitis. In complicated appendicitis, OA was associated with a lower probability of OSI in patients with WBC >12 cells × 10(3)/μL. In noncomplicated appendicitis, OA was associated with a lower probability of OSI in patients with a body mass index OSI, however, SSI is consistently lower in LA patients. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

    Directory of Open Access Journals (Sweden)

    Robert Kaba Alhassan

    Full Text Available Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS in Ghana are also discussed.This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001. Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in

  13. Role of Age and Acculturation in Diet Quality Among Mexican Americans - Findings From the National Health and Nutrition Examination Survey, 1999-2012.

    Science.gov (United States)

    Yoshida, Yilin; Scribner, Richard; Chen, Liwei; Broyles, Stephanie; Phillippi, Stephen; Tseng, Tung-Sung

    2017-07-20

    Age and acculturation may play a role in diet quality among Mexican Americans. This study examined diet quality in Mexican Americans by age and whether acculturation influences diet quality across different age groups, using data from the National Health and Nutrition Examination Survey (NHANES). Diet quality, measured by the Healthy Eating Index 2010, improved with age except in categories of dairy, sodium, and refined grains. More acculturation was associated with lower scores in overall diet quality and categories of vegetables, fruits, and sodium and empty calories across almost all ages, but higher scores in grain categories, especially in younger groups. A diet rich in fruits and vegetables but low in fat and sodium should be promoted among more acculturated Mexican Americans, and whole-grain foods should be promoted among young but less acculturated Mexican Americans.

  14. Assessment of air quality benefits from the national pollution control policy of thermal power plants in China: A numerical simulation

    Science.gov (United States)

    Wang, Zhanshan; Pan, Libo; Li, Yunting; Zhang, Dawei; Ma, Jin; Sun, Feng; Xu, Wenshuai; Wang, Xingrun

    2015-04-01

    In 2010, an emission inventory of air pollutants in China was created using the Chinese Bulletin of the Environment, the INTEX-B program, the First National Pollution Source Census, the National Generator Set Manual, and domestic and international research studies. Two emission scenarios, the standard failed emission scenario (S1) and the standard successful emission scenario (S2), were constructed based upon the Instructions for the Preparation of Emission Standards for Air Pollutants from Thermal Power Plants (second draft). The Fifth-Generation NCAR/Penn State Mesoscale Model (MM5) and the U.S. EPA Models-3 Community Multiscale Air Quality (CMAQ) model were applied to China to study the air quality benefits from Emission Standards for Air Pollutants from Thermal Power Plants GB13223-2011. The performance of MM5 and CMAQ was evaluated with meteorological data from Global Surface Data from the National Climatic Data Center (NCDC) and the daily Air Pollution Index (API) reported by Chinese local governments. The results showed that the implementation of the new standards could reduce the concentration of air pollutants and acid deposition in China by varying degrees. The new standards could reduce NO2 pollution in China. By 2020, for the scenario S2, the area with an NO2 concentration higher than the second-level emission standard, and the average NO2 concentration in 31 selected provinces would be reduced by 55.2% and 24.3%, respectively. The new standards could further reduce the concentration of declining SO2 in China. By 2020, for S2, the area with an SO2 concentration higher than the second-level emission standard and the average SO2 concentration in the 31 selected provinces would be reduced by 40.0% and 31.6%, respectively. The new standards could also reduce PM2.5 pollution in China. By 2020, for S2, the area with a PM2.5 concentration higher than the second-level emission standard and the average concentration of PM2.5 in the 31 selected provinces would be

  15. Water quality, meteorological, and nutrient data collected by the the National Estuarine Research Reserve System's System-wide Monitoring Program (NERRS SWMP) from January 1, 1995 to August 1, 2011 (NODC Accession 0052765)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Estuarine Research Reserve System's System-wide Monitoring Program (NERRS SWMP) collected water quality, meteorological, and nutrient data in 26...

  16. Reoperation and readmission after clipping of an unruptured intracranial aneurysm: a National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Dasenbrock, Hormuzdiyar H; Smith, Timothy R; Rudy, Robert F; Gormley, William B; Aziz-Sultan, M Ali; Du, Rose

    2018-03-01

    OBJECTIVE Although reoperation and readmission have been used as quality metrics, there are limited data evaluating the rate of, reasons for, and predictors of reoperation and readmission after microsurgical clipping of unruptured aneurysms. METHODS Adult patients who underwent craniotomy for clipping of an unruptured aneurysm electively were extracted from the prospective National Surgical Quality Improvement Program registry (2011-2014). Multivariable logistic regression and recursive partitioning analysis evaluated the independent predictors of nonroutine hospital discharge, unplanned 30-day reoperation, and readmission. Predictors screened included patient age, sex, comorbidities, American Society of Anesthesiologists (ASA) classification, functional status, aneurysm location, preoperative laboratory values, operative time, and postoperative complications. RESULTS Among the 460 patients evaluated, 4.2% underwent any reoperation at a median of 7 days (interquartile range [IQR] 2-17 days) postoperatively, and 1.1% required a cranial reoperation. The most common reoperation was ventricular shunt placement (23.5%); other reoperations were tracheostomy, craniotomy for hematoma evacuation, and decompressive hemicraniectomy. Independent predictors of any unplanned reoperation were age greater than 51 years and longer operative time (p ≤ 0.04). Readmission occurred in 6.3% of patients at a median of 6 days (IQR 5-13 days) after discharge from the surgical hospitalization; 59.1% of patients were readmitted within 1 week and 86.4% within 2 weeks of discharge. The most common reason for readmission was seizure (26.7%); other causes of readmission included hydrocephalus, cerebrovascular accidents, and headache. Unplanned readmission was independently associated with age greater than 65 years, Class II or III obesity (body mass index > 35 kg/m 2 ), preoperative hyponatremia, and preoperative anemia (p ≤ 0.04). Readmission was not associated with operative time

  17. Implementing the European Quality Assurance in Vocational Education and Training (EQAVET) at National Level: Some Insights from the PEN Leonardo Project

    Science.gov (United States)

    Gatt, Suzanne; Faurschou, Kim

    2016-01-01

    EQAVET, the quality assurance tool in vocational and educational training, was developed in response to the need for a supply of a trained workforce for labour market needs. Implementation of EQAVET at national level, however, remains a challenge. The research reported here focused on the implementation of QA processes by VET providers in 4…

  18. What Counts as Quality in Education? Australian College of Educators (ACE) National Conference Proceedings (Adelaide, Australia, September 11-12, 2014)

    Science.gov (United States)

    Ghirelli, Paola S., Ed.

    2014-01-01

    The 2014 Australian College of Educators (ACE) National Conference was held September 11-12 in Adelaide, Australia, with the theme, "What counts as quality in education?" There has been concern with a general downward trend in Australia's performance on international measures of student achievement, but there is equal concern over the…

  19. Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry

    NARCIS (Netherlands)

    Berrevoets, M.A.H.; Oever, J. ten; Sprong, T.; Hest, R.M. van; Groothuis, I.; Heijl, I. van; Schouten, J.A.; Hulscher, M.E.J.L.; Kullberg, B.J.

    2017-01-01

    BACKGROUND: The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the

  20. Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands : The national NABON Breast Cancer Audit

    NARCIS (Netherlands)

    van Bommel, Annelotte C.M.; Spronk, Pauline E.R.; Vrancken Peeters, Marie-Jeanne T.F.D.; Jager, Agnes; Lobbes, Marc; Maduro, John H.; Mureau, Marc A.M.; Schreuder, Kay; Smorenburg, Carolien; Verloop, Janneke; Westenend, Pieter J.; Wouters, Michel W.J.M.; Siesling, Sabine; Tjan-Heijnen, Vivianne C.G.; van Dalen, Thijs

    2017-01-01

    Background In 2011, the NABON Breast Cancer Audit (NBCA) was instituted as a nation-wide audit to address quality of breast cancer care and guideline adherence in the Netherlands. The development of the NBCA and the results of 4 years of auditing are described. Methods Clinical and pathological

  1. Assessment of water-quality data from Long Lake National Wildlife Refuge, North Dakota--2008 through 2012

    Science.gov (United States)

    Tangen, Brian A.; Finocchiaro, Raymond G.; Gleason, Robert A.; Rabenberg, Michael J.; Dahl, Charles F.; Ell, Mike J.

    2013-01-01

    ong Lake National Wildlife Refuge, located in south-central North Dakota, is an important habitat for numerous migratory birds and waterfowl, including several threatened or endangered species. The refuge is distinguished by Long Lake, which is approximately 65 square kilometers and consists of four primary water management units. Water levels in the Long Lake units are maintained by low-level dikes and water-control structures, which after construction during the 1930s increased the water-storage capacity of Long Lake and reduced the frequency and volume of flushing flows downstream. The altered water regime, along with the negative precipitation:evaporation ratio of the region, may be contributing to the accumulation of water-borne chemical constituents such as salts, trace metals, and other constituents, which at certain threshold concentrations may impair aquatic plant, invertebrate, and bird communities of the refuge. The refuge’s comprehensive conservation planning process identified the need for water-quality monitoring to assess current (2013) conditions, establish comparative baselines, evaluate changes over time (trends), and support adaptive management of the wetland units. In 2008, the U.S. Geological Survey, U.S. Fish and Wildlife Service, and North Dakota Department of Health began a water-quality monitoring program at Long Lake National Wildlife Refuge to address these needs. Biweekly water-quality samples were collected for ions, trace metals, and nutrients; and in situ sensors and data loggers were installed for the continuous measurement of specific conductance and water depth. Long Lake was characterized primarily by sodium, bicarbonate, and sulfate ions. Overall results for total alkalinity and hardness were 580 and 329 milligrams per liter, respectively; thus, Long Lake is considered alkaline and classified as very hard. The mean pH and sodium adsorption ratio for Long Lake were 8.8 and 10, respectively. Total dissolved solids concentrations

  2. Microbiological Water Quality in Relation to Water-Contact Recreation, Cuyahoga River, Cuyahoga Valley National Park, Ohio, 2000 and 2002

    Science.gov (United States)

    Bushon, Rebecca N.; Koltun, G.F.

    2004-01-01

    The microbiological water quality of a 23-mile segment of the Cuyahoga River within the Cuyahoga Valley National Park was examined in this study. This segment of the river receives discharges of contaminated water from stormwater, combined-sewer overflows, and incompletely disinfected wastewater. Frequent exceedances of Ohio microbiological water-quality standards result in a health risk to the public who use the river for water-contact recreation. Water samples were collected during the recreational season of May through October at four sites on the Cuyahoga River in 2000, at three sites on the river in 2002, and from the effluent of the Akron Water Pollution Control Station (WPCS) both years. The samples were collected over a similar range in streamflow in 2000 and 2002. Samples were analyzed for physical and chemical constituents, as well as the following microbiological indicators and pathogenic organisms: Escherichia coli (E. coli), Salmonella, F-specific and somatic coliphage, enterovirus, infectious enterovirus, hepatitis A virus, Clostridium perfringens (C. perfringens), Cryptosporidium, and Giardia. The relations of the microorganisms to each other and to selected water-quality measures were examined. All microorganisms analyzed for, except Cryptosporidium, were detected at least once at each sampling site. Concentrations of E. coli exceeded the Ohio primary-contact recreational standard (298 colonies per 100 milliliters) in approximately 87 percent of the river samples and generally were higher in the river samples than in the effluent samples. C. perfringens concentrations were positively and significantly correlated with E. coli concentrations in the river samples and generally were higher in the effluent samples than in the river samples. Several of the river samples that met the Ohio E. coli secondary-contact recreational standard (576 colonies per 100 milliliters) had detections of enterovirus, infectious enterovirus, hepatitis A virus, and

  3. Predictors of readmission in nonagenarians: analysis of the American College of Surgeons National Surgical Quality Improvement Project dataset.

    Science.gov (United States)

    Hothem, Zachary; Baker, Dustin; Jenkins, Christina S; Douglas, Jason; Callahan, Rose E; Shuell, Catherine C; Long, Graham W; Welsh, Robert J

    2017-06-01

    Increased longevity has led to more nonagenarians undergoing elective surgery. Development of predictive models for hospital readmission may identify patients who benefit from preoperative optimization and postoperative transition of care intervention. Our goal was to identify significant predictors of 30-d readmission in nonagenarians undergoing elective surgery. Nonagenarians undergoing elective surgery from January 2011 to December 2012 were identified using the American College of Surgeons National Surgical Quality Improvement Project participant use data files. This population was randomly divided into a 70% derivation cohort for model development and 30% validation cohort. Using multivariate step-down regression, predictive models were developed for 30-d readmission. Of 7092 nonagenarians undergoing elective surgery, 798 (11.3%) were readmitted within 30 d. Factors significant in univariate analysis were used to develop predictive models for 30-d readmissions. Diabetes (odds ratio [OR]: 1.51, 95% confidence interval [CI]: 1.24-1.84), dialysis dependence (OR: 2.97, CI: 1.77-4.99), functional status (OR: 1.52, CI: 1.29-1.79), American Society of Anesthesiologists class II or higher (American Society of Anesthesiologist physical status classification system; OR: 1.80, CI: 1.42-2.28), operative time (OR: 1.05, CI: 1.02-1.08), myocardial infarction (OR: 5.17, CI: 3.38-7.90), organ space surgical site infection (OR: 8.63, CI: 4.04-18.4), wound disruption (OR: 14.3, CI: 4.80-42.9), pneumonia (OR: 8.59, CI: 6.17-12.0), urinary tract infection (OR: 3.88, CI: 3.02-4.99), stroke (OR: 6.37, CI: 3.47-11.7), deep venous thrombosis (OR: 5.96, CI: 3.70-9.60), pulmonary embolism (OR: 20.3, CI: 9.7-42.5), and sepsis (OR: 13.1, CI: 8.57-20.1), septic shock (OR: 43.8, CI: 18.2-105.0), were included in the final model. This model had a c-statistic of 0.73, indicating a fair association of predicted probabilities with observed outcomes. However, when applied to the validation

  4. Dosimetric commissioning and quality assurance of scanned ion beams at the Italian National Center for Oncological Hadrontherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mirandola, Alfredo, E-mail: mirandola@cnao.it; Molinelli, S.; Vilches Freixas, G.; Mairani, A.; Gallio, E.; Panizza, D.; Russo, S.; Ciocca, M. [Fondazione CNAO, strada Campeggi 53, Pavia 27100 (Italy); Donetti, M. [INFN, Torino 10125, Italy and Fondazione CNAO, strada Campeggi 53, Pavia 27100 (Italy); Magro, G. [INFN–Dipartimento di Fisica, Università degli Studi di Pavia, Via U. Bassi 6, Pavia 27100, Italy and Fondazione CNAO, strada Campeggi 53, Pavia 27100 (Italy); Giordanengo, S. [INFN, Torino 10125 (Italy); Orecchia, R. [Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy and Radiotherapy Division, European Institute of Oncology, Via Ripamonti 435, Milano 20141 (Italy)

    2015-09-15

    Purpose: To describe the dosimetric commissioning and quality assurance (QA) of the actively scanned proton and carbon ion beams at the Italian National Center for Oncological Hadrontherapy. Methods: The laterally integrated depth-dose-distributions (IDDs) were acquired with the PTW Peakfinder, a variable depth water column, equipped with two Bragg peak ionization chambers. FLUKA Monte Carlo code was used to generate the energy libraries, the IDDs in water, and the fragment spectra for carbon beams. EBT3 films were used for spot size measurements, beam position over the scan field, and homogeneity in 2D-fields. Beam monitor calibration was performed in terms of number of particles per monitor unit using both a Farmer-type and an Advanced Markus ionization chamber. The beam position at the isocenter, beam monitor calibration curve, dose constancy in the center of the spread-out-Bragg-peak, dose homogeneity in 2D-fields, beam energy, spot size, and spot position over the scan field are all checked on a daily basis for both protons and carbon ions and on all beam lines. Results: The simulated IDDs showed an excellent agreement with the measured experimental curves. The measured full width at half maximum (FWHM) of the pencil beam in air at the isocenter was energy-dependent for both particle species: in particular, for protons, the spot size ranged from 0.7 to 2.2 cm. For carbon ions, two sets of spot size are available: FWHM ranged from 0.4 to 0.8 cm (for the smaller spot size) and from 0.8 to 1.1 cm (for the larger one). The spot position was accurate to within ±1 mm over the whole 20 × 20 cm{sup 2} scan field; homogeneity in a uniform squared field was within ±5% for both particle types at any energy. QA results exceeding tolerance levels were rarely found. In the reporting period, the machine downtime was around 6%, of which 4.5% was due to planned maintenance shutdowns. Conclusions: After successful dosimetric beam commissioning, quality assurance measurements

  5. Dosimetric commissioning and quality assurance of scanned ion beams at the Italian National Center for Oncological Hadrontherapy

    International Nuclear Information System (INIS)

    Mirandola, Alfredo; Molinelli, S.; Vilches Freixas, G.; Mairani, A.; Gallio, E.; Panizza, D.; Russo, S.; Ciocca, M.; Donetti, M.; Magro, G.; Giordanengo, S.; Orecchia, R.

    2015-01-01

    Purpose: To describe the dosimetric commissioning and quality assurance (QA) of the actively scanned proton and carbon ion beams at the Italian National Center for Oncological Hadrontherapy. Methods: The laterally integrated depth-dose-distributions (IDDs) were acquired with the PTW Peakfinder, a variable depth water column, equipped with two Bragg peak ionization chambers. FLUKA Monte Carlo code was used to generate the energy libraries, the IDDs in water, and the fragment spectra for carbon beams. EBT3 films were used for spot size measurements, beam position over the scan field, and homogeneity in 2D-fields. Beam monitor calibration was performed in terms of number of particles per monitor unit using both a Farmer-type and an Advanced Markus ionization chamber. The beam position at the isocenter, beam monitor calibration curve, dose constancy in the center of the spread-out-Bragg-peak, dose homogeneity in 2D-fields, beam energy, spot size, and spot position over the scan field are all checked on a daily basis for both protons and carbon ions and on all beam lines. Results: The simulated IDDs showed an excellent agreement with the measured experimental curves. The measured full width at half maximum (FWHM) of the pencil beam in air at the isocenter was energy-dependent for both particle species: in particular, for protons, the spot size ranged from 0.7 to 2.2 cm. For carbon ions, two sets of spot size are available: FWHM ranged from 0.4 to 0.8 cm (for the smaller spot size) and from 0.8 to 1.1 cm (for the larger one). The spot position was accurate to within ±1 mm over the whole 20 × 20 cm"2 scan field; homogeneity in a uniform squared field was within ±5% for both particle types at any energy. QA results exceeding tolerance levels were rarely found. In the reporting period, the machine downtime was around 6%, of which 4.5% was due to planned maintenance shutdowns. Conclusions: After successful dosimetric beam commissioning, quality assurance measurements

  6. US Environmental Protection Agency National Coastal Assessment for Hawaii 2002: Water Quality, Fish Taxon, Sediment Chemistry Data (NODC Accession 0061250)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — In 2002, the Environmental Protection Agency (EPA) Environmental Monitoring and Assessment Program (EMAP) National Coastal Assessment (NCA), in conjunction with...

  7. The Quality Assurance_Quality Control of the Monitored Drift Tubes at the HEP Laboratory of the National Technical University of Athens

    CERN Document Server

    Alexopoulos, T; Dris, M; Filippas, A V; Fokitis, E; Gazis, E N; Katsoufis, E C; Maltezos, A; Maltezos, S; Papadopoulos, E; Papadopoulou, T D; Savva, Panagiota S; Stavropoulos, G D; Tsipolitis, G; Tzamariudaki, E

    2001-01-01

    The description of the Quality Assurance and Quality Control (QA_QC) procedures for the Monitored Drift Tubes (MDT's) followed at the HEP Laboratory of NTUA are presented and results of the tested tubes are given. The MDT's are the elements from which muon chambers for the ATLAS/LHC Muon Spectrometer are built..

  8. Wound healing in plastic surgery: does age matter? An American College of Surgeons National Surgical Quality Improvement Program study.

    Science.gov (United States)

    Karamanos, Efstathios; Osgood, Geoff; Siddiqui, Aamir; Rubinfeld, Ilan

    2015-03-01

    Increasing age has traditionally been associated with impairment in wound healing after operative interventions. This is based mostly on hearsay and anecdotal information. This idea fits with the authors’ understanding of biology in older organisms. This dictum has not been rigorously tested in clinical practice. The American College of Surgeons National Surgical Quality Improvement Program database was retrospectively queried for all patients undergoing plastic surgery from 2005 to 2010. Variables extracted included basic demographics, comorbidities, previous steroid and tobacco use, wound classification at the end of the surgery, and development of postoperative surgical-site infections. Multivariate analyses were used to investigate the impact of aging in wound dehiscence. A total of 25,967 patients were identified. Overall, the incidence of wound dehiscence was 0.75 percent (n = 196). When patients younger than 30 years were compared to older patient groups, no difference in the probability of developing wound dehiscence was noted. Specifically, the groups of patients aged 61 to 70 years and older than 70 years did not have statistically significant wound healing deficiencies [adjusted OR, 0.63 (95 percent CI, 0.11 to 3.63), adjusted p = 0.609; 2.79 (0.55 to 14.18), adjusted p = 0.217, for 61 to 70 years and older than 70 years, respectively]. Factors independently associated with wound dehiscence included postoperative abscess development, paraplegia, quadriplegia, steroid and tobacco use, deep surgical-site infection development, increasing body mass index, and wound classification at the end of surgery. In patients undergoing plastic surgery, wound dehiscence is a rare complication (0.75 percent). Aging is not associated with an increased incidence of wound dehiscence. Risk, III.

  9. Water-quality characteristics and trends for selected sites at and near the Idaho National Laboratory, Idaho, 1949-2009

    Science.gov (United States)

    Bartholomay, Roy C.; Davis, Linda C.; Fisher, Jason C.; Tucker, Betty J.; Raben, Flint A.

    2012-01-01

    The U.S. Geological Survey, in cooperation with the U.S. Department of Energy, analyzed water-quality data collected from 67 aquifer wells and 7 surface-water sites at the Idaho National Laboratory (INL) from 1949 through 2009. The data analyzed included major cations, anions, nutrients, trace elements, and total organic carbon. The analyses were performed to examine water-quality trends that might inform future management decisions about the number of wells to sample at the INL and the type of constituents to monitor. Water-quality trends were determined using (1) the nonparametric Kendall's tau correlation coefficient, p-value, Theil-Sen slope estimator, and summary statistics for uncensored data; and (2) the Kaplan-Meier method for calculating summary statistics, Kendall's tau correlation coefficient, p-value, and Akritas-Theil-Sen slope estimator for robust linear regression for censored data. Statistical analyses for chloride concentrations indicate that groundwater influenced by Big Lost River seepage has decreasing chloride trends or, in some cases, has variable chloride concentration changes that correlate with above-average and below-average periods of recharge. Analyses of trends for chloride in water samples from four sites located along the Big Lost River indicate a decreasing trend or no trend for chloride, and chloride concentrations generally are much lower at these four sites than those in the aquifer. Above-average and below-average periods of recharge also affect concentration trends for sodium, sulfate, nitrate, and a few trace elements in several wells. Analyses of trends for constituents in water from several of the wells that is mostly regionally derived groundwater generally indicate increasing trends for chloride, sodium, sulfate, and nitrate concentrations. These increases are attributed to agricultural or other anthropogenic influences on the aquifer upgradient of the INL. Statistical trends of chemical constituents from several wells near

  10. Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012).

    Science.gov (United States)

    Flores-Hernández, Sergio; Saturno-Hernández, Pedro J; Reyes-Morales, Hortensia; Barrientos-Gutiérrez, Tonatiuh; Villalpando, Salvador; Hernández-Ávila, Mauricio

    2015-01-01

    The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

  11. Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012.

    Directory of Open Access Journals (Sweden)

    Sergio Flores-Hernández

    Full Text Available The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico.We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear with combined data files, including survey year as covariate to assess change.Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94. Age more than 65 years old, the type of health subsystem, gender (males, and high socio-economic status were also significantly associated to glycemic control.Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

  12. Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)

    Science.gov (United States)

    Flores-Hernández, Sergio; Saturno-Hernández, Pedro J.; Reyes-Morales, Hortensia; Barrientos-Gutiérrez, Tonatiuh; Villalpando, Salvador; Hernández-Ávila, Mauricio

    2015-01-01

    Background The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. Methods We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Results Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Conclusions Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care. PMID:26230991

  13. Geographic Information for Analysis of Highway Runoff-Quality Data on a National or Regional Scale in the Conterminous United States

    Science.gov (United States)

    Smieszek, Tomas W.; Granato, Gregory E.

    2000-01-01

    Spatial data are important for interpretation of water-quality information on a regional or national scale. Geographic information systems (GIS) facilitate interpretation and integration of spatial data. The geographic information and data compiled for the conterminous United States during the National Highway Runoff Water-Quality Data and Methodology Synthesis project is described in this document, which also includes information on the structure, file types, and the geographic information in the data files. This 'geodata' directory contains two subdirectories, labeled 'gisdata' and 'gisimage.' The 'gisdata' directory contains ArcInfo coverages, ArcInfo export files, shapefiles (used in ArcView), Spatial Data Transfer Standard Topological Vector Profile format files, and meta files in subdirectories organized by file type. The 'gisimage' directory contai