Bayesian hierarchical models in statistical quality control methods to improve healthcare in hospitals

Quality oriented management systems and methods have become the dominant business and governance paradigm. From this perspective, satisfying customers’ expectations by supplying reliable, good quality products and services is the key factor for an organization and even government. During recent decades, Statistical Quality Control (SQC) methods have been developed as the technical core of quality management and continuous improvement philosophy and now are being applied widely to improve the quality of products and services in industrial and business sectors. Recently SQC tools, in particular quality control charts, have been used in healthcare surveillance. In some cases, these tools have been modified and developed to better suit the health sector characteristics and needs. It seems that some of the work in the healthcare area has evolved independently of the development of industrial statistical process control methods. Therefore analysing and comparing paradigms and the characteristics of quality control charts and techniques across the different sectors presents some opportunities for transferring knowledge and future development in each sectors. Meanwhile considering capabilities of Bayesian approach particularly Bayesian hierarchical models and computational techniques in which all uncertainty are expressed as a structure of probability, facilitates decision making and cost-effectiveness analyses. Therefore, this research investigates the use of quality improvement cycle in a health vii setting using clinical data from a hospital. The need of clinical data for monitoring purposes is investigated in two aspects. A framework and appropriate tools from the industrial context are proposed and applied to evaluate and improve data quality in available datasets and data flow; then a data capturing algorithm using Bayesian decision making methods is developed to determine economical sample size for statistical analyses within the quality improvement cycle. Following ensuring clinical data quality, some characteristics of control charts in the health context including the necessity of monitoring attribute data and correlated quality characteristics are considered. To this end, multivariate control charts from an industrial context are adapted to monitor radiation delivered to patients undergoing diagnostic coronary angiogram and various risk-adjusted control charts are constructed and investigated in monitoring binary outcomes of clinical interventions as well as postintervention survival time. Meanwhile, adoption of a Bayesian approach is proposed as a new framework in estimation of change point following control chart’s signal. This estimate aims to facilitate root causes efforts in quality improvement cycle since it cuts the search for the potential causes of detected changes to a tighter time-frame prior to the signal. This approach enables us to obtain highly informative estimates for change point parameters since probability distribution based results are obtained. Using Bayesian hierarchical models and Markov chain Monte Carlo computational methods, Bayesian estimators of the time and the magnitude of various change scenarios including step change, linear trend and multiple change in a Poisson process are developed and investigated. The benefits of change point investigation is revisited and promoted in monitoring hospital outcomes where the developed Bayesian estimator reports the true time of the shifts, compared to priori known causes, detected by control charts in monitoring rate of excess usage of blood products and major adverse events during and after cardiac surgery in a local hospital. The development of the Bayesian change point estimators are then followed in a healthcare surveillances for processes in which pre-intervention characteristics of patients are viii affecting the outcomes. In this setting, at first, the Bayesian estimator is extended to capture the patient mix, covariates, through risk models underlying risk-adjusted control charts. Variations of the estimator are developed to estimate the true time of step changes and linear trends in odds ratio of intensive care unit outcomes in a local hospital. Secondly, the Bayesian estimator is extended to identify the time of a shift in mean survival time after a clinical intervention which is being monitored by riskadjusted survival time control charts. In this context, the survival time after a clinical intervention is also affected by patient mix and the survival function is constructed using survival prediction model. The simulation study undertaken in each research component and obtained results highly recommend the developed Bayesian estimators as a strong alternative in change point estimation within quality improvement cycle in healthcare surveillances as well as industrial and business contexts. The superiority of the proposed Bayesian framework and estimators are enhanced when probability quantification, flexibility and generalizability of the developed model are also considered. The empirical results and simulations indicate that the Bayesian estimators are a strong alternative in change point estimation within quality improvement cycle in healthcare surveillances. The superiority of the proposed Bayesian framework and estimators are enhanced when probability quantification, flexibility and generalizability of the developed model are also considered. The advantages of the Bayesian approach seen in general context of quality control may also be extended in the industrial and business domains where quality monitoring was initially developed.

Design and construction of fixed bed pyrolysis system and plum seed pyrolysis for bio-oil production

This work investigated the production of bio oil from plum seed (Zyziphus jujuba) by fixed bed pyrolysis technology. A fixed bed pyrolysis system has been designed and fabricated for production of bio oil. The major components of the system are: fixed bed reactor, liquid condenser and liquid collector. Nitrogen gas was used to maintain the inert atmosphere in the reactor where the pyrolysis reaction takes place. The feedstock considered in this study is plum seed as it is available waste material in Bangladesh. The reactor is heated by means of a cylindrical biomass external heater. Rice husk was used as the energy source. The products are oil, char and gas. The parameters varied are reactor bed temperature, running time and feed particle size. The parameters are found to influence the product yields significantly. The maximum liquid yield of 39 wt% at 5200C for a feed particle size of 2.36-4.75 mm and a gas flow rate of 8 liter/min with a running time of 120 minute. The pyrolysis oil obtained at these optimum process conditions are analyzed for some of their properties as an alternative fuel. The density of the liquid was closer with diesel. The viscosity of the plum seed liquid was lower than that of the conventional fuels. The calorific value of the pyrolysis oil is one half of the diesel fuel.

Fast pyrolysis for better utilization of tamarind seed from renewable energy point of view

The conversion of tamarind seeds into pyrolytic oil by fixed bed fire-tube heating reactor has been taken into consideration in this study. The major components of the system were fixed bed fire-tube heating reactor, liquid condenser and collectors. The raw and crushed tamarind seed in particle form was pyrolized in an electrically heated 10 cm diameter and 27 cm high fixed bed reactor. The products are oil, char and gases. The parameters varied were reactor bed temperature, running time, gas flow rate and feed particle size. The parameters were found to influence the product yields significantly. The maximum liquid yield was 45 wt% at 4000C for a feed size of 1.07cm3 at a gas flow rate of 6 liter/min with a running time of 30 minute. The pyrolysis oil was obtained at these optimum process conditions were analyzed for physical and chemical properties to be used as an alternative fuel.

Pyrolysis decomposition of mahogony seeds (Swietenia macrophylla) for alternative fuel oil

A fixed bed pyrolysis has been designed and fabricated for obtaining liquid fuel from Mahogany seeds. The major components of the system are fixed bed pyrolysis reactor, liquid condenser and liquid collectors. The Mahogany seed in particle form is pyrolysed in an externally heated 10 cm diameter and 36 cm high fixed bed reactor with nitrogen as the carrier gas. The reactor is heated by means of a biomass source cylindrical heater from 450oC to 600oC. The products are oil, char and gas. The reactor bed temperature, running time and feed particle size are considered as process parameters. A maximum liquid yield of 54wt% of biomass feed is obtained with particle size of 1.18 mm at a reactor bed temperature of 5500C with a running time of 90 minutes. The oil is found to possess favorable flash point and reasonable density and viscosity. The higher calorific value is found to be 39.9 MJ/kg which is higher than other biomass derived pyrolysis oils.

Fixed bed pyrolysis of pulm seed waste for liquid oil production

Among various thermo-chemical conversion processes, pyrolysis is considered as an emerging technology for liquid oil production. The conversion of biomass waste in the form of plum seed into pyrolysis oil by fixed bed pyrolysis reactor has been taken into consideration in this study. A fixed bed pyrolysis has been designed and fabricated for obtaining liquid fuel from this plum seeds. The major component of the system are fixed bed pyrolysis reactor, liquid condenser and liquid collectors. The plum seed in particle form is pyrolysed in an externally heated 7.6 cm diameter and 46 cm high fixed bed reactor with nitrogen as the carrier gas. The reactor is heated by means of a biomass source cylindrical heater from 4000C to 6000C. The products are oil, char and gas. The reactor bed temperature, running time and feed particle size are considered as process parameters. The parameters are found to influence the product yield significantly. A maximum liquid yield of 39 wt% of biomass feed is obtained with particle size of 2.36-4.75 mm at a reactor bed temperature of 520oC with a running time of 120 minutes. The pyrolysis oil obtained at this optimum process conditions are analyzed for some fuel properties and compared with some other biomass derived pyrolysis oils and conventional fuels. The oil is found to possess favorable flash point and reasonable density and viscosity. The higher calorific value is found to be 22.39 MJ/kg which is higher than other biomass derived pyrolysis oils.

Influence of organic matter in road deposited particulates in heavy metal accumulation and transport

The research study discussed in the paper investigated the influence of organic matter on heavy metal adsorption for different particle size ranges of build-up solids. Samples collected from road surfaces were assessed for organic matter content, mineral composition, particle size distribution and effective cation exchange capacity. It was found that the organic matter plays a key role in >75µm particles in the adsorption of Zinc, Lead, Nickel and Copper, which are generated by traffic activities. Clay forming minerals and metal oxides of Iron, Aluminium and Manganese was found to be important for heavy metal adsorption to <75µm particles. It was also found that heavy metals adsorbed to organic matter are strongly bound to particles and these metal ions will not be bio-available if the chemical quality of the media remains stable.

Production of liquid fuel and activated carbon from mahogany seed by using pyrolysis technology

The renovation of biomass waste in the form of Mahogany seed waste into bio-fuel as well as activated carbon by fixed bed pyrolysis reactor has been taken into consideration in this study. The mahogany seed in particle form is pyrolyzed in an enormously heated fixed bed reactor with nitrogen as the carrier gas. The reactor is heated from 4000C to 6000C using a external heater in which rice husk and charcoal are used as the heater biomass fuel. Reactor bed temperature, running time and feed particle size have been varied to get the optimum operating conditions of the system. The parameters are found to influence the product yields to a large extent. A maximum liquid and char yield are 49 wt. % and 35 wt. % respectively obtained at a reactor bed temperature 5000C when the running time is 90 minutes. Acquired pyrolyzed oil at these optimal process conditions were analyzed for some of their properties as an alternative fuel. The oil possesses comparable flame temperature, favorable flash point and reasonable viscosity along with somewhat higher density. The kinematic viscosity of the derived fuel is 3.8 cSt and density is 1525 kg/m3. The higher calorific value is found 32.4 MJ/kg which is significantly higher than other biomass derived fuel. Moderate adsorption capacity of the prepared activated carbon in case of methyl blue & tea water was also revealed.

Adsorption of heavy metals by road deposited solids

The research study discussed in the paper investigated the adsorption/desorption behaviour of heavy metals commonly deposited on urban road surfaces, namely, Zn, Cu, Cr and Pb for different particle size ranges of solids. The study outcomes, based on field studies and batch experiments confirmed that road deposited solids particles contain a significantly high amount of vacant charge sites with the potential to adsorb additional heavy metals. Kinetic study and adsorption experiments indicated that Cr is the most preferred metal element to associate with solids due to the relatively high electro negativity and high charge density of trivalent cation (Cr3+). However, the relatively low availability of Cr in the urban road environment could influence this behaviour. Comparing total adsorbed metals present in solids particles, it was found that Zn has the highest capacity for adsorption to solids. Desorption experiments confirmed that a low concentration of Cu, Cr and Pb in solids was present in water-soluble and exchangeable form, whilst a significant fraction of adsorbed Zn has a high likelihood of being released back into solution. Among heavy metals, Zn is considered to be the most commonly available metal among road surface pollutants.

Suspended sediment properties and suspended sediment flux estimates in an inundated urban environment during a major flood event

During a major flood event, the inundation of urban environments leads to some complicated flow motion most often associated with significant sediment fluxes. In the present study, a series of field measurements were conducted in an inundated section of the City of Brisbane (Australia) about the peak of a major flood in January 2011. Some experiments were performed to use ADV backscatter amplitude as a surrogate estimate of the suspended sediment concentration (SSC) during the flood event. The flood water deposit samples were predominantly silty material with a median particle size about 25 μm and they exhibited a non-Newtonian behavior under rheological testing. In the inundated urban environment during the flood, estimates of suspended sediment concentration presented a general trend with increasing SSC for decreasing water depth. The suspended sediment flux data showed some substantial sediment flux amplitudes consistent with the murky appearance of floodwaters. Altogether the results highlighted the large suspended sediment loads and fluctuations in the inundated urban setting associated possibly with a non-Newtonian behavior. During the receding flood, some unusual long-period oscillations were observed (periods about 18 min), although the cause of these oscillations remains unknown. The field deployment was conducted in challenging conditions highlighting a number of practical issues during a natural disaster.

The El Chichon stratospheric cloud : solid particulates and settling rates

Sampling of the El Chichón stratospheric cloud in early May and in late July, 1982, showed that a significant proportion of the cloud consisted of solid particles between 2 μm and 40 μm size. In addition, many particles may have been part of larger aggregates or clusters that ranged in size from < 10 μm to > 50 μm. The majority of individual grains were angular aluminosilicate glass shards with various amounts of smaller, adhering particles. Surface features on individual grains include sulfuric acid droplets and larger (0.5 μm to 1 μm) sulfate gel droplets with various amounts of Na, Mg, Ca and Fe. The sulfate gels probably formed by the interaction of sulfur-rich gases and solid particles within the cloud soon after eruption. Ca-sulfate laths may have formed by condensation within the plume during eruption, or alternatively, at a later stage by the reaction of sulfuric acid aerosols with ash fragments within the stratospheric cloud. A Wilson-Huang formulation for the settling rate of individual particles qualitatively agrees with the observed particle-size distribution for a period at least four months after injection of material into the stratosphere. This result emphasizes the importance of particle shape in controlling the settling rate of volcanic ash from the stratosphere.

Kaolinite-NMF intercalates

Bulk and size-fractionated kaolinites from seven localities in Australia as well as the Clay Minerals Society Source Clays Georgia KGa-1 and KGa-2 have been studied by X-ray diffraction (XRD), laser scattering, and electron microscopy in order to understand the variation of particle characteristics across a range of environments and to correlate specific particle characteristics with intercalation behavior. All kaolinites have been intercalated with N-methyl (NMF) after pretreatment with hydrazine hydrate, and the relative efficiency of intercalation has been determined using XRD. Intercalate yields of kaolinite: NMF are consistently low for bulk samples that have a high proportion of small-sized particles (i.e., <0.5 µm) and for biphased kaolinites with a high percentage (>60%) of low-defect phase. In general, particle size appears to be a more significant controlling factor than defect distribution in determining the relative yield of kaolinite: NMF intercalate.

A multivariate approach to the identification of surrogate parameters for heavy metals in stormwater

Stormwater is a potential and readily available alternative source for potable water in urban areas. However, its direct use is severely constrained by the presence of toxic pollutants, such as heavy metals (HMs). The presence of HMs in stormwater is of concern because of their chronic toxicity and persistent nature. In addition to human health impacts, metals can contribute to adverse ecosystem health impact on receiving waters. Therefore, the ability to predict the levels of HMs in stormwater is crucial for monitoring stormwater quality and for the design of effective treatment systems. Unfortunately, the current laboratory methods for determining HM concentrations are resource intensive and time consuming. In this paper, applications of multivariate data analysis techniques are presented to identify potential surrogate parameters which can be used to determine HM concentrations in stormwater. Accordingly, partial least squares was applied to identify a suite of physicochemical parameters which can serve as indicators of HMs. Datasets having varied characteristics, such as land use and particle size distribution of solids, were analyzed to validate the efficacy of the influencing parameters. Iron, manganese, total organic carbon, and inorganic carbon were identified as the predominant parameters that correlate with the HM concentrations. The practical extension of the study outcomes to urban stormwater management is also discussed.

Atmospheric deposition as a source of heavy metals in urban stormwater

Atmospheric deposition is one of the most important pathways of urban stormwater pollution. Atmospheric deposition which can be in the form of either wet or dry deposition have distinct characteristics in terms of associated particulate sizes, pollutant types and influential parameters. This paper discusses the outcomes of a comprehensive research study undertaken to identify important traffic characteristics and climate factors such as antecedent dry period and rainfall characteristics which influences the characteristics of wet and dry deposition of solids and heavy metals. The outcomes confirmed that Zinc (Zn) is correlated with traffic volume whereas Lead (Pb), Cadmium (Cd), Nickel (Ni), and Copper (Cu) are correlated with traffic congestion. Consequently, reducing traffic congestion will be more effective than reducing traffic volume for improving air quality particularly in relation to Pb, Cd, Ni, and Cu. Zn was found to have the highest atmospheric deposition rate compared to other heavy metals. Zn in dry deposition is associated with relatively larger particle size fractions (>10 µm), whereas Pb, Cd, Ni and Cu are associated with relatively smaller particle size fractions (<10 µm). The analysis further revealed that bulk (wet plus dry) deposition which is correlated with rainfall depth and contains a relatively higher percentage of smaller particles compared to dry deposition which is correlated with the antecedent dry period. As particles subjected to wet deposition are smaller, they disperse over a larger area from the source of origin compared to particles subjected to dry deposition as buoyancy forces become dominant for smaller particles compared to the influence of gravity. Furthermore, exhaust emission particles were found to be primarily associated with bulk deposition compared to dry deposition particles which mainly originate from vehicle component wear.

Bismuth oxide nanoparticles in the stratosphere

Platey grains of cubic Bi2O3, α-Bi2O3, and Bi2O2.75 nanograins were associated with chondritic porous interplanetary dust particles W7029C1, W7029E5, and 2011C2 that were collected in the stratosphere at 17-19 km altitude. Similar Bi oxide nanograins were present in the upper stratosphere during May 1985. These grains are linked to the plumes of several major volcanic eruptions during the early 1980s that injected material into the stratosphere. The mass of sulfur from these eruptions is a proxy for the mass of stratospheric Bi from which we derive the particle number densities (p m -3) for "average Bi2O3 nanograins" due to this volcanic activity and those necessary to contaminate the extraterrestrial chondritic porous interplanetary dust particles via collisional sticking. The match between both values supports the idea that Bi2O3 nanograins of volcanic origin could contaminate interplanetary dust particles in the Earth's stratosphere. Copyright 1997 by the American Geophysical Union.

Manufacture of specific BSCCO powder compositions by co-precipitation

A co-precipitation process for large-scale manufacture of bismuth-based HTSC powders has been demonstrated. Powders manufactured by this process have a high phase purity and precisely reproducible stoichiometry. Controlled time and temperature variations are used to convert precursors to HTSC compounds and to obtain specific particle-size distributions. The process has been demonstrated for a variety of compositions in the BSCCO system. Electron microscopy X-ray diffraction, inductively coupled plasma spectroscopy and magnetic-susceptibility measurements are used to characterize the powders.