Prediction of improvement in skin fibrosis in diffuse cutaneous systemic sclerosis: a EUSTAR analysis

OBJECTIVES Improvement of skin fibrosis is part of the natural course of diffuse cutaneous systemic sclerosis (dcSSc). Recognising those patients most likely to improve could help tailoring clinical management and cohort enrichment for clinical trials. In this study, we aimed to identify predictors for improvement of skin fibrosis in patients with dcSSc. METHODS We performed a longitudinal analysis of the European Scleroderma Trials And Research (EUSTAR) registry including patients with dcSSc, fulfilling American College of Rheumatology criteria, baseline modified Rodnan skin score (mRSS) ≥7 and follow-up mRSS at 12±2 months. The primary outcome was skin improvement (decrease in mRSS of >5 points and ≥25%) at 1 year follow-up. A respective increase in mRSS was considered progression. Candidate predictors for skin improvement were selected by expert opinion and logistic regression with bootstrap validation was applied. RESULTS From the 919 patients included, 218 (24%) improved and 95 (10%) progressed. Eleven candidate predictors for skin improvement were analysed. The final model identified high baseline mRSS and absence of tendon friction rubs as independent predictors of skin improvement. The baseline mRSS was the strongest predictor of skin improvement, independent of disease duration. An upper threshold between 18 and 25 performed best in enriching for progressors over regressors. CONCLUSIONS Patients with advanced skin fibrosis at baseline and absence of tendon friction rubs are more likely to regress in the next year than patients with milder skin fibrosis. These evidence-based data can be implemented in clinical trial design to minimise the inclusion of patients who would regress under standard of care.

A qualitative analysis of leadership styles and the selection of quality improvement in primary care practice

In the Practice Change Model, physicians act as key stakeholders, people who have both an investment in the practice and the capacity to influence how the practice performs. This leadership role is critical to the development and change of the practice. Leadership roles and effectiveness are an important factor in quality improvement in primary care practices.^ The study conducted involved a comparative case study analysis to identify leadership roles and the relationship between leadership roles and the number and type of quality improvement strategies adopted during a Practice Change Model-based intervention study. The research utilized secondary data from four primary care practices with various leadership styles. The practices are located in the San Antonio region and serve a large Hispanic population. The data was collected by two ABC Project Facilitators from each practice during a 12-month period including Key Informant Interviews (all staff members), MAP (Multi-method Assessment Process), and Practice Facilitation field notes. This data was used to evaluate leadership styles, management within the practice, and intervention tools that were implemented. The chief steps will be (1) to analyze if the leader-member relations contribute to the type of quality improvement strategy or strategies selected (2) to investigate if leader-position power contributes to the number of strategies selected and the type of strategy selected (3) and to explore whether the task structure varies across the four primary care practices.^ The research found that involving more members of the clinic staff in decision-making, building bridges between organizational staff and clinical staff, and task structure are all associated with the direct influence on the number and type of quality improvement strategies implemented in primary care practice.^ Although this research only investigated leadership styles of four different practices, it will offer future guidance on how to establish the priorities and implementation of quality improvement strategies that will have the greatest impact on patient care improvement. ^

Can accreditation work as a tool for quality improvement in public health? A critical review

Public health departments play an important role in promoting and preserving the health of communities. The lack of a system to ensure their quality and accountability led to the development of a national voluntary accreditation program by Public Health Accreditation Board (PHAB). The concept that accreditation will lead to quality improvement in public health which will ultimately lead to healthy communities seems intuitive but lacks a robust body of evidence. A critical review of literature was conducted to explore if accreditation can lead to quality improvement in public health. The articles were selected from publically available databases using a specific set of criteria for inclusion, exclusion, and appraisal. To understand the relationship between accreditation and quality improvement, the potential strengths and limitations of accreditation process were evaluated. Recommendations for best practices are suggested so that public health accreditation can yield maximum benefits. A logic model framework to help depict the impact of accreditation on various levels of public health outcomes is also discussed in this thesis. The literature review shows that existing accreditation programs in other industries show limited but encouraging evidence that accreditation will improve quality and strengthen the delivery of public health services. While progress in introducing accreditation in public health can be informed by other accredited industries, the public health field has its own set of challenges. Providing incentives, creating financing strategies, and having a strong leadership will allow greater access to accreditation by all public health departments. The suggested recommendations include that continuous evaluation, public participation, systems approach, clear vision, and dynamic standards should become hallmarks of the accreditation process. Understanding the link between accreditation, quality improvement, and health outcomes will influence the successful adoption and implementation of the public health accreditation program. This review of literature suggests that accreditation is an important step in improving the quality of public health departments and in ultimately improving the health of communities. However, accreditation should be considered in an integrated system of tools and approaches to improve the public health practice. Hence, it is a means to an end - not an end unto itself.^

Ronald E. Heine, Origen. Scholarship in the service of the church, Oxford University Press, Oxford, 2010, pp. 275. ISBN 978-0-19-920907-1.

Fil: Peretó Rivas, Rubén.

Automated attribute inference in complex service workflows based on sharing analysis

The properties of data and activities in business processes can be used to greatly facilítate several relevant tasks performed at design- and run-time, such as fragmentation, compliance checking, or top-down design. Business processes are often described using workflows. We present an approach for mechanically inferring business domain-specific attributes of workflow components (including data Ítems, activities, and elements of sub-workflows), taking as starting point known attributes of workflow inputs and the structure of the workflow. We achieve this by modeling these components as concepts and applying sharing analysis to a Horn clause-based representation of the workflow. The analysis is applicable to workflows featuring complex control and data dependencies, embedded control constructs, such as loops and branches, and embedded component services.

A Process Asset Library to support Software Process Improvement in Small Settings

A main factor to the success of any organization process improvement effort is the Process Asset Library implementation that provides a central database accessible by anyone at the organization. This repository includes any process support materials to help process deployment. Those materials are composed of organization's standard software process, software process related documentation, descriptions of the software life cycles, guidelines, examples, templates, and any artefacts that the organization considers useful to help the process improvement. This paper describe the structure and contents of the Web-based Process Asset Library for Small businesses and small groups within large organizations. This library is structured using CMMI as reference model in order to implement those Process Areas described by this model.

Development and implementation of a virtual laboratory for training process improvement in the mechanics of continuous media

The project arises from the need to develop improved teaching methodologies in field of the mechanics of continuous media. The objective is to offer the student a learning process to acquire the necessary theoretical knowledge, cognitive skills and the responsibility and autonomy to professional development in this area. Traditionally the teaching of the concepts of these subjects was performed through lectures and laboratory practice. During these lessons the students attitude was usually passive, and therefore their effectiveness was poor. The proposed methodology has already been successfully employed in universities like University Bochum, Germany, University the South Australia and aims to improve the effectiveness of knowledge acquisition through use by the student of a virtual laboratory. This laboratory allows to adapt the curricula and learning techniques to the European Higher Education and improve current learning processes in the University School of Public Works Engineers -EUITOP- of the Technical University of Madrid -UPM-, due there are not laboratories in this specialization. The virtual space is created using a software platform built on OpenSim, manages 3D virtual worlds, and, language LSL -Linden Scripting Language-, which imprints specific powers to objects. The student or user can access this virtual world through their avatar -your character in the virtual world- and can perform practices within the space created for the purpose, at any time, just with computer with internet access and viewfinder. The virtual laboratory has three partitions. The virtual meeting rooms, where the avatar can interact with peers, solve problems and exchange existing documentation in the virtual library. The interactive game room, where the avatar is has to resolve a number of issues in time. And the video room where students can watch instructional videos and receive group lessons. Each audiovisual interactive element is accompanied by explanations framing it within the area of knowledge and enables students to begin to acquire a vocabulary and practice of the profession for which they are being formed. Plane elasticity concepts are introduced from the tension and compression testing of test pieces of steel and concrete. The behavior of reticulated and articulated structures is reinforced by some interactive games and concepts of tension, compression, local and global buckling will by tests to break articulated structures. Pure bending concepts, simple and composite torsion will be studied by observing a flexible specimen. Earthquake resistant design of buildings will be checked by a laboratory test video.

The relationship between young people's transit use and their perceptions of equity concepts in transit service provision

This study investigates the effect of price and travel mode fairness and spatial equity in transit provision on the perceived transit service quality, willingness to pay, and habitual frequency of use. Based on the theory of planned behavior, we developed a web-based questionnaire for revealed preferences data collection. The survey was administered among young people in Copenhagen and Lisbon to explore the transit perceptions and use under different economic and transit provision conditions. The survey yielded 499 questionnaires, analyzed by means of structural equation models. Results show that higher perceived fairness relates positively to higher perceived quality of transit service and higher perceived ease of paying for transit use. Higher perceived spatial equity in service provision is associated with higher perceived service quality. Higher perceived service quality relates to higher perceived ease of payment, which links to higher frequency of transit use.

Assessing the passengers’ perception of implemented advanced management measures in bus service

The aim of this investigation is to evaluate the passenger?s perception of some attributes related to quality of bus services, and how this perception changes with the implementation of different measures. Surveys to passengers riding different bus lines were conducted in two scenarios: before the implementation of the measures and after the measures were implemented. The results of the passenger surveys were statistically analysed; then, an ordered logit model was used to analyse the differences between surveys thanks to the implemented measures. Finally, a factor analysis was done to identify the underlying unobserved factors (latent variables) that the respondents perceived

New strategies in laser processing of TCOs for light management improvement in thin-film silicon solar cells

Light confinement strategies play a crucial role in the performance of thin-film (TF) silicon solar cells. One way to reduce the optical losses is the texturing of the transparent conductive oxide (TCO) that acts as the front contact. Other losses arise from the mismatch between the incident light spectrum and the spectral properties of the absorbent material that imply that low energy photons (below the bandgap value) are not absorbed, and therefore can not generate photocurrent. Up-conversion techniques, in which two sub-bandgap photons are combined to give one photon with a better matching with the bandgap, were proposed to overcome this problem. In particular, this work studies two strategies to improve light management in thin film silicon solar cells using laser technology. The first one addresses the problem of TCO surface texturing using fully commercial fast and ultrafast solid state laser sources. Aluminum doped Zinc Oxide (AZO) samples were laser processed and the results were optically evaluated by measuring the haze factor of the treated samples. As a second strategy, laser annealing experiments of TCOs doped with rare earth ions are presented as a potential process to produce layers with up-conversion properties, opening the possibility of its potential use in high efficiency solar cells.

Working to Form a More Perfect Union: Honoring Women in Public Service in the State of Missouri

https://bluetigercommons.lincolnu.edu/pli/1010/thumbnail.jpg

Working to Form a More Perfect Union: Honoring Women in Public Service in the State of Missouri

https://bluetigercommons.lincolnu.edu/pli/1009/thumbnail.jpg

The differentiated effects of CSR actions in the service industry

Purpose – The purpose of this study is to attempt to explain why the impact of Corporate Social Responsibility (CSR) initiatives may be different and/or more important in service firms compared to manufacturing firms. CSR is becoming a common strategy, hence its extensive research. Central to it is the analysis of the effect of CSR on a firm’s performance, whose outcome depends on firm-specific and industry-related factors. Design/methodology/approach – The event study methodology is applied to all the 248 companies that have ever traded on the Spanish Stock Market between 1990 and 2007. A regression analysis examines potential different effects of CSR on service and goods firms. Findings – The results show that CSR activities have a positive impact on firm performance that is higher for service firms than for manufacturing firms. Actions related to the environment, responsible labor relationships and good corporate governance are especially important in the service context. Research limitations/implications – This research is focused on shareholders’ performance, but it does not consider other stakeholders, such as real consumer behavior or employees’ commitment and productivity. Practical implications – Service firms are likely to gain from focusing on some CSR activities (environment, employees and good corporate governance) and should use their responsible behavior as a valuable tool for public relations and differentiation in the market. Originality/value – This article is the first attempt to empirically test and explain why the relationship between CSR and firm performance may be different (more positive) for service vs manufacturing firms.