A cross-sectional study assessing the association between online ratings and structural and quality of care measures : results from two German physician rating websites

BACKGROUND: Even though physician rating websites (PRWs) have been gaining in importance in both practice and research, little evidence is available on the association of patients' online ratings with the quality of care of physicians. It thus remains unclear whether patients should rely on these ratings when selecting a physician. The objective of this study was to measure the association between online ratings and structural and quality of care measures for 65 physician practices from the German Integrated Health Care Network "Quality and Efficiency" (QuE). METHODS: Online reviews from two German PRWs were included which covered a three-year period (2011 to 2013) and included 1179 and 991 ratings, respectively. Information for 65 QuE practices was obtained for the year 2012 and included 21 measures related to structural information (N = 6), process quality (N = 10), intermediate outcomes (N = 2), patient satisfaction (N = 1), and costs (N = 2). The Spearman rank coefficient of correlation was applied to measure the association between ratings and practice-related information. RESULTS: Patient satisfaction results from offline surveys and the patients per doctor ratio in a practice were shown to be significantly associated with online ratings on both PRWs. For one PRW, additional significant associations could be shown between online ratings and cost-related measures for medication, preventative examinations, and one diabetes type 2-related intermediate outcome measure. There again, results from the second PRW showed significant associations with the age of the physicians and the number of patients per practice, four process-related quality measures for diabetes type 2 and asthma, and one cost-related measure for medication. CONCLUSIONS: Several significant associations were found which varied between the PRWs. Patients interested in the satisfaction of other patients with a physician might select a physician on the basis of online ratings. Even though our results indicate associations with some diabetes and asthma measures, but not with coronary heart disease measures, there is still insufficient evidence to draw strong conclusions. The limited number of practices in our study may have weakened our findings.

Role of substrate quality on the performance of semipolar (11 2 - 2) InGaN light-emitting diodes

We compare the optical properties and device performance of unpackaged InGaN/GaN multiple-quantum-well light-emitting diodes (LEDs) emitting at ∼430 nm grown simultaneously on a high-cost small-size bulk semipolar (11 2 - 2) GaN substrate (Bulk-GaN) and a low-cost large-size (11 2 - 2) GaN template created on patterned (10 1 - 2) r-plane sapphire substrate (PSS-GaN). The Bulk-GaN substrate has the threading dislocation density (TDD) of ∼ and basal-plane stacking fault (BSF) density of 0 cm-1, while the PSS-GaN substrate has the TDD of ∼2 × 108cm-2 and BSF density of ∼1 × 103cm-1. Despite an enhanced light extraction efficiency, the LED grown on PSS-GaN has two-times lower internal quantum efficiency than the LED grown on Bulk-GaN as determined by photoluminescence measurements. The LED grown on PSS-GaN substrate also has about two-times lower output power compared to the LED grown on Bulk-GaN substrate. This lower output power was attributed to the higher TDD and BSF density.

Quality balancing for parallel adaptive FEM

We present a dynamic distributed load balancing algorithm for parallel, adaptive finite element simulations using preconditioned conjugate gradient solvers based on domain-decomposition. The load balancer is designed to maintain good partition aspect ratios. It can calculate a balancing flow using different versions of diffusion and a variant of breadth first search. Elements to be migrated are chosen according to a cost function aiming at the optimization of subdomain shapes. We show how to use information from the second step to guide the first. Experimental results using Bramble's preconditioner and comparisons to existing state-ot-the-art load balancers show the benefits of the construction.

Participatory Patterns in an International Air Quality Monitoring Initiative

The issue of sustainability is at the top of the political and societal agenda, being considered of extreme importance and urgency. Human individual action impacts the environment both locally (e.g., local air/water quality, noise disturbance) and globally (e.g., climate change, resource use). Urban environments represent a crucial example, with an increasing realization that the most effective way of producing a change is involving the citizens themselves in monitoring campaigns (a citizen science bottom-up approach). This is possible by developing novel technologies and IT infrastructures enabling large citizen participation. Here, in the wider framework of one of the first such projects, we show results from an international competition where citizens were involved in mobile air pollution monitoring using low cost sensing devices, combined with a web-based game to monitor perceived levels of pollution. Measures of shift in perceptions over the course of the campaign are provided, together with insights into participatory patterns emerging from this study. Interesting effects related to inertia and to direct involvement in measurement activities rather than indirect information exposure are also highlighted, indicating that direct involvement can enhance learning and environmental awareness. In the future, this could result in better adoption of policies towards decreasing pollution.

The Phosphate Source Influences Gene Expression and Quality of Mineralization during In Vitro Osteogenic Differentiation of Human Mesenchymal Stem Cells

For in vitro differentiation of bone marrow-derived mesenchymal stem cells/mesenchymal stromal cells into osteoblasts by 2-dimensional cell culture a variety of protocols have been used and evaluated in the past. Especially the external phosphate source used to induce mineralization varies considerably both in respect to chemical composition and concentration. In light of the recent findings that inorganic phosphate directs gene expression of genes crucial for bone development, the need for a standardized phosphate source in in vitro differentiation becomes apparent. We show that chemical composition (inorganic versus organic phosphate origin) and concentration of phosphate supplementation exert a severe impact on the results of gene expression for the genes commonly used as markers for osteoblast formation as well as on the composition of the mineral formed. Specifically, the intensity of gene expression does not necessarily correlate with a high quality mineralized matrix. Our study demonstrates advantages of using inorganic phosphate instead of beta-glycerophosphate and propose colorimetric quantification methods for calcium and phosphate ions as cost-and time-effective alternatives to X-ray diffraction and Fourier-transform infrared spectroscopy for determination of the calcium phosphate ratio and concentration of mineral matrix formed under in vitro-conditions. We critically discuss the different assays used to assess in vitro bone formation in respect to specificity and provide a detailed in vitro protocol that could help to avoid contradictory results due to variances in experimental design.

Cost efficient supply processes for the Compact Slim Elevator Door

The aim of this thesis was to observe possibilities to enhance the development of manufacturing costs savings and competitiveness related to the compact KONE Renova Slim elevator door. Compact slim doors are especially designed for EMEA markets. EMEA market area is characterized by highly competitive pricing and lead times which are manifested as pressures to decrease manufacturing costs and lead times of the compact elevator door. The new elevator safety code EN81-20 coming live during the spring 2016 will also have a negative impact on the cost and competitiveness development making the situation more acute. As a sheet metal product the KONE Renova slim is highly variable. Manufacturing methods utilized in the production are common and robust methods. Due to the low volumes, high variability and tight lead times the manufacturing of the doors is facing difficulties. Manufacturing of the doors is outsourced to two individual suppliers Stera and Wittur. This thesis was implemented in collaboration with Stera. KONE and Stera pursue a long term and close partnership where the benefits reached by the collaboration are shared equally. Despite the aims, the collaboration between companies is not totally visible and various barriers are hampering the development towards more efficient ways of working. Based on the empirical studies related to this thesis, an efficient standardized (A+) process was developed for the main variations of the compact elevator door. Using the standardized process KONE is able to order the most important AMDS door variations from Stera with increased quality, lower manufacturing costs and manufacturing lead time compared to the current situation. In addition to all the benefits, the standardized (A+) process also includes risks in practice. KONE and the door supplier need to consider these practical risks together before decisions are made.

Optimization of aeroponic technology for future integration in quality potato seed production systems in tropical environments

Virus and soil borne pathogens negatively impact on the production of potatoes in tropical highland and sub-tropical environments, limiting supply of an increasingly popular and important vegetable in these regions. It is common for latent disease infected seed tubers or field grown cuttings to be used as potato planting material. We utilised an International Potato Centre technique, using aeroponic technology, to produce low cost mini-tubers in tropical areas. The system has been optimised for increased effectiveness in tropical areas. High numbers of seed tubers of cultivar Sebago (630) and Nicola per m2 (>900) were obtained in the first generation, and the system is capable of producing five crops of standard cultivars in every two years. Initial results indicate that quality seed could be produced by nurseries and farmers, therefore contributing to the minimisation of soil borne diseases in an integrated management plan. This technology reduces seed production costs, benefiting seed and potato growers. © ISHS.

Consideration of the relevance of standard quality techniques in Mass Customisation

The business philosophy of Mass Customisation (MC) implies rapid response to customer requests, high efficiency and limited cost overheads of customisation. Furthermore, it also implies the quality benefits of the mass production paradigm are guaranteed. However, traditional quality science in manufacturing is premised on volume production of uniform products rather than of differentiated products associated with MC. This creates quality challenges and raises questions over the suitability of standard quality engineering techniques. From an analysis of relevant MC and quality literature it is argued the aims of MC are aligned with contemporary thinking on quality and that quality concepts provide insights into MC. Quality issues are considered along three dimensions - product development, order fulfilment and customer interaction. The applicability and effectiveness of conventional quality engineering techniques are discussed and a framework is presented which identifies key issues with respect to quality for a spectrum of MC strategies.

Modified atmosphere packaging effects on the postharvest quality of papaya fruit

Export of Fijian papaya (Carica papaya) fruit to destinations such as New Zealand has increased significantly over the last several years. Shipment by sea rather than air is the preferred method, given the capacity for larger volumes and reductions in cost. Long shipping times, however, can compromise fruit quality, although the use of modified atmosphere packaging (MAP) may provide a viable solution for extending fruit storage life. In a collaborative ACIAR project, Australian and Fijian researchers investigated the potential of using MAP to extend storage life of a Fijian papaya ('Fiji Red') fruit based on simulated sea transport conditions. Fruit were packed in one of three MAP environments within cartons, consisting of either a (1) Low Density Polyethylene (LDPE) bag with 10 g of KMnO4, (2) Polyamide Film (PF) bag with macro-perforations or (3) without a bag (control fruit). Fruit were held for 1, 2 or 3 weeks at 10°C before being unpacked, ripened and assessed for quality. On day 6 after outturn, fruit with the highest overall quality were those held in LDPE bags. LDPE fruit generally coloured up faster at outturn than PF or control fruit, had less overall moisture loss and scored high in flavour. Headspace carbon dioxide and oxygen concentrations within the LDPE bags were also near recommended levels for maintaining optimum storage-life quality. The LDPE bag provided the most suitable conditions for long term storage of fresh papaya fruit and is therefore the recommended MAP type for use with sea freight export out of Fiji.

Preparation of environmental monitoring plan pattern for surface water quality in Iran (Case study: Gharehsou River)

Using water quality management programs is a necessary and inevitable way for preservation and sustainable use of water resources. One of the important issues in determining the quality of water in rivers is designing effective quality control networks, so that the measured quality variables in these stations are, as far as possible, indicative of overall changes in water quality. One of the methods to achieve this goal is increasing the number of quality monitoring stations and sampling instances. Since this will dramatically increase the annual cost of monitoring, deciding on which stations and parameters are the most important ones, along with increasing the instances of sampling, in a way that shows maximum change in the system under study can affect the future decision-making processes for optimizing the efficacy of extant monitoring network, removing or adding new stations or parameters and decreasing or increasing sampling instances. This end, the efficiency of multivariate statistical procedures was studied in this thesis. Multivariate statistical procedure, with regard to its features, can be used as a practical and useful method in recognizing and analyzing rivers’ pollution and consequently in understanding, reasoning, controlling, and correct decision-making in water quality management. This research was carried out using multivariate statistical techniques for analyzing the quality of water and monitoring the variables affecting its quality in Gharasou river, in Ardabil province in northwest of Iran. During a year, 28 physical and chemical parameters were sampled in 11 stations. The results of these measurements were analyzed by multivariate procedures such as: Cluster Analysis (CA), Principal Component Analysis (PCA), Factor Analysis (FA), and Discriminant Analysis (DA). Based on the findings from cluster analysis, principal component analysis, and factor analysis the stations were divided into three groups of highly polluted (HP), moderately polluted (MP), and less polluted (LP) stations Thus, this study illustrates the usefulness of multivariate statistical techniques for analysis and interpretation of complex data sets, and in water quality assessment, identification of pollution sources/factors and understanding spatial variations in water quality for effective river water quality management. This study also shows the effectiveness of these techniques for getting better information about the water quality and design of monitoring network for effective management of water resources. Therefore, based on the results, Gharasou river water quality monitoring program was developed and presented.

Water quality trading: credit stacking and ancillary benefits

Ecosystems can provide many services. Wetlands, for example, can help mitigate water pollution from point sources as well as non-point sources, serve as habitat for wildlife, sequester carbon and serve as a place for recreation. Studies have found that these services can have substantial value to society. The sale of ecosystem credits has been found to be a possible way to finance construction investments in wetlands and easements to farmers to take their land out of production. At the same time, selling one ecosystem service credit may not always be enough to justify the investment. Traditionally market participants have only been allowed to sell a single credit from one piece of land, but recently there have been discussions about the possibility of selling more than one credit from a piece of land because it potentially could lead to more efficient ecosystem service provision. Selling multiple credits is sometimes referred to as credit stacking. This paper is an empirical study of the potential for credit stacking applied to the services provided by wetlands in the Upper Mississippi River Basin, specifically nitrogen, phosphorus and wildlife credits. In the setting of our study where costs are discrete rather than continuous we found that wetlands are a cost-effective way to reduce the nitrogen loads from wastewater treatment plants and that stacking nitrogen, phosphorus and wildlife credits may improve social welfare while leading to a higher level of ecosystem services. However, for credit stacking to be welfare improving we found that there needs to be a substantial demand for the credit that covers the majority of the investment in wetlands, while the credit aggregator has a choice between what ecosystem projects to undertake. If the credit that covers the majority of investment is sold first and is the sole basis of the investment decision and the objective is to improve welfare, a sequential implementation of ecosystem credits is not recommended; it would not lead to an increase in the total amount of ecosystem services provided though it would increase profit for the credit producer.

Social/economic costs and health-related quality of life in patients with epidermolysis bullosa in Europe

BACKGROUND: The aim of this study was to determine the social/economic costs and health-related quality of life (HRQOL) of patients with epidermolysis bullosa (EB) in eight EU member states. METHODS: We conducted a cross-sectional study of patients with EB from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden and the United Kingdom. Data on demographic characteristics, health resource utilisation, informal care, labour productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. RESULTS: A total of 204 patients completed the questionnaire. Average annual costs varied from country to country, and ranged from euro9509 to euro49,233 (reference year 2012). Estimated direct healthcare costs ranged from euro419 to euro10,688; direct non-healthcare costs ranged from euro7449 to euro37,451 and labour productivity losses ranged from euro0 to euro7259. The average annual cost per patient across all countries was estimated at euro31,390, out of which euro5646 accounted for direct health costs (18.0 %), euro23,483 accounted for direct non-healthcare costs (74.8 %), and euro2261 accounted for indirect costs (7.2 %). Costs were shown to vary across patients with different disability but also between children and adults. The mean EQ-5D score for adult EB patients was estimated at between 0.49 and 0.71 and the mean EQ-5D visual analogue scale score was estimated at between 62 and 77. CONCLUSION: In addition to its negative impact on patient HRQOL, our study indicates the substantial social/economic burden of EB in Europe, attributable mostly to high direct non-healthcare costs.

A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC)

Background: Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC. Methods: A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument. Results: Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion criteria. The majority of studies analyzed the CE of first-line maintenance and second-line treatment with erlotinib. Five studies dealt with bevacizumab in first-line regimes. Gefitinib and pharmacogenomic profiling were each covered by only two studies. Furthermore, the available evidence was of only fair quality. Conclusion: First-line maintenance treatment with erlotinib compared to Best Supportive Care (BSC) can be considered cost-effective. In comparison to docetaxel, erlotinib is likely to be cost-effective in subsequent treatment regimens as well. The insights for bevacizumab are miscellaneous. There are findings that gefitinib is cost-effective in first- and second-line treatment, however, based on only two studies. The role of pharmacogenomic testing needs to be evaluated. Therefore, future research should improve the available evidence and consider pharmacogenomic profiling as specified by the European Medicines Agency. Upcoming agents like crizotinib and afatinib need to be analyzed as well. © Lange et al.

Observed Social Problem Solving and Friendship Quality in Children with a Traumatic Brain Injury

Children who have experienced a traumatic brain injury (TBI) are at risk for a variety of maladaptive cognitive, behavioral and social outcomes (Yeates et al., 2007). Research involving the social problem solving (SPS) abilities of children with TBI indicates a preference for lower level strategies when compared to children who have experienced an orthopedic injury (OI; Hanten et al., 2008, 2011). Research on SPS in non-injured populations has highlighted the significance of the identity of the social partner (Rubin et al., 2006). Within the pediatric TBI literature few studies have utilized friends as the social partner in SPS contexts, and fewer have used in-vivo SPS assessments. The current study aimed to build on existing research of SPS in children with TBI by utilizing an observational coding scheme to capture in-vivo problem solving behaviors between children with TBI and a best friend. The current study included children with TBI (n = 41), children with OI (n = 43), and a non-injured typically developing group (n = 41). All participants were observed completing a task with a friend and completed a measure of friendship quality. SPS was assessed using an observational coding scheme that captured SPS goals, strategies, and outcomes. It was expected children with TBI would produce fewer successes, fewer direct strategies, and more avoidant strategies. ANOVAs tested for group differences in SPS successes, direct strategies and avoidant strategies. Analyses were run to see if positive or negative friendship quality moderated the relation between group type and SPS behaviors. Group differences were found between the TBI and non-injured group in the SPS direct strategy of commands. No group differences were found for other SPS outcome variables of interest. Moderation analyses partially supported study hypotheses regarding the effect of friendship quality as a moderator variable. Additional analyses examined SPS goal-strategy sequencing and grouped SPS goals into high cost and low cost categories. Results showed a trend supporting the hypothesis that children with TBI had fewer SPS successes, especially with high cost goals, compared to the other two groups. Findings were discussed highlighting the moderation results involving children with severe TBI.