Continuous quality improvement in a Maltese hospital using logical framework analysis

Purpose: The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital. Design/methodology/approach: This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings: This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively. Research limitations/implications: This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications: LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement. Originality/value: LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.

Lost in translation? The potential psychobiotic Lactobacillus rhamnosus (JB-1) fails to modulate stress or cognitive performance in healthy male subjects

Background: Preclinical studies have identified certain probiotics as psychobiotics a live microorganisms with a potential mental health benefit. Lactobacillus rhamnosus (JB-1) has been shown to reduce stress-related behaviour, corticosterone release and alter central expression of GABA receptors in an anxious mouse strain. However, it is unclear if this single putative psychobiotic strain has psychotropic activity in humans. Consequently, we aimed to examine if these promising preclinical findings could be translated to healthy human volunteers. Objectives: To determine the impact of L. rhamnosus on stress-related behaviours, physiology, inflammatory response, cognitive performance and brain activity patterns in healthy male participants. An 8 week, randomized, placebo-controlled, cross-over design was employed. Twenty-nine healthy male volunteers participated. Participants completed self-report stress measures, cognitive assessments and resting electroencephalography (EEG). Plasma IL10, IL1β, IL6, IL8 and TNFα levels and whole blood Toll-like 4 (TLR-4) agonist-induced cytokine release were determined by multiplex ELISA. Salivary cortisol was determined by ELISA and subjective stress measures were assessed before, during and after a socially evaluated cold pressor test (SECPT). Results: There was no overall effect of probiotic treatment on measures of mood, anxiety, stress or sleep quality and no significant effect of probiotic over placebo on subjective stress measures, or the HPA response to the SECPT. Visuospatial memory performance, attention switching, rapid visual information processing, emotion recognition and associated EEG measures did not show improvement over placebo. No significant anti-inflammatory effects were seen as assessed by basal and stimulated cytokine levels. Conclusions: L. rhamnosus was not superior to placebo in modifying stress-related measures, HPA response, inflammation or cognitive performance in healthy male participants. These findings highlight the challenges associated with moving promising preclinical studies, conducted in an anxious mouse strain, to healthy human participants. Future interventional studies investigating the effect of this psychobiotic in populations with stress-related disorders are required.

The official roster of South Carolina soldiers, sailors and marines in the World War, 1917-18, volume 1, part 1

This is the Official Roster of the South Carolina soldiers, sailors and marines who served in the World War and contains the names and records, briefly compiled, of the men and women from this state who responded to the call of the President when the United States entered the great conflict. This record gives in as compact form as practicable the following : name; serial number; residence; branch of service; date and place of entry into service; place of birth and age; organizations served in, with dates of assignments and transfers; grades with dates of appointment; engagements, if any; wound received in action, with degree and date; if killed in action or died while in service; person notified, relationship and address; oversea service; date of discharge; citations.

The official roster of South Carolina soldiers, sailors and marines in the World War, 1917-18, volume 1, part 2

This is the Official Roster of the South Carolina soldiers, sailors and marines who served in the World War and contains the names and records, briefly compiled, of the men and women from this state who responded to the call of the President when the United States entered the great conflict. This record gives in as compact form as practicable the following : name; serial number; residence; branch of service; date and place of entry into service; place of birth and age; organizations served in, with dates of assignments and transfers; grades with dates of appointment; engagements, if any; wound received in action, with degree and date; if killed in action or died while in service; person notified, relationship and address; oversea service; date of discharge; citations.

The official roster of South Carolina soldiers, sailors and marines in the World War, 1917-18, volume 1, part 3

This is the Official Roster of the South Carolina soldiers, sailors and marines who served in the World War and contains the names and records, briefly compiled, of the men and women from this state who responded to the call of the President when the United States entered the great conflict. This record gives in as compact form as practicable the following : name; serial number; residence; branch of service; date and place of entry into service; place of birth and age; organizations served in, with dates of assignments and transfers; grades with dates of appointment; engagements, if any; wound received in action, with degree and date; if killed in action or died while in service; person notified, relationship and address; oversea service; date of discharge; citations.

The official roster of South Carolina soldiers, sailors and marines in the World War, 1917-18, volume 2, part 1

This is the Official Roster of the South Carolina soldiers, sailors and marines who served in the World War and contains the names and records, briefly compiled, of the men and women from this state who responded to the call of the President when the United States entered the great conflict. This record gives in as compact form as practicable the following : name; serial number; residence; branch of service; date and place of entry into service; place of birth and age; organizations served in, with dates of assignments and transfers; grades with dates of appointment; engagements, if any; wound received in action, with degree and date; if killed in action or died while in service; person notified, relationship and address; oversea service; date of discharge; citations.

The official roster of South Carolina soldiers, sailors and marines in the World War, 1917-18, volume 2, part 2

This is the Official Roster of the South Carolina soldiers, sailors and marines who served in the World War and contains the names and records, briefly compiled, of the men and women from this state who responded to the call of the President when the United States entered the great conflict. This record gives in as compact form as practicable the following : name; serial number; residence; branch of service; date and place of entry into service; place of birth and age; organizations served in, with dates of assignments and transfers; grades with dates of appointment; engagements, if any; wound received in action, with degree and date; if killed in action or died while in service; person notified, relationship and address; oversea service; date of discharge; citations.

Soil quality assessment in conservation agriculture systems

Soil is a key resource that provides the basis of food production and sustains and delivers several ecosystems services including regulating and supporting services such as water and climate regulation, soil formation and the cycling of nutrients carbon and water. During the last decades, population growth, dietary changes and the subsequent pressure on food production, have caused severe damages on soil quality as a consequence of intensive, high input-based agriculture. While agriculture is supposed to maintain and steward its most important resource base, it compromises soil quality and fertility through its impact on erosion, soil organic matter and biodiversity decline, compaction, etc., and thus the necessary yield increases for the next decades. New or improved cropping systems and agricultural practices are needed to ensure a sustainable use of this resource and to fully take the advantages of its associated ecosystem services. Also, new and better soil quality indicators are crucial for fast and in-field soil diagnosis to help farmers decide on the best management practices to adopt under specific pedo-climatic conditions. Conservation Agriculture and its fundamental principles: minimum (or no) soil disturbance, permanent organic soil cover and crop rotation /intercropping certainly figure among the possibilities capable to guarantee sustainable soil management. The iSQAPER project – Interactive Soil Quality Assessment in Europe and China for Agricultural Productivity and Environmental Resilience – is tackling this problem with the development of a Soil Quality application (SQAPP) that links soil and agricultural management practices to soil quality indicators and will provide an easy-to-use tool for farmers and land managers to judge their soil status. The University of Évora is the leader of WP6 - Evaluating and demonstrating measures to improve Soil Quality. In this work package, several promising soil and agricultural management practices will be tested at selected sites and evaluated using the set of soil quality indicators defined for the SQAPP tool. The project as a whole and WP6 in specific can contribute to proof and demonstrate under different pedoclimatic conditions the impact of Conservation Agriculture practices on soil quality and function as was named the call under which this project was submitted.

Reducing the global burden of depression : population level analysis of intervention cost-effectiveness in 14 world regions

International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims: To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. Method: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. Results: Evaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. Conclusions: Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantlyif there is a substantialincrease substantial increase intreatment coverage.