Quality assurance experience with the randomized neuropathic bone pain trial (Trans-Tasman Radiation Oncology Group, 96.05)

Background and purpose: Trans-Tasman Radiation Oncology Group 96.05 is a prospective randomized controlled trial comparing a single 8 Gy with 20 Gy in five fractions of radiotherapy (RT) for neuropathic pain due to bone metastases. This paper summarizes the quality assurance (QA) activities for the first 234 patients (accrual target 270). Materials and methods: Independent audits to assess compliance with eligibility/exclusion criteria and appropriateness of treatment of the index site were conducted after each cohort of approximately 45 consecutive patients. Reported serious adverse events (SAEs) in the form of cord/cauda equina compression or pathological fracture developing at the index site were investigated and presented in batches to the Independent Data Monitoring Committee. Finally, source data verification of the RT prescription page and treatment records was undertaken for each of the first 234 patients to assess compliance with the protocol. Results: Only one patient was found conclusively not to have genuine neuropathic pain, and there were no detected 'geographical misses' with RT fields. The overall rate of detected infringements for other eligibility criteria over five audits (225 patients) was 8% with a dramatic improvement after the first audit. There has at no stage been a statistically significant difference in SAEs by randomization arm. There was a 22% rate of RT protocol variations involving ten of the 14 contributing centres, although the rate of major dose violations (more than +/- 10% from protocol dose) was only 6% with no statistically significant difference by randomization arm (P = 0.44). Conclusions: QA auditing is an essential but time-consuming component of RT trials, including those assessing palliative endpoints. Our experience confirms that all aspects should commence soon after study activation. Crown Copyright (C) 2003 Published by Elsevier Science Ltd. All rights reserved.

Quality assurance of paediatric cardiac surgery: A prospective 6-year analysis

Objective: To audit effective quality assurance methods to monitor outcomes following paediatric cardiac surgery at a single institution. Methods: All patients undergoing cardiac surgery from January 1996 to December 2001 were enrolled prospectively. Patients were stratified by complexity of surgical procedure into four groups, with Category 4 being the most complex procedure. Outcome measures included death, length of admission and morbidity from complications. Results: A total of 1815 patients underwent 1973 surgical procedures. Of these, 1447 (73.3%) were cardiopulmonary bypass procedures, and 543 (27.5%) were more complex (Category 3 and 4) procedures. Median patient age was 3.5 years (range, 1 day-20 years) and patient weight 15.0 kg (range, 900 g to 90 kg). Sixty-six patients (3.6%) died during the study period. Of the procedures in 1996, 22.7% were classified as complex compared with 29.2% of procedures in 2001. The annual surgical mortality ranged from 1.9-4.7% (P=0.20), and when mortality was adjusted for complexity of surgery, there was no significant yearly variation in the mortality rate (P=0.57). Analysis of individual surgeon's results showed no significant difference in the mortality rate by complexity of surgery performed (P=0.90). Mean ventilation times did not change significantly over time (P=0.79). The yearly incidence of significant neurological complications ranged from 0.6% to 4.5% and the incidence of arrhythmias from 4.2% to 8.0%. No difference was detected between the years. Conclusions: Stratifying complexity of surgery proved valuable in monitoring surgical outcomes and detecting differences in performance over time as large subgroups were created for analysis.

Development of a co-operative distributed process mining system for quality assurance

In this paper, a co-operative distributed process mining system (CDPMS) is developed to streamline the workflow along the supply chain in order to offer shorter delivery times, more flexibility and higher customer satisfaction with learning ability. The proposed system is equipped with the ‘distributed process mining’ feature which is used to discover the hidden relationships among each working decision in distributed manner. This method incorporates the concept of data mining and knowledge refinement into decision making process for ensuring ‘doing the right things’ within the workflow. An example of implementation is given, based on the case of slider manufacturer.

The acceptability of alcohol fuels for automobile engines

The aim of this project was to carry out an investigastion into suitable alternatives to gasoline for use in modern automobiles. The fuel would provide the western world with a means of extending the natural gasoline resources and the third world a way of cutting down their dependence on the oil producing countries for their energy supply. Alcohols, namely methanol and ethanol, provide this solution. They can be used as gasoline extenders or as fuels on their own.In order to fulfil the aims of the project a literature study was carried out to investigate methods and costs of producing these fuels. An experimental programme was then set up in which the performance of the alcohols was studied on a conventional engine. The engine used for this purpose was the Fiat 127 930cc four cylinder engine. This engine was used because of its popularity in the European countries. The Weber fixed jet carburettor, since it was designed to be used with gasoline, was adapted so that the alcohol fuels and the blends could be used in the most efficient way. This was mainly to take account of the lower heat content of the alcohols. The adaptation of the carburettor was in the form of enlarging the main metering jet. Allowances for the alcohol's lower specfic gravity were made during fuel metering.Owing to the low front end volatility of methanol and ethanol, it was expected that `start up' problems would occur. An experimental programme was set up to determine the temperature range for a minimum required percentage `take off' that would ease start-up since it was determined that a `take off' of about 5% v/v liquid in the vapour phase would be sufficient for starting. Additions such as iso-pentane and n-pentane were used to improve the front end volatility. This proved to be successful.The lower heat content of the alcohol fuels also meant that a greater charge of fuel would be required. This was seen to pose further problems with fuel distribution from the carburettor to the individual cylinders on a multicylinder engine. Since it was not possible to modify the existing manifold on the Fiat 127 engine, experimental tests on manifold geometry were carried out using the Ricardo E6 single cylinder variable compression engine. Results from these tests showed that the length, shape and cross-sectional area of the manifold play an important part in the distribution of the fuel entering the cylinder, ie. vapour phase, vapour/small liquid droplet/liquid film phase, vapour/large liquid droplet/liquid film phase etc.The solvent properties of the alcohols and their greater electrical conductivity suggested that the materials used on the engine would be prone to chemical attack. In order to determine the type and rate of chemical attack, an experimental programme was set up whereby carburettor and other components were immersed in the alcohols and in blends of alcohol with gasoline. The test fuels were aerated and in some instances kept at temperatures ranging from 50oC to 90oC. Results from these tests suggest that not all materials used in the conventional engine are equally suitable for use with alcohols and alcohol/gasoline blends. Aluminium for instance was severely attacked by methanol causing pitting and pin-holing in the surface.In general this whole experimental programme gave valuable information on the acceptability of substitute fuels. While the long term effects of alcohol use merit further study, it is clear that methanol and ethanol will be increasingly used in place of gasoline.

Automatic processing, quality assurance and serving of real-time weather data over lightweight protocols

Recent advances in technology have produced a significant increase in the availability of free sensor data over the Internet. With affordable weather monitoring stations now available to individual meteorology enthusiasts a reservoir of real time data such as temperature, rainfall and wind speed can now be obtained for most of the United States and Europe. Despite the abundance of available data, obtaining useable information about the weather in your local neighbourhood requires complex processing that poses several challenges. This paper discusses a collection of technologies and applications that harvest, refine and process this data, culminating in information that has been tailored toward the user. In this case we are particularly interested in allowing a user to make direct queries about the weather at any location, even when this is not directly instrumented, using interpolation methods. We also consider how the uncertainty that the interpolation introduces can then be communicated to the user of the system, using UncertML, a developing standard for uncertainty representation.

Automobile friction materials: a test instrument and technique for determining dynamic mechanical properties in relation to brake squeal

This study is primarily concerned with the problem of break-squeal in disc brakes, using moulded organic disc pads. Moulded organic friction materials are complex composites and due to this complexity it was thought that they are unlikely to be of uniform composition. Variation in composition would under certain conditions of the braking system, cause slight changes in its vibrational characteristics thus causing resonance in the high audio-frequency range. Dynamic mechanical propertes appear the most likely parameters to be related to a given composition's tendency to promote squeal. Since it was necessary to test under service conditions a review was made of all the available commercial test instruments but as none were suitable it was necessary to design and develop a new instrument. The final instrument design, based on longitudinal resonance, enabled modulus and damping to be determined over a wide range of temperatures and frequencies. This apparatus has commercial value since it is not restricted to friction material testing. Both used and unused pads were tested and although the cause of brake squeal was not definitely established, the results enabled formulation of a tentative theory of the possible conditions for brake squeal. The presence of a temperature of minimum damping was indicated which may be of use to braking design engineers. Some auxilIary testing was also performed to establish the effect of water, oil and brake fluid and also to determine the effect of the various components of friction materials.

Automatic processing, quality assurance and serving of real-time weather data

Recent advances in technology have produced a significant increase in the availability of free sensor data over the Internet. With affordable weather monitoring stations now available to individual meteorology enthusiasts a reservoir of real time data such as temperature, rainfall and wind speed can now be obtained for most of the United States and Europe. Despite the abundance of available data, obtaining useable information about the weather in your local neighbourhood requires complex processing that poses several challenges. This paper discusses a collection of technologies and applications that harvest, refine and process this data, culminating in information that has been tailored toward the user. In this case we are particularly interested in allowing a user to make direct queries about the weather at any location, even when this is not directly instrumented, using interpolation methods. We also consider how the uncertainty that the interpolation introduces can then be communicated to the user of the system, using UncertML, a developing standard for uncertainty representation.