774 resultados para Healthcare improvement
Resumo:
Determination of varicella zoster virus (VZV) immunity in healthcare workers without a history of chickenpox is important for identifying those in need of vOka vaccination. Post immunisation, healthcare workers in the UK who work with high risk patients are tested for seroconversion. To assess the performance of the time-resolved fluorescence immunoassay (TRFIA) for the detection of antibody in vaccinated as well as unvaccinated individuals, a cut-off was first calculated. VZV-IgG specific avidity and titres six weeks after the first dose of vaccine were used to identify subjects with pre-existing immunity among a cohort of 110 healthcare workers. Those with high avidity (≥60%) were considered to have previous immunity to VZV and those with low or equivocal avidity (<60%) were considered naive. The former had antibody levels ≥400mIU/mL and latter had levels <400mIU/mL. Comparison of the baseline values of the naive and immune groups allowed the estimation of a TRFIA cut-off value of >130mIU/mL which best discriminated between the two groups and this was confirmed by ROC analysis. Using this value, the sensitivity and specificity of TRFIA cut-off were 90% (95% CI 79-96), and 78% (95% CI 61-90) respectively in this population. A subset of samples tested by the gold standard Fluorescence Antibody to Membrane Antigen (FAMA) test showed 84% (54/64) agreement with TRFIA.
Resumo:
This paper proposes a three-shot improvement scheme for the hard-decision based method (HDM), an implementation solution for linear decorrelating detector (LDD) in asynchronous DS/CDMA systems. By taking advantage of the preceding (already reconstructed) bit and the matched filter output for the following two bits, the coupling between temporally adjacent bits (TABs), which always exists for asynchronous systems, is greatly suppressed and the performance of the original HDM is substantially improved. This new scheme requires no signaling overhead yet offers nearly the same performance as those more complicated methods. Also, it can easily accommodate the change in the number of active users in the channel, as no symbol/bit grouping is involved. Finally, the influence of synchronisation errors is investigated.
Resumo:
The current research agenda for construction process improvement is heavily influenced by the rhetoric of business process re-engineering (BPR). In contrast to the wider literature on BPR, there is little evidence of critical thought within the construction management research community. A postmodernist interpretation is advocated whereby the reality of management practice is defined by the dominant management discourse. The persuasiveness of BPR rhetoric is analysed with particular reference to the way in which it plays on the insecurity of modern managers. Despite the lip service given to ‘empowerment’ and ‘teamwork’, the dominant theme of the re-engineering movement is that of technocratic totalitarianism. From a critical perspective, it is suggested that BPR is imposed on construction organizations to ensure continued control by the industry's dominant power groups. Whilst industry leaders are fond of calling for ‘attitudinal and cultural improvement’, the language of the accepted research agenda continually reinforces the industry's dominant culture of ‘control and command’. Therefore, current research directions in process improvement perpetuate existing attitudes rather than facilitating cultural change. The concept of lean construction is seen to be the latest manifestation of this phenomenon.