Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

Experimental and modeling studies of forced convection storage and drying systems for sweet potatoes

Sweet potato is an important strategic agricultural crop grown in many countries around the world. The roots and aerial vine components of the crop are used for both human consumption and, to some extent as a cheap source of animal feed. In spite of its economic value and growing contribution to health and nutrition, harvested sweet potato roots and aerial vine components has limited shelf-life and is easily susceptible to post-harvest losses. Although post-harvest losses of both sweet potato roots and aerial vine components is significant, there is no information available that will support the design and development of appropriate storage and preservation systems. In this context, the present study was initiated to improve scientific knowledge about sweet potato post-harvest handling. Additionally, the study also seeks to develop a PV ventilated mud storehouse for storage of sweet potato roots under tropical conditions. In study one, airflow resistance of sweet potato aerial vine components was investigated. The influence of different operating parameters such as airflow rate, moisture content and bulk depth at different levels on airflow resistance was analyzed. All the operating parameters were observed to have significant (P < 0.01) effect on airflow resistance. Prediction models were developed and were found to adequately describe the experimental pressure drop data. In study two, the resistance of airflow through unwashed and clean sweet potato roots was investigated. The effect of sweet potato roots shape factor, surface roughness, orientation to airflow, and presence of soil fraction on airflow resistance was also assessed. The pressure drop through unwashed and clean sweet potato roots was observed to increase with higher airflow, bed depth, root grade composition, and presence of soil fraction. The physical properties of the roots were incorporated into a modified Ergun model and compared with a modified Shedd’s model. The modified Ergun model provided the best fit to the experimental data when compared with the modified Shedd’s model. In study three, the effect of sweet potato root size (medium and large), different air velocity and temperature on the cooling/or heating rate and time of individual sweet potato roots were investigated. Also, a simulation model which is based on the fundamental solution of the transient equations was proposed for estimating the cooling and heating time at the centre of sweet potato roots. The results showed that increasing air velocity during cooling and heating significantly (P < 0.05) affects the cooling and heating times. Furthermore, the cooling and heating times were significantly different (P < 0.05) among medium and large size sweet potato roots. Comparison of the simulation results with experimental data confirmed that the transient simulation model can be used to accurately estimate the cooling and heating times of whole sweet potato roots under forced convection conditions. In study four, the performance of charcoal evaporative cooling pad configurations for integration into sweet potato roots storage systems was investigated. The experiments were carried out at different levels of air velocity, water flow rates, and three pad configurations: single layer pad (SLP), double layers pad (DLP) and triple layers pad (TLP) made out of small and large size charcoal particles. The results showed that higher air velocity has tremendous effect on pressure drop. Increasing the water flow rate above the range tested had no practical benefits in terms of cooling. It was observed that DLP and TLD configurations with larger wet surface area for both types of pads provided high cooling efficiencies. In study five, CFD technique in the ANSYS Fluent software was used to simulate airflow distribution in a low-cost mud storehouse. By theoretically investigating different geometries of air inlet, plenum chamber, and outlet as well as its placement using ANSYS Fluent software, an acceptable geometry with uniform air distribution was selected and constructed. Experimental measurements validated the selected design. In study six, the performance of the developed PV ventilated system was investigated. Field measurements showed satisfactory results of the directly coupled PV ventilated system. Furthermore, the option of integrating a low-cost evaporative cooling system into the mud storage structure was also investigated. The results showed a reduction of ambient temperature inside the mud storehouse while relative humidity was enhanced. The ability of the developed storage system to provide and maintain airflow, temperature and relative humidity which are the key parameters for shelf-life extension of sweet potato roots highlight its ability to reduce post-harvest losses at the farmer level, particularly under tropical climate conditions.

Investigating the Roles and Requirements, Manifestations and Management of Metadata in the Creation of Reliable and Preservation of Authentic Electronic Entities Created by Dynamic, Interactive and Experiential Systems: Report on the Work and Findings of the Interpares 2 Description Cross Domain Group

Metadata that is associated with either an information system or an information object for purposes of description, administration, legal requirements, technical functionality, use and usage, and preservation, plays a critical role in ensuring the creation, management, preservation and use and re-use of trustworthymaterials, including records. Recordkeeping1 metadata, of which one key type is archival description, plays a particularly important role in documenting the reliability and authenticity of records and recordkeeping systemsas well as the various contexts (legal-administrative, provenancial, procedural, documentary, and technical) within which records are created and kept as they move across space and time. In the digital environment, metadata is also the means by which it is possible to identify how record components – those constituent aspects of a digital record that may be managed, stored and used separately by the creator or the preserver – can be reassembled to generate an authentic copy of a record or reformulated per a user’s request as a customized output package.Issues relating to the creation, capture, management and preservation of adequate metadata are, therefore, integral to any research study addressing the reliability and authenticity of digital entities, regardless of the community, sector or institution within which they are being created. The InterPARES 2 Description Cross-Domain Group (DCD) examined the conceptualization, definitions, roles, and current functionality of metadata and archival description in terms of requirements generated by InterPARES 12. Because of the needs to communicate the work of InterPARES in a meaningful way across not only other disciplines, but also different archival traditions; to interface with, evaluate and inform existing standards, practices and other research projects; and to ensure interoperability across the three focus areas of InterPARES2, the Description Cross-Domain also addressed its research goals with reference to wider thinking about and developments in recordkeeping and metadata. InterPARES2 addressed not only records, however, but a range of digital information objects (referred to as “entities” by InterPARES 2, but not to be confused with the term “entities” as used in metadata and database applications) that are the products and by-products of government, scientific and artistic activities that are carried out using dynamic, interactive or experiential digital systems. The nature of these entities was determined through a diplomatic analysis undertaken as part of extensive case studies of digital systems that were conducted by the InterPARES 2 Focus Groups. This diplomatic analysis established whether the entities identified during the case studies were records, non-records that nevertheless raised important concerns relating to reliability and authenticity, or “potential records.” To be determined to be records, the entities had to meet the criteria outlined by archival theory – they had to have a fixed documentary format and stable content. It was not sufficient that they be considered to be or treated as records by the creator. “Potential records” is a new construct that indicates that a digital system has the potential to create records upon demand, but does not actually fix and set aside records in the normal course of business. The work of the Description Cross-Domain Group, therefore, addresses the metadata needs for all three categories of entities.Finally, since “metadata” as a term is used today so ubiquitously and in so many different ways by different communities, that it is in peril of losing any specificity, part of the work of the DCD sought to name and type categories of metadata. It also addressed incentives for creators to generate appropriate metadata, as well as issues associated with the retention, maintenance and eventual disposition of the metadata that aggregates around digital entities over time.

Integrated soil fertility management in eastern and western Africa: The role of knowledge and innovation systems, its adoption and impact

The rise in population growth, as well as nutrient mining, has contributed to low agricultural productivity in Sub-Saharan Africa (SSA). A plethora of technologies to boost agricultural production have been developed but the dissemination of these agricultural innovations and subsequent uptake by smallholder farmers has remained a challenge. Scientists and philanthropists have adopted the Integrated Soil Fertility Management (ISFM) paradigm as a means to promote sustainable intensification of African farming systems. This comparative study aimed: 1) To assess the efficacy of Agricultural Knowledge and Innovation Systems (AKIS) in East (Kenya) and West (Ghana) Africa in the communication and dissemination of ISFM (Study I); 2) To investigate how specifically soil quality, and more broadly socio-economic status and institutional factors, influence farmer adoption of ISFM (Study II); and 3) To assess the effect of ISFM on maize yield and total household income of smallholder farmers (Study III). To address these aims, a mixed methodology approach was employed for study I. AKIS actors were subjected to social network analysis methods and in-depth interviews. Structured questionnaires were administered to 285 farming households in Tamale and 300 households in Kakamega selected using a stratified random sampling approach. There was a positive relationship between complete ISFM awareness among farmers and weak knowledge ties to both formal and informal actors at both research locations. The Kakamega AKIS revealed a relationship between complete ISFM awareness among farmers and them having strong knowledge ties to formal actors implying that further integration of formal actors with farmers’ local knowledge is crucial for the agricultural development progress. The structured questionnaire was also utilized to answer the query pertaining to study II. Soil samples (0-20 cm depth) were drawn from 322 (Tamale, Ghana) and 459 (Kakamega, Kenya) maize plots and analysed non-destructively for various soil fertility indicators. Ordinal regression modeling was applied to assess the cumulative adoption of ISFM. According to model estimates, soil carbon seemed to preclude farmers from intensifying input use in Tamale, whereas in Kakamega it spurred complete adoption. This varied response by farmers to soil quality conditions is multifaceted. From the Tamale perspective, it is consistent with farmers’ tendency to judiciously allocate scarce resources. Viewed from the Kakamega perspective, it points to a need for farmers here to intensify agricultural production in order to foster food security. In Kakamega, farmers with more acidic soils were more likely to adopt ISFM. Other household and farm-level factors necessary for ISFM adoption included off-farm income, livestock ownership, farmer associations, and market inter-linkages. Finally, in study III a counterfactual model was used to calculate the difference in outcomes (yield and household income) of the treatment (ISFM adoption) in order to estimate causal effects of ISFM adoption. Adoption of ISFM contributed to a yield increase of 16% in both Tamale and Kakamega. The innovation affected total household income only in Tamale, where ISFM adopters had an income gain of 20%. This may be attributable to the different policy contexts under which the two sets of farmers operate. The main recommendations underscored the need to: (1) improve the functioning of AKIS, (2) enhance farmer access to hybrid maize seed and credit, (3) and conduct additional multi-locational studies as farmers operate under varying contexts.

Identification of endophytic bactéria from micropropagated yacon (Smallanthus sonchifolius) crowing under autotrophic and Heterotrophic systems.

Yacon, Smallanthus sonchifolius, an Andean species. is a rich source of dictetíc oligofructans with low glucose content. proteins and phenolic compounds. These constituents have shown efficacy in the prevention of diet-related ehronic diseases, including gastroin-testinal disorders and diabetes |1,2|. Yacon is part of a research program at the National Center for Natural Products Research (NCNPR) and University of Mississippi Field Station to develop new alternative root crops for Mississippi while attempting to im-prove the diet of low incorne families. Yacon can be easily propa-gated by cultings. Virus and nematode infections have been re-ported on plants propagated by cuttings in Brazil. a country that hás adopted Yacon as specialty crop [3|. We have developed two culture systems. autotrophic and heterotrophic, to produce healthy plants. Herem we describe the presence of endophytic bactéria m micropropagated Yacon. In auxin free media, new roots were induced. Overa 15day period. the average root mduction per expiam was 5.45 to 8.75 under autotrophic and heterotrophic cul-tures, respectively. Root lenglh vaned between 3 and 60mrn. The presence of root hairs and lateral roots was noticed only in auto-trophic condilions. These beneficiai bactéria were identified and chemically ctiaracterized. Acknowledgement: This research work was partially supported by the USDA/ARS Cooperative Research Agreement No. 58-6408-2-009. Referentes; |1) Terada S. et ai. (2006] Yakugaku Zasshi 126(8): 665-669. (2| Valentová K. Ulri-chová j. (2003) Biomedical Papers 147: 119-130. [3| Mogor C. et ai, (2003) Acta Horticulturea 597: 311 -313.

Theoretical results of QoS-guaranteed resource scaling for cloud-based MapReduce

Quality of Service (QoS) is a new issue in cloud-based MapReduce, which is a popular computation model for parallel and distributed processing of big data. QoS guarantee is challenging in a dynamical computation environment due to the fact that a fixed resource allocation may become under-provisioning, which leads to QoS violation, or over-provisioning, which increases unnecessary resource cost. This requires runtime resource scaling to adapt environmental changes for QoS guarantee. Aiming to guarantee the QoS, which is referred as to hard deadline in this work, this paper develops a theory to determine how and when resource is scaled up/down for cloud-based MapReduce. The theory employs a nonlinear transformation to define the problem in a reverse resource space, simplifying the theoretical analysis significantly. Then, theoretical results are presented in three theorems on sufficient conditions for guaranteeing the QoS of cloud-based MapReduce. The superiority and applications of the theory are demonstrated through case studies.

Analysis of DNA sequence transformations on grids

Study of the evolution of species or organisms is essential for various biological applications. Evolution is typically studied at the molecular level by analyzing the mutations of DNA sequences of organisms. Techniques have been developed for building phylogenetic or evolutionary trees for a set of sequences. Though phylogenetic trees capture the overall evolutionary relationships among the sequences, they do not reveal fine-level details of the evolution. In this work, we attempt to resolve various fine-level sequence transformation details associated with a phylogenetic tree using cellular automata. In particular, our work tries to determine the cellular automata rules for neighbor-dependent mutations of segments of DNA sequences. We also determine the number of time steps needed for evolution of a progeny from an ancestor and the unknown segments of the intermediate sequences in the phylogenetic tree. Due to the existence of vast number of cellular automata rules, we have developed a grid system that performs parallel guided explorations of the rules on grid resources. We demonstrate our techniques by conducting experiments on a grid comprising machines in three countries and obtaining potentially useful statistics regarding evolutions in three HIV sequences. In particular, our work is able to verify the phenomenon of neighbor-dependent mutations and find that certain combinations of neighbor-dependent mutations, defined by a cellular automata rule, occur with greater than 90% probability. We also find the average number of time steps for mutations for some branches of phylogenetic tree over a large number of possible transformations with standard deviations less than 2.

Design of nonequivalent self-routing networks based on a matrix model

In earlier work, nonisomorphic graphs have been converted into networks to realize Multistage Interconnection networks, which are topologically nonequivalent to the Baseline network. The drawback of this technique is that these nonequivalent networks are not guaranteed to be self-routing, because each node in the graph model can be replaced by a (2 × 2) switch in any one of the four different configurations. Hence, the problem of routing in these networks remains unsolved. Moreover, nonisomorphic graphs were obtained by interconnecting bipartite loops in a heuristic manner; the heuristic nature of this procedure makes it difficult to guarantee full connectivity in large networks. We solve these problems through a direct approach, in which a matrix model for self-routing networks is developed. An example is given to show that this model encompases nonequivalent self-routing networks. This approach has the additional advantage in that the matrix model itself ensures full connectivity.

Toward Effective Scalar Hardware for Highly Vectorizable Applications

The performance of a program will ultimately be limited by its serial (scalar) portion, as pointed out by Amdahl′s Law. Reported studies thus far of instruction-level parallelism have mixed data-parallel program portions with scalar program portions, often leading to contradictory and controversial results. We report an instruction-level behavioral characterization of scalar code containing minimal data-parallelism, extracted from highly vectorized programs of the PERFECT benchmark suite running on a Cray Y-MP system. We classify scalar basic blocks according to their instruction mix, characterize the data dependencies seen in each class, and, as a first step, measure the maximum intrablock instruction-level parallelism available. We observe skewed rather than balanced instruction distributions in scalar code and in individual basic block classes of scalar code; nonuniform distribution of parallelism across instruction classes; and, as expected, limited available intrablock parallelism. We identify frequently occurring data-dependence patterns and discuss new instructions to reduce latency. Toward effective scalar hardware, we study latency-pipelining trade-offs and restricted multiple instruction issue mechanisms.

A Flat Concurrent Prolog compiler for PARAM

We describe a compiler for the Flat Concurrent Prolog language on a message passing multiprocessor architecture. This compiler permits symbolic and declarative programming in the syntax of Guarded Horn Rules, The implementation has been verified and tested on the 64-node PARAM parallel computer developed by C-DAC (Centre for the Development of Advanced Computing, India), Flat Concurrent Prolog (FCP) is a logic programming language designed for concurrent programming and parallel execution, It is a process oriented language, which embodies dataflow synchronization and guarded-command as its basic control mechanisms. An identical algorithm is executed on every processor in the network, We assume regular network topologies like mesh, ring, etc, Each node has a local memory, The algorithm comprises of two important parts: reduction and communication, The most difficult task is to integrate the solutions of problems that arise in the implementation in a coherent and efficient manner. We have tested the efficacy of the compiler on various benchmark problems of the ICOT project that have been reported in the recent book by Evan Tick, These problems include Quicksort, 8-queens, and Prime Number Generation, The results of the preliminary tests are favourable, We are currently examining issues like indexing and load balancing to further optimize our compiler.