ISO 9001 Quality Management Systems through the Lens of Organizational Culture

Both managers and scholars have convictions about the organizational approaches that best support organizational performance of the respective organizations and its Quality Management Systems. After a literature review of ISO 9001 Quality Management Systems (including the changes introduced by the 2015 edition), Organizational Culture theories are addressed and input from a CEO´s focus group was gathered. The importance of organizational culture for the success of Quality Management Systems and the achievement of the organizational desired results is highlighted. The article advances a proposal to analyze ISO 9001 International Standard through the lens of organizational culture theories identifying a stronger open systems approach (influence of the environment, dynamic perspective, need for survival) of the 2015 ISO 9001 edition when compared with the 2008 one. This provides additional knowledge both to scholars and practitioners for a better understanding of the culture issues that can maximize ISO 9001 Quality Management Systems 2015 edition contributions to organizational enduring success.

Utilization of Quality Tools: does sector and size matter?

This research focuses on the influence of company sector and size on the level of utilization of Basic and Advanced Quality Tools. The paper starts with a literature review and then presents the methodology used for the survey. Based on the responses from 202 managers of Portuguese ISO 9001:2008 Quality Management System certified organizations, statistical tests were performed. Results show, with 95% confidence level, that industry and services have a similar proportion of use of Basic and Advanced Quality Tools. Concerning size, bigger companies show a higher trend to use Advanced Quality Tools than smaller ones. For Basic Quality Tools, there was no statistical significant difference at a 95% confidence level for different company sizes. The three basic Quality tools with higher utilization were Check sheets, Flow charts and Histograms (for Services) or Control Charts/ (for Industry), however 22% of the surveyed organizations reported not using Basic Quality Tools, which highlights a major improvement opportunity for these companies. Additional studies addressing motivations, benefits and barriers for Quality Tools application should be undertaken for further validation and understanding of these results.

A Clinical Support System Based on Quality of Life Estimation

Quality of life is a concept influenced by social, economic, psychological, spiritual or medical state factors. More specifically, the perceived quality of an individual's daily life is an assessment of their well-being or lack of it. In this context, information technologies may help on the management of services for healthcare of chronic patients such as estimating the patient quality of life and helping the medical staff to take appropriate measures to increase each patient quality of life. This paper describes a Quality of Life estimation system developed using information technologies and the application of data mining algorithms to access the information of clinical data of patients with cancer from Otorhinolaryngology and Head and Neck services of an oncology institution. The system was evaluated with a sample composed of 3013 patients. The results achieved show that there are variables that may be significant predictors for the Quality of Life of the patient: years of smoking (p value 0.049) and size of the tumor (p value < 0.001). In order to assign the variables to the classification of the quality of life the best accuracy was obtained by applying the John Platt's sequential minimal optimization algorithm for training a support vector classifier. In conclusion data mining techniques allow having access to patients additional information helping the physicians to be able to know the quality of life and produce a well-informed clinical decision.

Comparison Among Aerobic Exercise and Other Types of Interventions to Treat Depression: A Systematic Review

Depression is a common and disabling disease that affects over 100 million people worldwide and can have a significant impact on physical and mental health, reducing their quality of life. Thus, the aim of this article was to provide information on research results and key chains related to the therapeutic effects of chronic aerobic exercise compared with other types of interventions to treat depression, which may become a useful clinical application in a near future. Researches have shown the effectiveness of alternative treatments, such as physical exercise, minimizing high financial costs and minimizing side effects. In this review, the data analyzed allows us to claim that alternative therapies, such as exercise, are effective on controlling and reducing symptoms. 69.3% of the studies that investigated the antidepressant effects of exercise on depressive were significant, and the other 30.7% of the studies improved only in general physiological aspects, such as increased oxygen uptake, increased use of blood glucose and decreased body fat percentage, with no improvement on symptoms of depression. From the sample analyzed, 71.4% was composed of women, and regarding the severity of symptoms, 85% had mild to moderate depression and only 15% had moderate to severe depression. However, there is still disagreement regarding the effect of exercise compared to the use of antidepressants in symptomatology and cognitive function in depression, this suggests that there is no consensus on the correct intensity of aerobic exercise as to achieve the best dose-response, with intensities high to moderate or moderate to mild.

Quality-of-service aware routing for static and mobile IPv6-based low-power and lossy sensor networks using RPL

The Internet of Things (IoT) has emerged as a paradigm over the last few years as a result of the tight integration of the computing and the physical world. The requirement of remote sensing makes low-power wireless sensor networks one of the key enabling technologies of IoT. These networks encompass several challenges, especially in communication and networking, due to their inherent constraints of low-power features, deployment in harsh and lossy environments, and limited computing and storage resources. The IPv6 Routing Protocol for Low Power and Lossy Networks (RPL) [1] was proposed by the IETF ROLL (Routing Over Low-power Lossy links) working group and is currently adopted as an IETF standard in the RFC 6550 since March 2012. Although RPL greatly satisfied the requirements of low-power and lossy sensor networks, several issues remain open for improvement and specification, in particular with respect to Quality of Service (QoS) guarantees and support for mobility. In this paper, we focus mainly on the RPL routing protocol. We propose some enhancements to the standard specification in order to provide QoS guarantees for static as well as mobile LLNs. For this purpose, we propose OF-FL (Objective Function based on Fuzzy Logic), a new objective function that overcomes the limitations of the standardized objective functions that were designed for RPL by considering important link and node metrics, namely end-to-end delay, number of hops, ETX (Expected transmission count) and LQL (Link Quality Level). In addition, we present the design of Co-RPL, an extension to RPL based on the corona mechanism that supports mobility in order to overcome the problem of slow reactivity to frequent topology changes and thus providing a better quality of service mainly in dynamic networks application. Performance evaluation results show that both OF-FL and Co-RPL allow a great improvement when compared to the standard specification, mainly in terms of packet loss ratio and average network latency. 2015 Elsevier B.V. Al

Trace Elements in Ambient Air at Porto Metropolitan Area—Checking for Compliance with New European Union (Eu) Air Quality Standards

Because of the scientific evidence showing that arsenic (As), cadmium (Cd), and nickel (Ni) are human genotoxic carcinogens, the European Union (EU) recently set target values for metal concentration in ambient air (As: 6 ng/m3, Cd: 5 ng/m3, Ni: 20 ng/m3). The aim of our study was to determine the concentration levels of these trace elements in Porto Metropolitan Area (PMA) in order to assess whether compliance was occurring with these new EU air quality standards. Fine (PM2.5) and inhalable (PM10) air particles were collected from October 2011 to July 2012 at two different (urban and suburban) locations in PMA. Samples were analyzed for trace elements content by inductively coupled plasma–mass spectrometry (ICP-MS). The study focused on determination of differences in trace elements concentration between the two sites, and between PM2.5 and PM10, in order to gather information regarding emission sources. Except for chromium (Cr), the concentration of all trace elements was higher at the urban site. However, results for As, Cd, Ni, and lead (Pb) were well below the EU limit/target values (As: 1.49 ± 0.71 ng/m3; Cd: 1.67 ± 0.92 ng/m3; Ni: 3.43 ± 3.23 ng/m3; Pb: 17.1 ± 10.1 ng/m3) in the worst-case scenario. Arsenic, Cd, Ni, Pb, antimony (Sb), selenium (Se), vanadium (V), and zinc (Zn) were predominantly associated to PM2.5, indicating that anthropogenic sources such as industry and road traffic are the main source of these elements. High enrichment factors (EF > 100) were obtained for As, Cd, Pb, Sb, Se, and Zn, further confirming their anthropogenic origin.

Adaptive modeling and high quality spectral estimation for speech enhancement

In this work an adaptive modeling and spectral estimation scheme based on a dual Discrete Kalman Filtering (DKF) is proposed for speech enhancement. Both speech and noise signals are modeled by an autoregressive structure which provides an underlying time frame dependency and improves time-frequency resolution. The model parameters are arranged to obtain a combined state-space model and are also used to calculate instantaneous power spectral density estimates. The speech enhancement is performed by a dual discrete Kalman filter that simultaneously gives estimates for the models and the signals. This approach is particularly useful as a pre-processing module for parametric based speech recognition systems that rely on spectral time dependent models. The system performance has been evaluated by a set of human listeners and by spectral distances. In both cases the use of this pre-processing module has led to improved results.

Adaptive filtering for high quality HMM based speech synthesis

In this work an adaptive filtering scheme based on a dual Discrete Kalman Filtering (DKF) is proposed for Hidden Markov Model (HMM) based speech synthesis quality enhancement. The objective is to improve signal smoothness across HMMs and their related states and to reduce artifacts due to acoustic model's limitations. Both speech and artifacts are modelled by an autoregressive structure which provides an underlying time frame dependency and improves time-frequency resolution. Themodel parameters are arranged to obtain a combined state-space model and are also used to calculate instantaneous power spectral density estimates. The quality enhancement is performed by a dual discrete Kalman filter that simultaneously gives estimates for the models and the signals. The system's performance has been evaluated using mean opinion score tests and the proposed technique has led to improved results.

Attachment, Physiological and Familial Vulnerability in Childhood Obesity: an Interactive Multisystem Approach

The aims of the present study were to test the association between insecure attachment and basal cortisol and catecholamines levels in a sample of obese children. The role of familial vulnerability and gender was also investigated. Methods: Cortisol and catecholamines levels of 8- to 13-year olds obese children were measured. Self-report questionnaires were used to assess attachment pattern and current anxiety and depression, and parent-report questionnaires were used to assess attachment, current anxiety and depression and familial vulnerability. Linear regression analyses were performed for individuals that scored low versus high on parental internalizing problems, and for boys and girls, separately. Results: In the group with high parental internalizing problems, insecure attachment was significantly associated with reduced basal levels of cortisol, in boys (p=0.007, b= -0.861, R2= 73.0%). In the group with low parental internalizing problems, the association between insecure attachment and cortisol was not significant in either boys or girls, and it was negative in boys (p=0.075, b= -0.606, R2= 36.7%) and positive in girls (p=0.677, b= 0.176, R2= 3.1%) . Conclusions: Apparently, physiological risk factors for psicopathology in obesity are more evident in individuals with a high familial vulnerability. In addition, patterns of physiological risk for psicopathology in obesity are different in boys and girls. Therefore, it is important to take into account familial vulnerability and gender when investigating physiological risk factors for psycopathology in obesity. Insecure attachment in childhood may be a risk factor for obesity. Interventions to increase children's attachment security should examine the effects on children's weight.

Simuladores Fisiológicos na avaliação metrológica de esfigmomanómetros

Este documento apresenta uma avaliação sobre o uso dos simuladores fisiológicos como padrão para avaliação metrológica dos esfigmomanómetros automáticos na estimação da pressão sanguínea pelo método não invasivo (PNI). O presente estudo procurou avaliar o enquadramento destes equipamentos com os procedimentos das normas e recomendações usadas para apreciação metrológica dos esfigmomanómetros digitais. No contexto da prática metrológica existente determinou-se a existência de uma oportunidade de melhoria nos processos relacionados. O trabalho procurou obter resposta a diversas questões, relacionando a medição da pressão pelo método não invasivo, com o uso dos simuladores fisiológicos, o contexto em que estes podem ser usados, as formas de simulação, as medições e os resultados, procurando a perspetiva metrológica como enquadramento. As recomendações existentes [1] [2] [3] [4] [5] [6] [7] [8], são muito claras nos procedimentos, validação e nos desvios permitidos para os monitores da tensão arterial (MTA), equipamento que permite a avaliação dos parâmetros fisiológicos do paciente, no entanto, quando se pretende avançar para outro domínio, como o do uso dos simuladores, em particular para a simulação da PNI, não existem recomendações ou normas tão claras, e não existe sobretudo um padrão de referência que imite a natureza dinâmica que caracteriza a pressão sanguínea. O trabalho procurou ainda estabelecer a ligação entre o método clássico de auscultação (o principio de determinação da PS), a técnica digital de medição e os simuladores, para uma melhor compreensão do que é a pressão sanguínea, e como relacionar a problemática da simulação e a de um padrão de referência. Neste trabalho estão ainda presentes abordagens a diversos tópicos, como as validações clínicas, acessórios, ou a metrologia e que influenciam no final os equipamentos e o contexto que se pretende avaliar. Os diversos equipamentos testados procuraram conter amostras diversificadas, quer para os MTA de uso profissional ou doméstico, assim como para os simuladores. A avaliação dos simuladores foi realizada contra um grupo de MTAs. Foi testada a influência na medição, causada pela mudança de acessórios, ou seja, nos resultados, merecendo consideração pela perspetiva metrológica. No resumo dos testes e do estudo sobre este tema, verificou-se que esta tipologia de equipamentos pode contribuir como complemento do processo de calibração típico (estático). Não constitui por si só um método alternativo, mas permitiu estimar possíveis limites de erro e desvio padrão a partir da observação dos resultados práticos, limites esses inferiores aos processos de validação clínica. Atendendo às particularidades, estimou-se como desvio aceitável um erro mais desvio padrão de 5 + 3 mmHg para o processo de simulação. Contudo considera-se ainda importante os testes adicionais em que o simulador permite, ao verificar as medidas de segurança implementadas no equipamento e a condição dos acessórios, que como verificado afetam os resultados. No entanto nem todos os simuladores se mostram adequados a este processo pelo que a qualidade da seleção do equipamento para este fim pode eventualmente reduzir ainda mais os possíveis limites.

Microbiological quality of drinking rainwater in the inland region of Pajeú, Pernambuco, Northeast Brazil

Despite all efforts to store and reduce its consumption, water is becoming less inexhaustible and its quality is falling faster. Considering that water is essential to animal life, it is necessary to adopt measures to ensure its sanitary conditions in order to be fit for consumption. The aim of this study was to analyze the microbiological quality of drinking rainwater used by rural communities of Tuparetama, a small town located in Northeast Brazil. The study covered seven rural communities, totaling 66 households. In each household two samples were collected, one from a tank and the other from a clay pot located inside the home, resulting in 132 samples (tank plus clay pot). Approximately 90% of samples were below the standard recommended by the current legislation, being considered unfit for human consumption. Part of this high microbiological contamination of drinking rainwater could be related to the lack of sanitary education and of an adequate sewerage sanitation system.

21st century quality: Looking into the “Crystal ball”

The discussion of possible scenarios for the future of Quality is on the priority list of major Quality Practitioners Societies. EOQ – European Organization for Quality (EOQ, 2014) main team for its 58th EOQ-Congress held June 2014 in Göteborg was “Managing Challenges in Quality Leadership” and ASQ - American Society for Quality (ASQ, 2015) appointed “the Future of Quality” for Quality Progress Magazine November 2015 issue. In addition, the ISO 9001:2008 revision process carried by ISO/TC 176 aims to assure that ISO 9001:2015 International Standard remains stable for the next 10 years (ISO, 2014) contributing to an increased discussion on the future of quality. The purpose of this research is to review available Quality Management approaches and outline, adding an academic perspective, expected developments for Quality within the 21st Century. This paper follows a qualitative approach, although data from international organizations is used. A literature review has been undertaken on quality management past and potential future trends. Based on these findings a model is proposed for organization quality management development and propositions for the future of quality management are advanced. Firstly, a state of the art of existing Quality Management approaches is presented, for example, like Total Quality Management (TQM) and Quality Gurus, ISO 9000 International Standards Series (with an outline of the expected changes for ISO 9001:2015), Six Sigma and Business Excellence Models.Secondly, building on theoretical and managerial approaches, a two dimensional matrix – Quality Engineering (QE - technical aspects of quality) and Quality Management (QM: soft aspects of quality) - is presented, outlining five proposed characterizations of Quality maturity levels and giving insights for applications and future developments. Literature review highlights that QM and QE may be addressing similar quality issues but their approaches are different in terms of scope breadth and intensity and they ought to complement and reciprocally reinforce one another. The challenges organizations face within the 21st century have stronger uncertainty, complexity, and differentiation. Two main propositions are advanced as relevant for 21st Century Quality: - QM importance for the sustainable success of organizations will increase and they should be aware of the larger ecosystem to be managed for improvement, possibly leading to the emergence of a new Quality paradigm, The Civilizacional Excellence paradigm. - QE should get more attention from QM and the Quality professionals will have to: a) Master and apply in wider contexts and in additional depth the Quality Tools (basic, intermediate and advanced); b) Have the soft skills needed for its success; c) Be results oriented and better understand and demonstrate the relationships between approaches and results These propositions challenge both scholars and practitioners for a sustained and supported discussion on the future of Quality. “All things are ready, if our mind be so.” (Shakespeare, Henry V, circa 1599).

Focus on: II – physiological principles of acid-base balance: an integrative perspective

Normal human metabolism leads to the daily production of large amounts of volatile and non-volatile acids. The maintenance of the pH within physiological limits is a demanding task in which several mechanisms are involved. The most immediate answer comes from several physiological buffers that quickly neutralize pH deviations caused by the addition of strong acids or bases to the body. Bicarbonate/carbonic acid is the most important buffer pair of the extracellular milieu, but is chemically inefficient and depends on the continuous activity of the lung and kidney. Other physiological buffers have higher efficacy and are very important in the intracellular environment and renal tubules. The capacity of the various chemical buffers is kept by operating in an open system and by several controlling mechanisms. The lung is responsible for the elimination of the carbon dioxide (CO2) produced in the body. In metabolic disorders, respiratory adjustment of the elimination of CO2 prolongs the effect of the bicarbonate/carbonic acid buffer, but this process consumes bicarbonate. The kidney contributes to acid-base balance through several mechanisms: 1) controls the reabsorption of filtered bicarbonate; 2) regenerates bicarbonate consumed in buffer reactions; 3) eliminates non-volatile acids. Renal elimination of acid and bicarbonate regeneration is only possible due to the existence of several urinary buffers and to the ability of the kidneys to produce ammonia

Position Statement on Bioresorbable Vascular Scaffolds in Portugal

BACKGROUND: Bioresorbable vascular scaffolds (BVS) were recently approved for percutaneous coronary intervention in Europe. The aim of this position statement is to review the information and studies on available BVS, to stimulate discussion on their use and to propose guidelines for this treatment option in Portugal. METHODS AND RESULTS: A working group was set up to reach a consensus based on current evidence, discussion of clinical case models and individual experience. The evidence suggests that currently available BVS can produce physiological and clinical improvements in selected patients. There are encouraging data on their durability and long-term safety. Initial indications were grouped into three categories: (a) consensual and appropriate - young patients, diabetic patients, left anterior descending artery, long lesions, diffuse disease, and hybrid strategy; (b) less consensual but possible - small collateral branches, stabilized acute coronary syndromes; and (c) inappropriate - left main disease, tortuosity, severe calcification. CONCLUSION: BVS are a viable treatment option based on the encouraging evidence of their applicability and physiological and clinical results. They should be used in appropriate indications and will require technical adaptations. Outcome monitoring and evaluation is essential to avoid inappropriate use. It is recommended that medical societies produce clinical guidelines based on high-quality registries as soon as possible.