Metastatic non-small cell lung cancer: a benchmark for quality end-of-life cancer care?

Objectives: To investigate the quality of end-of-life care for patients with metastatic non-small cell lung cancer (NSCLC). Design and participants: Retrospective cohort study of patients from first hospitalisation for metastatic disease until death, using hospital, emergency department and death registration data from Victoria, Australia, between 1 July 2003 and 30 June 2010. Main outcome measures: Emergency department and hospital use; aggressiveness of care including intensive care and chemotherapy in last 30 days; palliative and supportive care provision; and place of death. Results: Metastatic NSCLC patients underwent limited aggressive treatment such as intensive care (5%) and chemotherapy (< 1%) at the end of life; however, high numbers died in acute hospitals (42%) and 61% had a length of stay of greater than 14 days in the last month of life. Although 62% were referred to palliative care services, this occurred late in the illness. In a logistic regression model adjusted for year of metastasis, age, sex, metastatic site and survival, the odds ratio (OR) of dying in an acute hospital bed compared with death at home or in a hospice unit decreased with receipt of palliative care (OR, 0.25; 95% CI, 0.21–0.30) and multimodality supportive care (OR, 0.65; 95% CI, 0.56–0.75). Conclusion: Because early palliative care for patients with metastatic NSCLC is recommended, we propose that this group be considered a benchmark of quality end-of-life care. Future work is required to determine appropriate quality-of-care targets in this and other cancer patient cohorts, with particular focus on the timeliness of palliative care engagement.

Failure of a numerical quality assessment scale to identify potential risk of bias in a systematic review: a comparison study

BACKGROUND: Assessing methodological quality of primary studies is an essential component of systematic reviews. Following a systematic review which used a domain based system [United States Preventative Services Task Force (USPSTF)] to assess methodological quality, a commonly used numerical rating scale (Downs and Black) was also used to evaluate the included studies and comparisons were made between quality ratings assigned using the two different methods. Both tools were used to assess the 20 randomized and quasi-randomized controlled trials examining an exercise intervention for chronic musculoskeletal pain which were included in the review. Inter-rater reliability and levels of agreement were determined using intraclass correlation coefficients (ICC). Influence of quality on pooled effect size was examined by calculating the between group standardized mean difference (SMD).

RESULTS: Inter-rater reliability indicated at least substantial levels of agreement for the USPSTF system (ICC 0.85; 95% CI 0.66, 0.94) and Downs and Black scale (ICC 0.94; 95% CI 0.84, 0.97). Overall level of agreement between tools (ICC 0.80; 95% CI 0.57, 0.92) was also good. However, the USPSTF system identified a number of studies (n = 3/20) as "poor" due to potential risks of bias. Analysis revealed substantially greater pooled effect sizes in these studies (SMD -2.51; 95% CI -4.21, -0.82) compared to those rated as "fair" (SMD -0.45; 95% CI -0.65, -0.25) or "good" (SMD -0.38; 95% CI -0.69, -0.08).

CONCLUSIONS: In this example, use of a numerical rating scale failed to identify studies at increased risk of bias, and could have potentially led to imprecise estimates of treatment effect. Although based on a small number of included studies within an existing systematic review, we found the domain based system provided a more structured framework by which qualitative decisions concerning overall quality could be made, and was useful for detecting potential sources of bias in the available evidence.

Caught in a 'spiral': barriers to healthy eating and dietary health promotion needs from the perspective of unemployed young people and their service providers

The number of young people in Europe who are not in education, employment or training (NEET) is increasing. Given that young people from disadvantaged backgrounds tend to have diets of poor nutritional quality, this exploratory study sought to understand barriers and facilitators to healthy eating and dietary health promotion needs of unemployed young people aged 16-20 years. Three focus group discussions were held with young people (n=14). Six individual interviews and one paired interview with service providers (n=7). Data were recorded, transcribed verbatim and thematically content analysed. Themes were then fitted to social cognitive theory (SCT). Despite understanding of the principles of healthy eating, a ‘spiral’ of interrelated social, economic and associated psychological problems was perceived to render food and health of little value and low priority for the young people. The story related by the young people and corroborated by the service providers was of a lack of personal and vicarious experience with food. External, environmental factors such as the proliferation and proximity of fast food outlets and the high perceived cost of ‘healthy’ compared to ‘junk’ food rendered the young people low in self-efficacy and perceived control to make healthier food choices. Agency was instead expressed through consumption of junk food and substance abuse. Both the young people and service providers agreed that for dietary health promotion efforts to succeed, social problems needed addressed and agency encouraged through (individual and collective) active engagement of the young people themselves.

The application of early contractor involvement and its impact on project performance

Early contractor involvement is a topic that has attracted attention from construction practitioners and researchers in the UK since the 1990s. It has been adopted to introduce construction knowledge and experience to the design process, and to integrate design with construction. In contrast with the limited number of previous studies on early contractor involvement, which used case studies, a questionnaire survey was conducted in this study, to investigate the application of early contractor involvement in current practice and its impact on project performance in terms of time, cost and quality. From an analysis of the questionnaire results, early contractor involvement is found to be increasingly used in the construction industry, and to have a significant impact on cost and time performance. This research provides empirical evidence related to the practice of early contractor involvement. It demonstrates the major influence of early contractor involvement on management processes and working relationships during a project, which contribute to performance improvement and project success.

Novel system for distant assessment of cataract surgical quality in rural China

BACKGROUND: This study aims to assess the quality of various steps of manual small incision cataract surgery and predictors of quality, using video recordings.
DESIGN: This paper applies a retrospective study.
PARTICIPANTS: Fifty-two trainees participated in a hands-on small incision cataract surgery training programme at rural Chinese hospitals.
METHODS: Trainees provided one video each recorded by a tripod-mounted digital recorder after completing a one-week theoretical course and hands-on training monitored by expert trainers. Videos were graded by two different experts, using a 4-point scale developed by the International Council of Ophthalmology for each of 12 surgical steps and six global factors. Grades ranged from 2 (worst) to 5 (best), with a score of 0 if the step was performed by trainers.
MAIN OUTCOME MEASURES: Mean score for the performance of each cataract surgical step rated by trainers.
RESULTS: Videos and data were available for 49/52 trainees (94.2%, median age 38 years, 16.3% women and 77.5% completing > 50 training cases). The majority (53.1%, 26/49) had performed ≤ 50 cataract surgeries prior to training. Kappa was 0.57∼0.98 for the steps (mean 0.85). Poorest-rated steps were draping the surgical field (mean ± standard deviation = 3.27 ± 0.78), hydro-dissection (3.88 ± 1.22) and wound closure (3.92 ± 1.03), and top-rated steps were insertion of viscoelastic (4.96 ± 0.20) and anterior chamber entry (4.69 ± 0.74). In linear regression models, higher total score was associated with younger age (P = 0.015) and having performed >50 independent manual small incision cases (P = 0.039).
CONCLUSIONS: More training should be given to preoperative draping, which is poorly performed and crucial in preventing infection. Surgical experience improves ratings.© 2015 Royal Australian and New Zealand College of Ophthalmologists.

Impact of cataract screening outreach in rural China.

PURPOSE: To examine differences between patients with cataract detected during screening and presenting to clinic in rural China. METHODS: Subjects were recruited from 27 screenings and an eye clinic in the same town. All had pinhole-corrected vision < or =6/18 in > or =1 eye due to ophthalmologist-diagnosed cataract. Subjects were administered a previously validated questionnaire on barriers to surgery in four areas: knowledge (K), perceptions of quality (Q), transportation (T), and cost (C). RESULTS: Screening group (SG; n = 120) and clinic group (CG; n = 120) participants did not differ from eligible, examined screening and clinic patients respectively in age, gender, or vision. SG participants were significantly more likely to be female (P = 0.002) and had a smaller housing area and less education (P < 0.001 for both) than those in the CG. Those in the CG were more likely to be blind (habitual VA < or = 6/60) in the better-seeing eye (P = 0.05) and more willing to undergo and pay for cataract surgery (P < 0.001 for both) than SG. In logistic regression models, SG subjects had significantly lower quality scores (P < 0.001) and better habitual vision (P = 0.02) than did CG participants, and SG subjects who agreed to cataract surgery (78.3%) had significantly higher knowledge scores (P < 0.001) than those who refused. DISCUSSION: Screening outreach has the potential to ameliorate disparities in access to cataract surgery in rural China, as it appears more likely to detect patients with cataract with gender-related, economic, educational, and attitudinal barriers to surgery. However, education may be needed to convince screening subjects to undergo surgery.

School-based approaches to the correction of refractive error in children.

The World Health Organization estimates that 13 million children aged 5-15 years worldwide are visually impaired from uncorrected refractive error. School vision screening programs can identify and treat or refer children with refractive error. We concentrate on the findings of various screening studies and attempt to identify key factors in the success and sustainability of such programs in the developing world. We reviewed original and review articles describing children's vision and refractive error screening programs published in English and listed in PubMed, Medline OVID, Google Scholar, and Oxford University Electronic Resources databases. Data were abstracted on study objective, design, setting, participants, and outcomes, including accuracy of screening, quality of refractive services, barriers to uptake, impact on quality of life, and cost-effectiveness of programs. Inadequately corrected refractive error is an important global cause of visual impairment in childhood. School-based vision screening carried out by teachers and other ancillary personnel may be an effective means of detecting affected children and improving their visual function with spectacles. The need for services and potential impact of school-based programs varies widely between areas, depending on prevalence of refractive error and competing conditions and rates of school attendance. Barriers to acceptance of services include the cost and quality of available refractive care and mistaken beliefs that glasses will harm children's eyes. Further research is needed in areas such as the cost-effectiveness of different screening approaches and impact of education to promote acceptance of spectacle-wear. School vision programs should be integrated into comprehensive efforts to promote healthy children and their families.

Critical Success Factors of Construction Project Quality in Brunei Darussalam

This research concentrates on the critical success factors driving construction quality and the barriers that must be overcome to achieve quality in Brunei. It hopes to identify methods of quality improvement and clearly justify investment in this area of local industry. Over the past number of years, Brunei has attempted to diversify its industry from the dominant oil and gas sector into secondary sectors,
including construction. To date, very little research has been carried out in many areas of construction management that take into account the specific industry context in Brunei. A comprehensive literature review has been employed to enable a questionnaire to be constructed and distributed among Brunei construction
professionals. The results have been analyzed through mean testing. This analysis reveals that the key barriers to construction quality in Brunei relate to lack of skills, lack of clarity in responsibility and communication and poor commitment among the design team. The critical success factors include issues relating to competency, capability, commitment and effectiveness, primarily among managers and decision-makers. The results of this study will hopefully contribute to fill the knowledge gap related to construction management in the context of Brunei and facilitate movement towards improved techniques and strategies that will foster higher quality in construction. The findings can be generalised across similar
developing economies and it is suggested that in general, the management concepts governing construction quality remain similar across the borders of East and West.

EFFECT OF DIFFERENT STORAGE CONDITIONS ON NUTRITIONAL AND QUALITY PARAMETERS OF 'SWEETHEART' CHERRY.

Abstract The sweet cherry ‘Sweetheart’, although having a short shelf life, is highly appreciated by consumers due to its organoleptic characteristics. Different storage methods were tested to study the maintenance of quality during a period of 27 days: 1) cold (air at 1°C and 95% relative humidity) (CC), 2) cold and polypropylene film bags (1°C and 95% relative humidity) (MA) and 3) cold and controlled atmosphere (1°C, 95% RH, 10% CO2 and 8% O2) (CA). Quality parameters tested included external colour (L*, a*, b*), total soluble solids (TSS), and titratable acidity (TA). To evaluate nutritional quality anthocyanins, total antioxidant activity, and total phenolics were measured. Results allow us to say that phenolic compounds were relatively stable and similar during storage in CC and MA. Cherries stored under CA conditions presented lowest concentrations of phenolic compounds. Phenolic compounds, total anthocyanins and antioxidant activity were inversely correlated with values of colour coordinates. Considering all the evaluations done during this work it is unquestionable that fruits stored in controlled atmosphere conditions had significantly different quality.

QUALITY OF 'SWEETHEART' CHERRY UNDER DIFFERENT STORAGE CONDITIONS

Abstract: In Portalegre, Portugal, sweet cherry production is very important to the region’s economic sustainability. The sweet cherry ‘Sweetheart’ has exhibited short shelf life in spite of being highly appreciated by consumers due to its organoleptic characteristics. In this trial, we evaluated fruit quality of ‘Sweetheart’ stored under different storage conditions: 1) cold conditions (1ºC and high humidity 95%), 2) cold conditions and polypropylene film bags (MA), and 3) controlled atmosphere (CA) (1°C, 95% humidity, 10% CO2 and 8% O2). Fruit physical and chemical parameters were evaluated after 0, 6, 13, 20 and 27 days of cold storage. Quality parameters tested included weight loss, external colour (L* a* b*), visual assessment of the epidermis, epidermis and mesocarp penetration test, soluble solids content (SSC), and titratable acidity (TA). We also performed sensory analyses. The results for textural properties, colour coordinates and sensory analysis suggest that ‘Sweetheart’ fruit can be stored under cold conditions, 1°C, 95% humidity, for up to 21 days without significant loss of quality. Controlled atmosphere maintained tissue turgidity during storage; however, this was not noticed by the panelists, who consistently classified fruits stored under CA conditions with lower overall ratings than fruits under cold conditions with or without film bags.

Influence of Soil and Irrigation Management on the Quality of Seedless Crimson Table Grapes

The market for table grapes is moving into mass production of specialty seed-less grapes in covered areas, aiming at obtaining premium prices with early or late production of high quality products. Production of quality seedless grapes is not straightforward since it is requires the correct combination of various independent characteristics, such as color, sugars, size and quantity at the right moment for successful harvesting and marketing. The present study was carried out at the two largest Portuguese producers located in Alentejo, and has the objective of studying the effect of irrigation management strategies and two different soils on the various relevant parameters for successful production and marketing. The management strategies were the application of ten day stress at the end of the cycle, in order to promote early maturing of the grapes. Three different timings of the stress were applied. Soil moisture, sap flow, bark thickness, as well as leaf water potential, stomatal conductance and chlorophyll content were measured regularly during the production season. The results indicate that the roots explore a rather large soil volume and the plants can successfully withstand reasonable periods of drought without significant changes to the plant physiology. Additionally late rains can mask the effect of any farmer applied drought and invalidate any farmer induced stress to the plants. Water-logged soils tend to cause early onset of maturity, but cause the ripening stage to extend over a longer period of time, and thus, in effect result in a delay in the harvest date. Topography also has some effect on the ripening, since hot air tends to accumulate under the plastic at the higher areas of the field. This work is funded by PRODER, 4.1, within the scope of project MORECRIMSON

The notion of space in urban housing markets

O mercado imobiliário tem um papel importante nas economias modernas, tanto a nível macro como a nível micro. Ao nível macro, a construção de habitação representa um sector importante e influente na economia, com efeitos multiplicadores significativos sobre a produção e o emprego. Ao nível micro, uma residência representa o activo mais valioso da maioria dos indivíduos e uma parcela muito relevante da riqueza das famílias. Para estas, o custo e a qualidade das suas habitações influencia directa e indirectamente a sua qualidade de vida. A habitação é por isso mesmo um tema, que avaliado nas suas múltiplas dimensões, se caracteriza por ser bastante complexo, mas também ao mesmo tempo desafiante. De modo a delimitar o objecto de análise do trabalho de investigação, esta tese realça os aspectos de localização e distribuição espacial das habitações urbanas. Será desenvolvido um quadro conceptual e respectiva metodologia para a compreender a estrutura espacial da habitação urbana realçando os três aspectos fundamentais da análise espacial: heterogenidade espacial, dependência espacial e escala espacial. A metodologia, aplicada à área urbana de Aveiro e Ílhavo é baseada numa análise hedónica factorial de preços e na noção não geométrica do espaço. Primeiro, é fixada uma escala territorial e são definidos submercados habitacional. Posteriormente, quer a heterogeneidade quer a dependência espaciais são estudados utilizando métodos econométricos, sem considerar qualquer padrão fixo e conhecido de interações espaciais. Em vez disso, são desenvolvidos novos métodos,tendo como base o modelo hedónico factorial, para inferir sobre os potenciais drivers de difusão espacial no valor de uma habitação. Este modelo, foi aplicado a duas diferentes escalas espaciais, para compreender as preferências dos indivíduos em Aveiro ao escolher os seus locais de residencia, e como estas afectam os preços da habitação. O trabalho empírico, utilizando duas bases de dados de habitação distintas, aplicadas ao mercado de habitação de Aveiro mostram: i) em linha com a literatura, a dificuldade de definir submercados e compreender as inter-relações entre esses mercados; ii) a utilidade de uma abordagem híbrida, combinando análise factorial com regressão; iii) a importância fundamental que o efeito escala espacial desempenha no estudo da heterogeneidade e dos spillovers e, finalmente, iv) uma metodologia inovadora para analisar spillovers sem assumir aprioristicamente uma estrutura espacial específica de difusão espacial. Esta metodologia considera a matriz de pesos espaciais (W) desconhecida e estimatima as interações espaciais dentro e entre submercados habitação.

Implementation of a service quality strategy: application to the Algarve hotel industry

Tese dout., Doctor of Philisophy, Sheffield Hallam University, 2001

Potential biomarkers on gametogenesis process and in sperm quality of european EEL (Anguilla anguilla)

Dissertação de mestrado, Aquacultura, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Impact of energy-using product policies

Energy-using products (EuPs), such as domestic appliances, audio-visual and ICT equipment contribute significantly to CO2 emissions, both in the domestic and non-domestic sectors. Policies that encourage the use of more energy efficient products can therefore generate significant reductions in overall energy consumption and hence, CO2 emissions. To the extent that these policies cause an increase the average production cost of EuPs, they may impose economic costs on producers, or on consumers, or on both. In this theoretical paper, an adaptation of a simple vertical product differentiation model – in which products are characterised in terms of their quality and their energy consumption – is used to analyse the impact of the different EuP polices on product innovation and to assess the resultant economic impacts on producers and consumers. It is shown that whereas the imposition of a binding product standard for energy efficiency unambiguously reduces aggregate profit and increases the average market price in the absence of any learning effects, the introduction or strengthening of demand-side measures (such as energy labelling) may reduce, or increase, aggregate profit. Even in the case where the overall impact is unambiguously negative, the effects of product innovation and learning can be in either direction.