930 resultados para Evaluation Phase


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DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

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Objective: To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design: A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting: NHS hospitals in England. Participants: Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results: One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P=0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P=0.760 and P=0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P=0.652 and P=0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P=0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. Conclusions: Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.

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The major objective of this research project is to investigate how fly ash influences the chemical durability of portland cement based materials. The testing program is evaluating how Iowa fly ashes influence the sulfate durability of portland cement-fly ash pastes, mortars, and concretes. Also, alkali-reactivity studies are being conducted on mortar bar specimens prepared in accordance with ASTM C 311. Prelimary sulfate test results, based only on mortar bar studies, indicate that only the very high-calcium fly ash (29 percent CaO, by weight) consistently reduced the durability of test specimens exposed to a solution containing 5 percent sodium sulfate. The remaining four fly ashes that were used in the study showed negligible to dramatic increases in sulfate resistance. Concrete specimens were only beginning to respond to the sulfate solutions after about one year of exposure; and hence, considerably more time will be needed to assess their performance. Preliminary results from the alkali-reactivity tests have indicated that the Oreopolis aggregate is not sensitive to alkali attack. However, some of the test results have indicated that the testing procedure may be prone to delayed expansion due to the presence of periclase (MgO) in the Class C fly ashes. Research is being planned to: (1) verify if the periclase is influencing test results; and (2) estimating the magnitude of the potential error.

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Currently, no standard mix design procedure is available for CIR-emulsion in Iowa. The CIR-foam mix design process developed during the previous phase is applied for CIR-emulsion mixtures with varying emulsified asphalt contents. Dynamic modulus test, dynamic creep test, static creep test and raveling test were conducted to evaluate the short- and long-term performance of CIR-emulsion mixtures at various testing temperatures and loading conditions. A potential benefit of this research is a better understanding of CIR-emulsion material properties in comparison with those of CIR-foam material that would allow for the selection of the most appropriate CIR technology and the type and amount of the optimum stabilization material. Dynamic modulus, flow number and flow time of CIR-emulsion mixtures using CSS-1h were generally higher than those of HFMS-2p. Flow number and flow time of CIR-emulsion using RAP materials from Story County was higher than those from Clayton County. Flow number and flow time of CIR-emulsion with 0.5% emulsified asphalt was higher than CIR-emulsion with 1.0% or 1.5%. Raveling loss of CIR-emulsion with 1.5% emulsified was significantly less than those with 0.5% and 1.0%. Test results in terms of dynamic modulus, flow number, flow time and raveling loss of CIR-foam mixtures are generally better than those of CIR-emulsion mixtures. Given the limited RAP sources used for this study, it is recommended that the CIR-emulsion mix design procedure should be validated against several RAP sources and emulsion types.

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The missions of the research are to assist the Iowa Department of Transortation (Iowa DOT) to: Define pavement management (PM) optimization; Identify the characteristics of PM optimization systems being developed or implemented; Identify specific and achievable objectives for the Iowa DOT pavement management optimization; Evaluate different PM optimization methodologies; Identify a methodology to perform PM optimization that best satisfies the Iowa DOT's objectives; Develop a plan for the implementation of the PM optimization selected. The project is divided into three (3) phases. The first phase has been completed and accomplished the first three missions (identified above). The second phase has been completed and accomplished the next two missions. Phase three will accomplish the last mission.

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The following report summarizes research activities conducted on Iowa Department of Transportation Project HR-327, for the period April 1, 1990 through March 31, 1991. The purpose of this research project is to investigate how fly ash influences the chemical durability of portland cement based materials. The goal of this research is to utilize the empirical information obtained from laboratory testing to better estimate the durability of portland cement concrete pavements (with and without fly ash) subjected to chemical attack via the natural environment or the application of deicing salts. This project is being jointly sponsored by the Iowa Department of Transportation and the Iowa Fly Ash Affiliate Research group. The research work is also being cooperatively conducted by Iowa State University and Iowa Department of Transportation research personnel. Researchers at Iowa State University are conducting the paste and mortar studies while Iowa Department of Transportation researchers are conducting the concrete study.

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This report presents an evaluation of Phase 1 of the Working for Families Fund (WFF) covering 2004-06. WFF was established to invest in new initiatives to improve the employability of parents who have difficulties in participating in the labour market, specifically in employment, education or training. The Fund supported these parents through helping them find sustainable childcare solutions and through providing or accessing other relevant employability-related services. In rural areas, barriers created by poor transport, limited services and the lack of a critical mass of clients were also particularly important. WFF contributes to the Scottish Executive’s Closing the Opportunity Gap approach to tackling poverty and disadvantage, by improving rates of employment and economic activity, and to its commitment to eradicating child poverty within a generation.

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This is an initial report of the PolyU SD part of the team to study Pre-fabricated Building Design and Construction Methodology and marks the completion of Phase 1. It follows our first notes prepared for the meeting on 2 February that identified some critical issues including future lifestyles, life expectancy of buildings, sustainability, size, flexibility and planning considerations. It is also an expansion of our presentation in Dongguan on 23 February. It is not a comprehensive survey of existing approaches or possible ways forward, but it has homed in on certain specific issues and does give specific examples to make the suggestions concrete. It is recommended that more comprehensive research be done to establish previous work and experience internationally. It is also recommended that more research be done on lifestyles as a preliminary to developing at least three concepts for evaluation before proceeding to the detailed design of one concept for full prototyping and market testing. The goal at this point is not to define a single direction but to suggest several future trajectories for further consideration. By the same token, this report is not intended as an exhaustive description of the considerable base of knowledge and ideas brought by the PolyU team to this exciting task. Before taking on an issue of this magnitude and importance in the definition of Hong Kong's future, one must carry out a thoughtful analysis of the issues at hand and an informed definition of paradigms, directions, goals and methods whereby our energies can be best used in the next steps. This report is the result of this analysis