The impact of leadership and quality climate on hospital performance

Objective. To explore the relationship between leadership effectiveness and health-care trust performance, taking into account external quality measures and the number of patient complaints; also, to examine the role of care quality climate as a mediator. Design. We developed scales for rating leadership effectiveness and care quality climate. We then drew upon UK national indices of health-care trust performance—Commission for Health Improvement star ratings, Clinical Governance Review ratings and the number of patient complaints per thousand. We conducted statistical analysis to examine any significant relationships between predictor and outcome variables. Setting. The study is based on 86 hospital trusts run by the National Health Service (NHS) in the UK. The data collection is part of an annual staff survey commissioned by the NHS to explore the quality of working life. Participants. A total of 17 949 employees were randomly surveyed (41% of the total sample). Results. Leadership effectiveness is associated with higher Clinical Governance Review ratings and Commission for Health Improvement star ratings for our sample (ß = 0.42, P < 0.05; ß = 0.37, P < 0.05, respectively), and lower patient complaints (ß = –0.57, P < 0.05). In addition, 98% of the relationship between leadership and patient complaints is explained by care quality climate. Conclusions. Results offer insight into how non-clinical leadership may foster performance outcomes for health-care organizations. A frequently neglected area—patient complaints—may be a valid measure to consider when assessing leadership and quality in a health-care context.

The assessment of protein quality of carp (Cyprinus carpio) diets

Protein quality of carp diets was assessed by five methods: 1. True digestibility, true NPU, BV (as percentage) and PER were determined for approximately iso-energetic diets containing ca.38% protein from 4 different sources. Fish meal gave values of 94.0, 72.5, 77.0, and 1.21 respectively; egg 93.0, 65.4, 70.3, 1.26; Pruteen 68.4, 63.6, 68.40, 1.36; and Casein 91.0, 56.90, 62.5, 1.33. 2. Blood urea were determined and found to be significantly increased with increasing protein concentration in the diet. 3. Ammonia excretion rate was determined; it increased with a decline in protein quality, being greater on groundnut, rapeseed meal, and sunflower diets than on fishmeal, cottonseed meal, and pruteen. 4. Protein sources were incubated in vitro with digestive fluids of fish. Protein digestibilities for fishmeal diets containing 14 and 27% protein were 90.2 and 93.0% respectively; casein (18 and 36%), 91.5 and 93.2%; soybean (10 and 20%), 84.2 and 85.3% ; sunflower (8 and 16%), 64.2 and 66.1%; and fish meal plus soybean meal (ca. 18.2%) 86.5. 5. Plasma free amino acids were individually determined at 0, 6, 24 and 48 h after force-feeding diets containing 15 and 30% protein from six different sources. Total free AA were highest at 24 h for casein and fishmeal, and at 48 h for egg, soybean, rapeseed and sunflower. The 24 h essential amino acid indices (EAAI) for the six diets at 15% protein were, in the same order, 93.0, 100, 100, 86.4, 62.4, and 97.2. At 30% protein, the 24 h EAAI were 78.5, 84.3, 100, and 83.8 for casein, fishmeal, egg, and rapeseed respectively.

Anterior segment anomalies and effects on visual quality

The tear film, cornea and lens dictate the refractive power of the eye and the retinal image quality is principally defined by diffraction, whole eye wavefront error, scatter, and chromatic aberration. Diffraction and wave aberration are fundamentally pupil diameter dependent; however scatter can be induced by refractive surgery and in the normal ageing eye becomes an increasingly important factor defining retinal image quality. The component of visual quality most affected by the tear film, refractive surgery and multifocal contact and intraocular lenses is the wave aberration of the eye. This body of work demonstrates the effects of each of these anomalies on the visual quality of the eye. When assessing normal or borderline self-diagnosed dry eye subjects using aberrometry, combining lubricating eye drops and spray does not offer any benefit over individual products. However, subjects perceive a difference in comfort for all interventions after one hour. Total higher order aberrations increase after laser assisted sub-epithelial keratectomy performed using a solid-state laser on myopes, but this causes no significant decrease in contrast sensitivity or increase in glare disability. Mean sensitivity and reliability indices for perimetry were comparable to pre-surgery results. Multifocal contact lenses and intraocular lenses are designed to maximise vision when the patient is binocular, so any evaluation of the eyes individually is confounded by reduced individual visual acuity and visual quality. Different designs of aspheric multifocal contact lenses do not provide the same level of visual quality. Multifocal contact lenses adversely affect mean deviation values for perimetry and this should be considered when screening individuals with multifocal contact or intraocular lenses. Photographic image quality obtained through a multifocal contact or intraocular lens appears to be unchanged. Future work should evaluate the effect of these anomalies in combination; with the aim of providing the best visual quality possible and supplying normative data for screening purposes.

Efficiency analysis of forestry journals:suggestions for improving journals' quality

In this paper we attempt to assess the impact of journals in the field of forestry, in terms of bibliometric data, by providing an evaluation of forestry journals based on data envelopment analysis (DEA). In addition, based on the results of the conducted analysis, we provide suggestions for improving the impact of the journals in terms of widely accepted measures of journal citation impact, such as the journal impact factor (IF) and the journal h-index. More specifically, by modifying certain inputs associated with the productivity of forestry journals, we have illustrated how this method could be utilized to raise their efficiency, which in terms of research impact can then be translated into an increase of their bibliometric indices, such as the h-index, IF or eigenfactor score. © 2013 Elsevier Ltd.

Estimation of Inequality Indices of the Cumulative Distribution Function

Date of Acceptance: 02/03/2015

Estimation of Inequality Indices of the Cumulative Distribution Function

Date of Acceptance: 02/03/2015

(Table T1) Initial water quality conditions for bioassay experiments during Nathaniel B. Palmer cruise NBP09-01 in the Amundsen Sea

Nutrient addition experiments were performed during the austral summer in the Amundsen Sea (Southern Ocean) to investigate the availability of organically bound iron (Fe) to the phytoplankton communities, as well as assess their response to Fe amendment. Changes in autotrophic biomass, pigment concentration, maximum photochemical efficiency of photosystem II, and nutrient concentration were recorded in response to the addition of dissolved free Fe (DFe) and Fe bound to different model ligands. Analysis of pigment concentrations indicated that the autotrophic community was dominated by the prymnesiophyte Phaeocystis antarctica throughout most of the Amundsen Sea, although diatoms dominated in two experiments conducted in the marginal ice zone. Few significant differences in bulk community biomass (particulate organic carbon, nitrogen, and chlorophyll a) were observed, relative to the controls, in treatments with Fe added alone or bound to the ligand phytic acid. In contrast, when Fe was bound to the ligand desferrioxamine B (DFB), decreases in the bulk biomass indices were observed. The concentration of the diatom accessory pigment fucoxanthin showed little response to Fe additions, while the concentration of the P. antarctica-specific pigment, 19'-hexanoyloxyfucoxanthin (19'-hex), decreased when Fe was added alone or bound to the model ligands. Lastly, differences in the nitrate:phosphate (NO3- :PO4**3-) utilization ratio were observed between the Fe-amended treatments, with Fe bound to DFB resulting in the lowest NO3- :PO4**3- uptake ratios (~ 10) and the remaining Fe treatments having higher NO3- :PO4**3- uptake ratios (~ 17). The data are discussed with respect to glacial inputs of Fe in the Amundsen Sea and the bioavailability of Fe. We suggest that the previously observed high NO3- :PO4**3- utilization ratio of P. antarctica is a consequence of its production of dissolved organic matter that acts as ligands and increases the bioavailability of Fe, thereby stimulating the uptake of NO3-.

Biomass, quality traits and methane production of extensive grassland: biodiversity effects and sensor approaches

Energy policies around the world are mandating for a progressive increase in renewable energy production. Extensive grassland areas with low productivity and land use limitations have become target areas for sustainable energy production to avoid competition with food production on the limited available arable land resources and minimize further conversion of grassland into intensively managed energy cropping systems or abandonment. However, the high spatio-temporal variability in botanical composition and biochemical parameters is detrimental to reliable assessment of biomass yield and quality regarding anaerobic digestion. In an approach to assess the performance for predicting biomass using a multi-sensor combination including NIRS, ultra-sonic distance measurements and LAI-2000, biweekly sensor measurements were taken on a pure stand of reed canary grass (Phalaris aruninacea), a legume grass mixture and a diversity mixture with thirty-six species in an experimental extensive two cut management system. Different combinations of the sensor response values were used in multiple regression analysis to improve biomass predictions compared to exclusive sensors. Wavelength bands for sensor specific NDVI-type vegetation indices were selected from the hyperspectral data and evaluated for the biomass prediction as exclusive indices and in combination with LAI and ultra-sonic distance measurements. Ultrasonic sward height was the best to predict biomass in single sensor approaches (R² 0.73 – 0.76). The addition of LAI-2000 improved the prediction performance by up to 30% while NIRS barely improved the prediction performance. In an approach to evaluate broad based prediction of biochemical parameters relevant for anaerobic digestion using hyperspectral NIRS, spectroscopic measurements were taken on biomass from the Jena-Experiment plots in 2008 and 2009. Measurements were conducted on different conditions of the biomass including standing sward, hay and silage and different spectroscopic devices to simulate different preparation and measurement conditions along the process chain for biogas production. Best prediction results were acquired for all constituents at laboratory measurement conditions with dried and ground samples on a bench-top NIRS system (RPD > 3) with a coefficient of determination R2 < 0.9. The same biomass was further used in batch fermentation to analyse the impact of species richness and functional group composition on methane yields using whole crop digestion and pressfluid derived by the Integrated generation of solid Fuel and Biogas from Biomass (IFBB) procedure. Although species richness and functional group composition were largely insignificant, the presence of grasses and legumes in the mixtures were most determining factors influencing methane yields in whole crop digestion. High lignocellulose content and a high C/N ratio in grasses may have reduced the digestibility in the first cut material, excess nitrogen may have inhibited methane production in second cut legumes, while batch experiments proved superior specific methane yields of IFBB press fluids and showed that detrimental effects of the parent material were reduced by the technical treatment

The Relationship of Diet Quality and Blood Serum Lipid Levels in a Population at High Risk for Diabetes: The Strong Heart Family Study

Thesis (Master's)--University of Washington, 2016-08

Hospital Care for Newborn Babies: Quality Assessment, A Systematic Review

Context: Neonatal mortality rate is declining globally. The aim of the present study is to identify relevant indicators for assessing newborn care in hospitals by a systematic review. Evidence Acquisition: A search on electronic data base and manual searches of personal files for studies on quality indicators of newborn care were carried out. Searching 9 bibliographic databases, we found 85 articles of which 22 exactly related ones were selected and studied. Hand search yielded 1 record were also searched and 2 records were included. Results: A list of 87 structure, process and outcome indicators was formulated from the articles. Also 26 excess measures were identified in gray literature. After removing duplicates, and categorizing in 3 domains, 18 measures were input, 41 process and 34 outcome measures. Conclusions: These 93 indicators provide a framework for assessing how well the hospitals are providing neonatal care. These measures should be discussed in each context expert panels to address nationally applicable indices of neonatal care and may be adapted for local health settings.

Ecological quality assessment of transitional waters based on fish assemblages in Portuguese estuaries: The Estuarine Fish Assessment Index (EFAI)

The assessment of water quality has changed markedly worldwide over the last years, especially in Europe due to the implementation of the Water Framework Directive. Fish was considered a key-element in this context and several fish-based multi-metric indices have been proposed. In this study, we propose a multi-metric index, the Estuarine Fish Assessment Index (EFAI), developed for Portuguese estuaries, designed for the overall assessment of transitional waters, which could also be applied at the water body level within an estuary. The EFAI integrates seven metrics: species richness, percentage of marine migrants, number of species and abundance of estuarine resident species, number of species and abundance of piscivorous species, status of diadromous species, status of introduced species and status of disturbance sensitive species. Fish sampling surveys were conducted in 2006, 2009 and 2010, using beam trawl, in 13 estuarine systems along the Portuguese coast. Most of the metrics presented a high variability among the transitional systems surveyed. According to the EFAI values, Portuguese estuaries presented a "Good" water quality status (except the Douro in a particular year). The assessments in different years were generally concordant, with a few exceptions. The relationship between the EFAI and the Anthropogenic Pressure Index (API) was not significant, but a negative and significant correlation was registered between the EFAI and the expert judgement pressure index, at both estuary and water body level. The ordination analysis performed to evaluate similarities among North-East Atlantic Geographical Intercalibration Group (NEAGIG) fish-based indices put in evidence four main groups: the French index, since it is substantially different from all the other indices (uses only four metrics based on densities); indices from Ireland, United Kingdom and Spain (Asturias and Cantabria); the Dutch and German indices; and the indices of Belgium. Portugal and Spain (Basque country). The need for detailed studies, including comparative approaches, on several aspects of these assessment tools, especially in what regards their response to anthropogenic pressures was stressed. (C) 2011 Elsevier Ltd. All rights reserved.

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and its Association with Quality of Life in Ambulatory Patients Receiving Radiotherapy

OBJECTIVE: To evaluate the scored Patient-generated Subjective Global Assessment (PG-SGA) tool as an outcome measure in clinical nutrition practice and determine its association with quality of life (QoL). DESIGN: A prospective 4 week study assessing the nutritional status and QoL of ambulatory patients receiving radiation therapy to the head, neck, rectal or abdominal area. SETTING: Australian radiation oncology facilities. SUBJECTS: Sixty cancer patients aged 24-85 y. INTERVENTION: Scored PG-SGA questionnaire, subjective global assessment (SGA), QoL (EORTC QLQ-C30 version 3). RESULTS: According to SGA, 65.0% (39) of subjects were well-nourished, 28.3% (17) moderately or suspected of being malnourished and 6.7% (4) severely malnourished. PG-SGA score and global QoL were correlated (r=-0.66, P<0.001) at baseline. There was a decrease in nutritional status according to PG-SGA score (P<0.001) and SGA (P<0.001); and a decrease in global QoL (P<0.001) after 4 weeks of radiotherapy. There was a linear trend for change in PG-SGA score (P<0.001) and change in global QoL (P=0.003) between those patients who improved (5%) maintained (56.7%) or deteriorated (33.3%) in nutritional status according to SGA. There was a correlation between change in PG-SGA score and change in QoL after 4 weeks of radiotherapy (r=-0.55, P<0.001). Regression analysis determined that 26% of the variation of change in QoL was explained by change in PG-SGA (P=0.001). CONCLUSION: The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL.