Recent research results on deep level defects in semi-insulating InP - Application to improve material quality

An apparent defect suppression effect has been observed in InP through an investigation of deep level defects in different semi-insulating (SI) InP materials. Quality improvement of SI-InP based on the defect suppression mechanism is presented.

The quality of diabetes care in the community: practice, policy and culture

Aim: Diabetes is an important barometer of health system performance. This chronic condition is a source of significant morbidity, premature mortality and a major contributor to health care costs. There is an increasing focus internationally, and more recently nationally, on system, practice and professional-level initiatives to promote the quality of care. The aim of this thesis was to investigate the ‘quality chasm’ around the organisation and delivery of diabetes care in general practice, to explore GPs’ attitudes to engaging in quality improvement activities and to examine efforts to improve the quality of diabetes care in Ireland from practice to policy. Methods: Quantitative and qualitative methods were used. As part of a mixed methods sequential design, a postal survey of 600 GPs was conducted to assess the organization of care. This was followed by an in-depth qualitative study using semi-structured interviews with a purposive sample of 31 GPs from urban and rural areas. The qualitative methodology was also used to examine GPs’ attitudes to engaging in quality improvement. Data were analysed using a Framework approach. A 2nd observation study was used to assess the quality of care in 63 practices with a special interest in diabetes. Data on 3010 adults with Type 2 diabetes from 3 primary care initiatives were analysed and the results were benchmarked against national guidelines and standards of care in the UK. The final study was an instrumental case study of policy formulation. Semi-structured interviews were conducted with 15 members of the Expert Advisory Group (EAG) for Diabetes. Thematic analysis was applied to the data using 3 theories of the policy process as analytical tools. Results: The survey response rate was 44% (n=262). Results suggested care delivery was largely unstructured; 45% of GPs had a diabetes register (n=157), 53% reported using guidelines (n=140), 30% had formal call recall system (n=78) and 24% had none of these organizational features (n=62). Only 10% of GPs had a formal shared protocol with the local hospital specialist diabetes team (n=26). The lack of coordination between settings was identified as a major barrier to providing optimal care leading to waiting times, overburdened hospitals and avoidable duplication. The lack of remuneration for chronic disease management had a ripple effect also creating costs for patients and apathy among GPs. There was also a sense of inertia around quality improvement activities particularly at a national level. This attitude was strongly influenced by previous experiences of change in the health system. In contrast GP’s spoke positively about change at a local level which was facilitated by a practice ethos, leadership and special interest in diabetes. The 2nd quantitative study found that practices with a special interest in diabetes achieved a standard of care comparable to the UK in terms of the recording of clinical processes of care and the achievement of clinical targets; 35% of patients reached the HbA1c target of <6.5% compared to 26% in England and Wales. With regard to diabetes policy formulation, the evolving process of action and inaction was best described by the Multiple Streams Theory. Within the EAG, the formulation of recommendations was facilitated by overarching agreement on the “obvious” priorities while the details of proposals were influenced by personal preferences and local capacity. In contrast the national decision-making process was protracted and ambiguous. The lack of impetus from senior management coupled with the lack of power conferred on the EAG impeded progress. Conclusions: The findings highlight the inconsistency of diabetes care in Ireland. The main barriers to optimal diabetes management center on the organization and coordination of care at the systems level with consequences for practice, providers and patients. Quality improvement initiatives need to stimulate a sense of ownership and interest among frontline service providers to address the local sense of inertia to national change. To date quality improvement in diabetes care has been largely dependent the “special interest” of professionals. The challenge for the Irish health system is to embed this activity as part of routine practice, professional responsibility and the underlying health care culture.

Assessment of groundwater quality recovery strategies using nitrate transport modelling. Application to the Saône alluvial formations (Tournus, Saône-et-Loire)

To assess the efficiency of different agro-environmental strategies used to reduce groundwater pollution by nitrates, transport modelling in soils and groundwater has been carried out on two withdrawal areas in an alluvial plain. In a first time, the agro-environmental model AgriFlux allowed the simulation of water and nitrates fluxes flowing to groundwater. This model was calibrated for each agro-pedological unit of the studied territory. In a second time, the application of the hydrogeological model MODFLOW-MT3D allowed the simulation of nitrate transport in groundwater for the 1980-2004 period. This soil-groundwater coupled modelling has shown that soil nature is the first factor that conditions the vulnerability to nitrates. Thus, nitrate leaching occurs preferentially under sandy soils. Efficiency of different agro-environmental operations for groundwater quality recovery was quantified. The best results are obtained by combination of (1) grassland re-installation on sandy agricultural lots located in near well protection perimeter and (2) fertilization reduction on sandy agricultural lots located in the well alimentation area upstream the near protection perimeter. On other soils, the effect of grassland on groundwater quality improvement is more limited. Nevertheless, the control of nitrate fertilisation remains essential and is justified in both near and far well protection perimeters. Modelling thus allows optimising and priorizing agro-environmental actions in alluvial agricultural zones. [Comte J.-C., Banton O., Kockmann F., Villard A., Creuzot G. (2006), Assessment of groundwater quality recovery strategies using nitrate transport modelling. Application to the Saône alluvial formations (Tournus, Saône-et-Loire), Ingénieries Eau-Agriculture-Territoires, 45, 15-28]

Use of maternity surveys in improving the care experience – a review of the evidence

The use of surveys and direct feedback from women as a measurement of their maternity experience is seen as a means of stimulating quality improvement. Underpinning the overall rationale behind national maternity surveys is the acknowledgement that there is a need to document women's views of maternity services to inform policymakers with a view to enhancing the delivery of quality care to women. The evidence suggests that using maternity surveys to improve maternity care experience is central to UK health policy. It is also evident that qualitative input from women has the power to highlight mismatches of experience between women and professionals. Trusts are required to look to the future and invest in qualitative methodologies, which elicit rich and detailed information on women's experiences. The aim of this literature review is to critically analyse the use of maternity surveys and their validity in improving the care experienced by users of maternity services.

Dedicated severe asthma services improve health-care use and quality of life

Background: Systematic assessment of severe asthma can be used to confirm the diagnosis, identify comorbidities, and address adherence to therapy. However, the prospective usefulness of this approach is yet to be established. The objective of this study was to determine whether the systematic assessment of severe asthma is associated with improved quality of life (QoL) and health-care use and, using prospective data collection, to compare relevant outcomes in patients referred with severe asthma to specialist centers across the United Kingdom. Methods: Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics, and health-care use between initial assessment and a median follow-up of 286 days. Results: The study population consisted of 346 patients with severe asthma. At follow-up, there were significant reductions in health-care use in terms of primary care or ED visits (66.4% vs 87.8%, P < .0001) and hospital admissions (38% vs 48%, P = .0004). Although no difference was noted in terms of those requiring maintenance oral corticosteroids, there was a reduction in steroid dose (10 mg [8-20 mg] vs 15 mg [10-20 mg], P = .003), and fewer subjects required short-burst steroids (77.4% vs 90.8%, P = .01). Significant improvements were seen in QoL and control using the Asthma Quality of Life Questionnaire and the Asthma Control Questionnaire. Conclusions: To our knowledge, this is the first time that a prospective study has shown that a systematic assessment at a dedicated severe asthma center is associated with improved QoL and asthma control and a reduction in health-care use and oral steroid burden.

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.

The importance of quality in the consolidation of textile in Minho

The textile industry has a long tradition in Portugal and it is one of the most important sectors, despite the current economic crisis. It has always assumed a prominent role in terms of employment and a relevant position within the Portuguese economy. The lack of quality and the lower prices that other countries offer causes the loss of clients. Quality is a main tool to survive nowadays in the textile sector. To undertake our analysis, we made use of an existing database where 55 firms belonged to the textile industry, namely to the manufacturing sector. A new survey was created based on the original survey and was sent to 5 firms. Besides the survey, we also sent a few questions to the firms in order to retract more information about the actually situation in our country, concerning the textile industry. Several tables, graphs and pie charts were made to help shed light on our findings. This research was conducted in order to determine the importance of quality in the consolidation of textile firms in the north of Portugal. Most firms in our sample feel that quality improvement, business benefits, mobilizing employees’ knowledge and business image were important and that competition is very intense and is mainly by price and not by differentiation of product or service. The quality program has contributed to improve their competitive position and the improvement of their overall performance. The majority of the firms in our sample undertake TQM measures for quality purposes to meet customer expectations and prevent errors. Of all firms surveyed, the quality is certainly very important for its survival.

Melhoria da qualidade do produto numa empresa de produção por lotes

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecânica

Treatment intensification and risk factor control: toward more clinically relevant quality measures.

BACKGROUND: Intensification of pharmacotherapy in persons with poorly controlled chronic conditions has been proposed as a clinically meaningful process measure of quality. OBJECTIVE: To validate measures of treatment intensification by evaluating their associations with subsequent control in hypertension, hyperlipidemia, and diabetes mellitus across 35 medical facility populations in Kaiser Permanente, Northern California. DESIGN: Hierarchical analyses of associations of improvements in facility-level treatment intensification rates from 2001 to 2003 with patient-level risk factor levels at the end of 2003. PATIENTS: Members (515,072 and 626,130; age >20 years) with hypertension, hyperlipidemia, and/or diabetes mellitus in 2001 and 2003, respectively. MEASUREMENTS: Treatment intensification for each risk factor defined as an increase in number of drug classes prescribed, of dosage for at least 1 drug, or switching to a drug from another class within 3 months of observed poor risk factor control. RESULTS: Facility-level improvements in treatment intensification rates between 2001 and 2003 were strongly associated with greater likelihood of being in control at the end of 2003 (P < or = 0.05 for each risk factor) after adjustment for patient- and facility-level covariates. Compared with facility rankings based solely on control, addition of percentages of poorly controlled patients who received treatment intensification changed 2003 rankings substantially: 14%, 51%, and 29% of the facilities changed ranks by 5 or more positions for hypertension, hyperlipidemia, and diabetes, respectively. CONCLUSIONS: Treatment intensification is tightly linked to improved control. Thus, it deserves consideration as a process measure for motivating quality improvement and possibly for measuring clinical performance.

Réorganiser les services de réadaptation destinés aux enfants : utilisation d'une recherche-action participative pour documenter un nouveau modèle de services

Cette thèse a pour but de documenter la réorganisation des services effectuée au programme Enfants et adolescents (PEA) du Centre de réadaptation Estrie, Sherbrooke. Une démarche de recherche-action participative (RAP) est utilisée afin de collaborer au développement, à l’implantation et à l’évaluation d’un nouveau modèle de services visant à accroître l’accessibilité et la qualité des services de réadaptation offerts aux enfants ayant une déficience physique. Spécifiquement, les objectifs sont : 1) de documenter les retombées de la réorganisation des services; 2) de réaliser une analyse critique du processus de changement. Des méthodes quantitatives et qualitatives sont utilisées afin d’atteindre ces objectifs. Tout d’abord, la Mesure des processus de soins (MPOC) documente la perception de la qualité avant (2007), pendant (2008) et après (2009) l’implantation du nouveau modèle de services. Au total, cet outil est employé auprès de 222 familles et 129 intervenants. À quatre reprises, les intervenants et les gestionnaires répondent également à un questionnaire sur leurs perceptions des forces, des faiblesses, des opportunités et des menaces au PEA. En 2008 et en 2009, des focus groups et des entrevues téléphoniques sont réalisées auprès des familles (n=5), des intervenants (n=19) et des gestionnaires (n=13) afin de documenter leurs perceptions sur le processus de changement et sur les retombées de la réorganisation des services. Quant à l’observation participante, elle permet de recueillir de l’information sur le processus de réorganisation des services tout au long de ces trois années. Enfin, les informations recueillies sont analysées à l’aide de différentes approches, dont des tests statistiques et des analyses de contenu utilisant une grille de codification inspirée de la théorie des systèmes d’actions organisées. Les résultats indiquent que davantage d’enfants reçoivent des services en 2009 en comparaison à 2007. De plus, la qualité des services s’est maintenue selon les perceptions évaluées par la MPOC (article 1). L’utilisation d’interventions de groupe contribue fort probablement à augmenter le nombre d’enfants qui reçoivent des services, mais plusieurs défis doivent être adressés afin que cette modalité d’intervention soit réellement efficiente (article 2). Les résultats font ressortir que le processus de réorganisation des services est complexe. L’évaluation des forces, des faiblesses, des opportunités et des menaces d’un programme, de même que l’implication des acteurs dans le processus de développement d’un nouveau modèle de services, favorisent l’amélioration continue de la qualité (article 3). Or, les facilitateurs et les obstacles à l’implantation du nouveau modèle de services évoluent durant la réorganisation des services. Considérant cela, il est important de poser les actions nécessaires afin de soutenir le changement tout au long du processus (article 4). En résumé, cette thèse contribue à l’avancement des connaissances en réadaptation en comblant une lacune dans les écrits scientifiques. En effet, peu de projets visant le développement et l’implantation de nouveaux modèles de services sont évalués et documentés. Pourtant, des modèles tels que celui développé par le PEA semblent prometteurs afin d’améliorer l’accessibilité, et éventuellement, la qualité des services de réadaptation chez l’enfant.

Measuring and evaluating quality of care in referral maternities in Mali and Senegal in the context of overlapping interventions

Dans cette thèse, nous décrivons les résultats d’un projet de recherche visant à mesurer et évaluer la qualité des soins obstétricaux des hôpitaux de référence au Mali et au Sénégal. Dans ces pays, la mortalité maternelle hospitalière est élevée et est liée en partie à la pratique médicale inadéquate. Cette recherche a été réalisée dans le cadre de l’étude QUARITE, un essai randomisé en grappe évaluant l’efficacité du programme GESTA International visant à réduire la mortalité maternelle hospitalière. GESTA a été mis en œuvre entre 2008 et 2010 et consistait en la formation des professionnels de santé et en la revue des cas de décès maternels. En parallèle de QUARITE, les programmes de prévention de la transmission du VIH de la mère à l’enfant (PTME) ont été mis à l’échelle à travers les pays. Ces derniers ayant également la capacité d’augmenter la qualité des soins obstétricaux, nous avons donc évalué les effets des deux programmes (GESTA et PTME) sur la qualité des soins. Dans un premier temps, à l’aide d’une recension des écrits nous avons évalué la capacité d’un audit clinique basé sur des critères à mesurer la qualité des soins obstétricaux. Cet audit vérifiait si l’offre des soins avait respecté les critères cliniques définissant la meilleure prise en charge selon l’évidence scientifique et l’avis des experts. Nous avons démontré que cet outil est largement utilisé dans les pays à faibles et moyens revenus, malgré le peu d’évidence sur sa validité (article 1). Dans un deuxième temps, nous avons développé un audit clinique basé sur des critères qui s’applique au contexte ouest-africain et qui a été approuvé par des experts-obstétriciens nationaux et internationaux. À partir des dossiers obstétricaux, les actes médicaux posés pendant le travail et l’accouchement ont été évalués à l‘aide de cet instrument. La qualité des soins a été estimée sous forme de pourcentage de critères atteints. Appliqué dans différents contextes et par différents auditeurs, nous avons démontré que notre instrument est fiable et valide (article 3). Néanmoins, l’expérience de l’audit nous a amenés à nous questionner sur le mauvais remplissage des dossiers médicaux et ses conséquences sur la qualité des soins (article 2). Dans un troisième temps, l’outil a été appliqué à large échelle pour évaluer les effets de l’intervention GESTA (article 4). Nous avons mené une révision de plus de 800 dossiers obstétricaux dans 32 hôpitaux de référence (16 bénéficiaires de l’intervention et 16 non-bénéficiaires). Grâce à cet audit clinique, nous avons démontré que le programme GESTA contribue à l’amélioration de la qualité des soins, spécifiquement l’examen clinique lors de l’admission et le suivi après l’accouchement. Dernièrement, nous avons utilisé cet instrument afin d’évaluer les effets des programmes de PTME sur la qualité des soins obstétricaux (article 5). Notre travail a documenté que seulement certaines composantes du programme de PTME améliorent la qualité des soins telles que la formation des professionnels et les services complémentaires en nutrition. En conclusion, cette recherche a identifié plusieurs pistes d’intervention pour améliorer la qualité des soins obstétricaux en Afrique de l’Ouest.

Influence of compounding and process variables on quality of condams made from natural rubber latex

Condoms are widely accepted as a contraceptive for family planning and population control. It is also accepted as the most effective barrier against sexually transmitted diseases, especially AIDS, the incurable disease. But presence of pinholes and low film strength of condoms make it unsuitable for the purpose. Quality improvement of condoms by reducing the pinhole formation and increasing the film strength is thus an essential requirement for population control as well as for preventing the spread of sexually transmitted diseases. Strict implementation of WHO specification of condoms further increases the rejection percentage. This causes higher rejection loss to condom manufacturers because the defects could be identified only at the final stage of processing. If the influence of various factors which cause these defects is known, manufacturers can take remedial measures to reduce the defectives so that rejection loss can be decreased and quality of condoms increased. In the present study, it was proposed to conduct experiments to improve the quality of condoms by reducing the pinhole rejection percentage and increasing the tensile properties, burst volume, and burst pressure. Ageing property improvement also was an important target among other parameters. Until a cure for AIDS is found, a high quality latex condom is the only effective device in the prevention of the spread of HIV, AIDS and STD's. Hence it is all the more necessary to have high quality condoms.

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Another look at the culture-quality-performance link

Quality improvement is usually driven by quality, safety and risk agendas leading to a focus on measurements of the outputs of care; outputs such as fewer complaints, fewer accidents and adverse events. An oft-neglected theme is the impact of the quality improvement initiative within the organisation itself. This paper presents the findings of the first stage of an evaluation that has examined the changes which have occurred within organisations since participating in a quality improvement initiative. These findings indicate that engaging with a quality improvement program can change the nature of social interactions within the organisation. In this way, quality improvement programs can impact on organisational culture, particularly in relation to organisational learning. Thus, this paper argues that successful engagement with a quality improvement program can enhance organisational learning, and, in turn, build organisational capacity.

Towards development of a quality cost model for automotive stamping

The current work used discrete event simulation techniques to model the economics of quality within an actual automotive stamping plant. Automotive stamping is a complex, capital intensive process requiring part-specific tooling and specialised machinery. Quality control and quality improvement is difficult in the stamping environment due to the general lack of process understanding and the large number to interacting variables. These factors have prevented the widespread use of statistical process control. In this work, a model of the quality control techniques used at the Ford Geelong Stamping plant is developed and indirectly validated against results from production. To date, most discrete event models are of systems where the quality control process is clearly defined by the rules of statistical process control. However, the quality control technique used within the stamping plant is for the operator to perform a 100% visual inspection while unloading the finished panels. In the developed model, control is enacted after a cumulative count of defective items is observed, thereby approximating the operator who allows a number of defective panels to accumulate before resetting the line. Analysis of this model found that the cost sensitivity to inspection error is dependent upon the level of control and that the level of control determines line utilisation. Additional analysis of this model demonstrated that additional inspection processes would lead to more stable cost structures but these structures many not necessarily be lower cost. The model was subsequently applied to investigate the economics of quality improvement. The quality problem of panel blemishes, induced by slivers (small metal fragments), was chosen as a case stuffy. Errors of 20-30% were observed during direct validation of the cost model and it was concluded that the use of discrete event simulation models for applications requiring high accuracy would not be possible unless the production system was of low complexity. However, the model could be used to evaluate the sensitivity of input factors and investigating the effects of a number of potential improvement opportunities. Therefore, the research concluded that it is possible to use discrete event simulation to determine the quality economics of an actual stamping plant. However, limitations imposed by inability of the model to consider a number of external factors, such as continuous improvement, operator working conditions or wear and the lack of reliable quality data, result in low cost accuracy. Despite this, it still can be demonstrated that discrete event simulation has significant benefits over the alternate modelling methods.