Managing healthcare quality using logical framework analysis

Purpose - The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance. Design/methodology/approach - This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps - problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case-study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended. Practical implications - The proposed model can be implemented in hospital-based healthcare services in order to improve performance. It may also be applied to other services. Originality/value - Quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services. © Emerald Group Publishing Limited.

Integrated approach to healthcare quality management:a case study

Purpose - The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically. Design/methodology/approach - This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, Accident and emergency, and Intensive care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well. Practical implications - In the paper the proposed model can be practised in hospital-based healthcare services for improving performance. Originality/value - The paper shows that quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies. © Emerald Group Publishing Limited.

Pregnancy loss in lesbian and bisexual women: An online survey of experiences

Background: Although pregnancy loss is a distressing health event for many women, research typically equates women’s experiences of pregnancy loss to ‘married heterosexual women’s experiences of pregnancy loss’. The objective of this study was to explore lesbian and bisexual women’s experiences of miscarriage, stillbirth and neonatal death. Methods: This study analysed predominantly qualitative online survey data from 60 non-heterosexual, mostly lesbian, women from the UK, USA, Canada and Australia. All but one of the pregnancies was planned. Most respondents had physically experienced one early miscarriage during their first pregnancy, although a third had experienced multiple losses. Results: The analysis highlights three themes: processes and practices for conception; amplification of loss; and health care and heterosexism. Of the respondents, 84% conceived using donor sperm; most used various resources to plan conception and engaged in preconception health care. The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood. Most felt that their loss(es) had made a ‘significant’/‘very significant’ impact on their lives. Many respondents experienced health care during their loss. Although the majority rated the overall standard of care as ‘good’/‘very good’/‘outstanding’, a minority reported experiencing heterosexism from health professionals. Conclusions: The implications for policy and practice are outlined. The main limitation was that the inflexibility of the methodology did not allow the specificities of women’s experiences to be probed further. It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.

Aluminium and Alzheimer's disease: review of possible pathogenic mechanisms

Chronic exposure to aluminium (Al) remains a controversial possible cause of sporadic forms of Alzheimer's disease (AD). This article reviews the evidence that once Al enters the brain and individual brain cells, it may be involved in three pathological processes: (1) the production of abnormal forms of tau leading to the formation of cellular neurofibrillary tangles and neuropil threads; (2) the processing of the amyloid precursor protein, resulting in the formation of beta-amyloid deposits and senile plaques, and (3) that via the mutual histocompatibility system, Al could be involved in the initiation of the immune response observed in AD patients. Despite recent evidence that Al could be involved in these processes, a conclusive case that exposure to Al initiates the primary pathological process in sporadic AD remains to be established.

Strong long-period fiber gratings recorded at 352 nm

We describe long-period grating inscription in hydrogenated telecom fibers by use of high-intensity femto-second 352 nm laser pulses. We show that this technique allows us to fabricate high-quality 30 dB gratings of 300 μm period and 2 cm length by use of a three-photon absorption mechanism. © 2005 Optical Society of America.

Decomposition of the B2-type matrix

The microstructural stability of aluminide diffusion coatings, prepared by means of a two-stage pack-aluminization treatment on single-crystal nickel-base superalloy substrates, is considered in this article. Edge-on specimens of coated superalloy are studied using transmission electron microscopy (TEM). The effects of coating thickness and post-coating heat treatment (duration, temperature, and atmosphere) on coating microstructure are examined. The article discusses the partial transformation of the matrix of the coating, from a B2-type phase (nominally NiAl) to a L12 phase (nominally Ni3(Al, Ti)), during exposure at temperatures of 850 °C and 950 °C in air and in vacuum for up to 138 hours. Three possible processes that can account for decom- position of the coating matrix are investigated, namely, interdiffusion between the coating and the substrate, oxidation of the coating surface, and aging of the coating. Of these processes, aging of the coating is shown to be the predominant factor in the coating transformation under the conditions considered. © 1992 The Minerals, Metals and Materials Society, and ASM International.

Investigations on sediment coring site PS1823 in the Riiser-Larsen Sea, Southern Ocean

Physical and sedimentological investigations were carried out on a 14 m long gravity core and a 0.5 m long box core from 4440 m water depth off Queen Maud Land, East-Antarctica. Strongly bioturbated hemipelagic muds of predominantly terrigenous origin and a very small biogenic part build up the 'Normal-Facies'. Several sandy to silty layers are inserted in the 'Normal-Facies'. These layers are seperated by lithology, structure and the investigated parameters of this study and are interpreted as turbidites. The source area for the turbidity currents is supposed to be at the uppermost continental margin, close to the shelf break and there is evidenee for this gravity transport within the erosive Ritscher-Canyon, which extends close to the core position. The distribution of biogenic components indicates an age of 1.3 million years or more, with an average sedimentation rate of about 1 cm/1000 years. Early diagenetic proeesses caused water loss by compaction, errosion and dissolution of biogenic components and precipitation and recrystallization of manganese micronodules. Cyclic fluctuations of the sediment-parameters within the 'Normal-Facies' enable the distinction of a 'Glazial'- and an 'Interglazial'-Facies. The 'Glazial'-Facies reflects glacial sedimentary conditions and shows a dark olive gray colour, high susceptibility, low silt/clay-ratios, only a few biogenic components and the regular occurence of interrelated turbidite layers. In contrast, the 'Interglazial'-Facies is dominated by a light olive or olive-brown colour, low susceptibility, high silt/clay-ratios and an increased number of biogenic components. This facies corresponds to interglacial conditions. Three main processes are supposed to have been responsible for the observed facies changes: (1) the bottom water mass circulation, (2) the gravity transport by turbidity currents and (3) the biogenic surface production. These processes are related to the quaternary climatic changes. The extension of the ice shelves directed the gravity transport to the deep sea and the formation of Antarctic Bottom Water, which in turn influenced the silt/clay-ratios in the sediment record. Fluctuations in sea ice coverage controlled the biogenic surface production.

The international diffusion of project management

This paper examines the international diffusion of one business practice, project management, through the prism of prior literature and data on the diffusion of ISO 9000. The study took an inductive approach, building theory through the iterative collection and analysis of quantitative and qualitative data. The findings problematise the central position accorded to the S-curve model and neo-institutional theory in explaining technology diffusion. The research posits three distinct processes driving the diffusion process: utility, institutional isomorphism, and competitive isomorphism, with the latter consisting of three primary mechanisms: competitive imitation, trendslators and fashion retailers. Contrary to prior literature, national, quasi-professional associations are found to be central to the diffusion process and play a key role in advocating and containing management technologies.

Modos projetuais de simulação: uso de ferramentas de simulação térmica no processo projetual de arquitetura

This thesis aims to describe and demonstrate the developed concept to facilitate the use of thermal simulation tools during the building design process. Despite the impact of architectural elements on the performance of buildings, some influential decisions are frequently based solely on qualitative information. Even though such design support is adequate for most decisions, the designer will eventually have doubts concerning the performance of some design decisions. These situations will require some kind of additional knowledge to be properly approached. The concept of designerly ways of simulating focuses on the formulation and solution of design dilemmas, which are doubts about the design that cannot be fully understood nor solved without using quantitative information. The concept intends to combine the power of analysis from computer simulation tools with the capacity of synthesis from architects. Three types of simulation tools are considered: solar analysis, thermal/energy simulation and CFD. Design dilemmas are formulated and framed according to the architect s reflection process about performance aspects. Throughout the thesis, the problem is investigated in three fields: professional, technical and theoretical fields. This approach on distinct parts of the problem aimed to i) characterize different professional categories with regards to their design practice and use of tools, ii) investigate preceding researchers on the use of simulation tools and iii) draw analogies between the proposed concept, and some concepts developed or described in previous works about design theory. The proposed concept was tested in eight design dilemmas extracted from three case studies in the Netherlands. The three investigated processes are houses designed by Dutch architectural firms. Relevant information and criteria from each case study were obtained through interviews and conversations with the involved architects. The practical application, despite its success in the research context, allowed the identification of some applicability limitations of the concept, concerning the architects need to have technical knowledge and the actual evolution stage of simulation tools

Efeito da adição de óleo essencial de Origanum vulgar e Ocimum gratissimum L. no perfil lipídico da gordura de palma usada em fritura de batata tipo chips

The objective of this study was to determine the antioxidant effect of essential oregano and alfavaca oil on the fatty acid profile of palm oil, used in industrial potato chips processing, aiming to reduce the oxidative state of palm oil. Essential oregano oil was obtained from industrial residues and commercial essential oregano oil was also acquired. The antioxidant activity of Oregano’s essential oil was taken by DPPH method. The DPPH analysis of the essential oil of oregano residue resulted in an IC50 of 797.04 mg.mL-1 and the essential oil of commercial oregano was 424.25 mg.mL-1. Regarding the content of total phenols, the essential oil of commercial oregano showed 0.167 ± 0.058 ug EAG.g-1. Based on these results, concentrations of 50, 100 e 150ug.g-1 of commercial oregano essential oil was added to palm oil and the fatty acid profile was determined by gas cromatography. Analysis were done with palm oil without being used in frying processes and without added essential oil, as well as with the different essential oil concentrations submitted at three frying processes at one single day. In the second part of the project, the effect of oreganos’s comercial essential oil compared to alfavacão essential oil, at the concentration of 100ug.g-1 in palm oil, and submitted to three frying processes during eleven cycles, was studied. The lipid profile was similar to that described in the literature, which an increase in the number of frying times caused a polyunsaturated fatty acids decrease and, therefore, a proportional increase in saturated fatty acids. It was noted an increase in the amounts of total saturated fatty acids from 43.36% (control) to 43.60% (palm oil with essential oil after 11 frying cycles at the concentration of 100ug.g-1). This fact proves that during the frying process, there is an increase in the rate of formation of saturated fatty acids. However, the addition of oregano essential oil did not provide significant change in the fatty acids of palm oil used in frying process of potato chips. The addition of oregano essential oil in a concentration of 100 ug./mL-1 until the third frying cycle showed a reduction effect of trans fatty acid formation. Although, during 11 frying cycles it was not noticed the essential oil effect under trans fatty acid formation. It can be suggested that this factor may be correlated to the frying time, which may not have been sufficient for significant formation of saturated and trans compounds.

Acompanhando o processo criativo de João Mota

Relatório de Estágio submetido à Escola Superior de Teatro e Cinema para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Teatro – especialização em Encenação

Degenerate Gases of Strontium for Studies of Quantum Magnetism

We describe the construction and characterization of a new apparatus that can produce degenerate quantum gases of strontium. The realization of degenerate gases is an important first step toward future studies of quantum magnetism. Three of the four stable isotopes of strontium have been cooled into the degenerate regime. The experiment can make nearly pure Bose-Einstein condensates containing approximately 1x10^4 atoms, for strontium-86, and approximately 4x10^5 atoms, for strontium-84. We have also created degenerate Fermi gases of strontium-87 with a reduced temperature, T/T_F of approximately 0.2. The apparatus will be able to produce Bose-Einstein condensates of strontium-88 with straightforward modifications. We also report the first experimental and theoretical results from the strontium project. We have developed a technique to accelerate the continuous loading of strontium atoms into a magnetic trap. By applying a laser addressing the 3P1 to 3S1 transition in our magneto-optical trap, the rate at which atoms populate the magnetically-trapped 3P2 state can be increased by up to 65%. Quantum degenerate gases of atoms in the metastable 3P0 and 3P2 states are a promising platform for quantum simulation of systems with long-range interactions. We have performed an initial numerical study of a method to transfer the ground state degenerate gases that we can currently produce into one of the metastable states via a three-photon transition. Numerical simulations of the Optical Bloch equations governing the three-photon transition indicate that >90% of a ground state degenerate gas can be transferred into a metastable state.

Modos projetuais de simulação: uso de ferramentas de simulação térmica no processo projetual de arquitetura

This thesis aims to describe and demonstrate the developed concept to facilitate the use of thermal simulation tools during the building design process. Despite the impact of architectural elements on the performance of buildings, some influential decisions are frequently based solely on qualitative information. Even though such design support is adequate for most decisions, the designer will eventually have doubts concerning the performance of some design decisions. These situations will require some kind of additional knowledge to be properly approached. The concept of designerly ways of simulating focuses on the formulation and solution of design dilemmas, which are doubts about the design that cannot be fully understood nor solved without using quantitative information. The concept intends to combine the power of analysis from computer simulation tools with the capacity of synthesis from architects. Three types of simulation tools are considered: solar analysis, thermal/energy simulation and CFD. Design dilemmas are formulated and framed according to the architect s reflection process about performance aspects. Throughout the thesis, the problem is investigated in three fields: professional, technical and theoretical fields. This approach on distinct parts of the problem aimed to i) characterize different professional categories with regards to their design practice and use of tools, ii) investigate preceding researchers on the use of simulation tools and iii) draw analogies between the proposed concept, and some concepts developed or described in previous works about design theory. The proposed concept was tested in eight design dilemmas extracted from three case studies in the Netherlands. The three investigated processes are houses designed by Dutch architectural firms. Relevant information and criteria from each case study were obtained through interviews and conversations with the involved architects. The practical application, despite its success in the research context, allowed the identification of some applicability limitations of the concept, concerning the architects need to have technical knowledge and the actual evolution stage of simulation tools

Composition and characteristics of the ferromanganese crusts from the western Arctic Ocean

Layered ferromanganese crusts collected by dredge from a water depth range of 2770 to 2200 m on Mendeleev Ridge, Arctic Ocean,were analyzed formineralogical and chemical compositions and dated using the excess 230Th technique. Comparison with crusts from other oceans reveals that Fe-Mn deposits of Mendeleev Ridge have the highest Fe/Mn ratios, are depleted inMn, Co, and Ni, and enriched in Si and Al aswell as some minor elements, Li, Th, Sc, As and V. However, the upper layer of the crusts shows Mn, Co, and Ni contents comparable to crusts from the Atlantic and Indian Oceans. Growth rates vary from3.03 to 3.97mm/Myr measured on the uppermost 2mm. Mn and Fe oxyhydroxides (vernadite, ferroxyhyte, birnessite, todorokite and goethite) and nonmetalliferous detrital minerals characterize the Arctic crusts. Temporal changes in crust composition reflect changes in the depositional environment. Crust formation was dominated by three main processes: precipitation of Fe-Mn oxyhydroxides from ambient ocean water, sorption of metals by those Fe and Mn phases, and fluctuating but large inputs of terrigenous debris.

Effect of handling and fixation processes on fluorescence spectroscopy of mouse skeletal muscles under two-photon excitation

We investigated the effects of handling and fixation processes on the two-photon fluorescence spectroscopy of endogenous fluorophors in mouse skeletal muscle. The skeletal muscle was handled in one of two ways: either sectioned without storage or sectioned following storage in a freezer. The two-photon fluorescence spectra measured for different storage or fixation periods show a differential among those samples that were stored in water or were fixed either in formalin or methanol. The spectroscopic results indicate that formalin was the least disruptive fixative, having only a weak effect on the two-photon fluorescence spectroscopy of muscle tissue, whereas methanol had a significant influence on one of the autofluorescence peaks. The two handling processes yielded similar spectral information, indicating no different effects between them.