Does audit improve quality in a hospital manufacturing unit?

OBJECTIVE - To establish whether auditing improves the overall quality of a hospital manufacturing unit. DESIGN - Continuous assessment of the quality level of a hospital manufacturing unit using 14 quality indicators over a nine-month period, and two periods of audit carried out towards the beginning and end of the assessment period. SETTING - The non-sterile manufacturing, sterile manufacturing and repackaging services areas at the pharmacy manufacturing unit at Queens Hospital, Burton-on- Trent. RESULTS - Compliance ratings for the second audit were better than those for the first audit, but there was no overall improvement in quality over the study period. CONCLUSION - Auditing probably improves compliance by focusing the minds of the staff involved, rather than by initiating a sustained improvement in overall quality.

Simultaneous measurement for liquid level and refractive index based on all-fiber modal interferometer

A simple fiber sensor capable of simultaneous measurement of liquid level and refractive index (RI) is proposed and experimentally demonstrated. The sensing head is an all-fiber modal interferometer manufactured by splicing an uncoated single-mode fiber with two short sections of multimode fiber. The interference pattern experiences blue shift along with an increase of axial strain and surrounding RI. Owing to the participation of multiple cladding modes with different sensitivities, the height and RI of the liquid could be simultaneously measured by monitoring two dips of the transmission spectrum. Experimental results show that the liquid level and RI sensitivities of the two dips are 245.7 pm/mm, -38 nm/RI unit (RIU), and 223.7 pm/mm, -62 nm/RIU, respectively. The approach has distinctive advantages of easy fabrication, low cost, and high sensitivity for liquid level detection with the capability of distinguishing the RI variation simultaneously. © 2013 Copyright Taylor and Francis Group, LLC.

A small scale Multi-effect Distillation (MED) unit for rural micro enterprises:part I-design and fabrication

Removal of dissolved salts and toxic chemicals in water, especially at a few parts per million (ppm) levels is one of the most difficult problems. There are several methods used for water purification. The choice of the method depends mainly on the level of feed water salinity, source of energy and type of contaminants present. Distillation is an age old method which can remove all types of dissolved impurities from contaminated water. In multiple effect distillation (MED) latent heat of steam is recycled several times to produce many units of distilled water with one unit of primary steam input. This is already being used in large capacity plants for treating sea water. But the challenge lies in designing a system for small scale operations that can treat a few cubic meters of water per day, especially suitable for rural communities where the available water is brackish. A small scale MED unit with an extendable number of effects has been designed and analyzed for optimum yield in terms of total distillate produced. © 2010 Elsevier B.V.

A comparative study to evaluate surface microbial contamination associated with copper-containing and stainless steel pens used by nurses in the critical care unit

A clinical study was undertaken to compare the surface microbial contamination associated with pens constructed of either a copper alloy or stainless steel used by nurses on intensive care units. A significantly lower level of microbial contamination was found on the copper alloy pens. Copyright © 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The effect of different instructional groupings on student achievement and attitudes from a computer-based interactive videodisk biology unit

The purpose of this research study was to determine the effect of two different instructional groupings (cooperative and traditional whole-class) on student achievement and attitudes using a computer-based interactive videodisc biology unit. The subjects were 64 high school biology students assigned to two heterogeneous experimental groups, randomly selected from two preassigned summer school biology classes, one honors, the other regular. A two-group, posttest-only, control group experimental research design was utilized. Achievement at three cognitive levels and attitudes towards science laserdisc instruction were measured at the conclusion of the study. The cooperative group consistently outperformed the traditional group in achievement posttest scores. Factorial ANOVA on total (overall) achievement scores indicated that subjects in cooperative groups significantly outperformed those in the traditional group, and also that the instructional group, class level, and gender interacted in an ordinal fashion to make a significant difference in how female and male subjects were affected by the treatments depending on their class (aptitude) level. Regular level females and honors level males performed much better when in cooperative groups, whereas group membership did not appear to make a difference for either honors level females or regular level males. A t-test comparing honors level males revealed that cooperative groups were close to being significantly better in total achievement posttest scores than their traditional group counterparts. Factorial MANOVA comparing the instructional groups at three cognitive levels found no significant difference. Analysis on the attitudes posttest data also revealed that subjects in cooperative groups demonstrated more positive attitudes towards science laserdisc instruction; however these differences were not found to be significant. Significant interactions in attitudes of females and males from different class levels had the opposite effect as achievement: honors level females and regular level males demonstrated more positive attitudes towards science laserdisc instruction when in cooperative groups, whereas group membership did not appear to make a difference for honors level males, and regular level females demonstrated the lowest attitudes ratings of any group when involved in cooperative groups. This contrast between achievement and attitudinal results suggests cross-gender interaction in traditionally defined gender roles.

Women at work: Nurse and intern talk to patient, coronary-intensive care unit, Douglas County Hospital, Alexandria, Minnesota

Inscription: Verso: Women at work: miscellaneous occupations.

An analysis of wind curtailment and constraint at a nodal level

Many countries have set challenging wind power targets to achieve by 2020. This paper implements a realistic analysis of curtailment and constraint of wind energy at a nodal level using a unit commitment and economic dispatch model of the Irish Single Electricity Market in 2020. The key findings show that significant reduction in curtailment can be achieved when the system non-synchronous penetration limit increases from 65% to 75%. For the period analyzed, this results in a decreased total generation cost and a reduction in the dispatch-down of wind. However, some nodes experience significant dispatch-down of wind, which can be in the order of 40%. This work illustrates the importance of implementing analysis at a nodal level for the purpose of power system planning.

A DEA-based incentives system for centrally managed multi-unit organisations

In multi-unit organisations such as a bank and its branches or a national body delivering publicly funded health or education services through local operating units, the need arises to incentivize the units to operate efficiently. In such instances, it is generally accepted that units found to be inefficient can be encouraged to make efficiency savings. However, units which are found to be efficient need to be incentivized in a different manner. It has been suggested that efficient units could be incentivized by some reward compatible with the level to which their attainment exceeds that of the best of the rest, normally referred to as “super-efficiency”. A recent approach to this issue (Varmaz et. al. 2013) has used Data Envelopment Analysis (DEA) models to measure the super-efficiency of the whole system of operating units with and without the involvement of each unit in turn in order to provide incentives. We identify shortcomings in this approach and use it as a starting point to develop a new DEA-based system for incentivizing operating units to operate efficiently for the benefit of the aggregate system of units. Data from a small German retail bank is used to illustrate our method.

Using alcohol unit-marked glasses enhances capacity to monitor intake:evidence from a mixed-method intervention trial

AIMS: In the UK, people tend to have poor knowledge of government guidelines for alcohol use, and lack the motivation and skills required to use them to monitor their drinking. The study aim was to determine whether using glasses marked with such guidelines would improve knowledge and attitudes, increase frequency of counting units and lower alcohol intake. METHODS: A total of 450 adults in the UK participated in an intervention vs control study with 1-month follow-up. The intervention group was encouraged to use glasses supplied by the researchers that indicated the unit content of drinks of different strengths and volumes, and stated the intake guidelines. Data were collected online. A further more in-depth interview with 13 intervention group participants enquired into their experiences of using the glasses. RESULTS: Analyses adjusted for baseline variables showed that the intervention improved the following: knowledge of unit-based guidelines, ability to estimate the unit content of drinks, attitudes toward the guidelines and frequency of counting unit intake. However, there was no significant difference in alcohol consumption between the groups at follow-up. Interviews suggested that the glasses encouraged people to think about their drinking and to discuss alcohol with other people. The design of the glasses was not appealing to all, and their initial impact did not always persist. CONCLUSION: Use of unit-marked glasses led to changes in people's reported use of unit-based guidelines to monitor their drinking but, in the short term, no change in consumption. Qualitative data suggested that the glasses could have an impact at the individual level (on knowledge and attitudes) and at a broader level (by prompting discussion of alcohol use).

Understanding Red Blood Cell Parameters In The Context Of The Frailty Phenotype: Interpretations Of The Fibra (frailty In Brazilian Seniors) Study.

Frailty and anemia in the elderly appear to share a common pathophysiology associated with chronic inflammatory processes. This study uses an analytical, cross-sectional, population-based methodology to investigate the probable relationships between frailty, red blood cell parameters and inflammatory markers in 255 community-dwelling elders aged 65 years or older. The frailty phenotype was assessed by non-intentional weight loss, fatigue, low grip strength, low energy expenditure and reduced gait speed. Blood sample analyses were performed to determine hemoglobin level, hematocrit and reticulocyte count, as well as the inflammatory variables IL-6, IL-1ra and hsCRP. In the first multivariate analysis (model I), considering only the erythroid parameters, Hb concentration was a significant variable for both general frailty status and weight loss: a 1.0g/dL drop in serum Hb concentration represented a 2.02-fold increase (CI 1.12-3.63) in an individual's chance of being frail. In the second analysis (model II), which also included inflammatory cytokine levels, hsCRP was independently selected as a significant variable. Each additional year of age represented a 1.21-fold increase in the chance of being frail, and each 1-unit increase in serum hsCRP represented a 3.64-fold increase in the chance of having the frailty phenotype. In model II reticulocyte counts were associated with weight loss and reduced metabolic expenditure criteria. Our findings suggest that reduced Hb concentration, reduced RetAbs count and elevated serum hsCRP levels should be considered components of frailty, which in turn is correlated with sarcopenia, as evidenced by weight loss.

Ant-caterpillar Antagonism At The Community Level: Interhabitat Variation Of Tritrophic Interactions In A Neotropical Savanna.

Ant foraging on foliage can substantially affect how phytophagous insects use host plants and represents a high predation risk for caterpillars, which are important folivores. Ant-plant-herbivore interactions are especially pervasive in cerrado savanna due to continuous ant visitation to liquid food sources on foliage (extrafloral nectaries, insect honeydew). While searching for liquid rewards on plants, aggressive ants frequently attack or kill insect herbivores, decreasing their numbers. Because ants vary in diet and aggressiveness, their effect on herbivores also varies. Additionally, the differential occurrence of ant attractants (plant and insect exudates) on foliage produces variable levels of ant foraging within local floras and among localities. Here, we investigate how variation of ant communities and of traits among host plant species (presence or absence of ant attractants) can change the effect of carnivores (predatory ants) on herbivore communities (caterpillars) in a cerrado savanna landscape. We sampled caterpillars and foliage-foraging ants in four cerrado localities (70-460 km apart). We found that: (i) caterpillar infestation was negatively related with ant visitation to plants; (ii) this relationship depended on local ant abundance and species composition, and on local preference by ants for plants with liquid attractants; (iii) this was not related to local plant richness or plant size; (iv) the relationship between the presence of ant attractants and caterpillar abundance varied among sites from negative to neutral; and (v) caterpillars feeding on plants with ant attractants are more resistant to ant predation than those feeding on plants lacking attractants. Liquid food on foliage mediates host plant quality for lepidopterans by promoting generalized ant-caterpillar antagonism. Our study in cerrado shows that the negative effects of generalist predatory ants on herbivores are detectable at a community level, affecting patterns of abundance and host plant use by lepidopterans. The magnitude of ant-induced effects on caterpillar occurrence across the cerrado landscape may depend on how ants use plants locally and how they respond to liquid food on plants at different habitats. This study enhances the relevance of plant-ant and ant-herbivore interactions in cerrado and highlights the importance of a tritrophic perspective in this ant-rich environment.

Factors Associated With The Onset Of Hypertension In Women Of 50 Years Of Age Or More In A City In Southeastern Brazil.

To evaluate factors associated with hypertension in Brazilian women of 50 years of age or more. A cross-sectional population based study using self-reports. A total of 622 women were included. The association between sociodemographic, clinical and behavioral factors and the woman's age at the onset of hypertension was evaluated. Data were analyzed according to cumulative continuation rates without hypertension, using the life-table method and considering annual intervals. Next, a Cox multiple regression analysis model was adjusted to analyze the occurrence rates of hypertension according to various predictor variables. Significance level was pre-established at 5% (95% confidence level) and the sampling plan (primary sampling unit) was taken into consideration. Median age at onset of hypertension was 64.3 years. Cumulative continuation rate without hypertension at 90 years was 20%. Higher body mass index (BMI) at 20-30 years of age was associated with a higher cumulative occurrence rate of hypertension over time (coefficient=0.078; p<0.001). Being white was associated with a lower cumulative occurrence rate of hypertension over time (coefficient= -0.439; p=0.003), while smoking >15 cigarettes/day was associated with a higher rate over time (coefficient=0.485; p=0.004). The results of the present study highlight the importance of weight control in young adulthood and of avoiding smoking in preventing hypertension in women aged ≥50 years.

Comparative In vitro Mechanical Evaluation Of Techniques Using A 2.0 mm Locking Fixation System For Simulated Fractures Of The Mandibular Body.

To perform a comparative evaluation of the mechanical resistance of simulated fractures of the mandibular body which were repaired using different fixation techniques with two different brands of 2.0 mm locking fixation systems. Four aluminum hemimandibles with linear sectioning simulating a mandibular body fracture were used as the substrates and were fixed using the two techniques and two different brands of fixation plate. These were divided into four groups: groups I and II were fixed with one four-hole plate, with four 6 mm screws in the tension zone and one four-hole plate, with four 10 mm screws in the compression zone; and groups III and IV were fixed with one four-hole plate with four 6 mm screws in the neutral zone. Fixation plates manufactured by Tóride were used for groups I and III, and by Traumec for groups II and IV. The hemimandibles were submitted to vertical, linear load testing in an Instron 4411 servohydraulic mechanical testing unit, and the load/displacement (3 mm, 5 mm and 7 mm) and the peak loads were measured. Means and standard deviations were evaluated applying variance analysis with a significance level of 5%. The only significant difference between the brands was seen at displacements of 7 mm. Comparing the techniques, groups I and II showed higher mechanical strength than groups III and IV, as expected. For the treatment of mandibular linear body fracture, two locking plates, one in the tension zone and another in the compression zone, have a greater mechanical strength than a single locking plate in the neutral zone.

Effect Of Low-level Laser Therapy (lllt) On Peripheral Nerve Regeneration Using Fibrin Glue Derived From Snake Venom.

The purpose of this study was to assess whether the adhesive permits the collateral repair of axons originating from a vagus nerve to the interior of a sural nerve graft, and whether low-level laser therapy (LLLT) assists in the regeneration process. Study sample consisted of 32 rats randomly separated into three groups: Control Group (CG; n=8), from which the intact sural nerve was collected; Experimental Group (EG; n=12), in which one of the ends of the sural nerve graft was coapted to the vagus nerve using the fibrin glue; and Experimental Group Laser (EGL; n=12), in which the animals underwent the same procedures as those in EG with the addition of LLLT. Ten weeks after surgery, the animals were euthanized. Morphological analysis by means of optical and electron microscopy, and morphometry of the regenerated fibers were employed to evaluate the results. Collateral regeneration of axons was observed from the vagus nerve to the interior of the autologous graft in EG and EGL, and in CG all dimensions measured were greater and presented a significant difference in relation to EG and EGL, except for the area and thickness of the myelin sheath, that showed significant difference only in relation to the EG. The present study demonstrated that the fibrin glue makes axonal regeneration feasible and is an efficient method to recover injured peripheral nerves, and the use of low-level laser therapy enhances nerve regeneration.

Low-level Laser Therapy To The Mouse Femur Enhances The Fungicidal Response Of Neutrophils Against Paracoccidioides Brasiliensis.

Neutrophils (PMN) play a central role in host defense against the neglected fungal infection paracoccidioidomycosis (PCM), which is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb). PCM is of major importance, especially in Latin America, and its treatment relies on the use of antifungal drugs. However, the course of treatment is lengthy, leading to side effects and even development of fungal resistance. The goal of the study was to use low-level laser therapy (LLLT) to stimulate PMN to fight Pb in vivo. Swiss mice with subcutaneous air pouches were inoculated with a virulent strain of Pb or fungal cell wall components (Zymosan), and then received LLLT (780 nm; 50 mW; 12.5 J/cm2; 30 seconds per point, giving a total energy of 0.5 J per point) on alternate days at two points on each hind leg. The aim was to reach the bone marrow in the femur with light. Non-irradiated animals were used as controls. The number and viability of the PMN that migrated to the inoculation site was assessed, as well as their ability to synthesize proteins, produce reactive oxygen species (ROS) and their fungicidal activity. The highly pure PMN populations obtained after 10 days of infection were also subsequently cultured in the presence of Pb for trials of protein production, evaluation of mitochondrial activity, ROS production and quantification of viable fungi growth. PMN from mice that received LLLT were more active metabolically, had higher fungicidal activity against Pb in vivo and also in vitro. The kinetics of neutrophil protein production also correlated with a more activated state. LLLT may be a safe and non-invasive approach to deal with PCM infection.