Quality Assurance in Swiss University Hospitals: a Survey Among Clinical Department Heads

Objective: To obtain information to help design and implement quality improvement programmes. Design: Questionnaire survey. Setting: Swiss University Hospitals. Setting: Swiss University Hospitals. Study participants: Clinical Department heads. Main outcome measures: Attitudes towards quality assurance and percentage of departments with procedures for measurement and improvement of structure, process and outcome of medical care. Results: Among 138 departments responding, 69 indicated a designated person or group in charge of quality and 57 were involved in collaborative quality improvement programmes. Mortality data at the level of the department was unavailable to 33% of respondents, and data on adverse treatment effects to 67% of them. Most respondents (69%) favoured the use of outcome indicators for quality control; only 13% favoured indicators pertaining to process or structure of care. Among indicators of outcome, patient satisfaction was the preferred indicator (25% of respondents), followed by morbidity (16%) and mortality (12%) data. Conclusion: Although the quality of medical care in Switzerland enjoys an excellent reputation, this study highlights important gaps in the information system and the processes necessary to evaluate quality. Copyright © 1996 Eslevier Science Lt

In Search of the Solar Wind Nitrogen Isotope Composition: Analysis of a Gold Plate from the Genesis Spacecraft Concentrator

We report N isotope analysis of a gold plate from the Genesis spacecraft concentrator. We did not find evidence for a light N component in the solar wind

Data Pipeline Management in Practice: Challenges and Opportunities

Data pipelines involve a complex chain of interconnected activities that starts with a data source and ends in a data sink. Data pipelines are important for data-driven organizations since a data pipeline can process data in multiple formats from distributed data sources with minimal human intervention, accelerate data life cycle activities, and enhance productivity in data-driven enterprises. However, there are challenges and opportunities in implementing data pipelines but practical industry experiences are seldom reported. The findings of this study are derived by conducting a qualitative multiple-case study and interviews with the representatives of three companies. The challenges include data quality issues, infrastructure maintenance problems, and organizational barriers. On the other hand, data pipelines are implemented to enable traceability, fault-tolerance, and reduce human errors through maximizing automation thereby producing high-quality data. Based on multiple-case study research with five use cases from three case companies, this paper identifies the key challenges and benefits associated with the implementation and use of data pipelines

The transcription and notation of Elizabeth Fry's journal 1780-1845

This thesis proposes to explain the production of Fry's journal and make available to researchers a full transcription of the autobiographical journal of Elizabeth Fry. This journal tells Fry's life story in an episodic diary format that encapsulates the last forty-eight years of her life. The justification for the production of the transcription and the motivation behind It: The thesis will investigate the importance of Fry's Journal in the evolution of the diary genre. It will justify the huge undertaking entailed in making a full transcription of Fry's journal and will discuss the condition of the journal books and their different locations. How these factors contributed to the delay in producing a transcription earlier will be considered. What motivated Fry to write her journal and what influenced her to continue the process unabated for all her adult life? The reasons Fry had originally given for her journal production changed as her journal evolved and her life priorities changed. I will investigate the destruction of Fry's early journal books and her reasoning behind such editorial interference and her motivation for keeping others. Finally this section will close with an analysis of Fry's journal in order to establish what class within the diary genre it belongs. Dyslexia and its effect on Fry's journal text and the editorial procedures adopted: This part of this thesis discusses the indicators of dyslexia within the journal text and their effect on the journal's production. I explain the resulting methodology adopted to alleviate the destructive effect that dyslexia had on the journal text. I have limited the editorial interventions undertaken when producing the transcription as I wished to maintain the integrity of Fry's journal. The final part of the thesis evaluates Fry's journal by making a comparison with a contemporary journal. The journal I used for comparison was written by Deborah Darby, a woman who shared many of Fry's life experiences. This thesis will establish Fry's journal as belonging to that elite group of great diarists that includes Pepys. The appendices: these consist of a short biography of Fry with a published work explaining her role in the founding of modern nursing. A glossary of Quakers and the Gurney family terminology and finally a bibliography and the first two books, from Fry's journal with notes.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Argon, krypton, and xenon abundances in the solar wind measured in silicon from the genesis mission

Up to now solar wind (SW) abundances of Kr and Xe have been exclusively determined using SW irradiated regolith [1]. Hence, one of Genesis’s major objectives is to obtain the heavy noble gas composition of the present-day SW using artificial targets exposed to the SW for 2.5 years. SW abundances will allow to study fractionation processes upon SW formation, e.g., due to the first ionization potential (FIP-effect) [2]. This is of importance to deduce solar abundances of noble gases and other elements from SW data. Solar, i.e., photospheric, abundances of noble gases are indirectly determined due to the lack of suitable lines in the spectrum. Recently, solar abundance estimates for Ne and Ar were strongly reduced whereas Kr and Xe changed only slightly [3]. This led to a dramatic decrease of the solar Ar/Kr ratio by a factor of ~3 from the earlier value [4] of 2140. If true, this change would invalidate theories of heavy noble gas fractionation in the SW identified with regolith data [1, 5]. The Kr and Xe composition in present-day SW will enable us to reassess solar abundances and fractionation theories. Thus, we concentrate here on abundances of Ar, Kr and Xe in the bulk SW

Gas emissions and active tectonics within the submerged section of the North Anatolian Fault zone in the Sea of Marmara

The submerged section of the North Anatolian fault within the Marmara Sea was investigated using acoustic techniques and submersible dives. Most gas emissions in the water column were found near the surface expression of known active faults. Gas emissions are unevenly distributed. The linear fault segment crossing the Central High and forming a seismic gap – as it has not ruptured since 1766, based on historical seismicity, exhibits relatively less gas emissions than the adjacent segments. In the eastern Sea of Marmara, active gas emissions are also found above a buried transtensional fault zone, which displayed micro-seismic activity after the 1999 events. Remarkably, this zone of gas emission extends westward all along the southern edge of Cinarcik basin, well beyond the zone where 1999 aftershocks were observed. The long term monitoring of gas seeps could hence be highly valuable for the understanding of the evolution of the fluid-fault coupling processes during the earthquake cycle within the Marmara Sea

Patients' experiences of illness, operation and outcome with reference to gastro-oesophageal reflux disease.

Background. Describing the illness-story from a patient perspective could increase understanding of living with a chronic disease for health professionals and others, facilitate decision-making about treatment and enhance information about the outcome from a patient perspective. Aim. To illuminate patients' illness experiences of having a gastro-oesophageal reflux disease (GORD), going through surgery and the outcome. Methods. Twelve patients were interviewed 5 years after having had the operation; six patients had had fundoplication via laparoscopy and six via open surgery. Each patient was asked to talk openly about their experiences, thoughts, feelings and consequences of living with the illness, going through surgery and the period from surgery to the day of interview. A qualitative content analysis was performed concerning the context of the data and its meaning. Findings. Three central categories were identified and nine subcategories: living with GORD- symptoms of the disease affecting daily living, taking medicines, work, family and social life; concerns related to surgery- decision-making about the operation, influence by physicians; life after the operation- outcomes and consequences, side-effects and complications of the operation, sick leave, information and sharing experiences with future patients. All patients were free from symptoms of the illness after surgery independent of type of surgery, but side-effects from surgical treatment varied individually. Interviewees would have liked information concerning side-effects after surgery from previous patients. Conclusions. This study contributes to knowledge about patients' long-term suffering, their control of symptoms and how they have tried to cure themselves, but also about their concerns about surgery and the importance of surgical treatment to their quality of life. They wanted information about treatment, outcome and consequences, not only from a health care perspective but also from previous patients having had the same treatment

Patient perspectives of managing fatigue in ankylosing spondylitis, and views on potential interventions: a qualitative study

<p>Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely over-looked, and currently there are no specific agreed management strategies.</p> <p>Methods: This qualitative exploratory study involved participants who are members of an existing population-based ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis.</p> <p>Results: Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73 years (mean age 53 years). Three main themes were identified: (1) The effects of fatigue were multi-dimensional with participants expressing feelings of being ‘drained’ (physical), ‘upset’ (emotional) and experiencing ‘low-mood’ (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course.</p> <p>Conclusions: Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.</p&gt

Question-posing & question-responding at the heart of possibility thinking in the early years.

publication-status: Publishedtypes: ArticleDrawing on research that sought to explore the characteristics of ‘Possibility Thinking’ as central to creativity in young children’s learning, this paper considers question-posing and question-responding as the driving features of ‘Possibility Thinking’ (PT). This qualitative study employed micro-event analysis of peer and pupil–teacher interaction. Events were sampled from two early years settings in England, one a Reception classroom (4- to 5-year olds) and the other a Year 2 classroom (6- to 7-year olds). This article arises out of the second stage of an ongoing research programme (2004–2007) involving the children and practitioners in these settings. This phase considers the dimensions of question-posing and the categories of question-responding and their interrelationship within PT. Three dimensions of questioning were identified as characteristic of PT. These included: (i) question framing, reflecting the purpose inherent within questions for adults and children (including leading, service and follow-through questions); (ii) question degree: manifestation of the degree of possibility inherent in children’s questions (including possibility narrow, possibility moderate, possibility broad); (iii) question modality, manifestation of the modality inherent in children’s questions (including verbal and non-verbal forms). The fine-grained data analysis offers insight into how children engage in PT to meet specific needs in responding to creative tasks and activities and reveals the crucial role that question-posing and question-responding play in creative learning. It also provides more detail about the nature of young children’s thinking, made visible through question-posing and responding in engaging playful contexts