Empfehlungen zur Umsetzung des Qualitätsmanagements im Straßen- und Verkehrswesen

Für die Bereitstellung eines qualitativ hochwertigen Verkehrssystems müssen die verfügbaren Finanzmittel im Straßen- und Verkehrswesen besonders effizient eingesetzt werden. Das Qualitätsmanagement hat sich hierfür in vielen Bereichen der Industrie als geeignet erwiesen, wird aber im Straßen- und Verkehrswesen bisher erst nur ansatzweise eingesetzt. Dies spiegelt sich auch im Technischen Regelwerk der Forschungsgesellschaft für Straßen- und Verkehrswesen (FGSV) wider. Darin lassen sich zahlreiche Regelungen mit zum Teil großem Einfluss auf die Qualität finden, allerdings fehlt ein einheitlicher Rahmen für ein umfassendes Qualitätsmanagement im Straßen- und Verkehrswesen. Die Umsetzung eines solchen Qualitätsmanagements sollte durch Leitfäden unterstützt werden. Während das Technische Regelwerk der FGSV bereits alle fachlichen Informationen bereitstellt, sollten diese Leitfäden auf die Umsetzung des Qualitätsmanagements in der Praxis ausgerichtet werden. Ziel der Forschungsarbeit ist daher, die Entwicklung eines Musterleitfadens des Qualitätsmanagements (Muster-QM-Leitfaden), welcher als Grundlage für die weitere Ausgestaltung und Ausformulierung des Qualitätsmanagements für die Produkte und Dienstleistungen über alle Lebensphasen im Straßen- und Verkehrswesen dient. Dazu werden zunächst die Grundlagen des Qualitätsmanagements erläutert und auf das Straßen- und Verkehrswesen übertragen, welches im Sinne der FGSV begrifflich abgegrenzt wird. Des Weiteren wird der derzeitige Entwicklungsstand des Qualitätsmanagements im Straßen- und Verkehrswesen in Deutschland und in ausgewählten Ländern dargestellt. Diese Auswertung zeigt, dass neben dem Technischen Regelwerk in der Praxis einige Ansätze des Qualitätsmanagements zu finden sind und demnach bereits eine gute Grundlage in der Theorie und Praxis besteht. Anschließend wird das komplexe Straßen- und Verkehrswesen in eigenständige und kombinierbare Bausteine (Module) unterteilt. Dafür werden zunächst die grundlegenden Begriffe der Modularisierung beschrieben und die Kriterien zur Abgrenzung der einzelnen Modularten definiert. Daraufhin werden die Grundmodule des Straßen- und Verkehrswesens basierend auf der Einordnung des Technischen Regelwerks der FGSV in den Qualitätsmanagementprozess abgegrenzt. Zur Umsetzung dieser Grundmodule in die Praxis wird ein Muster-QM-Leitfaden entwickelt, welcher eine Ergänzung zum Technischen Regelwerk der FGSV darstellen soll und schließlich für alle Grundmodule als QM-Leitfaden ausgestaltet werden soll. Abschließend werden Empfehlungen zur Umsetzung eines umfassenden Qualitätsmanagements bzw. zur Umsetzung des Muster-QM-Leitfadens bzw. der QM-Leitfäden im Straßen- und Verkehrswesen gegeben. Der Muster-QM-Leitfaden stellt einen ersten konkreten Schritt zur Entwicklung bzw. Umsetzung eines umfassenden Qualitätsmanagements im Straßen- und Verkehrswesen dar. Allerdings sind zu dessen Umsetzung in der Praxis noch weitere Schritte erforderlich. Dabei steht außer Frage, dass die Umsetzung eines solchen Qualitätsmanagements einen erheblichen organisatorischen und personellen Aufwand mit sich bringt. Ebenso tragen die gewachsenen Strukturen des Technischen Regelwerks der FGSV dazu bei, dass die Umsetzung einen mittel- bis langfristigen Prozess darstellt, den es sorgfältig anzugehen gilt, um den Nutzen eines umfassenden Qualitätsmanagements zu ermöglichen. Zudem wird es sehr wichtig sein, dass die beteiligten Akteure im Straßen- und Verkehrswesen hinreichend motiviert werden und die Prinzipien des Qualitätsmanagements sowohl bei der Weiterentwicklung des Regelwerks als auch bei der Umsetzung in die Praxis beachten. Die vorliegende Arbeit will einen Beitrag zu dieser Entwicklung eines umfassenden Qualitätsmanagements im Straßen- und Verkehrswesen leisten, indem sie wichtige Grundlagen wissenschaftlich aufbereitet und einen Vorschlag zum weiteren Vorgehen unterbreitet

Does Delay in the Diagnosis of Rudimentary Horn Pregnancy in Patients with Unicornuate Uteri Impact Treatment Outcomes?

OBJECTIVE: Rudimentary horn pregnancy (RHP) is a very rare form of ectopic pregnancy (EP) that tends to rupture in the second trimester. Similar to other EPs, the treatment of RHPs is excision, hence delay in diagnosis (DID) can be detrimental. Our objective is to determine whether DID of RHP in patients with unicornuate uteri (UCU) impacts the treatment outcome. DESIGN: Retrospective cohort study of published case reports in PubMed database. MATERIALS AND METHODS: A computerized PubMed search of case reports of RHP from 2007 to 2020 was performed using the key words; unicornuate uterus, rudimentary horn, pregnancy, case. Data was analyzed with SPSS version 26. RESULTS: Of the 97 published cases, due to limited information available, 95 cases were included, 40 (42.1%) in which the diagnosis of RHP was made at first encounter and 55 (57.9%) in which the diagnosis was delayed. Out of these cases, it was possible to calculate the median [range] length of delay (35 [1-1825] days) in only 32 cases. Of 95 cases, 27 (28.4%), 5 (5.3%), 61 (64.2%), 1 (1.1%), underwent laparoscopy, laparoscopy converted to laparotomy, laparotomy, and methotrexate injection respectively. Diagnosis was made at autopsy in one case. CONCLUSIONS: Diagnosis of RHP was significantly more likely to be made at first encounter when patients were known to have a uterine anomaly. DID was associated with a significantly higher GA at the time of treatment but there was no significant difference in the proportion of fetuses that were alive upon entrance to the abdomen, rate of ruptured RH and hemoperitoneum. Out of all of the cases, only one maternal death was reported. Therefore, delaying surgery to confirm a diagnosis of RHP does not adversely impact the maternal fetal outcome

Idiopathic sclerosing orbital inflammation mimicking a malignant spindle cell tumor in a dog

A dog presented with a retrobulbar mass, diagnosed histopathologically as malignant spindle cell neoplasia. Emergence of analogous findings in the contralateral orbit prompted extended immunohistochemistry of the original mass and reassignment to idiopathic sclerosing orbital inflammation. Early incisional biopsy with extended immunohistochemical analysis should be considered for canine orbital tumors

Central of Georgia Depot

This interpretive plan gives a brief and condensed history of the central of Georgia Depot. Alongside a history of the depot, this resource provides potential interpretive themes for the historic site to pursue in future programs. The resource also contains reproductions of many historic photographs, as well as survey information regarding the depot\u27s events and programming.https://scholarworks.gsu.edu/history_heritagepreservation/1017/thumbnail.jp

Pilot, randomized, placebo-controlled clinical field study to evaluate the effectiveness of bupivacaine liposome injectable suspension for the provision of post-surgical analgesia in dogs undergoing stifle surgery

Abstract Background Local anesthetics are an important component of perioperative pain management, but the duration of action of available products is limited. We hypothesized that a single local infiltration of a novel bupivacaine liposome injectable suspension (AT-003) would provide clinically effective analgesia over a 72-h period. In a masked, randomized, placebo-controlled, multi-center pilot field study, dogs undergoing lateral retinacular suture placement for cranial cruciate insufficiency were randomly assigned to surgical site infiltration with AT-003 (5.3 mg/kg) or an equivalent volume of saline. Infiltration of the surgical site was done prior to closure. Primary outcome measure was the Glasgow Composite Measure Pain Scale (CMPS-SF) assessed prior to surgery and at 2, 4, 8, 12, 24, 30, 36, 48, 54, 60 and 72 h following surgery by trained individuals. Provision for rescue analgesia was employed. Repeated measures analysis of variance were utilized to test for possible differences between treatment groups and a success/failure analysis was also employed, based on the need for rescue analgesia. Results Forty-six dogs were enrolled and evaluated. For CMPS-SF scores there was a significant overall treatment effect (p = 0.0027) in favor of AT-003. There were significantly more successes in the AT-003 group compared to placebo over each time period (p = 0.0001 for 0–24 h, p = 0.0349 for 0–48 h, and p = 0.0240 for 0-72 h). No significant adverse events were seen. Conclusions AT-003 (bupivacaine liposome injectable suspension) provided measurable local analgesia over a 72-h period following post-stifle surgery surgical site tissue infiltration. Further work is indicated to develop this product for clinical use

The Efficacy of Exercise in Reducing Depressive Symptoms among Cancer Survivors: A Meta-Analysis

INTRODUCTION: The purpose of this meta-analysis was to examine the efficacy of exercise to reduce depressive symptoms among cancer survivors. In addition, we examined the extent to which exercise dose and clinical characteristics of cancer survivors influence the relationship between exercise and reductions in depressive symptoms. METHODS: We conducted a systematic search identifying randomized controlled trials of exercise interventions among adult cancer survivors, examining depressive symptoms as an outcome. We calculated effect sizes for each study and performed weighted multiple regression moderator analysis. RESULTS: We identified 40 exercise interventions including 2,929 cancer survivors. Diverse groups of cancer survivors were examined in seven exercise interventions; breast cancer survivors were examined in 26; prostate cancer, leukemia, and lymphoma were examined in two; and colorectal cancer in one. Cancer survivors who completed an exercise intervention reduced depression more than controls, d(+) = -0.13 (95% CI: -0.26, -0.01). Increases in weekly volume of aerobic exercise reduced depressive symptoms in dose-response fashion (β = -0.24, p = 0.03), a pattern evident only in higher quality trials. Exercise reduced depressive symptoms most when exercise sessions were supervised (β = -0.26, p = 0.01) and when cancer survivors were between 47-62 yr (β = 0.27, p = 0.01). CONCLUSION: Exercise training provides a small overall reduction in depressive symptoms among cancer survivors but one that increased in dose-response fashion with weekly volume of aerobic exercise in high quality trials. Depressive symptoms were reduced to the greatest degree among breast cancer survivors, among cancer survivors aged between 47-62 yr, or when exercise sessions were supervised

Targeting the MAPK7/MMP9 axis for metastasis in primary bone cancer

Metastasis is the leading cause of cancer related death. This multistage process involves contribution from both tumour cells and the tumour stroma to release metastatic cells into the circulation. Circulating tumour cells (CTCs) survive circulatory cytotoxicity, extravasate and colonise secondary sites effecting metastatic outcome. Reprogramming the transcriptomic landscape is a metastatic hallmark but detecting underlying master regulators that drive pathological gene expression is a key challenge, especially in childhood cancer. Here we used whole tumour plus single cell RNA sequencing in primary bone cancer and CTCs to perform weighted gene co-expression network analysis to systematically detect coordinated changes in metastatic transcript expression. This approach with comparisons applied to data collected from cell line models, clinical samples and xenograft mouse models revealed MAPK7/MMP9 signalling as a driver for primary bone cancer metastasis. RNAi knockdown of MAPK7 reduces proliferation, colony formation, migration, tumour growth, macrophage residency/polarisation and lung metastasis. Parallel to these observations were reduction of activated interleukins IL1B, IL6, IL8 plus mesenchymal markers VIM and VEGF in response to MAPK7 loss. Our results implicate a newly discovered, multidimensional MAPK7/MMP9 signalling hub in primary bone cancer metastasis that is clinically actionable

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts