A systematic review of approaches for continuous quality improvement capacity-building

Context: Continuous quality improvement (CQI) has become prominent in public health settings; yet, little consolidated guidance exists for building CQI capacity of community-based organizations. Objective: To synthesize relevant literature to identify guiding principles and core components critical to building the capacity of organizations to adopt and use CQI. Design: We employed a systematic review approach to assess guiding principles and core components for CQI capacity-building as outlined in the literature. Eligibility Criteria: Studies meeting the following criteria were eligible for review: (1) empirical, peer-reviewed journal article, evaluation study, review, or systematic review; (2) published in 2010 or later; and (3) capacity-building activities were described in enough detail to be replicable. Studies not including human subjects, published in a language other than English, or for which full text was not available were excluded. Study Selection: The initial return of records included 6557 articles, of which 1455 were duplicates. The research team single-screened titles and abstracts of 5102 studies, resulting in the exclusion of 4842 studies. Two hundred sixty-two studies were double-screened during full-text review, yielding a final sample of 61 studies from which data were extracted. Main Outcome Measures: Outcome measures of interest were operationalized descriptions of guiding principles and core components of the CQI capacity-building approach. Results: Results yielded articles from medical education, health care, and public health settings. Findings included guiding principles and core components of CQI capacity-building identified in current practice, as well as infrastructural and contextual elements needed to build CQI capacity. Conclusions: This consolidation of guiding principles and core components for CQI capacity-building is valuable for public health and related workforces. Despite the uneven distribution of articles from health care, medical education, and public health settings, our findings can be used to guide public health organizations in building CQI capacity in a well-informed, systematic manner

Nutritive value of forages as affected by soil and climatic differences

This is the third test to measure differences, if any, in performance of cattle in various parts of Kansas due to location, soil, climate, rainfall and/or local feed. Forty-eight Hereford steer calves from the same herd averaging 475 pounds each were divided as uniformly as possible into four groups of 12 animals. One group was assigned to each of four locations: Colby, Garden City, Manhattan, and Mound Valley. Uniform-size concrete lots with sheds were used at each location. Each group of 12 animals was subdivided into two groups of six. The wintering ration consisted of locally grown sorghum silage (FSla) fed free choice with 5 pounds of locally grown second-cutting alfalfa hay per head daily. At the end of the wintering phase, silage was gradually decreased and removed from the ration. At the same time, locally grown sorghum grain was introduced and gradually increased until the grown sorghum grain was self-fed. Salt was the only added mineral throughout the test. Analyses of the feeds used are show in in table 13

Eogenetic Karst Hydrology: Insights From the 2004 Hurricanes, Peninsular Florida

Eogenetic karst lies geographically and temporally close to the depositional environment of limestone in warm marine water at low latitude, in areas marked by midafternoon thunderstorms during a summer rainy season. Spring hydrographs from such an environment in north-central Florida are characterized by smooth, months-long, seasonal maxima. The passage of Hurricanes Frances and Jeanne in September 2004 over three field locations shows how the eogenetic karst of the Upper Floridan Aquifer responds to unequivocal recharge events. Hydrographs at wells in the High Springs area, Rainbow Springs, and at Morris, Briar, and Bat Caves all responded promptly with a similar drawn-out rise to a maximum that extended long into the winter dry season. The timing indicates that the typical hydrograph of eogenetic karst is not the short-term fluctuations of springs in epigenic, telogenetic karst, or the smoothed response to all the summer thunderstorms, but rather the protracted response of the system to rainfall that exceeds a threshold. The similarity of cave and noncave hydrographs indicates distributed autogenic recharge and a free communication between secondary porosity and permeable matrix—both of which differ from the hydrology of epigenic, telogenetic karst. At Briar Cave, drip rates lagged behind the water table rise, suggesting that recharge was delivered by fractures, which control the cave’s morphology. At High Springs, hydrographs at the Santa Fe River and a submerged conduit apparently connected to it show sharp maxima after the storms, unlike the other cave hydrographs. Our interpretation is that the caves, in general, are discontinuous