Structure and Microstructure Properties of Ball Milled Fe-Zn

Nanocrystalline Fe10 %Zn and Fe30 %Zn alloys have been prepared from pure elemental powders by mechanical alloying processing in a high energy planetary ball-mill. Microstructural, structural, and magnetic characterizations of the powders were investigated by X-ray diffraction, and vibrating sample magnometer. The crystallite size reduction to the nanometer scale is accompanied by an increase in the atomic level strain. The reaction between Fe and Zn leads to the formation of a bcc Fe(Zn) solid solution with a lattice parameter close to (0.2912 nm for Fe30 %Zn and 0,2885 nm for Fe10 %Zn) after 5 h of milling. The complete dissolution of the elemental Zn powders in the a-Fe lattice gives rise to the formation of a highly disordered Fe(Zn) solid solution, where a-Fe(Zn) nanograins have a crystallite size of (229,29 Å for Fe10 %Zn (24 h) 30,09 Å for Fe30 %Zn (24 h), on prolonged milling time. The coercivity and magnetization values are 18,90 (Fe10 %Zn)Oe and 26,59 (Fe30 %Zn) emu/g, respectively, after 24 h of milling. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/3514

Involvement of patients or their representatives in quality management functions in EU hospitals:implementation and impact on patient-centred care strategies

OBJECTIVE: The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. DESIGN: A cross-sectional, multilevel STUDY DESIGN: that surveyed quality managers and department heads and data from an organizational audit. SETTING: Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). PARTICIPANTS: Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. MAIN OUTCOME MEASURES: Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. RESULTS: Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. CONCLUSIONS: There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect

Patient Experience Shows Little Relationship with Hospital Quality Management Strategies.

OBJECTIVES: Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. MATERIALS AND METHODS: We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. RESULTS: Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures. CONCLUSION: This is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services

Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries.

BACKGROUND: Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. OBJECTIVE: To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. DESIGN: Multicenter, multilevel cross-sectional study. SETTING AND PARTICIPANTS: Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. INTERVENTION: None. MEASURES: Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. RESULTS AND LIMITATIONS: Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. CONCLUSIONS: There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems

Involvement of patients or their representatives in quality management functions in EU hospitals : Implementation and impact on patient-centred care strategies

The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no 241822.Objective: The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. Design: A cross-sectional, multilevel study design that surveyed quality managers and department heads and data from an organizational audit. Setting: Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Participants: Hospital qualitymanagers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. Main Outcome Measures: Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. Results: Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. Conclusions: There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect

A systematic review of instruments that assess the implementation of hospital quality management systems.

PURPOSE: Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess the implementation of hospital quality management systems, (ii) describe their measurement properties and (iii) assess the effects of quality management on quality improvement and quality of care outcomes. DATA SOURCES: We performed a systematic literature search from 1990 to 2011 in PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science. In addition, we used snowball strategies, screened the reference lists of eligible papers, reviewed grey literature and contacted experts in the field. STUDY SELECTION: and data extraction Two reviewers screened eligible papers based on pre-defined inclusion and exclusion criteria and all authors extracted data. Eligible papers are described in terms of general characteristics (settings, type and level of respondents, mode of data collection), methodological properties (sampling strategy, item derivation, conceptualization of quality management, assessment of reliability and validity, scoring) and application/implementation (accounting for context, organizational adaptations, sensitivity to change, deployment and effect size). RESULTS: Eighteen papers were deemed eligible for inclusion. While some common domains emerged in measurement conceptualization, substantial differences in scope persist. The instruments' measurement properties were insufficiently described and only few instruments assessed links between the implementation of quality management systems (QMS) and improvement strategies or outcomes. CONCLUSIONS: There is currently no well-established measure to assess the implementation and effectiveness of quality management systems. Future research should address this gap

A new aircraft architecture based on the ACHEON Coanda effect nozzle: flight model and energy evaluation

Purpose Aeronautic transport has an effective necessity of reducing fuel consumption and emissions to deliver efficiency and competitiveness driven by today commercial and legislative requirements. Actual aircraft configurations scenario allows envisaging the signs of a diffused technological maturity and they seem very near their limits. This scenario clearly shows the necessity of radical innovations with particular reference to propulsion systems and to aircraft architecture consequently. Methods This paper presents analyses and discusses a promising propulsive architecture based on an innovative nozzle, which allows realizing the selective adhesion of two impinging streams to two facing jets to two facing Coanda surfaces. This propulsion system is known with the acronym ACHEON (Aerial Coanda High Efficiency Orienting Nozzle). This paper investigates how the application of an all-electric ACHEONs propulsion system to a very traditional commuter aircraft can improve its relevant performances. This paper considers the constraints imposed by current state-of-the-art electric motors, drives, storage and conversion systems in terms of both power/energy density and performance and considers two different aircraft configurations: one using battery only and one adopting a more sophisticated hybrid cogeneration. The necessity of producing a very solid analysis has forced to limit the deflection of the jet in a very conservative range (±15°) with respect to the horizontal. This range can be surely produced also by not optimal configurations and allow minimizing the use of DBD. From the study of general flight dynamics equations of the aircraft in two-dimensional form it has been possible to determine with a high level of accuracy the advantages that ACHEON brings in terms of reduced stall speed and of reduced take-off and landing distances. Additionally, it includes an effective energy analysis focusing on the efficiency and environmental advantages of the electric ACHEON based propulsion by assuming the today industrial grade high capacity batteries with a power density of 207 Wh/kg. Results It has been clearly demonstrated that a short flight could be possible adopting battery energy storage, and longer duration could be possible by adopting a more sophisticated cogeneration system, which is based on cogeneration from a well-known turboprop, which is mostly used in helicopter propulsion. This electric generation system can be empowered by recovering the heat and using it to increase the temperature of the jet. It is possible to transfer this considerable amount of heat to the jet by convection and direct fluid mixing. In this way, it is possible to increase the energy of the jets of an amount that allows more than recover the pressure losses in the straitening section. In this case, it is then possible to demonstrate an adequate autonomy of flight and operative range of the aircraft. The proposed architecture, which is within the limits of the most conservative results obtained, demonstrates significant additional benefits for aircraft manoeuvrability. In conclusion, this paper has presented the implantation of ACHEON on well-known traditional aircraft, verifying the suitability and effectiveness of the proposed system both in terms of endurance with a cogeneration architecture and in terms of manoeuvrability. It has demonstrated the potential of the system in terms of both takeoff and landing space requirements. Conclusions This innovation opens interesting perspectives for the future implementation of this new vector and thrust propulsion system, especially in the area of greening the aeronautic sector. It has also demonstrated that ACHEON has the potential of renovating completely a classic old aircraft configuration such as the one of Cessna 402

Development and validation of an index to assess hospital quality management systems

The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 241822.Objective: The aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries. Design: Questionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken between May 2011 and February 2012. We used psychometric methods to explore the factor structure, reliability and validity of the instrument. Setting and participants. As part of the Deepening our Understanding of Quality improvement in Europe (DUQuE) project, we invited a random sample of 188 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Main Outcome Measure. The extent of implementation of QMSs. Results: Factor analysis yielded nine scales, which were combined to build the Quality Management Systems Index. Cronbach's reliability coefficients were satisfactory (ranging from 0.72 to 0.82) for eight scales and low for one scale (0.48). Corrected item-total correlations provided adequate evidence of factor homogeneity. Inter-scale correlations showed that every factor was related, but also distinct, and added to the index. Construct validity testing showed that the index was related to recent measures of quality. Participating hospitals attained a mean value of 19.7 (standard deviation of 4.7) on the index that theoretically ranged from 0 to 27. Conclusion: Assessing QMSs across Europe has the potential to help policy-makers and other stakeholders to compare hospitals and focus on the most important areas for improvement