MARQulS: quality improvement strategies for European cross-border healthcare

This supplement is focused on the methods, results and recommendations from the research project ''Methods of Assessing Response to Quality Improvement Strategies'' (MARQuIS). MARQuIS was funded by the Scientific Support to Policies component of the European Union Sixth Framework Research Programme (Contract SP21-CT2004-513712), and it lasted from January 2004 to June 2008

Lava flow morphology at an erupting andesitic stratovolcano: a satellite perspective on El Reventador, Ecuador

Lava flows pose a significant hazard to infrastructure and property located close to volcanoes, and understanding how flows advance is necessary to manage volcanic hazard during eruptions. Compared to low-silica basaltic flows, flows of andesite composition are infrequently erupted and so relatively few studies of their characteristics and behaviour exist. We use El Reventador, Ecuador as a target to investigate andesitic lava flow properties during a 4.5 year period of extrusive eruption between February 2012 and August 2016. We use satellite radar to map the dimensions of 43 lava flows and look at variations in their emplacement behaviour over time. We find that flows descend the north and south flanks of El Reventador, and were mostly emplaced during durations shorter than the satellite repeat interval of 24 days.Flows ranged in length from 0.3 to 1.7 km, and the length of these flows decreased over the observation period. We measure a decrease in flow volume with time that is correlated with a long-term exponential decrease in eruption rate, and propose that this behaviour is caused by temporary magma storage in the conduit acting as a melt capacitor between the magma reservoir and the surface. We use the dimensions of the flow levees and widths to estimate the flow yield strengths, which were of the order of 10-100 kPa. We observe that some flows were diverted by topographic obstacles, and compare measurements of decreased channel width and increased flow thickness at the obstacles with observations from laboratory experiments. Radar observations, such as those presented here, could be used to map and measure properties of evolving lava flow fields at other remote or difficult to monitor volcanoes

Modelling the Influence of Layout On Overheating Risk of London Flats

An analysis of overheating levels corresponding to building morphology yielded the modelling uncertainty due to the geometry and layout of two-bedroom flats in London, England. A new method is introduced, which collates information on various flat layouts in the current London housing stock. To ensure an unbiased sample was selected, dwellings were chosen randomly, yielding twelve flats in and around inner London. Dynamic thermal simulations were performed using EnergyPlus to determine individual dwellings’ overheating risk. The results described the influence of geometry and layout configuration on overheating risk, which has rarely been analysed in previous studies. Irregular façades led to higher overheating levels in the set-back part of the building. Default configurations were used to model basecase archetypes, with further simulations performed to study the effects of orientation, ceiling heights and window glazing fractions. Compared with these factors, bigger differences between mean operative temperatures of flats were due to layout, with 3.5 °C in bedrooms, 1.5 °C in living rooms and 2.2 °C in kitchens

Passive cooling applicability mapping: A tool for designers

The applicability of passive cooling methods has been a recurring subject in architectural engineering science. The integration of these methods in architecture often requires feasibility studies and, in most cases, a deep knowledge of the climatic conditions is required to succeed in this task. The number of parameters to be evaluated will depend on the complexity of the cooling system, the physics involved and the context. This paper addresses the climatic applicability of convective and evaporative cooling systems in the context of United States (US) through the creation of a series of applicability maps deriving from processed climate data. This work is a revision of the climatic maps for downdraught cooling developed in Europe and in China with an extension to evaluate the opportunity for natural ventilation. More specifically, the studied cooling solutions are: Natural Convective Cooling (NCC), Passive Evaporative Cooling (PEC), and Active Downdraught Cooling (ADC). The maps obtained demonstrate the strong potential for the use of passive evaporative and convective cooling solutions in the US to overcome the current dependency on mechanical systems

Sun safety in construction: a UK intervention study

Background: Interventions to promote sun safety in the UK construction sector are warranted given the high incidence of skin cancer attributable to sun exposure relative to other occupational groups. Aims: To evaluate change in sun safety knowledge and practices among construction workers in response to an educational intervention. Methods: A baseline questionnaire was administered, followed by a bespoke sector-specific DVD-based intervention. At 12-month follow-up participants completed a further questionnaire. Results: Analyses were conducted on a sample of 120 workers (intervention group, n = 70; comparison group, n = 50). At follow-up the proportion of intervention group participants that reported correct sun safety knowledge was not significantly greater than at baseline. However, the intervention group demonstrated significant positive change on nine out of ten behavioural measures, the greatest change being use of a shade/cover when working in the sun followed by regularly checking skin for moles or unusual changes. Conclusions: Exposure to this intervention was linked to some specific positive changes in construction workers’ self-reported sun safety practices. These findings highlight the potential for educational interventions to contribute to tackling skin cancer in the UK construction sector. The findings support the development of bespoke educational interventions for other high-risk outdoor worker groups

Quality requirements for cross-border care in Europe: a qualitative study of patients’, professionals’ and healthcare financiers’ views

In the past decade the issue of patient mobility has emerged on the European health policy agenda. Although the volume of patients crossing borders to obtain healthcare is low, it is increasing continuously and, due to its legal, financial and medical implications, has generated considerable interest among health policy and other decision makers. However, there is little information available on the safety and patient-centredness of cross-border care and neither governments nor citizens have an explicit basis for comparing healthcare delivery in Europe. This study investigated the viewpoints of patients, professionals and healthcare financiers on the safety and patient-centredness of cross-border care. Qualitative interviews were carried out during 2005 and early 2006 with 40 patients, 30 professionals (doctors, nurses and managers) and 3 healthcare-financing bodies. Although cross-border care has become a common issue in many European countries, there remain uncertainties on the side of each of the parties addressed-patients, professionals and financiers-with regard to the provision of cross-border care. One of the most striking results of this project is the current lack of research on systematic knowledge on the quality of cross-border care. Many of the issues identified through this research may have a potential impact on the quality and safety of cross-border care and will support further investigation and help shape the health policy agenda on patients crossing borders in European Union countries

An abridged Spanish version of Sexual Double Standard Scale: Factorial structure, reliability and validity evidence

Background/Objective Sexual double standard (SDS) has long been associated to several dimensions of sexual health. Therefore the assessment of SDS is relevant and requires self-reported measures with adequate psychometric properties. This study aims to adapt the Sexual Double Standard Scale (SDSS) into heterosexual Spanish population and examine its psychometric properties. Method: Using quota incidental sampling, we recruited a sample of 1, 206 individuals (50% women), distributed across three groups based on their age (18-34, 35-49 and 50 years old and older). Results: We performed both, Exploratory Factor Analysis and Confirmatory Factor Analysis. An abridged version was yielded, consisting of 16 items distributed into two factors (Acceptance for sexual freedom and Acceptance for sexual shyness). A second-order factor structure was also adequate, which facilitates the use of a global index for SDS. Reliability, based on internal consistency and temporal stability was good for the factors. Evidence of validity is also shown and reported. Conclusions: This adapted version of the SDSS is reliable and valid. The importance for its use to estimate the prevalence of both traditional and modern forms of this phenomenon is discussed. Antecedentes/Objetivo: El doble estándar sexual (DES) se ha asociado a distintas dimensiones de la salud sexual, por lo que su evaluación es relevante y requiere de instrumentos con ade- cuadas propiedades psicométricas. Se plantea la adaptación a población heterosexual espa ~ nola de la Sexual Double Standard Scale (SDSS) y examinar sus propiedades psicométricas. Método : Mediante un muestreo incidental por cuotas se obtuvo una muestra de 1.206 sujetos (50% mujeres), distribuidos en tres grupos en función de la edad (18-34 a ~ nos, 35-49 a ~ nos y 50 a ~ nos o más). Resultados : Mediante Análisis Factorial Exploratorio y Análisis Factorial Confirmatorio se consiguió una versión de 16 ítems distribuidos en dos factores (Aceptación de la libertad sexual y Aceptación del recato sexual), cuya combinación en un factor de segundo orden per- mite obtener un índice global de doble estándar sexual. La fiabilidad de consistencia interna y test-retest es óptima para los dos subfactores y sus medidas presentan adecuados índices de validez. Conclusiones : Esta versión adaptada de la SDSS es fiable y válida. Se discute su impor- tancia para detectar la prevalencia de DES tradicional y de expresiones más modernas de este fenómeno

Do European hospitals have quality and safety governance systems and structures in place?

Internal systems for quality and safety were assessed in 89 hospitals in six European states, by external teams using standardised criteria and procedures, as part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. The assessments were made primarily to identify the current use of quality management systems in the sample hospitals, and also to demonstrate a potential tool for comparable assessment of hospitals in general. The large majority of the hospitals had a formal, documented infrastructure to manage quality and safety, but a significant minority had no designated mission, programme or coordination. In two-thirds of hospitals, the governing body was active in defining policy and programmes for improvement, and received reports on quality, safety and patient satisfaction at least once a year. The brief on-site assessments identified systematic variations, within and between countries, in structures and processes of governance and to document the uptake of best practice. Unacceptable variations in practice could be reduced, to the benefit of consumers and providers, by developing and publishing basic organisational standards relevant to all European states. The simple assessment criteria designed for this project could be developed into a practical tool for self-assessment, peer review or benchmarking of hospitals across national borders. This assessment, combined with explicit, relevant and achievable standards, could provide a vehicle to promote the voluntary uptake of best practice and consistency in quality and safety among hospitals in Europe