The development and testing of a contextual model for healthcare quality improvement using Lean and the Model for Understanding Success in Quality (MUSIQ) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Quality Systems at Massey University, Palmerston North, New Zealand

This study developed a new theoretical model of quality improvement (QI) contextual factors, for QI activity undertaken at the healthcare microsystem level. The Model for Understanding Success in Quality (MUSIQ) (Kaplan, Provost, Froehle, & Margolis, 2012), was aligned with Lean improvement activity using the Toyota Way framework. The aim of the research was to improve the effectiveness of healthcare quality improvement initiatives by providing more understanding of the associations, relative importance and precise functioning of critical contextual factors. A new survey instrument, based on the literature, was developed to collect data and the hypothesised theoretical relationships were tested using the partial least squares path modelling (PLSPM) technique. QI practitioners at a large New Zealand District Health Board were surveyed on a range of contextual factors hypothesised to influence improvement outcomes. All survey participants had recently completed a small-scale improvement project using Lean, or were participants in training programmes that introduced them to Lean thinking and methods. Some participants worked autonomously on improvements of their own selection; others were part of a wider training programme derived from the National Health Service’s (UK) ‘productive ward’ programme. In the healthcare organisational context, the majority of these improvement initiatives were carried out at the microsystem level – initiated and delivered by the teams responsible for the work processes being modified. Survey responses were first analysed via principal components analysis (to examine the dimensionality of the scales) and then PLSPM. The defined contextual factors for ‘Teamwork’, ‘Respect for People’, ‘Lean Actions’ and the influence of negatively motivating factors all reached significance. Defined contextual factors for ‘Previous Experience’ and the influence of positive motivating factors did not reach significance at 5% level. The final model showed a statistically significant, moderate predictive strength, with an overall adjusted R2 of 0.58. This result was an encouraging validation of the microsystem-level layer of the MUSIQ model using Lean as the QI method (context). The relative influence of ‘Teamwork’, ‘Respect for People’, ‘Motivation’, and a mediating mechanism for making process changes (in this instance, Lean) were measured and found to be consistent with the MUSIQ model. Identifying more detailed causal mechanisms (the present model was intentionally parsimonious due to the time frame allowed and the resources available for the research), refining the operational definitions, and developing and testing predictive models for the defined contextual factors are the proposed next steps in the research

Agro-terrorism and the Grain Handling Systems in Canada and the United States

The grain handling sector in Canada and the United States is vital to agriculture and trade. In a typical year on the Canadian prairies, about 140,000 producers deliver some 20 to 30 mmt of grain for export to primary elevators. In the United States, about 2.1 million producers deliver about 300 mmt of grain to primary elevators. Canadian grain is moved to export position using more than 400,000 hopper cars and marine containers, where about 1,200 ships per year are loaded. In the United States, about 1.08 million rail carloads of grain are originated per year, and about 23 mmt of grain are shipped on barges per year. These U.S. figures are in addition to trucks, which, more so than in Canada, are also used to deliver grain to primary processors and to terminal and export markets. The volume of grain trade gives rise to concern about risks of terrorism in the sector.(1) From a security perspective, the grain, pulse and oilseed supply chain is noteworthy because much of it is characterized by relatively long-term, insecure, bulky storage (particularly on farms) along with numerous modal and inter-modal product transfers. These factors suggest there are many places where chemical or biological contaminants could be introduced into this supply chain. From the perspective of the United States, security throughout the Canadian system as well as the U.S. system is a concern, since cross-border traffic in these products is significant, with an average of about six million tonnes of grain products alone imported into the U.S. each year (USDA-FAS, 2003). Numerous interventions to enhance food safety and mitigate the risk of terrorism have been adopted or are in the process of being developed. Some of these are private initiatives and voluntary, as a component of firm-level security processes. Others are being adopted in response to legislated initiatives. The stakes are large, and there are likely to be substantial differences in costs and effectiveness of different approaches.Agricultural and Food Policy, Food Consumption/Nutrition/Food Safety,

Predictions of the emergence of vaccine-resistant hepatitis B in The Gambia using a mathematical model

Vaccine escape variants of hepatitis B virus (HBV) have been identified world-wide. A mathematical model of HBV transmission is used to investigate the potential pattern of emergence of such variants. Attention is focused on The Gambia as a country with high quality epidemiological data, universal infant immunization and in which escape mutants after childhood infections have been observed. We predict that a variant cannot become dominant for at least 20 years from the start of vaccination, even when using a vaccine which affords no cross protection. The dominant factor responsible for this long time scale is the low rate of infectious contacts between infected and susceptible individuals (we estimate the basic reproduction number of hepatitis B in The Gambia to be 1·7). A variant strain that achieves high prevalence will also take many years to control, and it is questionable whether emergence will be identifiable by sero-surveillance until of high prevalence. The sensitivity of the model predictions to epidemiological and demographic factors is explored

Predictions of the emergence of vaccine-resistant hepatitis B in The Gambia using a mathematical model

Vaccine escape variants of hepatitis B virus (HBV) have been identified world-wide. A mathematical model of HBV transmission is used to investigate the potential pattern of emergence of such variants. Attention is focused on The Gambia as a country with high quality epidemiological data, universal infant immunization and in which escape mutants after childhood infections have been observed. We predict that a variant cannot become dominant for at least 20 years from the start of vaccination, even when using a vaccine which affords no cross protection. The dominant factor responsible for this long time scale is the low rate of infectious contacts between infected and susceptible individuals (we estimate the basic reproduction number of hepatitis B in The Gambia to be 1·7). A variant strain that achieves high prevalence will also take many years to control, and it is questionable whether emergence will be identifiable by sero-surveillance until of high prevalence. The sensitivity of the model predictions to epidemiological and demographic factors is explored

Faith based institutions and youth participation in community development : issues and opportunities

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2002.Includes bibliographical references (leaves 38-40).There is growing interest among schools, other public agencies, and secular non-profit organizations to involve young people in current community planning efforts. Missing from discourse, however are the roles churches and other faith-based institutions can play in involving youth. Across the nation, churches and church-affiliated community organizations provide adults opportunities to revitalize their communities. In this thesis, two types of challenges that hinder these organizations from providing similar opportunities to urban youth will be examined. One such challenge focuses on internal obstacles within faith-based organizations that dissuade new models of participation. The second challenge focuses on several relational obstacles that contribute to a disconnection between leadership of faith-based organizations and contemporary urban youth culture. In spite of these challenges, this thesis suggest that some churches and church-affiliated community organizations serving low-income communities are well positioned to include urban youth bring in their community planning efforts. This thesis will explore the merits of that claim. The goals of this thesis are (1) to identify the various institutional and relational challenges that impede collaborations between faith-based institutions and urban youth in community development; and (2) to draw the attention of youth serving- and other church-affiliated community organizations to innovative and progressive approaches for youth participation.by James W. Wilson.M.C.P

Remarks on the Nature and Treatment of Puriform Ophthalmia

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Cross-talk: A Shared Parameter Space for Gesturally Extended Human/Machine Improvisation

This paper describes Cross-talk, a piece of music and performance system for two instruments augmented with infrared motion-tracking capability, and an artificial software improviser. Cross-talk was commissioned by the Ammerman Center for Arts and Technology at Connecticut College, for the 13th Biennial Symposium on Arts and Technology. The work is part of an ongoing collaboration focused on developing integrated hardware and software performance systems to extend the timbral and expressive capabilities of traditional musical instruments and to generate musical structure in response to information retrieved from human performers in real-time. Artistic motivations and prior related work are presented here, along with a summary of the programmatic narrative behind Cross-talk and an accompanying qualitative description of the piece. Technical details are provided for important components of the work, including the Gesturally Extended Piano and the “factorOracle” software module, which is used to facilitate the system\u27s machine improvisation capability

The Specificity of Pleading in Modern Civil Practice: Addressing Common Misconceptions

The pleading procedure serves as the foundation for the entire legal process. Pleadings focus the issues, narrow the evidence admissible at trial, apprise the adverse party and the court of the matter in dispute, and provide the extent of the res judicata effect of the judgment. To secure the foundation and to effectuate the purposes of the pleading procedure, it is imperative that the pleading set forth sufficient allegations. The standard for determining the sufficiency of the allegations is referred to as the specificity requirement and serves as the focus of this Note