Methodology for Process Improvement Through Basic Components and Focusing on the Resistance to Change.

This paper describes a multi-model methodology that implements a smooth and continuous process improvement, depending on the organization's business goals and allowing users to establish their improvement implementation pace. The methodology focuses on basic process components known as ‘best practices’. Besides, it covers following the topics: knowledge management and change management. The methodology description and the results of a case study on project management process are included

Using Complex, Multi-Sectoral Data in a Needs Assessment to Inform Future Strategies in Childhood Asthma Management

The purpose of this needs assessment was to study the current state of asthma management in high-risk children in Houston, Texas to inform a theory-based approach to improving asthma management. The mixed-method assessment included multi-sectoral survey, quantitative, and geospatial data that address a range of social and community factors in family, community, home, and medical contexts. Houston Emergency Medical Services (EMS) provided ambulance-treated asthma data mapped by geographic area to identify where childhood asthma management was weakest. Texas Children’s Health Plan (TCHP) provided medication compliance rates and counts of children by zip code that TCHP considered high-risk according to claims data. Houston Independent School District (HISD) provided school nurse survey results from schools with high-rates of ambulance-treated asthma attacks regarding local barriers to asthma management. Elementary schools with children at highest risk were identified by overlaying the EMS data, TCHP data, and HISD school zone boundaries. Survey results from the high-rate schools indicate the priority challenges to childhood asthma management, including lack of resources, lack of communication, lack of knowledge of triggers, and inadequate time for quality care from providers. By weaving together EMS, TCHP, and HISD data, the needs assessment informed a socio-ecological view of gaps in high-risk childhood asthma management and control, specifically where and what to target. An assessment approach with multi-sectoral data, geospatial mapping, nurse input, current systems of care, education, and funding helped focus planning on a practical approach to asthma control solutions for high-risk children

Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

<p>Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions. Given the paucity of</p> <p>hospitals capable of PCI, early identification of more severe myocardial infarction may prompt</p> <p>emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions.</p> <p>Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of</p> <p>proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset.</p> <p>Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35), the mean sum of ST elevation (STE) in leads V1 through V6 plus ST depression (STD) in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007). A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37), there was no significant difference in ST-segment deviation between the 2 groups.</p> <p>Conclusion: The sum STE (V1-V6) and STD (II, III, aVF) on a 12-lead ECG can be used to predict proximal LAD occlusions if performed within the first hour of symptom onset. This should be considered a high-risk finding and may prompt prehospital direction of such patients to PCI-capable hospitals. [West J Emerg Med. 2011;12(4):408–413.]</p

Systemizing Virtual Learning and Technologies by Managing Organizational Competency and Talents

The article presents promising components and practices of virtual learning and technologies and discusses how systemization can be made through managing organizational competency and talents. The main goal is to suggest how technologies should be incorporated within an organization to improve the effectiveness of employees’ learning, performance, and development. For technology implementation and adoption, we also introduce models for examining organizational maturity levels and integrating technologies.We argue that virtual learning and technologies are fundamentally pressing HRD roles to change from experts of learning and development to work solution partners leading and supporting the creation of a smart organization.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

United States Bureau of Mines Information Circular 8439

Report issued by the U.S. Bureau of Mines discussing bismuth ores and supplies in the United States. As stated in the abstract, "domestic bismuth supply was projected from production figures for the ores in which it occurs - copper, lead, zinc, and tungsten" (p. 1). This report includes maps, tables, and illustrations

Process Improvement Essentials

Process Improvement Essentials combines the foundation needed to understand process improvement theory with the best practices to help individuals implement process improvement initiatives in their organization. The three leading programs: ISO 9001:2000, CMMI, and Six Sigma--amidst the buzz and hype--tend to get lumped together under a common label. This book delivers a combined guide to all three programs, compares their applicability, and then sets the foundation for further exploration

Geelong Grammar boy saw deep inside the atom

"John Gordon Rushbrooke, whose brilliant career as a high-energy physicist has been cut short by cancer, was one of a succession of scientists educated at Geelong Grammar School in the middle years of the 20th century who achieved world eminence in their fields" (1 page)