Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth ...and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal.
We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 ± 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio aOR, 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient ICC, 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided.
These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care.
ISRCTN30829654.
The deteriorating groundwater quality due to natural genesis and anthropogenic activities has prevented the sustainable use of groundwater. The characteristics and factors affecting groundwater ...quality for drinking in shallow aquifers (depth ≤ 100 m) in the plain area of Yarkant River Basin in Xinjiang were analyzed using water quality index (WQI), geostatistics, and geochemical methods. Results showed that the groundwater was weak-alkaline with neutral pH, with dominant water types being SO
4
•HCO
3
-Ca•Mg, SO
4
•Cl•HCO
3
-Na•Ca, SO
4
•HCO
3
•Cl-Ca•Na, Cl•SO
4
-Na•Ca, and HCO
3
•SO
4
-Mg•Ca. WQI ranged between 31.79 and 549.37, and about 14.43%, 31.96%, 18.56%, 22.68%, and 12.37% of the all samples were excellent, good, medium, poor, and extremely poor quality, respectively. The proportion of excellent quality was the highest in single structure phreatic aquifer (SSPA, 50.00%) and good quality were the highest in multilayered structure phreatic aquifer (MSPA, 34.21%) and multilayered structure confined aquifer (MSCA, 28.89%). With the extension of the river, the groundwater quality gradually degenerated from south to north in phreatic aquifer (PA, including SSPA and MSPA). The further away from the Yarkant river, the worse the groundwater quality of PA. Furthermore, the WQI showed excellent, good, and an alternation of medium and poor quality (including extremely poor quality) from south to north in the MSCA. The groundwater quality deterioration might have been affected by the dissolution of evaporite minerals, such as halite, gypsum, and anhydrite and ion exchange process. In addition, local effects of anthropogenic activities and land usage patterns on the groundwater quality should be reckoned as well.
Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve ...care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients' individual differences, respects providers' clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians' rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11-51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care.
The purpose of this article is to create a snapshot of 25 years' quality movement. The creation process of the snapshot, as well as the result of the study, aims to help in diagnosing the current ...status of quality management (QM) and further contribute in understanding and shaping its future direction. For this purpose, all published articles during the last 25 years' period (1987-2011) under the subject of Total Quality Management (TQM), Business Excellence (BE), quality tools, techniques as well as core values/principles have been collected through the ABI/INFORM complete periodical database. The collected data were analysed and reflected in order to show the current status, evolution trends of the past, and the predicted future directions. The results show that the total number of articles under the subject of TQM has been decreasing after having reached its peak in 1995. However, papers focusing on techniques and tools within the QM framework in terms of Lean, Just-in-Time/Toyota Production System, Benchmarking, and Six-Sigma Quality have been increasing. In addition, papers focusing on core values/key principles needed to build a quality culture in terms of leadership, people-based management, continuous improvements, management based on facts, and focus on the customer have been slightly increasing during the last decade. The findings indicate that QM is now at a more mature stage where focuses have shifted from being initially on TQM to tools, techniques, and core values which are needed for building a quality and BE culture. Based on its evolution, it is concluded that TQM can be understood as a management innovation, if not a management revolution.
The ubiquity of smartphones equipped with an array of sophisticated sensors, ample processing power, network connectivity and a convenient interface makes them a promising tool for non-invasive, ...portable food quality assessment. Combined with the recent developments in the areas of IoT, deep learning algorithms and cloud computing, they present an opportunity for advancing wide-spread, equitable and sustainable food analytical methods that could be used at each stage of food production and distribution.
This review focuses on the use of smartphone-based methods in food quality assessment and monitoring, with particular emphasis on the ones in which smartphones are used as detectors, either on their own or in conjunction with more elaborate analytical procedures. The role of these methods in common and equitable access to information on food quality is discussed, together with a consideration of the sustainability and greenness of the smartphone-based methods and a perspective on the methodology and validation. Additionally, recent developments and future research trends are also outlined.
Despite the persisting limitations resulting from technical difficulties and the complexity of the food sample matrix, smartphones will play an increasingly important role in popularizing the access to food analytical techniques for on-site analysis as a readily available and convenient integrated interface, connectivity and remote sensing platforms.
•Smartphones are a promising tool for non-invasive, portable food quality assessment.•New vistas are open by recent advances in network connectivity and machine learning.•Smartphones applications are in line with green and equitable chemistry.
Meteorological normalisation is a technique which accounts for changes in meteorology over time in an air quality time series. Controlling for such changes helps support robust trend analysis because ...there is more certainty that the observed trends are due to changes in emissions or chemistry, not changes in meteorology. Predictive random forest models (RF; a decision tree machine learning technique) were grown for 31 air quality monitoring sites in Switzerland using surface meteorological, synoptic scale, boundary layer height, and time variables to explain daily PM10 concentrations. The RF models were used to calculate meteorologically normalised trends which were formally tested and evaluated using the Theil–Sen estimator. Between 1997 and 2016, significantly decreasing normalised PM10 trends ranged between -0.09 and -1.16 µg m-3 yr-1 with urban traffic sites experiencing the greatest mean decrease in PM10 concentrations at -0.77 µg m-3 yr-1. Similar magnitudes have been reported for normalised PM10 trends for earlier time periods in Switzerland which indicates PM10 concentrations are continuing to decrease at similar rates as in the past. The ability for RF models to be interpreted was leveraged using partial dependence plots to explain the observed trends and relevant physical and chemical processes influencing PM10 concentrations. Notably, two regimes were suggested by the models which cause elevated PM10 concentrations in Switzerland: one related to poor dispersion conditions and a second resulting from high rates of secondary PM generation in deep, photochemically active boundary layers. The RF meteorological normalisation process was found to be robust, user friendly and simple to implement, and readily interpretable which suggests the technique could be useful in many air quality exploratory data analysis situations.
This study focused on the continuance usage intention toward online learning environments and also proposed and empirically tested an integrated model to better understand the determinants of ...students’ continuance intention to use these environments. For this purpose, variables which may have an effect on the continuance usage intention were examined and an “online continuance usage intention model” was revealed. When the variables of the hypothetical model were determined, Technology Continuance Theory, Information Systems Success Model, Cognitive Model and Information Systems Expectation Confirmation Model have been practiced on. Empirical data from 467 public university students who had used an online learning environment for the first time were tested against the proposed research model by using path analysis. The results indicated that, confirmation of the usage of online learning environments could be explained by information quality, system quality and service quality variables. 63% of the variance of the satisfaction variable was explained by information quality, system quality, service quality, confirmation, utilitarian value, outcome expectations and perceived value. Research results confirmed the propounded constructs of Information Systems Success Model and Information Systems Expectation Confirmation Model. In line with the obtained findings and results, some of the various suggestions were provided for the next studies and implementations.
•This study explores students’ intentions to continue using online learning environments.•We developed a continuance usage intention model for online learning environments.•Quality variables have significant effects on confirmation and satisfaction.•Confirmation has the strongest predictive effect on satisfaction.•Satisfaction has the strongest predictive effect on continuance intention.
Seawater intrusion into the Indus Delta, Pakistan, has spoiled groundwater aquifers in the area. In the delta, the groundwater is widely used by residents for drinking. Considering the gravity of the ...problem, and concerns expressed by affected communities, the present study was conducted to assess and map the quality of groundwater, based on the physico-chemical properties of 180 samples, using two standard numerical indices, geospatial and statistical techniques. The analysis of water samples revealed that several parameters exceeded the drinking water quality guidelines suggested by the World Health Organization (WHO). The water quality index (WQI) identified that about 1.7%, 1.1%, 27.8%, 42.8%, and 26.6% of the water samples were excellent, good, poor, very poor, and unsuitable for drinking purposes, respectively. However, the synthetic pollution index (SPI) ranked the quality of 2.8%, 2.2%, 23.9%, 41.7%, and 29.4% as suitable, slightly polluted, moderately polluted, highly polluted, and unsuitable, respectively. Though the numerical model’s input is different, the proportionate ranking revealed a fair correlation (
R
2
= 0.75) between the outcomes of both indices. The results of the numerical indices and the interpolated geographical information system (GIS) mapping revealed that the quality of groundwater in most of the delta does not meet WHO guidelines for potable water. Hence, it is recommended that the groundwater of the delta should be properly treated before its use for domestic purposes. The study highlights the significance of using numerical indices and geospatial techniques for water quality evaluation in the Indus Delta and similar deltaic regions throughout the world.
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