High Potential For Improvement Research Articles

Genetic parameters, prediction, and selection in a white Guinea yam early-generation breeding population using pedigree information.

Better understanding of the genetic control of traits in breeding populations is crucial for the selection of superior varieties and parents. This study aimed to assess genetic parameters and breeding values for six essential traits in a white Guinea yam (Dioscorea rotundata Poir.) breeding population. For this, pedigree‐based best linear unbiased prediction (P‐BLUP) was used. The results revealed significant nonadditive genetic variances and medium to high (.45–.79) broad‐sense heritability estimates for the traits studied. The pattern of associations among the genetic values of the traits suggests that selection based on a multiple‐trait selection index has potential for identifying superior breeding lines. Parental breeding values predicted using progeny performance identified 13 clones with high genetic potential for simultaneous improvement of the measured traits in the yam breeding program. Subsets of progeny were identified for intermating or further variety testing based on additive genetic and total genetic values. Selection of the top 5% progenies based on the multi‐trait index revealed positive genetic gains for fresh tuber yield (t ha−1), tuber yield (kg plant−1), and average tuber weight (kg). However, genetic gain was negative for tuber dry matter content and Yam mosaic virus resistance in comparison with standard varieties. Our results show the relevance of P‐BLUP for the selection of superior parental clones and progenies with higher breeding values for interbreeding and higher genotypic value for variety development in yam.

Results and Lessons Learned from Assessing 50 Industrial Parks in Eight Countries against the International Framework for Eco-Industrial Parks

Over the past two years the United Nations Industrial Development Organization (UNIDO) assessed 50 parks in eight developing and transition countries against 51 prerequisites and performance indicators outlined in the International Framework for Eco-Industrial Parks (International EIP Framework). The eight countries covered are: Colombia, Egypt, Indonesia, Nigeria, Peru, South Africa, Ukraine, and Viet Nam. This article provides a summary of the analysis and lessons learned from the assessments of the industrial parks and their performance against the International EIP Framework. The methodology is based on assessments of the current and intended performance of the industrial parks on four key categories (park management, environmental, social, and economic), supported by a scoring method. The analysis indicates that the International EIP Framework can be regarded as a practical and relevant means to assess the performance of industrial parks, as well as a basis to identify and prioritize EIP initiatives to strengthen their performance. There is a wide range of performance among the industrial parks assessed. Higher average current performance against the International Framework can be found in Colombia (68%), Indonesia (67%), and Viet Nam (63%). Ukraine and South Africa have the highest improvement potential (27% and 25%, respectively). Across all eight countries, the environmental and social performance categories have a lower compliance (34% and 44%, respectively) compared to economic performance (72% current compliance) and park management (55% compliance). A review of the root-causes indicates that the main compliance issue for 16 prerequisites and performance indicators outlined in the International EIP Framework seems mainly with the industrial park- and country-specific conditions. There is an opportunity to refine the formulation of five prerequisites and indicators outlined in the International EIP Framework. Across all 50 parks assessed, the following topics have the lowest current compliance: energy; local community outreach; environmental and park management and monitoring; waste and material use; and climate change and the natural environment. A low compliance with specific prerequisites and performance indicators under park management, economic, environmental, and social performance indicates a need by the industrial park for technical assistance. If high-performance industrial parks exist in a country, it implies that there is capacity in the country to develop an eco-industrial park. In this scenario, technical assistance should include a stronger focus on knowledge dissemination, sharing experiences, and peer-to-peer learning between industrial parks and the regulating authorities. Industrial parks managed by public–private partnerships and the private sector show a higher average EIP performance than industrial parks managed solely by the public sector. This seems to illustrate that industrial parks perform better if they are run like a private business or public–private partnership, rather than a government-managed initiative. This article is the first academic publication discussing the results from the application of the International EIP Framework with a large number of industrial parks in multiple countries. It is hoped that this article will encourage further EIP assessments to be undertaken in more industrial parks to assist in their transformation into eco-industrial parks.

Climate Adapted Façades in Zero-Waste and Cradle to Cradle Buildings – Comparison, Evaluation and Future Recommendations, e.g. in Regard to U-Values, G-Values, Photovoltaic Integration, Thermal Performance and Solar Orientation

The construction methods we are using today on a broad scale are highly unsustainable in regard to their resource efficiency. Fundamental improvements are necessary in order to change towards a more ecological future. The integration of reusable building components could be an adequate option to significantly reduce the ecological deficits we are facing today. The concepts of Zero-Waste and Cradle to Cradle are seen as viable solutions for the future. The few already existing Zero-Waste and Cradle to Cradle buildings are currently representing the most advanced construction standards of resource efficient design. In regard to their façades, however, there is still a high improvement potential. Therefore, methods have been elaborated within this research which demonstrates how the façades of Zero-Waste buildings can be strongly optimised. In particular, this research poses the question: with which interventions can we improve the performance of façades of Zero-Waste buildings? Which interventions are most important and how can we prioritize them? For example, which role does the insulation capacity of the building skin play in comparison to the building’s capability for natural ventilation and external shading? Within this paper, at first, the façades of selected existing Zero-Waste and Cradle to Cradle inspired buildings are examined and critically evaluated in regard to their u-values, g-values, photovoltaic integration, thermal performance and solar orientation. Furthermore, criteria such as sun exposure of glazed areas, natural ventilation capacity through façade openings etc. are investigated. Thereafter follows an assessment in the form of a list about which interventions could significantly improve the façade’s performance in regard to energy efficiency. The approaches include active strategies, such as improving the u-values, photovoltaic energy generation and passive strategies, such as enabling natural ventilation through the façade and external shading of sun exposed glazed areas. The selected case study buildings in Germany are “Aktivhaus B10” in Stuttgart by Werner Sobek, “Woodcube Building” in Hamburg by IfuH Architects and Architekturagentur, “ICON Rheinlanddamm” in Dortmund by William McDonough and Partners. In order to recommend which interventions are the best applicable in the relation between ecological performance and cost, the paper concludes with a prioritisation of the suggested improvement options. Overall, it demonstrates that the building’s overall energy performance can be significantly improved by adapting the façades towards a better implementation of passive strategies which take strong advantage of the project site’s individual climatic conditions.

Characterization of the Potential Recovery Residual Heat from the Exhaust Gases in a Small Diesel Engine Using Thermoelectric Generators

This study evaluates the effect of the operating conditions of a single-cylinder diesel engine on the performance and efficiency of a device to generate electrical energy through the recovery of residual heat from the exhaust gases. The studied device has been formed by coupling 20 thermoelectric modules on the surface of a rectangular heat exchanger. For the analysis, three experimental variables have been selected: engine torque, rotation speed, and temperature of the coolant, which have been varied under three different conditions. The results obtained show that the increase in the engine load generated by the increase in the rotation speed and torque causes an increase in the electrical power produced. The maximum power increase is 12% and 65% by causing changes in the rotation speed and torque of the engine. Similarly, reducing the temperature of the coolant increases the energy conversion efficiency. A decrease of 5 °C in the cooling water increases the overall performance of the device by 10%. The highest level of electrical energy recovered has been 38 W, with an efficiency of 2.4%. The reduced complexity of this type of device and its high potential for improvement makes it a viable way to recover thermal energy wasted by the transport sector.

Proxy indicators to estimate the appropriateness of medications prescribed by paediatricians in infectious diseases: a cross-sectional observational study based on reimbursement data.

BackgroundWe previously developed proxy indicators (PIs) that can be used to estimate the appropriateness of medications used for infectious diseases (in particular antibiotics) in primary care, based on routine reimbursement data that do not include clinical indications.ObjectivesTo: (i) select the PIs that are relevant for children and estimate current appropriateness of medications used for infectious diseases by French paediatricians and its variability while using these PIs; (ii) assess the clinimetric properties of these PIs using a large regional reimbursement database; and (iii) compare performance scores for each PI between paediatricians and GPs in the paediatric population.MethodsFor all individuals living in north-eastern France, a cross-sectional observational study was performed analysing National Health Insurance data (available at prescriber and patient levels) regarding antibiotics prescribed by their paediatricians in 2017. We measured performance scores of the PIs, and we tested their clinimetric properties, i.e. measurability, applicability and room for improvement.ResultsWe included 116 paediatricians who prescribed a total of 44 146 antibiotic treatments in 2017. For all four selected PIs (seasonal variation of total antibiotic use, amoxicillin/second-line antibiotics ratio, co-prescription of anti-inflammatory drugs and antibiotics), we found large variations between paediatricians. Regarding clinimetric properties, all PIs were measurable and applicable, and showed high improvement potential. Performance scores did not differ between these 116 paediatricians and 3087 GPs.ConclusionsThis set of four proxy indicators might be used to estimate appropriateness of prescribing in children in an automated way within antibiotic stewardship programmes.

Productivity, acylsugar concentrations and resistance to the two-spotted spider mite in genotypes of salad tomatoes

ABSTRACT The objective of this study was to characterize genotypes of the salad-type tomato with a determinate growth habit and select genotypes resistant to the two-spotted spider mite for higher productivity and fruit quality. The experiment was conducted at the Horticultural Experimental Station (18°42’43.19” S and 47°29’55.8” W, 873 m altitude) of the Universidade Federal de Uberlândia (UFU), Monte Carmelo campus, from January to June 2018. The experimental design was in randomized blocks containing 16 treatments [12 populations of the F3RC2 generation and four controls: two commercial cultivars (Santa Clara and Rio Grande), the recurrent parent (UFU-057) and the wild species Solanum pennellii (LA-716)] with three repetitions. The accessions UFU-057F3RC210#3.6.1 and UFU-057F3RC213#2.1.2 have high potential for genetic improvement regarding resistance to the two-spotted spider mite. The genotypes UFU-13#4.4.1, UFU-7#4.7.1, UFU-7#4.3.2, UFU-13#2.5.2 and UFU-13#2.1.3 present higher acylsugar concentrations than S. pennellii, in addition to higher productivity and number of fruits per plant. It is suggested to explore combinations between those genotypes previously described with UFU-8#2.4.1 to obtain hybrids with high acylsugar concentrations, two-spotted spider mite resistance, high productivity and increased fruit mass.

Urban land use efficiency and improvement potential in China: A stochastic frontier analysis

With economic growth facing increasing constraints of resource and environment, intensive land use becomes one of the effective ways to promote urban sustainable development. This paper aims to reveal the spatial and temporal differences in urban land use efficiency (ULUE) in provincial China, and examine the impact of undesirable output (e.g., industrial pollutant emissions) on ULUE using a one-stage stochastic frontier analysis (SFA). Furthermore, we analyze the improvement potential of ULUE. Results show that 1) ULUE in China is relatively low, and it shows a trend of slow growth at an annual growth rate of 0.34 %. 2) Undesirable output causes a loss of ULUE. The loss ratio in the western region is the highest (9.61 %), followed by the central region (8.41 %) and the eastern region (3.93 %). Estimation results of the technical inefficiency function also show that pollution intensity has a negative effect on ULUE. 3) ULUE varies significantly across the country. The mean efficiency values in the eastern, central, and western regions are 0.733, 0.535, and 0.507, respectively. ULUE levels in different provinces present a greater gap when undesirable output is considered. 4) The improvement potential analysis indicates a mismatch between the ULUE and the improvement potential. Areas with low efficiency does not necessarily have relatively high improvement potential (e.g., Ningxia and Xinjiang), or areas with relatively high efficiency may also have high improvement potential (e.g., Fujian and Shandong). Based on the difference in ULUE level and its improvement potential, targeted policy suggestions for ULUE improvement are further proposed.

Using vehicle data as a surrogate for highway accident data

Many studies have tried to use the surrogate safety measures (SSM) estimated from the microscopic traffic simulations. However, it is difficult to adopt these developed SSM to reflect real-world traffic conditions when the developed network in the simulation is not calibrated and validated accordingly. This paper proposed a method to develop the pattern-based surrogate safety measure (PSSM) using individual vehicle trajectory data. The PSSM can be estimated based on the pattern of hazardous driving behaviour (HDB). Using digital tacho graph data collected from the commercial vehicles, HDB patterns were obtained. Various PSSMs were developed and validated with the observed crash data using Random Forest. Then, the surrogate safety performance function was estimated based on the frequency of HDB. To enhance model performance, machine learning and data mining techniques were applied. The results show that sudden deceleration, sudden lane change, sudden overtaking and sudden U-turn are related to traffic crashes during HDB. The results also show that high potential for safety improvement was identified in the road section linking the urban and suburban areas. The findings from this study can provide new approach to adopt real-time individual vehicle trajectory data to evaluate safety performance of network levels.

Performance improvement of solar bakery unit by integrating with metal hydride based solar thermal energy storage reactor

Storage of solar thermal energy is an effective way to overcome the issue of incompatibility between the solar system and its users. This paper proposed a novel perception by integrating a metal hydride based thermochemical energy storage (MH-TES) system with a solar bakery unit (SBU). A numerical simulation was performed by using COMSOL MULTIPHYSIS 5.3a to assess the dynamic behavior of the reactor. The results showed that the high-temperature metal hydride (HTMH) reactor during the discharging process has a high improvement potential rate (0.195 kW), a high exergetic factor (59.97%) and low exergy efficiency (30.25%) as compared to HTMH reactor during the heat charging process. The overall exergy efficiency of the HTMH reactor was estimated as 34.03%. The maximum value of energy output (Qout), exergy output (Exout), gravimetric exergy output rate (GEOR) and gravimetric efficient heat output rate (GEHOR) during discharging period was calculated as 1560 W, 174 W, 7.4 W/kg and 66 W/kg, respectively. The energy efficiency of SBU is improved from 6% to 42.89% by integrating with the MH-TES system. This paper presents a comprehensive approach for thermal analysis of HTMH for the solar bakery system, which contributes to system optimization for efficient solar energy storage.

Proxy indicators to estimate appropriateness of antibiotic prescriptions by general practitioners: a proof-of-concept cross-sectional study based on reimbursement data, north-eastern France 2017.

BackgroundIn most countries, including France, data on clinical indications for outpatient antibiotic prescriptions are not available, making it impossible to assess appropriateness of antibiotic use at prescription level.AimOur objectives were to: (i) propose proxy indicators (PIs) to estimate appropriateness of antibiotic use at general practitioner (GP) level based on routine reimbursement data; and (ii) assess PIs’ performance scores and their clinimetric properties using a large regional reimbursement database.MethodsA recent systematic literature review on quality indicators was the starting point for defining a set of PIs, taking French national guidelines into account. We performed a cross-sectional study analysing National Health Insurance data (available at prescriber and patient levels) on antibiotics prescribed by GPs in 2017 for individuals living in north-eastern France. We measured performance scores of the PIs and their case-mix stability, and tested their measurability, applicability, and room for improvement (clinimetric properties).ResultsThe 3,087 GPs included in this study prescribed a total of 2,077,249 antibiotic treatments. We defined 10 PIs with specific numerators, denominators and targets. Performance was low for almost all indicators ranging from 9% to 75%, with values < 30% for eight of 10 indicators. For all PIs, we found large variation between GPs and patient populations (case-mix stability). Regarding clinimetric properties, all PIs were measurable, applicable, and showed high improvement potential.ConclusionsThe set of 10 PIs showed satisfactory clinimetric properties and might be used to estimate appropriateness of antibiotic prescribing in primary care, in an automated way within antibiotic stewardship programmes.

Strength Enhancement and Lead Immobilization of Sand Using Consortia of Bacteria and Blue-Green Algae

Abstract Metabolites generated from microorganisms have a high potential for the strength improvement and contaminant remediation of soils. The consortium of naturally available bacteria and microa...

Advanced Exergetic Analysis of a Double-Effect Series Flow Absorption Refrigeration System

Abstract This paper contains theoretical results of an advanced exergy study of a double-effect series flow absorption refrigeration cycle. Traditional second law of thermodynamics analysis was performed and revealed the absorber as the component with the highest exergy destruction of the system. In the evaporator, ≈49.34% of the exergy destruction is avoidable and almost in it’s entirety, ≈99.12% is of endogenous nature. The highest potential for improvement of the high-pressure generator is its design and manufacture because ≈67.47% of the endogenous exergy destruction is avoidable. A parametric study was presented to discuss the sensitivity of splitting exergy destruction concepts taking into account temperature variations in the absorber and condenser temperatures and the heat source temperature.

Identification of leading hazardous waste generating industries with high improvement potential in Spain

This paper employs Economic Input-Output Life Cycle Assessment and Data Envelopment Analysis to attribute total (direct and indirect) hazardous waste generation to the different industries and to connect total hazardous waste generation to the value added generated by each industry in Spain. In difference with previous studies we include all the industries of the economy and we focus on one specific type of environmental burden: the generation of hazardous waste. The results show that there is a very high concentration in total hazardous waste generation: only three industries accounted for almost 80% of total hazardous waste generation. This concentration also affects the type of hazardous waste generated. Thus, we find two main types of waste that account for 93% of total hazardous waste. Overall, the greatest hazardous waste generating industries are also the least efficient ones and exhibit a high improvement potential. Prevention measures directed to these industries should be implemented.

The Use of Life Cycle-Based Approaches in the Food Service Sector to Improve Sustainability: A Systematic Review

With the prevalence of eating out increasing, the food service sector has an increasing role in accelerating the transition towards more sustainable and healthy food systems. While life cycle-based approaches are recommended to be used as reference methods for assessing the environmental sustainability of food systems and supply chains, their application in the food service sector is still relatively scarce. In this study, a systematic review was conducted to examine the use and effectiveness of life-cycle based interventions in improving the sustainability of food services. This review found that life-cycle based approaches are not only useful for identifying hotspots for impact reduction, but also for comparing the performance of different sustainability interventions. In particular, interventions targeting the production phase, such as promoting dietary change through menu planning in which high-impact ingredients (e.g., animal products) are replaced with low-impact ingredients (e.g., plant foods), had the highest improvement potential. Interventions targeting other phases of the catering supply chain (e.g., food storage, meal preparation, waste management) had considerably lower improvement potentials. This review article provides valuable insights on how the sustainability of the food service sector can be improved without the burden shifting of impacts, which interventions to prioritise, and where knowledge gaps in research exist. A key recommendation for future research is to focus on combined life cycle thinking approaches that are capable of addressing sustainability holistically in the food service sector by integrating and assessing the environmental, social and economic dimensions of interventions.

An integrated mathematical model for production scheduling and preventive maintenance planning

PurposeThe integration between production scheduling and maintenance planning is attracting the attention of planners in the manufacturing sector with the increase in global competitiveness. Researchers have developed various methodologies to optimize integrated decisions in planning and scheduling, including mathematical modeling under different conditions. This paper considers the simultaneous scheduling of production and maintenance activities with the objective of minimizing the expected total tardiness cost on a single machine (production line).Design/methodology/approachScheduling in these two types of activities, production and maintenance, are traditionally done independently, causing conflicts between the two functional areas. To eliminate or at least reduce conflicts, the scheduling of both activities can be done simultaneously with the objective of meeting due dates and maintaining maximum machine availability. In this paper, a mathematical model for an integrated problem is developed and demonstrated by an example.FindingsThe proposed integrated model shows a high potential for significant improvements in performance with respect to the cost of tardiness in delivery and machine availability. This is demonstrated by an example showing an average savings of approximately 40%.Originality/valueThis substantial saving is owed to the integration of two important decision-making processes in manufacturing systems. Although the integrated problem is complex and difficult to solve, the fact that it is savings driven makes the problem of interest to researchers and practitioners in manufacturing.

Genetic improvement of indigenous Greek sheep and goat breeds

The objective of the study was twofold: (i) to review the genetics of production and resilience traits of indigenous Greek small ruminant breeds as well as the evolution of national breeding programs, and (ii) explore innovative and feasible approaches to overcome the challenges and constraints towards improving these breeds and enhancing the sustainability of the small ruminant sector. Previous studies on the genetic basis of production and resilience traits of indigenous breeds revealed high improvement potential. However, the lack of follow-up action has failed to produce applicable results. Thus, implementation of scientific findings in existing breeding programs for these breeds is extremely limited. The latter has contributed to the overall poor success of such programs. Furthermore, due to the fact that most farmers do not comprehend the strategic importance of genetic improvement and lack motivation for self-funding, breeding programs have mostly relied on European or government funding; the latter has resulted in intermittent implementation. Therefore, most programs failed to improve performance of indigenous Greek breeds, many of which were consequently replaced by foreign breeds of higher productivity and documented merit. In order to facilitate the design of breeding schemes and overcome the challenges towards improvement of indigenous breeds, an integrative approach is necessary. The latter should be based on identification of specific breeding objectives, reflecting the priorities and needs of the sector, as well as the capacity of the indigenous populations. Scientific advances exemplified by genomic selection and novel reproductive technologies will enable faster and more effective genetic improvement. The overall approach is expected to enhance the competitiveness of indigenous Greek small ruminant breeds and the sustainability of the sector.

Parametric study of absorption refrigeration with vapor compression refrigeration cycle using wet, isentropic and azeotropic working fluids: Conventional and advanced exergy approach

Advanced exergy analysis was carried out for absorption-compression refrigeration-cycles with a working fluid selection and parametric analysis. The exergy-destruction was split into endogenous-exogenous and avoidable-unavoidable-parts to reveal the interdependency within the components and determine the improvement potential. The results show that the largest exergy-destruction occurs in the generator, accounting for 53.8% of the total destruction. The largest irreversibility occurs for R507a/NH3–H2O while the lowest destruction occurs for R152a/NH3–H2O with an approximate reduction of 0.62 kW. The largest irreversibility occurs in the azeotropic-fluids while the lowest occurs in wet fluids. More than one-half of overall exergy-destruction rates of the systems falls into the part of the avoidable-destruction with 52.5% of overall irreversibility. The major part of the avoidable-destruction occurs in the generator with 11.47 kW and it accounts for 57.8% of the total avoidable part, meaning that it has the highest improvement potential. The parametric analysis of the advanced exergy shows that the avoidable-part of the exergy-destruction can be minimized to a considerable extent employing a temperature of the condenser below 40 °C and generator temperature larger from 100 °C.

Entwicklung eines Indikatorensets zur Evaluation der Integrierten Versorgung Gesundes Kinzigtal

IntroductionThe project “INTEGRAL−10-year evaluation of the population-based integrated health care model ‘Gesundes Kinzigtal’ (Healthy Kinzigtal)” (ICM-GK) is funded by the Innovation Committee of the Federal Joint Committee (G-BA) (grant no. 01VSF16002). The evaluation is to be based on a set of indicators that can be captured in routine data. On the one hand, they can be used to assess ICM-GK programs that are program-specific and geared towards prevention and disease management. On the other hand, possible negative side effects of the ICM-GK, which is designed as a “shared savings contract”, are to be examined by also observing care needs not covered by the ICM-GK contract. Since an indicator set for the evaluation of regional integrated care (IC) programs in Germany is not yet available, a suitable indicator set should be developed. Methods1.Defining a methodological framework for the development of indicators based on concepts from the literature2.Searching for potential quality indicators (QIs) a) in the literature (PubMed, Web of Science, Cochrane, Embase) and b) in indicator databases3.Conducting document analysis of the ICM-GK programs4.Conducting focus groups with patients, doctors and ICM-GK stakeholders5.Merging QIs from the various sources, removing duplicates, comparing the indicators with the data basis of routine statutory health insurance data6.Allocating indicators to disease categories, care needs and quality dimensions according to OECD and Donabedian7.Evaluating and consenting the indicators by a multidisciplinary group of experts using the modified RAND-UCLA Appropriateness Method (RAM) based on the relevance and feasibility of the indicators ResultsThe methodological framework links the OECD concept for quality assessment of health systems with Kessner's tracer methodology. Disease groups with a high prevalence (“common diseases”), prevention potential and potential for improvement through IC were selected as tracers. The literature search resulted in 239 QIs and the QI database search in 293 QIs, which were supplemented by 21 QIs from the focus groups. Out of a total of 553 QIs, 251 QIs remained after removal of duplicates and comparison with the data basis. This preliminary QI set was reduced to 101 QIs by consensus. In addition, 48 health reporting indicators were supplemented which serve to classify regional quality results. The final QI set maps the following 19 disease categories/tracers: heart failure (16 QIs), myocardial infarction (4 QIs), CHD (10 QIs), stroke (6 QIs), metabolic syndrome (7 QIs of which 5 were diabetes-related), COPD (6 QIs), asthma (3 QIs), chronic pain (5 QIs), back pain (3 QIs), geriatrics (7 QIs), dementia (8 QIs), osteoporosis (3 QIs), rheumatism (3 QIs), multiple sclerosis (2 QIs), depression (4 QIs), antibiotic therapy (3 QIs), drug safety (1 QI), child care (5 QIs), early detection/prevention (5 QIs). 33 of these QIs are dedicated to five tracers that are not explicitly ICM-GK programs. Most QIs assess aspects of the effectiveness of care for the chronically ill and measure process quality. DiscussionThe set of indicators initially enables the quality assessment of regional, cross-indication care quality in the population-based integrated health care model ‘Gesundes Kinzigtal’ on the basis of routine data. Although the QI set focuses on effectiveness and process quality, it also includes QIs for preventive and acute care, coordination of care, patient orientation and safety, and outcomes. In contrast to other QI sets, both primary care and specialist health care and integrated, cross-sectoral and cross-professional care aspects have been considered. The benefits of the QI set for comparisons of regional quality and the evaluation of different IC programs remain to be tested. ConclusionOn the basis of a broadly based research and participatory development process, a set of indicators has been developed that enables comprehensive evaluation of the regional quality of care of cross-indication, integrated care models focusing on common diseases. In order to be able to increasingly evaluate aspects of care coordination and patient orientation, health promotion as well as nursing, palliative and emergency care in the future, it would be helpful if routine data were collected or made accessible in these areas as well.

In-Hospital Cardiac Arrests: Potential for ECPR

In-hospital cardiac arrests (IHCA) have a poor survival. We studied IHCAs occurring over two years in order to identify subset of patients in whom extracorporeal cardiopulmonary resuscitation (ECPR) will have most favorable impact. We retrospectively analyzed patient charts for 2017 and 2018 in a tertiary hospital and examined survival to return of spontaneous circulation (ROSC) to determine characteristics and predictors of survival and find the areas best suitable for ECPR. Due to non-normality of distribution of most variables, we have compared continuous variables by the Mann-Whitney U test. Categorical variables were compared with the Chi square test and expressed as counts and percentages. Of the 710 codes in 572 patients, 543 (76.5%) codes resulted in ROSC, but only 199 (28%) patients were discharged alive. Mean age was 59.7±15.5 years. Mean duration of the code was 22.8±19.0 minutes. Out of 710 total codes, 409 (57.5%) codes occurred in the intensive care unit (ICU) or the cath lab, with 80% of those codes surviving to ROSC, 138 (19.4%) in telemetry (72.5% surviving to ROSC), 87 (12.3%) in the emergency room (survival 69%). Only 76 (10.7%) arrests occurred in unmonitored wards and still, 73.7% of those codes survived to ROSC. Only 189 (26.6%) codes had initial shockable rhythms (survival to ROSC 85.7%), while 410 (57.7%) arrests had pulseless electrical activity (PEA) as an initial rhythm and 109 (15.4%) arrests started asystolic, survival to ROSC 73.4% and 72.7%, respectively, p<0.05 when compared with shockable rhythm. When categorizing etiologies of arrest, cardiac emergencies make up 247 (34.8%) of all codes with 80.6% surviving to ROSC, similar to medical emergencies and better than any other diagnostic category, p<0.05. 164 codes (23.1%) occurred secondary to sepsis, and terminal diseases come in third with a 72% survival in both. Medical emergencies caused only 52 codes (7.3%) but had a code survival of 82.7%. Medical and cardiac emergencies represent reversible conditions have the highest potential for improvement in outcomes. Consideration of ECMO during the code should be primarily focused on cardiac and medical emergencies, especially if they occur in the cath lab or in the intensive care unit, followed by telemetry and emergency room. Survival is poor in patients with sepsis, and caution should be used when considering ECPR in this subset.

ASSESSMENT OF ENERGY EFFICIENCY OF CUSTOMER CARE BUILDINGS OF TELECOMMUNICATIONS COMPANIES IN SELECTED TOWNS IN NIGERIA

The importance of energy to human development cannot be overemphasized as it is a key determinant of economic development of all nations. However, the supply of energy has hardly ever been sufficient to meet up with the ever increasing demands exerted by multiplying population and industrialization. Buildings are accountable for nearly 40% of the total global annual energy consumption most of which is used for lighting and air conditioning. With the building sector having a relatively high potential for energy efficiency improvements compared to other sectors, this research therefore assessed the energy efficiency of the customer care buildings of telecommunication companies in selected towns in north-west Nigeria. This was done by finding out where and how energy is being used in the buildings by estimating the energy consumption of the buildings through assessment of the energy bills and a preliminary energy audit and benchmarking with set standard. Descriptive statistical analyses was done and it was found that 85.71% of the buildings have their HVAC systems consuming over 50% of their total energy with an average consumption of 74.58% per year. Also 57.14% of the buildings have higher energy use and energy use intensities than the benchmarks. It was concluded that the major energy consuming systems are the HVAC and lighting. It is therefore recommended that grid electricity which is the main source of energy to the buildings should be stabilized; while greater advantage should be taken of passive ventilation and cooling rather than mechanical HVAC systems.