Highest Priority For Improvement Research Articles

Improving Endoscopy Nursing Staff's Patient Management Through the Implementation of an Education Initiative.

Endoscopic procedure areas have high-volume, fast-paced work environments. This practice requires a diverse range of knowledge and skills that are continuously changing with the evolution of high-acuity procedures and the shift toward routine use of anesthesia services. Endoscopy nursing staff have recently shown higher levels of stress and emotional exhaustion than their colleagues in similar practice settings. Patient management and recovery from anesthesia are identified by this group of nurses as a perceived stressor with high priority for improvement in competencies. Standardized education in collaboration with anesthesia services regarding these topics does not exist. As an improvement initiative, a standardized education guide was developed and implemented in an urban endoscopy unit situated within a Level 1 trauma center to improve nursing staff's patient management, knowledge, and readiness. Nursing knowledge was evaluated before and after the delivery of an educational presentation. Results demonstrated a substantial improvement in nursing knowledge and preparedness for complex procedures and high-acuity patients. Implementation of a similar standardized endoscopy nursing education guide has the potential to positively impact endoscopy nursing staff's knowledge and preparedness related to complex endoscopy patient care delivery, possibly relieving a source of stress for endoscopy staff and improving patient safety.

Investigation of improvement potential of a double-efficient CO2 cooling and heating system using an ejector with advanced exergy analysis

This paper presents an improvement potential investigation of a double-efficient CO2 cooling and heating system using an ejector, which can operate in cooling or heating mode. For the first time, advanced exergy analysis is employed to offer improvement direction and guidance for the practical application of this novel system. Compared to the conventional exergy analysis, which is widely used in previous work, advanced exergy analysis can supply more information about the interaction among components and the avoidable exergy destruction under the technical constrains. Thus, more practical and accurate conclusions can be drawn. The results reveal that 74.56 % of the total exergy destruction is endogenous in cooling mode, demonstrating the weak interaction among components. The compressor should be given the highest priority for improvement, due to its largest sum of avoidable exergy destruction (17.71 W). The effect of ejector component efficiency is also discussed. As it varies from 0.5 to 0.9, the system exergy efficiency rises from 11.59 % to 14.18 %. Furthermore, the proposed system shows great advantage with 31.31 % less exergy destruction compared to ejector expansion refrigeration cycle. In heating mode, the compressor also deserves to be optimized first. But the expansion valve possesses no effort for improvement due to its negative sum of avoidable exergy destruction (−1.203 W).

An Integrated Ordered Probit Model for Evaluating University Commuters’ Satisfaction with Public Transport

Transport policymakers need to have an in-depth understanding of public transport (PT) customers in order to effectively manage transport systems and maintain the attractiveness of these systems to potential users. This research aims to compare the perceptions and satisfaction levels of two groups of PT users (habitual and occasional) among university staff and students regarding the quality of PT through a new integrated approach. A sample of 500 participants from Budapest, Hungary was used. Two stages of analysis were conducted: a descriptive analysis was conducted in the first stage, and Student’s t-tests of two independent samples were applied to identify the varying perceptions and overall satisfaction. Second, a new integrated ordered probit model (OPM) and an importance–performance analysis (IPA) were used to envisage how best to prioritize actions for transport enhancement. The results show that in the circle of commuters, the habitual PT users were more satisfied with the existing PT service than the occasional PT users. According to the findings of the IPA, for habitual users, the attribute “information provided” has a high priority for improvement, whereas the cost for both user types was found to be significant for all models, contributing to overall satisfaction. This factor was included in the possible overkill quadrant, suggesting that there might be more cost resources than needed. The new model, along with the case study results, may help policymakers and transport operators to make better decisions regarding the identification of service priority areas.

Co-simulation-based conventional exergy evaluation of a hybrid energy generation-vanadium redox flow battery-air source heat pump system

A conventional exergy assessment approach permits determining the magnitudes of irreversibility that have happened within the investigated system components, which indicates the potential for improvement for these components. In this study, this approach was applied to a hybrid powered air source heat pump with vanadium redox flow battery system through co-simulated (solar photovoltaic and wind turbine) TRNSYS integrated with MATLAB Simulink) work. Due to the absence of a sophisticated VRFB model in the TRNSYS application, the battery model created in the Matlab Simulink environment was utilized and then summoned into the TRNSYS simulation studio by use of the TRNSYS utility model.Exergy destruction and exergy efficiency were used as performance criteria for evaluating the conventional exergy performance of the utilized components in the established co-simulation model. While yearly cumulative exergy destruction values ranged from 194.2 kWh for R to 23318.2 kWh for the PV field, annual average exergy efficiency amounts varied between 0.0494 for ASHP and 0.9345 for R. The PV field with the highest exergy destruction and relatively low exergy efficiency causing the highest improvement priority, but the opposite is true for power conditioning equipment, specifically IR and R.

Optimizing palliative care education through undergraduate nursing students' perceptions: Application of importance-performance analysis and Borich needs assessment model

BackgroundWith the aging of the population and the increasing trend of chronic illnesses, the demand for palliative care is growing. Undergraduate nursing students will be the main providers of palliative care in the future. Therefore, it's important to enhance their capability for palliative care. ObjectivesThe purpose of this study was to optimize palliative care education, based on undergraduate nursing students' perceptions and educational needs through the application of the importance-performance analysis and Borich needs assessment model. DesignA cross-sectional descriptive study. SettingNursing department in Wenzhou, China. ParticipantsA total of 448 full-time undergraduate nursing students were recruited for the study. MethodsImportance-performance analysis was used to identify items that obtain high priority for improvement, and the Borich needs assessment model and the Locus for focus model were used to prioritize educational needs. The three methods were integrated to determine the top-priority content to meet undergraduate nursing students' educational needs in palliative care. ResultsThe items located in Quadrant II of Importance-performance analysis, ranked in the first 10 in Borich needs assessment, and located in Quadrant I of the Locus for focus model were defined as top-priority content. These included: “respiratory symptoms: pleural effusion, superior vena cava syndrome, respiratory difficulty,” “Care of terminal symptoms,” “Awareness of dying,” “Care of remains,” “Cooperation between interdisciplinary teams,” and “Rights and interests of dying patients.” ConclusionSeveral years of development of palliative care education have made nursing students aware of its importance. However, they have reported that education remains insufficient. A greater focus on palliative care education is needed to ensure they are better prepared. Specific attention should be given to cooperation between interdisciplinary teams, dealing with death and dying, rights and interests of people who were dying.

PROPOSED IMPROVEMENT OF OCCUPATIONAL SAFETY HEALTH IN GAMELAN WIRUN PALU GONGSO INDUSTRY USING PARTICIPATORY ERGONOMICS APPROACH

Gamelan Wirun Palu Gongso Industry is one of the businesses in the informal sector that produces several gamelan instruments such as gong, bonang, and kempul that has not paid attention to occupational safety and health (OSH). Based on observations, there are unsafe behaviors and conditions, health problems, and accidents experienced by workers. This study aims to identify hazards in the workplace, determine the highest priority of hazards to be solved, and then provide recommendations for improvement based on the priority. A participatory ergonomic approach is used to solve the problems in this study. ILO-PATRIS Check Sheet is used to identify hazards in the workplace. The Delphi method determines the hazards with the highest priority for improvement. The Delphi method is a group of interaction processes between researchers and a group of experts identified on a particular topic, usually asking a question that allows a communication process to discuss complex problems but does not allow attending in one meeting. The result of the ILO-PATRIS Check Sheet shows 19 sub-aspects in the workplace that need improvements.

A Model of Satisfaction Promotion for Students of Hormozgan University of Medical Sciences in Iran

Background: Universities of medical sciences, as organizations that ensure the progress of society in the fields of health, treatment, and medical education, have been considered in many ways. The first important goal in these universities is student satisfaction and promotion strategies. Therefore, in this study we presented a model of satisfaction promotion among the students of Hormozgan University of Medical Sciences, Iran. Methods: The population of this applied quantitative research included students of Hormozgan University of Medical Sciences. A total of 380 people were selected by multi-stage cluster sampling. The data collection tool included a researcher-made questionnaire whose validity and reliability were confirmed. Decision making trial and evaluation laboratory (DEMATEL) method, importance-performance analysis (IPA), as well as MATLAB and Excel software were used for quantitative data analysis. Results: The results of IPA showed that the research dimension was of great importance for students and the performance of the university was appropriate in this dimension. Welfare and management dimensions were of little importance, but the performance of the university was high in these dimensions. The administrative component of this dimension was not very important and the university’s performance was not good in it. The support services dimension was very important for students’ satisfaction but the performance of the university was at a low level. As a result, support services had the highest priority for improvement and the welfare, managerial, educational, research and administrative dimensions were in the next ranks for improvement, respectively. The results of causal relationships between dimensions showed that the managerial dimension had the most interaction (impact and effectiveness), followed by research, welfare, education, supportive, and administrative dimensions. The management dimension was the most effective one. According to R-J values, educational and research dimensions were the most effective dimensions, respectively. Conclusion: The results of the present study showed that university policy-makers and administrators need to recognize the basic needs of students in various fields such as education, research, welfare, etc. before taking policy actions, decision-making, and future orientations.

Fair Practice Evaluation Model for Public Construction Projects: Focusing on the Korean Construction Market

Despite the importance of client’s role in securing public trust, fairness, and equity in all transactions within the construction market, little is known about the current state of fair trade practices committed by the clients in public construction projects. Therefore, this study proposes an evaluation model for assessing fair practice of public project clients in the Korean construction industry. Twenty-four indicators grouped into six categories were derived as an evaluation framework through literature review, media, and expert interview. A questionnaire survey was conducted to evaluate the performance of fair practice and derive the gap between perceived importance and performance of each indicator. A total of 95 responses was analyzed using gap analysis and importance-performance analysis (IPA) to reveal specific practices with the highest priority for improvement. Lastly, this study proposes a performance evaluation index (PEI) to quantitatively rate the score on fairness of public clients in Korea. This study provides a thorough insight on the forms of unfair practice in the Korean construction industry, of which the results would be especially useful for industry practitioners and policy makers to effectively deal with unfair practices in the construction industry.

Exergy destruction analysis of a low-temperature Compressed Carbon dioxide Energy Storage system based on conventional and advanced exergy methods

Compressed Carbon dioxide Energy Storage (CCES) system is a novel energy storage technology, which provides a new method to solve the unstable problem of renewable energy. Since the CCES system using low-temperature thermal energy storage can avoid the technical difficulties from high-temperature thermal energy storage, the low-temperature Compressed Carbon dioxide Energy Storage (LT-CCES) system has more obvious application feasibility compared with the high-temperature energy storage system. As the research on energy conversion, transfer, and loss in CCES system under low-temperature heat storage is still missing, while it is important to understand the energy losses for the further optimization of this kind of system, in this paper, the conventional exergy analysis and advanced exergy analysis were utilized to analyze the thermodynamic characteristics of a LT-CCES system consisting of CO2 Brayton cycle, low-temperature thermal energy storage and cold energy storage, whose thermal energy storage temperature is below 200 °C. As the advanced exergy analysis takes into account the correlation between system components as well as the technical limitations of each component, exergy destruction can be split into more detailed parts (i.e., avoidable exergy destruction, unavoidable exergy destruction, endogenous exergy destruction, and exogenous exergy destruction), which makes the results of the advanced exergy analysis different from those of conventional exergy analysis. The results showed that, advanced exergy analysis pointed out that HEX3 should be given priority as endogenous avoidable exergy destruction in HEX3 was the largest, while the results from the conventional exergy analysis showed that HEX1 should be given priority. For all the components, the two methods indicated that the compressor should be given the highest priority for improvement, followed by the turbine. Besides, as the total exergy efficiency of the system was 55.3% under the real condition and the total exergy efficiency was 76.7% under the unavoidable condition, there was still room for improvement of the system. In brief, based on the advanced exergy analysis method, the real component that should be paid attention can be determined, which gives the designers a more profound understanding of exergy destruction in the LT-CCES system.

A structural equation method for improving customer satisfaction of e-commerce websites using the hybrid approach of QFD and WebQual

The present study has provided a framework in order to improve the satisfaction of users of e-commerce sites using quality function deployment (QFD) and WebQual instruments. A structural equation model (SEM) has been developed in order to determine the significance of each aspect of the WebQual model and its significance weight. This study has evaluated the satisfaction of users with the quality of website content, transaction quality and security, usability and service interaction quality, and provided the solutions to improve these factors in form of the QFD method. Results showed the transaction quality and security has the highest priority for improvement. Among all the customers' requirements, the indicators such as a wide range of exchanges, preserving privacy, ease of transaction, the right format, ease of search, the usefulness of transactions, and finally the clear and understandable interactions should be placed in a higher priority for improvement by management.

A structural equation method for improving customer satisfaction of e-commerce websites using the hybrid approach of QFD and WebQual

The present study has provided a framework in order to improve the satisfaction of users of e-commerce sites using quality function deployment (QFD) and WebQual instruments. A structural equation model (SEM) has been developed in order to determine the significance of each aspect of the WebQual model and its significance weight. This study has evaluated the satisfaction of users with the quality of website content, transaction quality and security, usability and service interaction quality, and provided the solutions to improve these factors in form of the QFD method. Results showed the transaction quality and security has the highest priority for improvement. Among all the customers' requirements, the indicators such as a wide range of exchanges, preserving privacy, ease of transaction, the right format, ease of search, the usefulness of transactions, and finally the clear and understandable interactions should be placed in a higher priority for improvement by management.

Advanced exergy and exergoeconomic analysis of a novel liquid carbon dioxide energy storage system

In the present study a liquid carbon dioxide energy storage system with 10 MW output power production is analyzed thermo-economically by utilizing conventional and advanced exergy-based analysis. New exergy-based concepts such as unavoidable/avoidable and endogenous/exogenous exergy destruction, exergy destruction costs and investment costs as well as the combination of the two concepts are introduced to provide valuable knowledge about the interchanges among system components and the true latent capacity for improvement of each significant system component. It is demonstrated from the overall system analysis that the avoidable endogenous value is only 42.1% for total exergy destruction, 43.42% for total exergy destruction costs and 55.43% for total investment costs in the proposed system. Results from conventional exergy analysis suggest that the compressor contributes the utmost influence to the overall exergy destruction, while results from both the advanced exergy and exergoeconomic evaluation introduce the expander as the most significant component that has the highest improvement priority. In brief, the advanced exergy-based analyses can enhance engineers perception on the processes of energy conversion in the proposed system and also can improve the quality of the conclusions.

A Model for Prioritization of Improvement Opportunities Based on Quality Costs in the Process Interdependency Context

In this paper, the PAF (preventive-appraisal-failure) quality costs model is used on the process level, in order to identify those processes which are critical as a top-priority for improvement. The elements of quality costs are considered in relation to the outputs of the processes, where the principle that one process affects the quality of another process by its outputs is taken into account. That is why the failure costs of the affected processes should also be assigned to the quality costs of the observed process. Using the factors proposed in the Process cost model, costs are identified and calculated for each process for two moments: the current (before improvements) and desired (after improvements). Improvements are implemented on the basis of the causes of nonconformity analysis and according to the PAF model assumption that preventive and appraisal activities reduce failure costs and the total costs of quality. The difference between the total costs of quality in two observed moments is seen as the greatest possible quality cost reduction for the observed process. This value is used as a criterion for ranking the processes according to their priority for improvements, taking into account the assumption of the PAF model that greater costs mean lower quality and hence a higher priority for improvement.

One Health Surveillance: perceived benefits and workforce motivations.

One Health Surveillance (OHS) implements the One Health approach to improving health by collecting data and producing information to support integrated action across the animal health, human health and environment sectors. The purpose of this study was to survey the biosurveillance community to assess its OHS practices and capabilities, its attitudes towards OHS (perceived value), and the factors that motivate its members to implement OHS practices. The authors used a convenience sample of 185 professionals from multiple domains and 44 nations. They examined the extent to which these professionals implemented OHS, gathered their opinions on the value of OHS, assessed their perceptions of the capacity to perform specific OHS tasks and identified their priorities for change. Over 85% of all respondents said that they considered OHS to be beneficial, with no significant differences between work domains or country income groups; over 50% indicated that they already applied OHS. Obtaining access to data collected by other domains was both the most frequent challenge and the most difficult to improve. The highest priority for improvement was having the ability to send and receive electronic data. Respondents from low-income or middle-income countries were more motivated to make improvements than stakeholders from high-income countries. These findings provide a snapshot of current opinions and practices and, together with suggestions for improvements from professionals in the field, can help to target priority needs for OHS information, training and resources.

The effect of blood flow rate on dialysis recovery time in patients undergoing maintenance hemodialysis: A prospective, parallel-group, randomized controlled trial.

A majority of patients with end-stage renal disease (ESRD) on in-center hemodialysis (HD) require several hours to recover from an HD session. Patients and caregivers identify fatigue as a high priority for improvement. However, evidence for practical interventions to improve recovery time from conventional in-center HD is lacking. The effect of blood flow rate reduction on dialysis recovery time (DRT) is unknown. Multicenter, single-blinded, randomized, parallel-design controlled trial of blood flow rate reduction vs. usual care. One-hundred two patients with ESRD undergoing maintenance HD in 18 centers with baseline DRT of greater than 6 hours were included as subjects. The intervention was a blood flow rate reduction of 100 mL/min, to a minimum of 300 mL/min. The primary outcome was the between-group difference in change in DRT. Secondary outcomes were changes in London Evaluation of Illness (LEVIL) survey responses from baseline. Baseline median DRT was 720 (IQR 360-1013) minutes in controls and 720 (IQR 360-1106) minutes in the intervention group. DRT decreased in both groups. Mean change from baseline (95% confidence interval) at Week 4 in the study was -324 (-473, -175) minutes in the control group and -120 (-329, 90) minutes in the intervention group. The change from baseline was more profound in the control group (P = 0.05). Secondary outcomes of measures of quality of life reported on the LEVIL survey showed more improvement in patients' feelings of general well-being in the control group (P = 0.01). Differences between groups in pain, feeling washed out or drained, sleep quality, shortness of breath, and appetite were not statistically significant. Blood flow rate reduction did not improve DRT over usual care. Though more work needs to be done to address patient-reported fatigue, a significant positive impact may not be achieved without substantial changes in dialysis prescription.

Improvement of Cycleway by Evaluating Road Environment and Estimating Bicycle Traffic Volume

The bicycle is widely used in Japan by people of all age groups, with daily frequency, which may significantly ease traffic congestion and reduce toxic gas emission from vehicles. Because of the increase in the number of cyclists, it is necessary to improve and develop cycleways in Japan. This study concentrated on improving the cycleways by using both the bicycle compatibility index (BCI) and four-step model (FSM) to select the road segments with the highest priority for improvement in Kumamoto City, Japan. The BCI was used to evaluate the road environment for cycling according to the road characteristics and land use types by means of a statistical analysis and a classification of the main roads into six compatibility levels. The FSM estimated the bicycle traffic volume on the links of the road network by GIS, and the bicycle traffic volume was expressed by the thickness of lines. As a result, based on the combined results from the BCI and FSM, eight road segments were identified as those with the highest priority for improvement (low compatibility levels and high bicycle traffic volume).

Performance Improvement Potential Analysis of a Booster-Assisted Ejector Refrigeration System

This paper presents a performance improvement potential analysis of a booster-assisted ejector refrigeration system. Both conventional and advanced exergy analysis methods are used to obtain detailed information about the interactions among system components and the real improvement potential of the system. The results show that 61.6% of the system exergy destruction is caused by the components themselves. Furthermore, 55.5% of the overall exergy destruction can be avoided by improving component efficiencies. The ejector has the highest improvement priority, followed by the booster and the condenser. The influences of operational conditions on the ejector performance are also discussed. The avoidable exogenous part in ejector exergy destruction could be reduced by increasing the temperature of the motive flow, increasing the discharge pressure of the booster or decreasing the inlet water temperature in the condenser.

Conventional and advanced exergy analyses of an air-conditioning system in a subway station

Air-conditioning systems in subway stations consume a large amount of energy. In this study, conventional and advanced exergy analyses were carried out to determine the energy-saving potential of an air-conditioning system in a subway station. Results show that air handling unit (AHU) should be improved for the highest values of relative irreversibility (RI) with conventional exergy analysis, whereas the compressor should have the highest improvement priority for the largest avoidable exergy destruction with advanced exergy analysis. Moreover, influences of compressor efficiency, condensation temperature, and evaporation temperature on avoidable exergy destruction of the air-conditioning system were also investigated. According to the findings, compressor efficiency significantly influences the system's total avoidable exergy destruction. The lower the compressor efficiency, the more rapidly the avoidable exergy destruction of the compressor increases. Furthermore, the avoidable exergy destruction of condenser, compressor, cooling tower (CT), and cooling water pump (CWP) increases with the rise of the condensation temperature, whereas that of the evaporator, throttling valve (TV), condenser, compressor, CT, and CWP decreases with the rise of the evaporation temperature.

Indoor environmental quality (IEQ) of LEED-certified home: Importance-performance analysis (IPA)

Despite immense increase in the number of Leadership in Energy and Environmental Design (LEED)-certified homes since LEED for Home was launched in 2008, little is known about occupant satisfaction with the indoor environmental quality (IEQ) of LEED-certified homes. The purpose of this study is to examine the performance of IEQ in LEED-certified homes by measuring differences between occupant's perceived importance and performance using the importance-performance analysis (IPA) developed by Martilla and James [1]. A mail-in survey was conducted to evaluate the performance of 13 IEQs with residents living in LEED-certified homes in the Midwest. A total of 235 completed surveys were analyzed using gap analysis and both traditional IPA and alternative IPA matrices. The findings revealed that the highest priority for improvement should be given to temperature, air quality, and humidity as well as cleanliness and view. Daylight and artificial lighting did not show a performance gap. Acoustic quality was in low priority. The gap analysis and IPA matrices were effective tools to prioritize IEQs for improvement action and provide useful information for the future improvement of LEED-certified homes. By applying an IPA approach, this study provides a practical research framework that helps researchers examine the performance of green buildings and provides policy makers, building practitioners, and LEED professionals with more insightful feedback for their decision making on future green home projects and policies.

Individuals affected by eosinophilic gastrointestinal disorders have complex unmet needs and frequently experience unique barriers to care

Eosinophilic gastrointestinal disorders (EGIDs) are a rare but emerging healthcare problem. Patient advocacy groups (PAGs) have an important role in representing the EGID community, and serve as valuable research partners. By leveraging the partnership between medical researchers and PAGs, we examined the unmet needs and barriers to care perceived by individuals affected by EGIDs. Next, we examined if these varied between adult EGID patients and adult caregivers of children with EGID. Adult EGID patients and adult caregivers of children (<18 years) with EGIDs participated in this study. PAGs conducted focus groups comprised of individuals affected by EGIDs to identify domains and questions meaningful to the EGID community and this information was used to develop an online REDCap survey. The survey consisted of 58 questions across medical, healthcare, social, and emotional impact domains. It was distributed via the PAGs' web-based platforms. Demographic data, and responses to questions on a six-point Likert scale were collected and analyzed. Of the 361 responses analyzed, 90 (25%) were from adult EGID patients and 271 (75%) were from adult caregivers. Of the applicable responses, in the medical domain only 19% of participants indicated that repeated endoscopies to monitor response to treatment was convenient. In the healthcare domain, 67% indicated that lack of insurance coverage for elemental formula was a barrier. In the social domain, only 5% of respondents reported adequate awareness of EGIDs in schools. In the emotional domain, 64% had experienced significant stress due to EGID related out-of-pocket costs. Multivariate logistic regression revealed that some of these responses varied between adult EGID patients and adult caregivers of children with EGID. The respondents indicated highest priority for improvement in the medical domain compared to other domains. Individuals affected by EGIDs have a constellation of complex unmet needs and perceived barriers across medical, healthcare, social and emotional domains. Addressing unmet needs in the medical domain is relatively more important for the EGID community. Understanding unmet needs and barriers will likely help design improved patient-centered EGID care paradigms.