Management Working Group Research Articles

Readiness for Accreditation of the Administration and Management Working Group at the Basaan Community Health Center Southeast Minahasa Regency

The policy implemented by the Ministry of Health in an effort to improve the quality of services at first level health facilities, especially Community Health Centers, is to issue Regulation of the Minister of Health (Permenkes) of the Republic of Indonesia Number 46 of 2015 concerning Accreditation of Community Health Centers, Primary Clinics, Doctors' Independent Practice Places, and Doctors' Independent Practice Places. Tooth. The aim of the research is to describe the readiness for accreditation of the administration and management working group at the Basaan Community Health Center, Southeast Minahasa Regency. This type of research is qualitative research with a case study approach. The results of the research show that the Basaan Community Health Center for the Community Health Center Administration and Management Working Group in terms of Quality Improvement of the Community Health Center is ready for accreditation based on Community Health Center accreditation standards. The conclusion is that the Basaan Community Health Center for the Community Health Center Administration and Management Working Group in terms of Puskesmas Quality Improvement (PMP) is ready for accreditation based on community health center quality improvement standards.

A Case Study of Enterprise Risk Management Implementation and its Impact on Sustainability Performance in State Government-Linked Company

Enterprise Risk Management (ERM) is an approach that systematically assesses, treats, monitors, and reviews risks to enhance an enterprise’s value and its ability to anticipate and prepare for imminent risks. Previous studies have mainly focused on the impact of ERM implementation on financial performance, while its relationship with non-financial performance, particularly sustainability performance, has received less attention. This study aims to explore the level of ERM implementation and develop a framework to investigate its effect on sustainability performance, encompassing economic, environmental, and social aspects. The study proposes a questionnaire survey to be distributed to respondents involved in risk management implementation, such as the risk committee, risk management workgroup, and the top corporate risk working group, among state government-linked companies. By gathering insights on companies’ ERM implementation and sustainability performance, the study aims to conceptualize the relationship between the two. For data analysis, the statistical package for social sciences (SPSS) is proposed to investigate relationships between constructs and latent variables. Understanding the penetration level of ERM implementation and its impact on sustainability performance will offer valuable insights for formulating strategies to improve the overall performance of state government-linked companies.
 Keywords: enterprise risk management, sustainability performance, COSO framework, government linked companies

ANALYSIS OF THE APPLICATION OF PATIENT SAFETY CULTURE IN PRABUMULIH CITY HOSPITAL, SOUTH SUMATERA, INDONESIA

Prabumulih City Hospital Accreditation graduation predicate in 2019 which decreased from fully accredited to mid-accredited, where one of the working groups that had not passed was the facility management and safety working group with a score of 67.62. This is also supported by data from the results of recording patient safety incidents for 3 consecutive years from 2018 to 2020. Departing from this problem, the authors are interested in conducting research on "Analysis of the Application of Patient Safety Culture in Prabumulih City Hospital in 2021. " The purpose of this study was to determine and analyze the application of patient safety culture and the factors that influence patient safety culture at Prabumulih City Hospital in 2021. This research is a quantitative study conducted in June and July 2021 on employees of the Prabumulih City Hospital. The sample in this study amounted to 252 people. Sampling was carried out using the stratified random sampling method with the research instrument being a questionnaire. The data were tested using univariate analysis, bivariate chi-square, and multivariate logistic regression. The results of the chi-square test showed that there is a significant relationship between Patient Safety Culture and the 8 independent variables studied, while the variables are age, gender, education level, employment status, work experience, type of work, income, and resources. Based on the multivariate analysis, it was found that the dominant variable that most influenced the application of patient safety culture was the resource variable, with an ap value of 0.000 <0.05 and the largest OR value of 84.564 meaning that the resource variable had 84.564 times the opportunity to influence the patient safety culture at the Prabumulih Hospital in 2021. In conclusion, there is a significant and dominant relationship between the resource variable and the application of patient safety culture at the Prabumulih City Hospital in 2021.

Top Policy Issues: A Powerful, Passionate Journey

Top Policy Issues: A Powerful, Passionate Journey

Process of medical nutrition therapy

Medical nutrition therapy is a very useful tool in maintaining and recovering the health of patients with disease-related malnutrition, although its implementation can be complex and is not without risks. Quality processes are understood as sets of activities that are related or interact to transform input elements into results. From the SENPE Management Work Group we present the process of medical nutrition therapy (PMNT), which aims to facilitate the management of clinical nutrition of a multidisciplinary nutrition support team in a hospital setting. This paper describes the seven sub-processes PMNT is comprised of, in addition to a previous nutritional screening sub-process. Each sub-process is divided into a first section with a technical sheet detailing its general aspects, while a second section proposes key objectives, quality indicators, and standards for their evaluation. .

The Asian Cohort for Alzheimer’s Disease (ACAD) study

AbstractBackgroundAsian Americans and Asian Canadians (ASACs) are the fastest growing minority group in the US and Canada. Roughly 21% of ASACs will be 65 years or older by 2060, underscoring the importance to understand how dementia and Alzheimer’s disease (AD) affect these large sectors of the populace. By comparison, ASACs are under‐sampled in AD research. Culturally appropriate, community‐based approaches to recruit these understudied communities are urgently needed.MethodThe Asian Cohort for Alzheimer’s Disease (ACAD) will be the first large dementia genetics cohort to examine genetic/non‐genetic risk factors for AD among ASACs. Our clinical and community‐based participatory research (CPBR) scientists have a long collaborative history, experience and leadership in AD research. The National Institute on Aging (NIA) has resourced our study, which will leverage national AD research resources and facilitate collaborations with international cohorts.ResultACAD consists of 8 recruiting sites (6 US and 2 Canada), a coordinating site, an analysis site, and 4 active workgroups. ACAD has developed a data collection packet (DCP) and pre‐screening/sample collection procedures. The Data Management Workgroup has implemented them into a central REDCap database. The Outreach Workgroup has translated the forms and are conducting an outreach campaign into Chinese (Mandarin and Cantonese), Vietnamese and Korean. The Training Workgroup has developed a training curriculum for the administration of the DCP and for culturally appropriate approaches to recruitment. We will recruit cases of dementia, mild cognitive impairment, subjective cognitive complaint, and controls without cognitive impairment in collaboration with community partners, clinics, and nursing homes that serve Asian communities. We will collect saliva or blood for DNA/genetics and biomarker studies.ConclusionAfter launching ACAD in November 2020, we built foundation materials to initiate recruitment in Spring 2021. ACAD will provide guidance for future studies to explore ASAC risk factors for AD and related dementias. In collaboration with ongoing consortium efforts in Alzheimer’s Disease Genetics Consortium, trans‐ethnic insights from ACAD may identify potential novel, population‐specific therapeutic pathways for AD. Our long‐term goal will be to extend ACAD to South Asians, Filipinos, and Japanese.

TUTOR PERFORMANCE ON FACE TO FACE TUTORIAL IN THE PERSPECTIVE OF UPBJJ UT BANJARMASIN

The Open University regularly and continuously carries out internal and external audits of the academic administration process both at UT Central and throughout UPBJJ in Indonesia. From the results of monitoring the Face-to-Face Tutorial process carried out at UPBJJ Banjarmasin, especially for Bidikmisi students, it turns out that there are still shortcomings, mainly because of direct monitoring of the working group for the management of Face-to-face Tutorials is rather difficult due to limited funds and current regulations. From the results of the survey distribution and direct monitoring of researchers at the Banjarmasin pokjar as well as document analysis through the results of filling out questionnaires distributed to Bidikmisi students, it appears that there are still some shortcomings in the implementation of Face-to-face Tutorials. Some deficiencies can actually be avoided if the tutor is disciplined in carrying out the standard operating procedures that have been given to them during the briefing before the implementation of the activity. The limited ability of UPBJJ to monitor evaluations at the management working group for these activities means that there are still tutors who lack discipline, especially in the implementation and reporting of activities. There is also a shortage that is difficult to avoid, namely the lack of qualified tutors who are domiciled in areas near the working groups that partner with UT.

Clinical Considerations for Routine Auditory and Vestibular Monitoring in Patients With Cystic Fibrosis.

Purpose Specific classes of antibiotics, such as aminoglycosides, have well-established adverse events producing permanent hearing loss, tinnitus, and balance and/or vestibular problems (i.e., ototoxicity). Although these antibiotics are frequently used to treat pseudomonas and other bacterial infections in patients with cystic fibrosis (CF), there are no formalized recommendations describing approaches to implementation of guideline adherent ototoxicity monitoring as part of CF clinical care. Method This consensus statement was developed by the International Ototoxicity Management Working Group (IOMG) Ad Hoc Committee on Aminoglycoside Antibiotics to address the clinical need for ototoxicity management in CF patients treated with known ototoxic medications. These clinical protocol considerations were created using consensus opinion from a community of international experts and available evidence specific to patients with CF, as well as published national and international guidelines on ototoxicity monitoring. Results The IOMG advocates four clinical recommendations for implementing routine and guideline adherent ototoxicity management in patients with CF. These are (a) including questions about hearing, tinnitus, and balance/vestibular problems as part of the routine CF case history for all patients; (b) utilizing timely point-of-care measures; (c) establishing a baseline and conducting posttreatment evaluations for each course of intravenous ototoxic drug treatment; and (d) repeating annual hearing and vestibular evaluations for all patients with a history of ototoxic antibiotic exposure. Conclusion Increased efforts for implementation of an ototoxicity management program in the CF care team model will improve identification of ototoxicity signs and symptoms, allow for timely therapeutic follow-up, and provide the clinician and patient an opportunity to make an informed decision about potential treatment modifications to minimize adverse events. Supplemental Material https://doi.org/10.23641/asha.16624366.

Beyond return of spontaneous circulation: update on post-cardiac arrest management in the intensive care unit.

A well-functioning chain of survival is critical for good outcomes following out-of-hospital cardiac arrest, a major public health concern in Singapore. While the percentage of survivors to hospital admission has increased over the years, the percentage of survivors to hospital discharge and the number of patients with good neurological recovery can be greatly improved. This underscores the urgent need to focus on 'post-cardiac arrest care', the fifth link in the chain of survival, to improve the outcomes of patients who are admitted to the intensive care unit (ICU) after return of spontaneous circulation. This review builds on earlier recommendations of the Singapore National Targeted Temperature Management Workgroup in 2017 to provide a focused update on post-cardiac arrest management and a practical guide for physicians managing resuscitated patients with cardiac arrest in the ICU.

A case study of document readiness in the Administration and Management Working Group on accreditation results at Lalolae Health Center

ObjectiveThe results of the self-assessment assessment at the Lalolae Public Health Center which was the target of the 2017–2019 accreditation assessment in East Kolaka Regency showed that most of the low scores were in the administration and management group. This study aims to determine the relations between the readiness of accreditation documents in the Administration and Management Working Group on the accreditation results of the Lalolae Public Health Center in East Kolaka Regency. MethodsThis type of research is quantitative using a cross sectional design. The number of samples in this study were all people in charge of the administrative and management working group at the Lalolae Public Health Center who were determined by the purposive sampling method. This research was carried out from May 1 to July 20, 2020 and took place at the Lalolae Health Center. The sample in this study is 30 respondents. ResultsThere are 3 documents in chapter I that have unfulfilled categories, there are 4 documents in chapter ii that have unfulfilled categories, and there are 4 documents in chapter III that have unfulfilled categories. ConclusionThere is a relation between the readiness of accreditation documents in the administration and management groups to the results of accreditation of Public Health Center.

Figures of the Heart Failure Association: Professor Dr. med. Johann Bauersachs, Chair of the Clinical Science Section.

Figures of the Heart Failure Association: Professor Dr. med. Johann Bauersachs, Chair of the Clinical Science Section.

Surgical management of pectus excavatum in China: results of a survey amongst members of the Chinese Association of Thoracic Surgeons.

At present, there are no randomized trial or higher levels of evidence than case studies to guide thoracic surgeons in the field of thoracic deformities, typically for pectus excavatum. This study investigates the current clinical practices amongst the Chinese Association of Thoracic Surgeon (CATS) members in order to seek potential consensus and divergence. A web-based questionnaire was designed by a subgroup of CATS Pectus Excavatum Management Working Group and was sent to all of the CATS members. The questionnaire was composed of 27 questions concerning debatable sections, including preoperative evaluations, indications, timings of surgery, anesthesia and analgesia methods, rehabilitations. A total of 385 questionnaires were mailed to available CATS members. Moreover, 208 questionnaires were retrieved, of them 170 were finally available for analysis. Results of high consensus were extracted. Besides well-known factors such as complaints of symptoms, a moderate to severe deformity by physical exam, a Haller CT index >3.2, pulmonary function deviance, and cardiology evaluation abnormality, cosmetic requests and severe social-psychological problems from deformity come to be the most common reasons (17.34% and 56.89%) for PE patients' demands for surgery, and also occupy high percentages (49.41% and 89.41%) in indications of surgery. Concerning CT scan, 3D reconstruction of the chest is performed additionally by two thirds (64.12%) of the investigated cohort. Two surgeons out of three (66.47%) responders consider the optimal age for surgery is 6-12 years old. After the Nuss procedure, the majority of responders (79.41%) agree on the removal of the bar 2-3 years after surgery. To deal with complicated or severe deformities, 84.71% of surgeons utilize the double bar or multiple bar techniques. The majority of responders (92.35%) prefer general anesthesia combined with intubation in PE surgery, as well as in the procedure of the Nuss bar removal (72.35%). The survey reveals a remarkable consistency of practice patterns in several aspects. Adequate preoperative evaluations are needed. Cosmetic request and psychological discomfort from deformity are crucial indications for surgery. We had better perform PE surgery before patients' puberty and bar removal 3 years after surgery. Several surgical skills are fully debated to enhance orthopedic effect and diminish complications. General anesthesia combined with intubation is considered as a standard maneuver. Surgeons now pay more and more attention to perioperative rehabilitations. The given results can be used as evidence in guiding clinical practice in circumstances where no evidence of higher levels exists, although divergences exist. Future studies, especially randomized trials, are needed to establish clinical practice guidelines for thoracic surgeons in PE surgery.

Can the number of surgery delays and postponements due to unavailable instrumentation be reduced? Evaluating the benefits of enhanced collaboration between the sterilization and orthopedic surgery units

IntroductionThe development of outpatient surgery, cost-reduction pressures and instrumentation storage limitations have led to their use “just-in-time”. A recent study showed that stoppage of surgical procedures immediately before the incision (No-Go) was often due to the management of supplies and implantable medical devices. To our knowledge, since the development of outpatient surgery and the shortening of hospital stays, managing the flow of instrumentation has not been optimized. At our hospital, we used a two-prong approach consisting of a tool to manage instrumentation and working group from the sterilization and orthopedic surgery units. The aims of this study were to: 1) evaluate whether this approach led to better notification of the risk of supply shortage for instrumentation and 2) determine whether it could reduce by at least half operating room disruptions such as delays or cancellation of surgical procedures. HypothesisThis approach results in better notification of the risk of supply shortage for instrumentation and reduces by at least half operating room disruptions such as delays or cancellation of surgical procedures. Material and methodsA tool was developed to manage instrumentation flow based on a retrospective analysis of data from 2015. This tool consisted of: (1) a list of instrumentation needed for each surgical procedure from an analysis of the surgical schedule and verification of traceability labels of the instrumentation actually used, (2) a list of reasons for supply shortage identified from an analysis of non-conformities occurring in the sterilization process of instrumentation kits. These analyses resulted in the development of checklists for instrument sets for each procedure, while identifying those with a high risk of shortage. In 2017, a working group focused on instrumentation was set up with personnel from the sterilization unit and the orthopedic surgery unit. Based on the check-lists and the schedule 24hours before the surgery, the sterilization unit alerted the surgery unit by email of the risk of material shortage; the surgery ward replied with potential changes to the material or the surgery planning. This approach (instrumentation management tool and working group) was named just-in-time (JIT). The main outcome was the number of notifications of potential supply shortage with and without JIT over a 10-week period. The secondary outcomes were the number of notifications resolved in time and the occurrence of operating room disruptions (delay>30min or postponement of surgery) related to unavailable instrumentation. ResultsNine reasons for potential supply shortage were identified such as instrumentation kits used for several types of procedures, those with fast rotation and low stock, or in double pathways (on loan and on deposit). The working group reported 163 potential shortages with JIT versus 41 without (p<10−5), of which 150 (92.5%) were resolved. Thirteen operating room disruptions occurred; only one was not detected by the JIT approach. ConclusionOur JIT approach (instrumentation management tool and working group) is effective at preventing instrumentation supply shortages. Level of evidenceIII, prospective comparative study.

An Evaluation of a Multidisciplinary Pediatric Behavioral Health Medication Initiative Workgroup's Interventions on Medication Prescribing in a Population of Medicaid Patients.

In response to concerns surrounding pediatric behavioral health medication prescribing, the Massachusetts Medicaid Pharmacy Program implemented a Pediatric Behavioral Health Medication Initiative (PBHMI), proactively requiring prior authorization for specific behavioral health medications and combination regimens. A multidisciplinary therapeutic class management (TCM) workgroup retrospectively reviews complex cases and conducts prescriber outreach to encourage evidence-based practices in Massachusetts. To evaluate recommendation outcomes of telephonic peer-to-peer consultations conducted by the PBHMI TCM workgroup by assessing the percentage of accepted, modified accepted, or rejected recommendations, as well as prescriber satisfaction with consultation. This retrospective evaluation reviewed PBHMI TCM workgroup cases with completed peer-to-peer consultations from September 1, 2015, to August 28, 2016. The proportion of medication interventions (e.g., medication changes, dose reductions, and elimination of polypharmacy within or across behavioral health medication classes) accepted, modified accepted, or rejected were assessed based on pharmacy claims data and prior authorization resubmission, following a peer-to-peer consultation. The medication class and prescriber type were categorized in relation to the acceptance, modified acceptance, or rejection outcomes. Satisfaction with the TCM workgroup process was evaluated with an anonymous survey offered to prescribers who participated in prescriber outreach. A total of 70 cases requiring a peer-to-peer consultation by a TCM workgroup child/adolescent psychiatrist had a completed outreach attempt during the evaluation period. Peer-to-peer consultations resulted in a recommendation acceptance rate of 31.4% (22/70), modified acceptance rate of 44.3% (31/70), and a rejection rate of 24.3% (17/70). Recommendations made during a peer-to-peer consultation were rejected by 30% (12/40) of child/adolescent psychiatrists compared with 16.7% (5/30) of nonchild/adolescent psychiatrists with completed peer-to-peer consultations (P = 0.43). Antipsychotics were most frequently recommended for regimen changes. All recommendations pertaining to a benzodiazepine were accepted by the prescriber. Results of an anonymous prescriber survey assessing satisfaction with the peer-to-peer consultation process exhibited variable responses among individual prescribers. The small sample size in this observational evaluation and lack of a defined control group prevented direct associations between the endpoints and outcomes. Further research is required to determine if prescriber specialty and medication class may be influencing factors on recommendation acceptance. No outside funding supported this study. The authors have nothing to disclose. A poster of this project was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2017; March 27-30, 2017; in Denver, CO.

Assessing Impact of Coordinated Comprehensive Regional Extension Publications: A Case Study of the Southern Nursery Integrated Pest Management Working Group

In 2014, the Southern Nursery Integrated Pest Management (SNIPM) Working Group published both print and electronic versions of IPM for Shrubs in Southeastern U.S. Nursery Production: Volume I. Five hundred print books (of 3000 copies) were distributed to commercial ornamental growers and extension educators in return for their participation in a follow-up survey. The survey was administered to determine the value of book contents, savings that growers realized from using the book, perceived value of the book had users been asked to pay for it, and demographic information. The survey response rate was 46.2%, with respondents from 18 states. Of 243 respondents, 194 (79.8%) had used the book. Entomology information was most used and most useful, followed by plant pathology, weed science, and cultural information. Collective savings attributed to book use totaled $408,832/year for the 194 nurseries that used the book. Applying the use rate (79.8%) identified in this survey, this represents $5.62 million in savings per year for the 3000 printed books, of which 2394 are estimated to have been used. Savings varied by the type and size of operation. Larger operations had greater savings per year. Container growers saved $44.15/acre and field growers $28.37/acre. The price that growers were willing to pay for the book also varied by operation type and size. Extension educators and growers were willing to pay an average of $41.20, with an additional $0.063/acre for container growers and $0.126/acre for field growers. Return on investment for the U.S. Department of Agriculture grant funding for the project was $187.60 per dollar of funding. This survey demonstrates that collaborative efforts can produce high-value deliverables with significant regional and/or national impact.

Improving Insulin Administration Through Redesigning Processes of Care: A Multidisciplinary Team Approach.

This article describes a quality improvement project using a multidisciplinary team approach to improve the rate of errors of omission of preprandial subcutaneous coverage insulin orders. A Diabetic Management Work Group was created to evaluate the system processes that affect success and failure of timely administration and documentation of preprandial coverage insulin, commonly referred to as sliding scale coverage. Data before and after the project were collected to evaluate the effectiveness of a process change through the bar code medication administration system, in which preprandial coverage insulin order sets were changed to eliminate errors of omission and improve documentation. A review of 833 random blood glucose measurements with corresponding short- or rapid-acting insulin coverage orders was conducted. A mean error of omission rate of 23.4% was identified with respect to coverage insulin that was clinically indicated by provider-ordered insulin set but not administered or documented in the electronic medication record. After process redesign and implementation, 951 blood glucose measurements with corresponding insulin coverage orders were randomly reviewed, and a mean of 10.7% of omission rate for coverage insulin administration was identified. This represented a decrease in omission of coverage insulin by 54% compared with preprocess improvement. Decreased errors of omission as well as improved administration and documentation of coverage insulin were demonstrated by this multimodal process change. Scheduled standardized order sets, extensive nursing staff education, and enhanced efficiency of the existing process led to improved outcomes.

Pharmacotherapy for Weight Management in the VHA.

Weight management medications (WMM) are underutilized as an adjunct to behavioral and lifestyle interventions. In fiscal years 2014-2015, a total of approximately 2500 veterans-a mere 2% of veterans receiving care from the Veterans Health Administration (VHA)-eligible for a WMM received a prescription for one. A State of the Art Conference on Weight Management workgroup, focused on pharmacotherapy, developed evidence-based recommendations and strategies to foster the appropriate use of WMM in the VHA. The workgroup identified patient, prescriber, and health system barriers to and facilitators for prescribing WMM. Barriers included patient and provider concerns about medication safety and efficacy, limited involvement of primary care, restrictive medication criteria for use (CFU), and skepticism among providers regarding the safety and efficacy of WMM and the perception of obesity as a disease. Potential facilitators for removing barriers included patient and provider education about WMM and the health benefits of weight loss, increased engagement of primary care providers in weight management, relaxation of the CFU, and creation of a system to help patients navigate through weight management treatment options. Several research questions were framed with regard to WMM in general, and specifically to the care of obese veterans. While some of the workgroup's conclusions reflect issues specific to the VHA, many are likely to be applicable to other health organizations.

Fragmented participation in management of the fishery for small pelagic fish in South Africa – inclusion of small-rights holders is a complex matter

The reasons why most small-rights holders do not participate in management of the fishery for small pelagic fish (‘small pelagics’) in South Africa, despite legislation and policy encouraging their participation, were analysed. Membership of the Small Pelagics Management Working Group (SPMWG), the main participatory governance organ, is limited to representatives of recognised stakeholder associations. Rights holders therefore have to belong to a stakeholder association, which then selects a member or members to represent them on the SPMWG. Small quotas and the difficulties of sourcing capital mean that small-rights holders are not able to invest in infrastructure. Besides, most of the small-rights holders and their companies lack experience and management skills to survive independently in this highly competitive industry, which is based on high volume and low profit margins. As a result, most of the small-rights holders have no option but to enter into complex catching and processing agreements with vessel- and factory owners belonging to the existing recognised stakeholder associations. For the small-rights holders, it does not make sense to join these associations or even to form their own if they cannot actively participate in the industry independently. Greater participation by small-rights holders should start with their genuine integration into the industry through improved ability to invest in infrastructure and through management skills development. Most likely, this will require an interventionist approach by government.

An Online Plant Diagnostics Module for Extension Master Gardeners

The North Central Consumer Horticulture Integrated Pest Management Working Group developed an online learning module entitled, “Introduction to Diagnostics for Master Gardener Volunteers: Approaches to Plant Pest Diagnosis.” The module is online in the campus or learn section of eXtension and is composed of three parts: part 1 covers the difficulties in diagnosing plant problems; part 2 discusses how to gather the information necessary for the diagnostic process; and part 3 covers the Ohio State Fact Sheet, “20 Questions on Plant Diagnostics.” The self-paced module takes a minimum of 2 hours to complete, although participants have access to the information for 10 weeks. The module costs $10 and the income is distributed between the module author(s), the state which the Extension Master Gardener (EMG) is from, and eXtension. Within 11 months, 451 people purchased the training. Participants reported a higher comfort and knowledge level of diagnostics after taking the training.

Water management for sustainable steel industry

The Worldsteel Water Management Project was initiated in June 2007 with the aim to prepare steel plants for future public and political pressures relating to water. Following several meetings and a presurvey, a water management survey was launched in July 2009. Data were received from 29 steel plants, representing 8% or approximately 111 million tonnes of the world’s total steel output in 2008. Results show that water consumption (consumption within this article refers to: intake water, when a complete steelworks is in question and to actual water needed by the process or facility (intake+reuse water) when talking at process level) at the steel plants varies from under 1–150 cubic metres per tonne of steel (m3 ts−1) produced. The volume and quality of consumed and discharged water relate to steel plant configuration, geographical location and local legislation. Nearly 82% of all the water is used for once-through cooling. The data collected on for example, waste water treatment technologies and discharge quality are available in a digital database that can be used for, as an example, optimising water management within processes. This paper is based largely on the Worldsteel report ‘Water Management in Steel Industry 2011’ and outlines finding of the Water Management Working Group.