Quality Performance Indicators Research Articles

Appraisal of six sigma in pre-analytical phase of clinical biochemistry laboratory

Objectives: The aim of the study is to measure the performance of pre-analytical phase of a clinical biochemistry laboratory using sigma metrics and the six sigma scale. Materials and Methods: The study included documented data of blood sample rejection from March 2023 to February 2024 and follow-up data from March 2024 to August 2024. International Federation of Clinical Chemistry and Laboratory Medicine developed Quality Indicators (QIs) used are QI-9 Wrong tubes; QI-10 Hemolyzed samples; QI-11 Clotted samples; QI-12 Insufficient samples; QI-14 Damaged samples in transport; and QI-15 Mislabeled samples. Based on “Six Sigma Quality Design and Control” established by Dr. Westgard, the sigma metric was calculated for the above-mentioned QIs. Statistical analysis: Obtained data were entered and analyzed using Microsoft Excel 2021. Results: Out of 162,380 received samples, 547 samples were rejected as not satisfied with the sample acceptance criteria. The most common pre-analytical error in the observed QIs is hemolyzed samples (458), followed by insufficient sample volume (55). The Sigma score of QI-10 was determined to be 4.81, whereas QI-9, QI-11, QI-12, and QI-15 were well maintained and graded excellent. Following training sessions, the follow-up month revealed a sigma score of 4.98 for QI-10. Conclusions: Six sigma metrics are a competent means to measure the performance of pre-analytical QIs in a clinical biochemistry laboratory. The observed QIs were effectively managed (>4 σ).

The synthesis of logistics performance and technological innovation on environmental quality

PurposeThis study aims to examine the impact of logistics performance and technological innovation on environmental quality in Africa, focusing on carbon dioxide (CO2) emissions and renewable energy consumption as indicators of environmental quality.Design/methodology/approachThe study employs a panel data analysis of 43 African countries over the period 1990–2021. Data on logistics performance, technological innovation, CO2 emissions, and renewable energy consumption are sourced from the World Development Indicators database of the World Bank. Grounded in the Triple Bottom Line (TBL) framework, which integrates economic, social and environmental dimensions of sustainability, the analysis utilises the generalised method of moments (GMM) technique to address the issue of endogeneity.FindingsThe regression results reveal significant relationships between logistics performance, technological innovation and environmental quality indicators. Logistics performance demonstrates a negative impact on CO2 emissions, while technological innovation positively influences renewable energy consumption. The interactive effect of logistics performance and technological innovation mitigates CO2 emissions, aligning with the TBL framework’s environmental dimension by promoting sustainability. Furthermore, trade openness exhibits a significant negative effect on both CO2 emissions and renewable energy consumption. The findings highlight the potential synergies between logistics performance and technological innovation in driving environmental sustainability while offering economic benefits and addressing social well-being.Practical implicationsThe findings suggest the importance of prioritising investments in enhancing logistics performance and fostering technological innovation to achieve environmental sustainability goals in Africa.Originality/valueTo the best of the researchers’ knowledge, this study presents an initial attempt to examine the nexus between logistics performance and environmental quality in Africa using the logistics performance index. Furthermore, beyond assessing the individual effects of logistics performance and technological innovation on environmental quality, we delve into their interactive dynamics, adding novelty to the study.

Effectiveness of implementation of innovative educational methods tpcbl into the educational process

Aim of the study. Assessing the effectiveness of introducing the innovative educational methodology TPCBL into the educational process by comparing qualitative indicators of student performance. Materials and methods. The effectiveness of introducing the innovative methodology TPCBL (theory, practice and clinic based learning), based on the trinity of theory, practice and clinic, when conducting classes at a medical university was studied. A lesson was conducted using the TPCBL methodology at the Astana Medical University NJSC from September to December 2023. The departments of normal physiology and internal medicine with a course in geriatrics participated. The experimental group consisted of 3rd year students in the educational program “General Medicine” in the amount of 679 people (66 groups) (166 students with Russian language of instruction, 513 students with Kazakh language of instruction). The clinical case of “Sabir Ramzai” was studied.Results and discussion. In general, in the Department of Internal Medicine with a course in geriatrics, the quality indicator of academic performance was before implementation (2022-2023 academic year) - 94%, after implementation (2023-2024 academic year) - 96.5%. That is, it increased by 2.5%. Compared to the 2022-2023 academic year, 3rd year students in the specialty “General Medicine” had a success rate before implementation (2022-2023 academic year) - 91.1%, after implementation (2023-2024 academic year) - 96.4%, that is, increased by 5.3%.Conclusions. An integrated, systematic approach to studying the material helps students consolidate theoretical knowledge, identify practical significance and better assimilate new material.

Temporal trend in quality indicators of diabetes care performance among persons with type 2 diabetes in primary care practice: a serial cross-sectional analytical study, 2013/14 to 2021/22.

Although the national-based policy implemented an initiative program to offer diabetes care management in Thailand, there are limited time trends of evidence to gauge whether the quality of diabetes care in primary care practice is improving. As such, we aimed to identify temporal trends in the quality of diabetes care performance among type 2 diabetes mellitus (T2DM) patients in primary care practice. Using assembled patient-level data from a suburban community in northern Thailand, this serial retrospective cross-sectional analytical study obtained adult T2DM patients from nine consecutive fiscal years 2013/14 (n = 976) to 2021/22 (n = 1,242). Based on international and national guidelines recommended, nine quality indicators were examined, namely, smoking cessation, hemoglobin A1c monitoring, foot and eye examinations, albuminuria testing, statin prescription, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription for chronic kidney disease (CKD)/albuminuria, and blood pressure and glycemic control. Rates and time trends achieved in each quality indicator performance were estimated. Differences in the rates of patients who met each quality indicator across reimbursement schemes were explored. From 2013/14 to 2021/22, all quality indicators have increased over time (p for trend <0.05) except for smoking cessation, which remained steady. In 2021/22, only three out of nine quality indicators (i.e., smoking cessation, annual HbA1c monitoring, and annual foot examination) were successfully met at 70% or greater. Differences in quality indicators of diabetes performance were observed, particularly those under the Civil Servant Medical Benefit Scheme compared with other health insurance counterparts. For overall time trends analysis (compared with 2013/14), significant relative changes in the fiscal year 2021/22 were found in the annual foot examination (adjusted 12.1% increase; p = 0.048), annual albuminuria testing (adjusted 12.1% increase; p = 0.048), and ACEI/ARB prescription for persons with CKD or albuminuria (adjusted 22.2% increase; p = 0.025). Among adult T2DM patients from 2013/14 to 2021/22, overall quality indicators for diabetes performance have substantially improved over time. However, health inequity regarding diabetes care performance was found across different reimbursement schemes. Sustainable policy implementation and innovative strategies to narrow health inequity are warranted to optimize diabetes care in primary care practice.

Influence of Tendering Process on Performance of County Governments in Kenya

Procurement is essential to every organization, serving as a platform for all stakeholders to come together and discuss their needs and goals related to purchasing. The study aimed to explore factors influencing the tendering processes of County Governments in Kenya, focusing specifically on Siaya County Government. The study was guided by three objectives, to examine supplier selection criteria on performance of county Governments in Kenya, to establish the influence of Ethical Practices in Tendering processes on performance of county Governments in Kenya, to investigate the influence of automation processes of Tendering processes on performance of county Governments in Kenya, and to establish moderating effect of government policy on Public procurement And Disposal Act on performance of County Governments in Kenya. The research utilized a Descriptive Research Design approach to gather pertinent information. The study involved Census Sampling in which all 74 participants from different management levels and ad hoc committee members within the department. Questionnaires were used as the main data collection instruments. Data was gathered through the distribution of questionnaires to the chosen participants by means of pick and drop. respondents of 66% were received and were completed accurately, demonstrating an adequate response rate. The statements of the problem mainly focused on major issues facing the tendering procedures and analyzes their influence on organizational performance. The study findings show that Supplier selection criteria Mean of 4.002 and standard Deviation of 0.1428 the highest score amongst the key performance indicators was quality with mean of 4.29 and standard deviation of 0.097 showing highly significant to supplier selection criteria. Ethical practices in Tendering Mean of 4.012 Standard deviation of 0.097, of highest score in key performance indicators was Integrity with mean of 4.468 and standard deviation of 0.097. its shows that highly significant to Ethical practices, Automation of Tendering mean of 4.093 standard deviation of 0.148 highest amongst the key performance indicators was E informing with mean 4.224 and standard deviation 0. 147 shows highly significant to Automation. Moderating variable Mean of 4.094 standard deviation of 0.136 highest score among st key performance indicators of quality 4.306 standard deviation of 0.114 shows highly significant to Moderating variable and all the variables were critical to the performance of County Governments in Kenya. The study recommends that there is need to enormously implement procurement policies which encourage tendering, in order to enhance performance

Diagnostic reference levels for the city of Moscow during X-ray examinations

Diagnostic reference levels are one of the effective tools for optimizing patient radiation doses in diagnostic radiology. The staff of domestic radiology departments does not have an understanding of the development process and use of diagnostic reference levels during X-ray examinations, although this tool is a generally accepted in practice abroad. The article shows the experience of forming regional diagnostic reference levels based on measurements provided by the accredited testing laboratory of the Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department. The diagnostic reference levels for radiography in Moscow were developed for eight of the most common types of examinations based on the operation of 216 digital X-ray machines. The resulting levels, expressed in the dose-area product (cGy-cm2) and effective dose (mSv), were compared with the local diagnostic reference levels for the Ryazan region, Russia, and national diagnostic reference levels for other countries. The analysis showed continuity in the values. Some types of studies have been optimized. The developed diagnostic reference levels are the quality performance indicators foe diagnostic radiology departments and will be used to optimize a patient radiation dose during diagnostic studies in Moscow.

Impact Quality Indicators onto Sustainable Manufacturing

This paper dealt study effect quality indicators of crushing Limestone process in quarries onto Sustainable Manufacturing. Sustainable Environment was achieving through minimizing quality indicators which were use resources and lead time during crushing of limestone in position. Non-value added time and use resources are studied in this paper. This paper aims to show impact key performance indicators of quality which were production efficiency, efficiency of manufacturing cycle and efficiency of use resources onto Operational and environmental sustainability in order to reduce environmental and operational impacts onto environment and human health. Crushing Limestone process had been employing on one year as a case study to evaluate operational and environmental sustainability of an Iraqi industry. Program of Minitab-Version 17 was employed to analyze information of production process. Results illustrated that the rate of efficiency of utilized resources and waste of resources on one year were 95% and 5%. Conclusions shown lead time was an important performance measure of quality from sustainable Manufacturing perspective.

Feasibility, clinical outcomes, and learning curves of robotic-assisted colorectal cancer surgery in a high-volume district general hospital: a cohort study

Introduction: Robotic-assisted surgery (RAS) is one of the most influential surgical advances with widespread clinical and health-economic benefits. West Hertfordshire Teaching Hospital NHS Trust was the first in the UK to simultaneously integrate two CMR Surgical Versius robots. This study aims to investigate clinical outcomes of RAS, explore surgeon learning curves and assess the feasibility of implementation within a district general hospital (DGH). Methods: A prospective cohort study of 100 consecutive patient data were collected between July 2022 and August 2023, including demographics, operative and clinical variables, and compared with laparoscopic surgery (LS) data from the National Bowel Cancer Audit. Surgeon learning curves were analysed using sequential surgical and console times. Results: In the RAS cohort, the median age was 70 (IQR 57–78 years) and 60% were male. Retrieval of a minimum of 12 lymph nodes significantly increased in RAS compared to LS (95% vs. 88%, P=0.05). The negative mesorectal margin rate was similar between RAS and LS (97% vs. 91%, P=0.10), as well as length of stay greater than 5 days (42% vs. 39%, P=0.27). For anterior resections performed by the highest volume surgeon (n=16), surgical time was reduced over 1 year by 35% (304.9–196.9 min), whilst console time increased by 111% (63.0–132.8 min). Conclusions: Key quality performance indicators were either unchanged or improved with RAS. There is potential for improved theatre utilisation and cost-savings with increased RAS. This study demonstrates the feasibility and easy integration of robotic platforms into DGHs, offering wider training opportunities for the next generation of surgeons.

Key needs, quality performance indicators and outcomes for patients with atrial fibrillation and multimorbidity: The AFFIRMO study.

Patients with atrial fibrillation (AF) often have concomitant long-term conditions that negatively impact their quality of life and the clinical management they receive. The AFFIRMO study aimed to identify the needs, quality performance indicators (QPIs), and outcomes relevant to patients, caregivers and healthcare professionals (HCPs) to improve the care of patients with AF. An on-line survey to collect the key needs, QPIs, and outcomes relevant to patients with AF, their caregivers and HCPs, was distributed between May 2022 and January 2023 in five countries (UK, Italy, Denmark, Romania and Spain). Results from the on-line survey were discussed in a three-round Delphi process with international representatives of patients with AF, caregivers, and HCPs to determine the key needs, QPIs and outcomes for the management of patients with AF and multimorbidity. 659 patients (47.2% males, mean (SD) age 70.9 (10.2) years), 201 caregivers (26.9% males, mean (SD) age: 58.3 (SD 15.2) years), and 445 HCPs (57.8% males, mean (SD) age 47.4 (10.6) years) participated in the survey. An initial list of 27 needs, 9 QPIs, and 17 outcomes were identified. Eight patients, two caregivers, and 11 HCPs participated in the Delphi process. Nineteen (70%) needs, 8 (89%) QPIs, and 13 (76%) outcomes reached "consensus in", and were included in the final list. The final key needs, QPIs and outcomes obtained from the Delphi process will inform the AFFIRMO clinical trial, which aims to test the iABC app which incorporates an empowerment toolbox for patients and their caregivers, providing information to improve patient engagement and empowerment to help improve the clinical and self-management of patients with AF in the context of multimorbidity.

The variation in post-endoscopy upper gastrointestinal cancer rates among endoscopy providers in England and associated factors: a population-based study.

Post-endoscopy upper gastrointestinal cancer (PEUGIC) is an important key performance indicator for endoscopy quality. We examined variation in PEUGIC rates among endoscopy providers in England and explored associated factors. The was a population-based, retrospective, case-control study, examining data from National Cancer Registration and Analysis Service and Hospital Episode Statistics databases for esophageal and gastric cancers diagnosed between 2009 and 2018 in England. PEUGIC were cancers diagnosed 6 to 36 months after an endoscopy that did not diagnose cancer. Associated factors were identified using multivariable logistic regression analyses. The national PEUGIC rate was 8.5%, varying from 5% to 13% among endoscopy providers. Factors associated with PEUGIC included: female sex (odds ratio [OR] 1.29 [95%CI 1.23-1.36]); younger age (age >80 years, OR 0.52 [0.48-0.56], compared with ≤60 years); increasing comorbidity (Charlson score >4, OR 5.06 [4.45-5.76]); history of esophageal ulcer (OR 3.30 [3.11-3.50]), Barrett's esophagus (OR 3.21 [3.02-3.42]), esophageal stricture (OR 1.28 [1.20-1.37]), or gastric ulcer (OR 1.55 [1.44-1.66]); squamous cell carcinoma (OR 1.50 [1.39-1.61]); and UK national endoscopy accreditation status - providers requiring improvement (OR 1.10 [1.01-1.20]), providers never assessed (OR 1.24 [1.04-1.47]). PEUGIC rates varied threefold among endoscopy providers, suggesting unwarranted differences in endoscopy quality. PEUGIC was associated with endoscopy findings known to be associated with upper gastrointestinal cancer and a lack of national endoscopy provider accreditation. PEUGIC variations suggest an opportunity to raise performance standards to detect upper gastrointestinal cancers earlier and improve outcomes.

Variability in Kidney Cancer Treatment and Survival in England: Results of a National Cohort Study

AimsTo establish whether there are geographic differences in treatments and outcomes for patients with kidney cancer (KC) in England which could potentially be improved by the creation of national guidelines. Materials and methodsA multidisciplinary group convened by the charity Kidney Cancer UK developed Quality Performance Indicators (QPIs) for the treatment of KC. Adherence to these QPIs was reported for all patients with a histological diagnosis of KC diagnosed in England between 2017 and 2018. Utilising data extracted from national datasets, logistic and linear probability models were used to estimate geographic variation in the delivery of surgery and systemic anti-cancer therapy at Cancer Alliance and NHS trust levels. Results were adjusted for a priori confounders, including age at diagnosis, area deprivation of residence, and Charlson Comorbidity Index. Differences in overall survival are reported. ResultsThe cohort comprised 18,640 tumours in 18,421 patients. Of tumours diagnosed, median patient age was 68 (interquartile range 58–77) years and 63.4% were in males. When stratified by Cancer Alliance, the proportions of T1a/T1b/N0/M0 KC that had radical nephrectomy (RN), nephron sparing surgery or ablation ranged from 53.3% (95% CI [48.7, 57.8]) to 80.3% (95% CI [73.0, 86.0]). For stage T1b-3 cancers, the proportion that received RN ranged from 65.6% (95% CI [60.3, 70.5]) to 77.3% (95% CI [72.1, 81.7]). Patients with M0 (n = 12,365) and M1 KC (n = 3312) at diagnosis had 24-month survival of 87.5% and 25.1%, respectively. Of patients diagnosed with M1 KC, 50.3% received systemic anti-cancer therapy, ranging from 39.7% (95% CI [33.7, 46.1]) to 70.7% (95% CI [59.6, 79.8]) between Cancer Alliances. The six-month survival of these patients was 77.4% compared to 27.6% for those that did not receive SACT. ConclusionThese major geographical differences in surgical and systemic therapy practice have led to national guideline development.

Quality performance indicators for oesophageal and gastric cancer: ANZ expert Delphi consensus.

Quality performance indicators for the management of oesophagogastric cancer can be used to objectively measure and compare the performance of individual units and capture key elements of patient care to improve patient outcomes. Two systematic reviews were completed to identify evidence-based quality performance indicators for the surgical management of oesophagogastric cancer. Based on the indicators identified, a two-round modified Delphi process with invitations was sent to all members of the Australia and Aotearoa New Zealand Gastric and Oesophageal Surgery Association. The expert working group discussed each suggested indicator and either removed, added, or adjusted the list of indicators of oesophagogastric cancer. The final list of both OG cancer indicators included Specialized Multi-disciplinary team discussion, Endoscopy documentation, Staging Contrast CT Chest/Abdomen and Pelvis, Neoadjuvant or Adjuvant chemo/radiotherapy administered in accordance with the Local multi-disciplinary team, Pathological margin clearance (R0 Resection), Lymphadenectomy retrieving 15 or more nodes, Formal review of pathological findings and documentation, Postoperative complications, 30-day and 90-day postoperative mortality, clinical surveillance and Specialized Dietetic guidance. Indicators specific to gastric cancer included Preoperative biopsy for pathological diagnosis and Staging Laparoscopy. Indicators specific to oesophageal cancer include positron emission tomography scan if CT negative for metastasis, Perioperative Oesophagectomy Care Pathway, length of stay of 21 days or more, and Unplanned readmission within 30 days. The results of this study present a core set of indicators for the surgical management of oesophagogastric cancer that can be used to measure quality and compare performance between different units.

Effects of minimum dissolved oxygen setpoints for aeration in semi-intensive pond production of Pacific white shrimp (Litopenaeus vannamei)

Aeration is considered one of the most critical factors in shrimp farming as it affects the metabolism of shrimp and other living organisms within a pond. Maintenance of proper dissolved oxygen (DO) concentrations is critical, as low DO can cause stress, lower resistance to disease, and inhibit growth. Although the effects of single, short-term hypoxia events have been widely studied, little to no research has examined effects of repeated exposure to hypoxia during multiple diurnal cycles that shrimp may experience in aquaculture ponds. Even though the concept is simple, proper DO management is not simple. It is dependent on numerous factors and often based on anecdotal recommendations. The present trial was conducted to help elucidate the effects of DO management strategies on shrimp performance. The trial examined the effects of three different DO set points for automatic aeration on shrimp production and water quality parameters in earthen ponds. In sixteen earthen ponds (0.1 ha), juvenile Pacific white shrimp (⁓0.030 g) were stocked at a density of 25ind/m2. Minimal DO setpoints that activated automatic aeration in each of the treatments were 2.5, 3.5, and 4.5 mg O2/L, respectively. Shrimp were fed using the AQ1 passive acoustic monitoring system that was set to not feed while DO was below the threshold of a given treatment. Each of the treatments was applied to 5 ponds, except for treatment 1 (2.5 mg/L) which was applied 6 ponds as it was considered of higher risk. Shrimp growth performance and water quality indicators were monitored weekly. At the end of the 79–81-day trial, results showed that different aeration control treatments had no significant effect in terms of growth performance, feed inputs or productivity parameters. The final weight of the shrimp ranged between 33.3 and 33.6 g, with average final yields of 7500–8500 kg per ha. Nonetheless, mean electrical costs differed significantly between treatments, with higher DO setpoints treatments exhibiting a higher aeration cost with no discernible benefit. Water quality parameters showed no significant difference, except for morning and afternoon DO concentrations.

Australia's first cardiac emergency department: Patient profile, activity and performance in the initial 6 months.

To profile the initial 6-month experience at the Victorian Heart Hospital (VHH) cardiac emergency (CE). The primary objective was to describe VHH CE patient characteristics, including presenting complaint, final diagnosis and disposition. Secondary objectives were to report on patient numbers, patient source and quality indicator performance including ambulance off-load by 40 min, waiting time and length of stay (LOS). A retrospective review included all patients who presented to the VHH CE from 9 March 2023 to 8 September 2023. Patient reports containing the relevant clinical information were generated from the CE electronic medical record system. Diagnoses of MI were checked for accuracy by full record review. There were 3303 CE presentations in the first 6 months of operation, of which 6% were transferred from other sites. Median age was 65 years (interquartile range [IQR]: 53-77), 56% were males; the most common presenting complaints were presumed cardiac chest pain (67%) and arrhythmia (17%). The admission, discharge and transfer rates were 38%, 54% and 8%, respectively. In total, 15% were diagnosed with MI. The most common diagnoses for discharged and admitted patients were non-specific chest pain (57%) and ST-elevation MI (22%), respectively. Ambulance off-load by 40 min was met for 96%. Median waiting time was 6 min (IQR: 3-10). Median CE LOS for discharged and admitted patients was 3.2 h (IQR: 2.5-4.0) and 3.7 h (IQR: 1.8-6.0), with 75% and 56% being <4 h, respectively. The population predominantly had cardiovascular disease as expected. Some performance indicators, including ED LOS, were identified as requiring intervention.

Effects of β-Mannanase Supplementation and Soyhull Inclusion on Production Performance, Economics, Egg Quality, Blood Biochemicals, Nutrient Digestibility, and Intestinal Morphology in Golden Brown Hens (RIR × Fayoumi) during Late Peak Production.

This study investigated the effects of the β-mannanase enzyme and soyhulls on production performance, economics, egg quality, hematology and serum biochemistry, nutrient digestibility, gut morphology, digesta viscosity, and excreta consistency in laying hens during the late peak production phase (37 to 40 weeks of age). Golden brown hens (RIR × Fayoumi; n = 200) were fed a control diet (no soyhulls or enzymes) and diets containing four combinations, i.e., 3% soyhulls with 20 mg/kg β-mannanase (D1), 3% soyhulls with 30 mg/kg β-mannanase (D2), 9% soyhulls with 20 mg/kg β-mannanase (D3), and 9% soyhulls with 30 mg/kg β-mannanase (D4), for four weeks in four replicates of 10 birds each. Overall, a significantly higher (p < 0.05) feed intake, weight gain, feed conversion ratio, and water intake were calculated in the D2 group as compared to the control and remaining combinations of soyhulls and β-mannanase. No mortality was recorded during the entire experiment. Economically, the D1 and D2 groups showed the best results as compared to the D3 and D4 groups. Egg quality parameters like egg weight, shell weight and shell thickness, yolk weight, albumen weight and height, and the Haugh unit remained unchanged (p > 0.05). Similarly, the D2 group showed significantly lower total cholesterol, LDL, and VLDL levels and enhanced gut morphology with greater villus width, height, crypt depth, and surface area across intestinal segments. Crude protein (CP), crude fiber (CF), crude fat, and ash digestibility were higher (p < 0.05) in the D1 and D2 groups compared to the control. Digesta viscosity, excreta consistency, and other egg quality parameters remained unaffected. In conclusion, the dietary inclusion of a combination of 3% soyhulls and 30 mg/kg β-mannanase may have potential benefits for laying hens by improving some production performance and egg quality indicators and economics, lowering blood cholesterol, LDL, and VLDL levels, enhancing nutrient digestibility, and improving gut morphology without affecting egg quality.

Study of physical and mechanical properties of plant fruits on the example of walnut

Perennial plantations that are zoned in Ukraine allow to obtain high-quality fruits (nuts), which are widely used in the perfumery, pharmaceutical, oil, confectionery and other industries, as well as in the production of feed and feed additives. The known technologies of mass processing of walnut kernels mostly work well with crops that have a spherical or close to spherical external shape. The simplest, but least productive, are primitive manual devices for peeling walnut shells. Despite the simplicity of their design, these devices are inefficient and unsuitable for adjusting their operation to different varieties and physical and mechanical properties of biological fruits. The analysis of the known designs of walnut shell destruction machines and mechanisms showed the need to study the physical and mechanical properties of biological fruits (walnuts), to develop technical recommendations for the design of impact mechanisms to improve the quality of shell destruction and the possibility of their application in mass production technologies. A research methodology was developed, a laboratory setup was manufactured, and experiments were conducted. To determine the strength characteristics, the author designed and manufactured a device. It consists of a lever mechanism and a deforming device. The dimensions and load measurements were carried out according to well-known methods of physical mechanics. The statistical analysis of the results showed the need for in-depth scientific research of the geometric parameters of the design of the working bodies of machines for destroying the walnut shell in the mechanisms of fruit peeling machines, taking into account the quality indicators performance of works with certain conditions of their implementation. We conclude that according to the results of the experiments, there is a fairly high dependence between the geometric dimensions of the walnut fruit at the level of 0.72, 0.57 and 0.49, respectively. The weight of the fruit also depends on its dimensional characteristics, which is logical at the level of 0.6–0.75. The force of critical static fracture has a weak correlation with the dimensional characteristics at the level of 0.3. And it depends little on the plane of its application.

Developing Dashboard Analytics and Visualization Tools for Effective Performance Management and Continuous Process Improvement

Performance management and continuous process improvement are essential for businesses to monitor how well their operations are running, find ways to improve them, and bring about good change. However, making decisions based on data in these areas can be challenging because performance data is complicated. This research looks into how panel analytics and data visualization tools can help manage performance well and make processes better all the time. A literature study is done on performance management frameworks, process improvement methods, data visualization techniques, and dashboard solutions that are already out there. The Lean, Six Sigma, and balanced scorecard methods are looked at for success indicators and metrics. It also looks into data visualization tools' design principles and methods like dashboards, tables, charts, and interactive features. Interviews, observations, document reviews, and internal files are ways a case organization gathers both primary and secondary data. Key performance indicators for quality, delivery, productivity, safety, and customer happiness are found in several different business roles and processes. To look at performance trends and relationships, SPSS is used for descriptive statistics and hypothesis testing. Interactive dashboard examples that use different data visualization methods are created by thinking about how the user will experience it, how it will work with other systems, and how it will help them make decisions. Dashboards let you dig deeper into processes, determine why problems happen, and compare actuals to goals. Usability testing checks how easy the tools are and how well decision-makers can learn from them. The results show that dashboard analytics can make handling performance and improvement projects easier based on data. Insights made it possible to keep track of KPIs, find methods that were not working well, and work together across teams. There are also talks about problems with data quality and change management.

Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers' Well-Being: Retrospective Population-Based Database Study With Embedded User Survey.

The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be £111 billion (US$ 152.7 billion) in England. This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers' support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery. This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses. The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89% (943/1929) to 86.68% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8%) and caregiver assessments (20.9%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers' well-being assessments, support needs checks, and peer support groups. Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers' access to, and engagement with, such services.

Adherence to diabetes quality indicators in primary care and all-cause mortality: A nationwide population-based historical cohort study

Background In the last three decades, much effort has been invested in measuring and improving the quality of diabetes care. We assessed the association between adherence to diabetes quality indicators and all-cause mortality in the primary care setting. Methods A nationwide, population-based, historical cohort study of all people aged 45–80 with pharmacologically-treated diabetes in 2005 (n = 222,235). Data on annual performance of quality indicators (including indicators for metabolic risk factor management and glycemic control) and vital status were retrieved from electronic medical records of the four Israeli health maintenance organizations. Cox proportional hazards and time-dependent models were used to estimate hazard ratios (HRs) for mortality by degree of adherence to quality indicators. Results During 2,000,052 person-years of follow-up, 35.8% of participants died. An inverse dose–response association between the degree of adherence and mortality was shown for most of the quality indicators. Participants who were not tested for proteinuria or did not visit an ophthalmologist during the first-5-years of follow-up had HRs of 2.60 (95%CI:2.49–2.69) and 2.09 (95%CI:2.01–2.16), respectively, compared with those who were fully adherent. In time-dependent analyses, not measuring LDL-cholesterol, blood pressure, HbA1c, or HbA1c&gt;9% were similarly associated with mortality (HRs ≈1.5). The association of uncontrolled blood pressure with mortality was modified by age, with increased mortality shown for those with controlled blood pressure at older ages (≥65 years). Conclusions Longitudinal adherence to diabetes quality indicators is associated with reduced all-cause mortality. Primary care professionals need to be supported by health care systems to perform quality indicators.

Impact of laboratory accreditation on the performance of quality indicators in an international indicator benchmarking program

Impact of laboratory accreditation on the performance of quality indicators in an international indicator benchmarking program