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To provide an international standard for the safe management and operation of ships and for pollution prevention, the International Maritime Organization (IMO) introduced the International Safety Management (ISM) Code (adopted in 1993 and entered in force on 1st July 1998). The Code, through its guidelines and recommendations, provides seafarers (ship’s crew) the course of action for the safety and quality assurance process on ships. Traditionally a paper-based system, the ISM Code is now being digitalized in every aspect to streamline the processes to improve ship operations. This paper presents findings of a review of existing literature available on the world wide web to highlight areas of the Code that have been impacted by technology and the benefits that are being reaped. However, recent cyber attacks on ships and the maritime industry require a discussion on various implications associated with ships becoming increasingly reliant on technology and the advancing digital world. This paper highlights and explains the related implications and suggests strategies to address them.

The Building Strong Library and Information Science Education (BSLISE) Working Group of the International Federation of Library Associations and Institutions (IFLA) was formed in 2016 to develop an international quality assurance (QA) framework that will guide and promote international educational standards in LIS. The first phase of its efforts has been to conduct an international survey (by means of questionnaires) of qualifications for LIS professional practice inclusive of regional and national contexts. Key findings of the study along with recommendations appear in the Building Strong Library and Information Science Education: a Call to Global and Local Action White Paper published in August 2018. This review briefly outlines the White Paper’s content and comments on its main points. Based on the analysis, the BSLISE Working Group identified six key findings with recommended actions and change agents, and prioritized three actions for its next steps: to develop an international resource that identifies local structures; to develop an international framework for the assessment of quality standards in LIS education; to identify core and other competencies for transferability and reciprocity. The article concludes that there has been a longstanding need for comprehensive documentation of LIS education globally.

Current product composition and quality test methods for the paper and pulp industry are mainly based on manual ex-situ wet-bench chemistry techniques. For example, the standard method for determining the furnish of paper, TAPPI T 401 "Fiber analysis of paper and paperboard," relies on the experience and visual acuity of a specially trained analyst to determine the individual plant species present and to quantify the amount of each constituent fiber type in a sheet of paper. Thus, there is a need for a fast, nondestructive analytical technique that leverages intrinsic attributes of the analytes. In this paper, we demonstrate an application of dielectric spectroscopy (DS) as a potential metrology to differentiate between nonwood pulp and wood pulp fibers. This in-situ, noncontact and nondestructive assessment method has inherent forensic capabilities and is also amiable to quality assurance techniques such as gauge capability studies and real-time statistical process control (SPC). Application The dielectric spectroscopy results presented in this paper can nondestructively determine the amount of lignin in paper products and are in principle comparable to the performance specifications of the TAPPI Standard Test Method T 401 and should enable the sources of printing substrates to be both authenticated and validated in real time in a paper testing laboratory environment.

Disorders or differences in sex development (DSD) comprise a heterogeneous group of conditions with an atypical sex development. For optimal diagnosis, highly specialised laboratory analyses are required across European countries. Working group 3 of EU COST (European Cooperation in Science and Technology) Action BM 1303 ‘DSDnet’ ‘Harmonisation of Laboratory Assessment’ has developed recommendations on laboratory assessment for DSD regarding the use of technologies and analytes to be investigated. This position paper on steroid hormone analysis in diagnosis and treatment of DSD was compiled by a group of specialists in DSD and/or hormonal analysis, either from participating European countries or international partner countries. The topics discussed comprised analytical methods (immunoassay/mass spectrometry-based methods), matrices (urine/serum/saliva) and harmonisation of laboratory tests. The following positions were agreed upon: support of the appropriate use of immunoassay- and mass spectrometry-based methods for diagnosis and monitoring of DSD. Serum/plasma and urine are established matrices for analysis. Laboratories performing analyses for DSD need to operate within a quality framework and actively engage in harmonisation processes so that results and their interpretation are the same irrespective of the laboratory they are performed in. Participation in activities of peer comparison such as sample exchange or when available subscribing to a relevant external quality assurance program should be achieved. The ultimate aim of the guidelines is the implementation of clinical standards for diagnosis and appropriate treatment of DSD to achieve the best outcome for patients, no matter where patients are investigated or managed.

The development of technology such as intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and stereotactic ablative body radiotherapy (SABR) has resulted in highly conformal radiotherapy treatments. While such technology has allowed for improved dose delivery, it has also meant that improved accuracy in the treatment room is required. Image-guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, has been shown to improve the accuracy of treatment delivery and in some circumstances, clinical outcomes. Allied with the adoption of highly conformal treatments, there is a need for stringent quality assurance processes in a multidisciplinary environment. In 2015, the Royal Australian and New Zealand College of Radiologist (RANZCR) updated its position paper on IGRT. The draft document was distributed through the membership of the Faculty of Radiation Oncology (FRO) for review and the final version was endorsed by the board of FRO. This article describes issues that radiotherapy departments throughout Australia and New Zealand should consider. It outlines the role of IGRT and reviews current clinical evidence supporting the benefit of IGRT in genitourinary, head and neck, and lung cancers. It also highlights important international publications which provide guidance on implementation and quality assurances for IGRT. A set of key recommendations are provided to guide safe and effective IGRT implementation and practice in the Australian and New Zealander context.

The experiment of quality assurance of polymeric outdoor insulators service life is necessary to be checked the class of wettability by using the digital image processing tools. The image processing can improve its pictorial information for human interpretation, render it more suitable for autonomous machine perception. This paper provides a survey of the recent technology and theoretical concept to explain the development of the Hydrophobicity Class (HC) of porcelain insulator. The hydrophobic properties of the housing material were found degraded to a different extent between field-aged insulators due to differences in material structure and pollution conditions. This paper contributes to the latest development of reviews relating to image processing for the implementation of porcelain insulator hydrophobic systems testing., and their related studies. We categorized the computer vision mainstream into 2 group such as Machine Learning Methods Applied to Digital Image Processing and Deep Learning Methods Applied to Digital Image Processing. Then compare pros/cons in each type of technique. We also provide brief explanation on the up-to-date information about the techniques and their performance.

Purpose The comprehensive identification and delineation of organs at risk (OARs) are vital to the quality of radiation therapy treatment planning and the safety of treatment delivery. This guidance aims to improve the consistency of ontouring OARs in external beam radiation therapy treatment planning by providing a single standardized resource for information regarding specific OARs to be contoured for each disease site. The guidance is organized in table format as a quality assurance tool for practices and a training resource for residents and other radiation oncology students (see supplementary materials). Methods and Materials The Task Force formulated recommendations based on clinical practice and consensus. The draft manuscript was peer reviewed by 16 reviewers, the American Society for Radiation Oncology (ASTRO) legal counsel, and ASTRO's Multidisciplinary Quality Assurance Subcommittee and revised accordingly. The recommendations were posted on the ASTRO website for public comment in June 2018 for a 6-week period. The final document was approved by the ASTRO Board of Directors in August 2018. Results Standardization improves patient safety, efficiency, and accuracy in radiation oncology treatment. This consensus guidance represents an ASTRO quality initiative to provide recommendations for the standardization of normal tissue contouring that is performed during external beam treatment planning for each anatomic treatment site. Table 1 defines 2 sets of structures for anatomic sites: Those that are recommended in all adult definitive cases and may assist with organ selection for palliative cases, and those that should be considered on a case-by-case basis depending on the specific clinical scenario. Table 2 outlines some of the resources available to define the parameters of general OAR tissue delineation. Conclusions Using this paper in conjunction with resources that define tissue parameters and published dose constraints will enable practices to develop a consistent approach to normal tissue evaluation and dose documentation.

The pathology peer review (PR) is an important part of the assessment process of key toxicological results and increases confidence in the quality of histopathology study data. On the other hand, in the last few years, on the basis of findings recorded in the Food and Drug Administration warning letters, a large debate on PR took place and several position papers were issued by either scientific association of pathologists and Quality Assurance (QA) associations. The Guidance on the GLP requirements for Peer Review of Histopathology was issued in May 2010 by the UK Medicines and Healthcare Products Regulatory Agency (MHRA). This document gave an opportunity to the Italian Group of Quality Assurance in Research (the Italian acronym for which is GIQAR) to discuss more in depth this matter in an ad hoc Round Table. The decision to comment the above MHRA document in order to issue a GIQAR position paper was based on the lack of guidance regarding pathology PR and on the need for a thorough exchange of views among all involved parties as well as to provide recommendations to QA professionals on this specific issue.

In 2001 the ACPSEM published a position paper on quality assurance in screen film mammography which was subsequently adopted as a basis for the quality assurance programs of both the Royal Australian and New Zealand College of Radiologists (RANZCR) and of BreastScreen Australia. Since then the clinical implementation of digital mammography has been realised and it has become evident that existing screen-film protocols were not appropriate to assure the required image quality needed for reliable diagnosis or to address the new dose implications resulting from digital technology. In addition, the advantages and responsibilities inherent in teleradiology are most critical in mammography and also need to be addressed. The current document is the result of a review of current overseas practice and local experience in these areas. At this time the technology of digital imaging is undergoing significant development and there is still a lack of full international consensus about some of the detailed quality control (QC) tests that should be included in quality assurance (QA) programs. This document describes the current status in digital mammography QA and recommends test procedures that may be suitable in the Australasian environment. For completeness, this document also includes a review of the QA programs required for the various types of digital biopsy units used in mammography. In the future, international harmonisation of digital quality assurance in mammography and changes in the technology may require a review of this document. Version 2.0 represented the first of these updates and key changes related to image quality evaluation, ghost image evaluation and interpretation of signal to noise ratio measurements. In Version 3.0 some significant changes, made in light of further experience gained in testing digital mammography equipment were introduced. In Version 4.0, further changes have been made, most notably digital breast tomosynthesis (DBT) testing and QC have been addressed. Some additional testing for conventional projection imaging has been added in order that sites may have the capability to undertake dose surveys to confirm compliance with diagnostic reference levels (DRLs) that may be established at the National or State level. A key recommendation is that dosimetry calculations are now to be undertaken using the methodology of Dance et al. Some minor changes to existing facility QC tests have been made to ensure the suggested procedures align with those most recently adopted by the Royal Australian and New Zealand College of Radiologists and BreastScreen Australia. Future updates of this document may be provided as deemed necessary in electronic format on the ACPSEM's website ( https://www.acpsem.org.au/whatacpsemdoes/standards-position-papers and see also http://www.ranzcr.edu.au/quality-a-safety/radiology/practice-quality-activities/mqap ).

This paper is the result of the collaboration between the professors of the Department of Mechanics and the Production Management of the University of Mondragon and the 4th year students of the Karelia University of Applied Sciences in Finland. The developed case is the optimization of the flight process of a paper propeller, based on the Six Sigma DMAIC methodology. The objective was to show how to train the students of the Master in Innovation and Project Management in Mondragon University, in the acquisition of the knowledge and skills needed in continuous improvement process (CIP) and quality engineering (QE). Student feedback reflect, that the application of simulation case, has been valid to understand the theory and acquiring skills related to the techniques of QE, specifically in standard methods of continuous improvement, statistical tools, and standardization systems.

Background: The Newborn Screening Quality Assurance Program at the Centers for Disease Control and Prevention assesses the adherence to established performance standards of manufactured lots of whole blood filter paper collection devices that are registered by the US FDA. We examined 26 newborn screening analytes measured from blood applied to filter papers from two FDA-cleared sources, Whatman® Grade 903 and Ahlstrom Grade 226. The dried blood spots contained analytes at both single levels and dose–response series. Results: We observed overlap at one standard deviation for each analyte, with no more than 4–5% difference between the papers. Conclusion: The data demonstrated similarities of analyte recovery between the papers, indicating comparability of the devices for newborn screening and other applications.

The coalition government has set out its stall in a cluster of white paper consultation documents. One theme to emerge is a commitment to monitoring outcomes. It is outcomes, underpinned by National Institute for Health and Clinical Excellence quality standards, that are to be used to regulate the NHS and these will be made available to the public. This paper sets out the importance of measuring quality in the NHS and some of the principles involved in analysis, presentation and interpretation of results. Clinicians have a duty to improve patient care and measurement and comparison is one of the tools at their disposal. Clinical involvement in the development of metrics and quality indicators is essential for meaningful results and it is vital that clinicians now take ownership of the quality of the clinical data captured on their patients.

The Conference of Radiation Control Program Directors (CRCPD) Task Force on Bone Densitometry (H-30) was assigned by the Healing Arts Council on Emerging Issues to address issues of bone densitometry. Issues for clarification included the practice of precision testing, in which multiple bone density determinations are performed on one patient; the use of quantitative computed tomographic (CT) densitometry; and radiation dose to patients and operators. This paper is a condensation of the white paper produced by the task force, which addresses the various methods of measuring bone density, the qualifications and responsibilities of personnel, the rationale for precision testing, and the doses patients and operators may receive. The white paper is available in its entirety on the CRCPD's Web site (http://crcpd.org).

Pediatric radiotherapy is a critical part of pediatric oncology protocols and the quality of the radiotherapy may determine the future quality of life for long-term survivors. Multidisciplinary team decision making provides the basis for high-quality care. However, delivery of high-quality radiotherapy is dependent on resources. This article provides guidelines for delivery of good quality radiation therapy in resource-limited countries based on rational procurement and maintenance planning, protocol development, three-dimensional planning, quality assurance, and adequate staff numbers and training.

Archiving of documents and specimens generated during a non-clinical laboratory study is a basic Good Laboratory Practice (GLP) requirement. The records and materials that should be archived as well as the characteristics and the organisation of archive facilities are addressed in the OECD Series on Principles of Good Laboratory Practice No. 1 (OECD Principles of Good Laboratory Practice (as revised in 1997) [1]. However, in recent years, questions concerning archiving have been raised and the need for a more detailed guidance on this matter has become evident The aim of the Society for Applied Pharmacological Sciences/Italian Group of Quality Assurance in Research (SSFA/GIQAR) working group on ‘Archiving according to GLP’ was to issue a position paper, present it for discussion in an ad hoc round table with representatives of the Italian GLP monitoring authority to promote common standards and to provide additional recommendations on storage and retention of records. Copyright © 2005 John Wiley & Sons, Ltd.

I. New Pulp Bale Feeding SystemA modern Pulp Bale Handling System has to meet the following requirements : * Highest Efficiency/Feasibility* Best Raw Material Preparation* Quality Assurance, Independent from Personnel* Safety of Work (Personnel) * Safety of Down-stream Equipment after PulperII. Automatic Waste Paper Bale Dewiring and Pulper Feed SystemsThe erection of Waste Paper recycling lines in the Paper and Board Industry with production capacities up to and above 1, 000 t/d is calling for highest standards and challenges for mechanical engineering. Paper manufacturing, based on Waste Paper, is looking nowadays for most economic and customised turnkey solutions for optimal material handling and processing in front of conventional Pulpers or Pulping Drums.FMW solutions include also approved machinery and equipment with highest efficiency for Automatic Waste Paper Bale Dewiring, wire treatment and reject handling systems.

製紙関連工場における品質保証型の防虫管理では, 次の点が重要である。1) 外部クレームのみでなく内部クレームについてもクレーム分析を実施する。具体的には, クレーム昆虫の種類の同定, 混入日時, 混入ラインや工程を記録書に記録し, 保管する。2) 捕獲されている昆虫のモニタリングデータを調べ, 工場オリジナルな危害昆虫図鑑を作成する。そして, クレーム昆虫とモニタリングデータとの相関関係を解析, 評価する。最後に, 昆虫の生態的な特徴を踏まえ, 予防対策を構築する。3) 工場の環境条件として, 昆虫モニタリングのみでなく, 光, 風向, 風速, 温度, 湿度, などを定量的にモニタリングする。4) 品質保証型の防虫管理では, 仕組み自身を定期的にバリデーションし, その効果の確認を行う。また, 活動自身が機能するように, ルールが正しく守られていることを確認し, 教育, 訓練を定期的に実施すること。以上について報告する。

Background: Lead testing on dried filter paper (FP) blood spots is used routinely by some laboratories for lead poisoning screening. Proficiency testing (PT) as required under CLIA ‘88 laboratory regulations has not been available for these methods. Methods: We describe a suitable PT scheme and evaluate FP laboratory performance based on program results. Monthly testing events consisting of five FP specimens were provided to six participating laboratories. Results were evaluated against target values determined by referee laboratories. Results: Preliminary FP laboratory results showed poor agreement with specimen target values, exhibiting a mean absolute bias of 0.29 μmol/L (5.9 μg/dL). Five of six participating laboratories demonstrated significant improvement in later testing events, with bias decreasing to 0.12 μmol/L (2.5 μg/dL). Performance varied widely between the participating laboratories and appeared to be method dependent. When evaluated using CLIA blood lead acceptability criteria, the proportion of acceptable individual specimen results (n = 35) ranged from 54% to 100%. On a testing event basis (n = 7), the proportion of acceptable events ranged from 29% to 100%. Conclusions: A suitable FP PT program now exists to capably assist and monitor FP laboratories. Based on overt PT results, properly utilized FP testing methods can accurately measure blood lead concentration.

To describe the paper-based and electronic formats of resident admission forms used in several aged care facilities in Australia and to compare the extent to which resident admission information was documented in paper-based and the electronic health records.Retrospective auditing and comparison of the documentation quality of paper-based and electronic resident admission forms were conducted. A checklist of admission data was qualitatively derived from different formats of the admission forms collected. Three measures were used to assess the quality of documentation of the admission forms, including completeness rate, comprehensiveness rate and frequency of documented data element. The associations between the number of items and their completeness and comprehensiveness rates were estimated at a general level and at each information category level.Various paper-based and electronic formats of admission forms were collected, reflecting varying practice among the participant facilities. The overall completeness and comprehensiveness rates of the admission forms were poor, but were higher in the electronic health records than in the paper-based records (60% versus 56% and 40% versus 29% respectively, p0.01). There were differences in the overall completeness and comprehensiveness rates between the different formats of admission forms (p0.01). At each information category level, varying degrees of difference in the completeness and comprehensiveness rates were found between different form formats and between the paper-based and the electronic records. A negative association between the completeness rate and the number of items in a form was found at each information category level (p0.01), i.e., more data items designed in a form, the less likely that the items would be completely filled. However, the associations between the comprehensiveness rates and the number of items were highly positive at both overall and individual information category levels (p0.01), suggesting more items designed in a form, more information would be captured.Better quality of documentation in resident admission forms was identified in the electronic documentation systems than in previous paper-based systems, but still needs to be further improved in practice. The quality of documentation of resident admission data should be further analysed in relation to its specific content.

Open source software (OSS) is a software product with the source code made public so that anyone can read, analyze, and change or improve the code. The use of this software is under a license, like Apache, GNU, MIT, Mozilla Public, and Eclipse Public License. Open source software development (OSSD) provides high quality assurance through user testing and peer reviews. The quality of these products depends on the size of the product community. This paper discusses the stakeholders of the OSS community, the quality assurance frameworks and models proposed in some studies, some statistics about OSS, the problems that affect the quality of OSSD, and the advantages and disadvantages of OSS compared to closed source software. This allows us to understand how we can achieve and improve the quality assurance and quality control of OSSD.

Representatives of the pulp and paper industry in the US have assembled guidelines for preparation for regulatory agency inspections of the framework of quality assurance associated with self-monitoring data collected for National Pollutant Discharge Elimination System (NPDES) disharge monitoring report purposes. These guidelines address effluent flow measurement; sample collection, preservation, and analysis; analysis methods quality control; and record keeping. This paper summarizes the guidelines and presents examples of the experience of the industry with quality assurance-oriented inspections. 30 references, 1 table.

Pulp and paper PCDD/PCDF analyses in the United States, particularly compliance testing, could be improved by implementing further methods development, consistent and standardized methods, statistically sound data criteria, and a better understanding of inter-laboratory variability. Efforts to achieve many of these improvements are underway.

Purpose: The path of subsequent dwell positions of an afterloader source being moved through a ring applicator for cervix cancer brachytherapy deviates from an ideal circle and the position of marker wires. This can lead to deviations of several millimetres between real and assumed dwell positions for treatment planning with simplified source path models. The aim of this study was to test video- and autoradiography-based methods for source path determination, and to study the influence of dwell position accuracy on dose-volume histogram (DVH)-parameters. Material and methods: Videos of the exact motion of the source wire through three different (r = 26, 30, 34 mm) computed tomography/magnetic resonance (CT/MR) compatible plastic ring applicators were recorded. Observed dwell positions covering the whole length of each applicators channel were used to adjust the circular source path model. The agreement of the true source positions derived from video analysis with those of the corrected circular source path was verified using autoradiography. The impact of an accurate source path definition on dose planning was analysed by simulating clinically relevant uncertainties in 10 clinical treatment plans. Results: Depending on the ring size, source path diameters had to be increased by 0.5-1.0 mm in order to achieve acceptable maximum differences between observed and corrected dwell positions (1.3-2.0 mm). Autoradiography analysis showed a positional accuracy within ± 3 mm (extended standard deviation k = 2). For shifts of ± 2.5 mm for even all dwell positions, the systematic and random variation of the D 2cm³ for bladder, rectum, and sigmoid was within 3%, while the impact on DVH uncertainties was much smaller for clinical target volume (CTV) HR and gross tumour volume (GTV). Conclusions: It is strongly advised to verify the real source path for ring applicators during acceptance testing in order to assure accurate source path definition and dose planning. Autoradiography can be used for source path verification with acceptable accuracy for treatment planning and dose reporting. J Contemp Brachytherapy 2015; 7, 3: 239-243 DOI: 10.5114/jcb.2015.52622

During 1992, Boise Cascade's white paper mill in Jackson, Alabama, USA successfully implemented the ISO 9002 quality system and received registration under the international organization for standardization. This paper reviews the process the mill followed with emphasis on the efforts of the maintenance department's electrical and instrument (EI developing and implementing an ISO quality system for process instrumentation; preparing for and experiencing a registration audit; and maintaining a compliant ISO quality system. >

Almost all financial crises in the world showed a real estate element if it was not the main cause after all, and so did the 2008 financial crisis with subprime mortgages. As a result of that the G 20 concluded : "never again". It meant that Central Banks and Financial Market Authorities started to investigate how to solve the problem and take precautions.In the Netherlands they first of all questioned the auditors. Their defence was that they relied upon valuation reports from certified valuers. Other than that in 2011 the Auditors addressed the problem to the valuers in a management letter.To improve the situation representatives from the Auditors and the valuers sat together and developed 28 recommendations about valuer’s independency, education, scope of work, the valuation itself and quality assurance procedures. The underlying guidance were international standards, from the auditor’s side the IAS and IFRS and from the valuer’s side the IVs and EVS. The recommendations were followed by good practices, examples for both disciplines to help them to interpret the recommendations.The paper will show the recommendations as well as the process at which the Netherlands Register of Certified Valuers was formed.

Purpose – The paper aims to assess the quality (content and legibility) of handwritten operation notes and the reader's interpretation of legibility by clinical seniority. Design/methodology/approach – Consecutive elective and emergency general surgical operations over a six-week period from September 2011 at one hospital were retrospectively collected. Non-retrieval of operation notes, typed notes and endoscopies were excluded. The content of each operation note was assessed against a 26-item checklist. Legibility was assessed by 4 readers (2 Foundation Doctors and 2 Registrars in General Surgery) using an original objective scoring system. Findings – A total of 404 operations were identified; 45 were excluded following review of operation notes. Operation notes were derived from 12 consultants and 11 registrars. Analysis of the content score suggested that time of procedure (1 per cent), ASA grade (1 per cent) and blood loss (5 per cent) were poorly reported. Clinical indication and post-operative instructions were documented in only 52 per cent and 66 per cent of operation notes respectively. Registrar notes had a higher content score compared with consultant notes (15.8 vs 13.5, ppp Research limitations/implications – The quality of handwritten notes varies. Registrar-written notes are more content-rich and legible. Practical implications – Clinical seniority and specialty training may improve the interpretation of handwritten operation notes. This study adds to growing evidence supporting the widespread adoption of a computerized immediate operation note. Originality/value – An objective scoring system to assess legibility of operation notes written as freehand was used. Also, legibility according to the reader's seniority in clinical training was evaluated.

Software architecture (SA) evaluation is a quality assurance technique that is increasingly attracting significant research and commercial interests. A number of SA evaluation methods have been developed. Most of these methods are scenario-based, which relies on the quality of the scenarios used for the evaluation. Most of the existing techniques for developing scenarios use stakeholders and requirements documents as main sources of collecting scenarios. Recently, architectures of large software systems are usually composed of patterns and styles. One of the purposes of using patterns is to develop systems with predictable quality attributes. Since patterns are documented in a format that requires the inclusion of problem, solution and quality consequences, we observed that scenarios are, though as informal text, pervasive in patterns description, which can be extracted and documented for the SA evaluation. Thus, we claim that the patterns can be another source of collecting quality attributes sensitive scenarios. This position paper presents arguments and examples to support our claim.

Protein analyses have been used in Malmo as a routine clinical diagnostic tool since 1953. Most serum samples are submitted for "protein profiles" including capillary zone electrophoresis and rate immune nephelometric quantification of nine proteins (five in urines), although analysis of single proteins may be requested. Standardization between laboratories in our region has been greatly improved by automation, CRM 470 calibration and external quality assurance. We are further extending standardization by developing computer supported interpretations using a program with improved user interface and graphical representation of electrophoretic curves superimposed upon a shaded reference interval. Programming is underway to provide complete automatic interpretation of these curves. Together, capillary electrophoresis (with access to mathematical analysis) and immunochemical quantifications allow a highly automated process accessible to further digital analysis and automated interpretation. Rapid, cost-effective and standardized analysis of serum protein profiles should improve the diagnostic evaluation of many categories of patients.

Aim: To develop an Australian nursing documentation in aged care (Quality of Australian Nursing Documentation in Aged Care (QANDAC)) instrument to measure the quality of paper-based and electronic resident records. Methods: The instrument was based on the nursing process model and on three attributes of documentation quality identified in a systematic review. The development process involved five phases following approaches to designing criterion-referenced measures. The face and content validities and the inter-rater reliability of the instrument were estimated using a focus group approach and consensus model. Results: The instrument contains 34 questions in three sections: completion of nursing history and assessment, description of care process and meeting the requirements of data entry. Estimates of the validity and inter-rater reliability of the instrument gave satisfactory results. Conclusion: The QANDAC instrument has a potential as a useful audit tool for the purposes of quality improvement and research in aged care documentation.

The NMT-1 and NMT-3 organizations within the Chemical and Metallurgical Research (CMR) facility at the Los Alamos National Laboratory (LANL) is working to achieve Waste Isolation Pilot Plant (WIPP) certification to enable them to transport their TRU waste to WIPP. In particular, the NMT-1 management is requesting support from the Idaho National Engineering and Environmental Laboratory (INEEL) to assist them in making the Laboratory Information Management System (LIMS) software WIPP certifiable. Thus, LIMS must be compliant with the recognized software quality assurance (SQA) requirements stated within the QAPD. Since the Idaho National Engineering and Environmental Laboratory (INEEL) has achieved WIPP certification, INEEL personnel can provide valuable assistance to LANL by sharing lessons learned and recommendations. Thus, this white paper delineates the particular software quality assurance requirements required for WIPP certification.

Objective To report the evidence for and challenges to the validity of Sheffield Peer Review Assessment Tool (SPRAT) with paediatric Specialist Registrars (SpRs) across the UK as part of Royal College of Paediatrics and Child Health workplace based assessment programme. Design Quality assurance analysis, including generalisability, of a multisource feedback questionnaire study. Setting All UK Deaneries between August 2005 and May 2006. Participants 577 year 2 and 4 Paediatric SpRs. Interventions Trainees were evaluated using SPRAT sent to clinical colleagues of their choosing. Data were analysed reporting totals, means and SD, and year groups were compared using independent t tests. A factor analysis was undertaken. Reliability was estimated using generalisability theory. Trainee and assessor demographic details were explored to try to explain variability in scores. Main outcome measures 4770 SPRAT assessments were provided about 577 paediatric SpRs. The mean scores between years were significantly different (Year 2 mean=5.08, SD=0.34, Year 4 mean=5.18, SD=0.34). A factor analysis returned a two-factor solution, clinical care and psychosocial skills. The 95% CI showed that trainees scoring ≥4.3 with nine assessors can be seen as achieving satisfactory performance with statistical confidence. Consultants marked trainees significantly lower (t=−4.52) whereas Senior House Officers and Foundation doctors scored their SpRs significantly higher (SHO t=2.06, Foundation t=2.77). Conclusions There is increasing evidence that multisource feedback (MSF) assesses two generic traits, clinical care and psychosocial skills. The validity of MSF is threatened by systematic bias, namely leniency bias and the seniority of assessors. Unregulated self-selection of assessors needs to end.

The purpose of this paper is to present the second part of a detailed, step-by-step case study of a simple Six Sigma Green Belt project. In the last edition of Quality Engineering, the first part of a Six Sigma Green Belt case study was presented. That paper showed the Define and Measure phases of the DMAIC method. This paper presents the rest of the case study, or the Analyze, Improve, and Control phases of the DMAIC method.

The Centers for Disease Control and Prevention and its partners have been operating the Newborn Screening Quality Assurance Program for >20 y. The program helps participating laboratories to evaluate and improve the quality of their newborn-screening testing efforts by providing quality control dried blood spot materials and proficiency-testing materials for the external evaluation of screening programs. The Newborn Screening Quality Assurance Program provides an independent evaluation of filter papers approved by the Food and Drug Administration for the collection of blood for clinical tests. These activities have created a mechanism for the validation of the filter paper blood collection device and the standardization of materials and methods for the analysis of dried blood spots.

Quality assurance is a key factor for the improvement of an organisational behaviour. It is quite challenging to enhance an organisational performance without realising internal errors and mistakes done by its employees. We have also experienced that most of the security solutions are unsuccessful wherever human behaviour is involved. Organisations sometimes pay huge cost for its survival especially when human error is untraceable and misleading. Online survey has been conducted from different professionals serving at different positions in different organisations. Variety of multi-agent system tools (MAS) is available in the market for modelling and simulation of human behaviour. Brahms modelling and simulation tool has been selected among different multi-agent system tools due to its distinguished features to detect human errors in an organisation which supports warning alert generation system.

The development and implementation of a Europe of knowledge or the European Higher Education Area has led at institutional, regional, national and European level to a wave or a tsunami of changes to policies, strategies and legal frameworks in a strive for balancing European collaboration and global competition.

Following the fundamental review by the Committee of Inquiry into Higher Education, under the Chairmanship of Sir Ron, (now Lord) Dearing, in July, 1997 (and Scottish equivalent under Sir Ron Garrick); the Quality Assurance Agency for higher education (QAA), is currently consulting on the detailed elaboration of those Committees’ main recommendations. The QAA proposals are designed to provide public assurance on both the quality and standards in higher education and comprise an inter‐related set of components under the following headings: the development of a complete and overarching framework of qualifications for the UK; the development of a national template for individual programme specifications; the development of benchmarking information and threshold standards across 41 subject areas; the development of institutional codes of practice and institutional reviews; and the strengthening of the existing external examiner system to encompass a formal role of feedback on quality and standards to the QAA. The paper was submitted by the Association of Business schools to the QAA, in the format specified by the QAA. It can therefore best be understood in conjunction with the QAA’s consultation paper “An agenda for quality”, which provides greater detail of the main components, set out above.

SUMMARY The Permanent Working Group of European Junior Hospital Doctors (PWG) represents the interests, in international matters, of trainees from 23 member states. The PWG recognizes the importance of postgraduate training (PGT) in the maintenance of high quality health care delivery, and in this paper presents its current policy on PGT. This replaces its policy previously published in Medical Education 1989, 23, 339–47. The paper examines the context within which PGT occurs, and calls for an urgent review of its provision and funding. Basic principles, such as PGT existing within a continuum of medical education and the application of a quality assurance-based model, underpin the development of later sections on the structure, process and outcomes of PGT. These recommend the establishment of structured training programmes which should incorporate modern educational practice in the provision and monitoring of PGT. Emphasis is placed on the opportunities for training in the clinical setting and the utilization of a range of educational techniques. Evaluation and guidance by and of clinical supervisors and designated trainers is linked with the responsibilities of the trainee, and is placed within the context of a system of accountability, thus closing the quality assurance cycle. It is recommended that the views of the consumers of PGT, the trainees, are more fully considered in the development of training programmes. Finally, the potential for further harmonization is considered, with cautious advances being proposed.

The Year 2000 (Y2K) “bug” has crawled into the consciousness of senior management and raised their awareness for the need to assure the quality of computerized systems. Publicity about the business opportunities on the Internet has also raised concerns about electronic crime and database security. Today’s quality assurance (QA) and systems professionals need a practical path to follow for balancing the risks and benefits of computerized systems with the business return for regulated applications. This article gives a 10-step practical path to follow for computer validation and the measurement of system quality for information technology (IT) professionals and corporate management.

Over the last decade, the routine collection of stakeholder feedback has gradually become embedded in university quality systems throughout Australia. The most common practice is the use of surveys to evaluate student perceptions of their units (subjects), course (programme) and overall student experience. Initially, most surveys were paper-based and administered in class. Over time, web-based surveys have been introduced and while it is accepted that this survey mode delivers administrative efficiencies, a widespread view is that students are less likely to respond to web-based surveys. This chapter tests this assumption by examining the usage patterns of print-based and web-based student unit evaluation surveys and response rate trends over a period of three years at a large research-intensive university in Australia. While this analysis is restricted to one university's data, it points to some important findings for leaders in other universities who are responsible for making decisions about quality assurance policies, practices and budgets.

The Obama administration is seeking to increase access to and improve the efficiency of the health care system in the United States. One aspect of those efforts is a push towards the utilization of electronic health records (EHRs) by health care providers. Nova Southeastern University College of Dental Medicine (NSU-CDM) opened its doors in 1997 and began its evolution from paper charts to EHRs in 2006. AxiUm, a computer-run patient record and clinical management system, has become an integral part of the college’s quality assurance program and its students’ clinical education. Since the introduction of axiUm, the school has already noticed an increase in the quality of patient care due to improved oversight of patient management and the ability to more efficiently track treatment outcomes. Over time, the system will enable data collected by students providing care in the clinics to be quantified. Opposition to EHRs tends to stem primarily from the amount of time required for users to gain proficiency in the new technology, as well as from the initial cost to the provider. But there is no better place to begin this learning process regarding the importance and utilization of EHR systems than universities, where health professions students can acquire a comfort level with EHRs in an academic environment that they may then implement in their future practice.

Introduction: The distinctive characteristics of the German health system are medical progress and financial pressure—and this is especially true of the hospitals. These challenges must be met by strategic management instruments for quality assurance, and by reducing costs. Purpose: This article presents the instrument “clinical pathway” (also known as “clinical treatment pathway”) and describes the possibilities it offers, both for quality assurance and risk management, and for cost reduction. The clinical pathway presented here will be that for “multimodal pain therapy”, as used in the context of acute inpatient care in Germany. Methods: A general presentation of the risks in hospital is followed by consideration of the risks associated with core processes. A comprehensive total cost analysis is performed for those patients who meet the pathway entry criteria and who fulfil the requirements for the structure of care provided within multimodal pain therapy. Discussion and Conclusion: Multimodal pain therapy places high demands on the structural, procedural and outcome quality of the medical, nursing and therapeutic services provided, and these demands are reflected in high costs for the provision of this care. The treatment process involves many different professional groups. These complex interfaces can potentially generate risks, which can lead to the possibility of legal liability. A clinical pathway must structure the core process and then combine elements of quality assurance in order to optimise patient care and minimise risk. The examination of costs reveals significant potential savings (patients with clinical pathway: EUR 3086±212; patients without clinical pathway: EUR 3774±460; Mann-Whitney U test; p

Short-chain chlorinated paraffins are a class of organic compounds widely used in many industrial applications, extensively diffused into the environment, persistent, bioaccumulative, and toxic towards aquatic organisms. However, their study and monitoring in the environment are still limited. Because of the enormous number of positional isomers that characterise their mixtures, the analysis of this class of pollutants is very difficult to perform. Beside this, the lack of certified reference materials poses a problem for the assessment of the quality assurance/quality control of any analytical procedure. At present, the scientific community does not agree on any analytical reference method, although the monitoring of short-chain chlorinated paraffins has already started in order to comply with the Water Framework Directive of the European Union on water quality. In this paper the regulatory framework, in which chlorinated paraffins are included, and the status concerning their determination are summarized. The main analytical difficulties still existing are discussed, and the definition of a method-defined parameter as well as the development of a standardised method are suggested as a way to obtain comparable monitoring data.

Several interesting developments are taking place in general practice in France. One of the new elements contributing to change is quality assurance. The Norwegian author spent the academic year 1997-98 in Paris, working one day a week at the State Agency ANAES (Agence Nationale d'Accreditation et d'Evaluation en Sante - National Agency for Accreditation and Evaluation in Health). General practitioners working part time in the ANAES Department of Liberal Medicine are currently organising regional networks of GPs throughout the country to coordinate quality assurance activities. GPs are also involved in the agency's production of clinical guidelines. In addition to ANAES, several GP organisations are active in different aspects of quality development. The article looks at quality assurance as part of a new and more important role of general practice within the French health system, with some reference to simultaneous developments in Northern Europe.

The purpose of the evaluation presented in this paper was to generate practical information for the Ministry of Health (MOH) and other program planners in Malawi as the performance and quality improvement intervention (PGI) assessed was on the verge of being expanded from the hospital level to the health center level. Although large well-funded randomized controlled trials may be the gold standard they are not always feasible or practical to conduct. Therefore evidence from applied studies such as this one should be considered among all the evidence about quality assurance interventions.

The control of documentation in large multi‐site operations brings many problems. One company addressed these by reviewing the nature of documentation and then transferring the bulk of the paper work to a network computer system. The transfer took two years and resulted in improvements in control, access and awareness of the quality system.