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Gregory KD Hackmeyer P Gold L Johnson AI Platt LD 《The Joint Commission journal on quality improvement》1999,25(12):619-629
BACKGROUND: In 1994 a five-year prospective observational study (including 38,541 singleton live-born deliveries) based on maternal and neonatal hospital administrative discharge data for DRGs 370-375 was launched at Cedars Sinai Medical Center (CSMC) in Los Angeles. In 1993 a cesarean section (C-section) reduction task force was first convened and several interventions were conducted and monitored during a two-year period. In 1995 CSMC joined the Institute for Healthcare Improvement's (IHI's) national collaborative on lowering C-section rates. RESULTS: The first intervention involved physician education (grand rounds) and occurred during the preintervention baseline period. Providing physician-specific data had been implemented before participation in the IHI collaborative. Two other interventions were implemented before the collaborative versus 13 interventions after. The C-section rate decreased from 26.0% in the baseline period in 1993 to 20.5% in 1997, a 21.2% reduction. During the postintervention period, the C-section rate increased to 23.5%. There was no statistically or clinically significant increase in clavicular fractures, brachial plexus injuries, or cerebral hemorrhage in the four study years, compared to the baseline period. DISCUSSION: It is possible to safely reduce C-section delivery rates. Activities are now under way to involve additional private physician leaders in the continuous quality improvement effort. Although the small increase in the C-section rate during the postintervention period may represent statistical variation, and in itself may not be clinically significant, it supports the thesis that ongoing, continuous organizational support is required to achieve and maintain gains. 相似文献
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Recent free flight proposals to relax airspace constraints and give greater autonomy to aircraft have raised concerns about their impact on controller performance. Relaxing route and altitude restrictions would reduce the regularity of traffic through individual sectors, possibly impairing controller situation awareness. We examined the impact of this reduced regularity in four visual search experiments that tested controllers' detection of traffic conflicts in the four conditions created by factorial manipulation of fixed routes (present vs. absent) and altitude restrictions (present vs. absent). These four conditions were tested under varying levels of traffic load and conflict geometry (conflict time and conflict angle). Traffic load and conflict geometry showed strong and consistent effects in all experiments. Color coding altitude also substantially improved detection times. In contrast, removing altitude restrictions had only a small negative impact, and removing route restrictions had virtually no negative impact. In some cases conflict detection was actually better without fixed routes. The implications and limitations of these results for the feasibility of free flight are discussed. Actual or potential applications include providing guidance in the selection of free flight operational concepts. 相似文献
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Jobs in many modern settings, including manufacturing, service, agriculture and construction, are variable in their content and timing. This prompts the need for exposure assessment methods that do not assume regular work cycles. A scheme is presented for classifying levels of routinization to inform development of an appropriate exposure assessment strategy for a given occupational setting. Five levels of routinization have been defined based on the tasks of which the job is composed: 1) a single scheduled task with a regular work cycle; 2) multiple cyclical tasks; 3) a mix of cyclical and non-cyclical tasks; 4) one non-cyclical task; 5) multiple non-cyclical tasks. This classification, based primarily on job observation, is illustrated through data from a study of automobile manufacturing workers (n = 1200), from which self-assessed exposures to physical and psychosocial stressors were also obtained. In this cohort, decision latitude was greater with higher routinization level (p < 0.0001), and the least routinized jobs showed the lowest self-reported exposure to physical ergonomic stressors. The job analysis checklist developed for non-routinized jobs is presented, and limitations of the task analysis method utilized in the study are discussed. A work sampling approach to job analysis is recommended as the most efficient way to obtain a comparable unbiased exposure estimate across all routinization levels. 相似文献
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想刻录一张能够启动系统、分区、格式化,让重装系统变得简单的自启动光盘吗?想刻录“自动还原系统光盘”,让系统恢复完全自动化、傻瓜化、一条龙吗?想让制作的光盘放入光驱后会自动打开Winamp播放音乐吗?……使用它们,可以给使用电脑带来无穷的便利与乐趣。实话告诉你,不难的! 相似文献
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We have developed a miniature fiber-optic probe with no focusing optics for in situ analysis of volatile organic compounds (VOCs). The probe uses an optical fiber to transmit a laser pulse to a vapor sample causing it to ionize adjacent to the fiber tip through a resonance-enhanced multiphoton ionization (REMPI) process. The distal end of the optical fiber is contained co-axially within 2-mm-inner-diameter stainless steel tubing that serves as an electrode. The electrode is biased at a high positive potential to collect electrons. The current generated is shown to be proportional over about two orders of magnitude to the concentration of the species ionized. Visible wavelength REMPI spectroscopy is used to determine probe sensitivities of 20 ppb (benzene) and 43 ppb (toluene). Designing the probe without focusing optics specifies an achromatic ionization region constant in size and position as the laser wavelength is scanned, which simplifies data collection and reduction. Focusing achromatic systems are discussed and the potential signal improvement is estimated. 相似文献
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对于国人而言,购买一款自己喜爱的笔记本电脑(注:以下简称本本)不容易.往往需要存上一两个月的工资才能搞定。因此,谁都不希望买到质量差,甚至是别人用过的二手货或者翻新机。别不信,电脑城里的伙计最喜欢把用来给顾客展示的本本样机高价兜售给用户,很多用户就这样糊里糊涂地把二手本本抱回了家。 相似文献
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Color characteristics of Cu-Zn-Al alloys 总被引:4,自引:0,他引:4
COLORCHARACTERISTICSOFCu-Zn-AlALLOYS ̄①Li,Baomian;Zhang,Xiuhua(ShenyangInstituteofGoldTechnology,Shenyang110015)COLORCHARACTER... 相似文献
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Shawn Gold 《中国设备工程》2009,(10):20-20
开放式系统除具备已有的优势外,也构成了重大的信息技术挑战。终端用户只能过多地依靠自动化供应商协助他们保持过程控制网络的安全性。事实上,关于Et趋复杂的开放式自动化构架和专业化信息技术支持的工作正在由厂房工程师来担当。 相似文献