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"Cowling, Graham"
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Quality Control Using Noise and Vibration Limit Testing
Unwarranted squeaks and rattles in delivered products may be perceived by the customer as an indication of poor quality. Moreover, they may be indicative of component or assembly faults leading to reduced life or unreliable operation.
Journal Article
How to do audiometry health surveillance
A quick reference guide to audiometry for occupational health practitioners. Practical audiometry programmes are discussed with reference to the 'Control of Noise at Work Regulations' (2005). [(BNI unique abstract)] 2 references
Journal Article
HOW TO... do audiometry health surveillance
Prior to the Control of Noise at Work Regulations (CoNAWR), employers still had a general duty to provide health surveillance where workers were exposed to hazards, including noise. CoNAWR Regulation 9 now determines when employers must use audiometry to ensure that workers' hearing is being protected, and how to go about it. The Health and Safety Executive (HSE) guidance states that you must ensure suitable health surveillance is provided to staff who are liable to be exposed to noise. Audiometry itself is a specialist task; larger organizations may have an in-house facility; smaller organizations may require the services of a visiting consultant or send their employees to a test center. If an employee is deemed to have suffered noise induced hearing loss, then you are also required to manage their employment. A successful hearing conservation program combines noise assessment, noise control and management.
Magazine Article
Efficacy of Baloxavir Treatment in Preventing Transmission of Influenza
In this randomized trial conducted over the 2019–2024 influenza seasons, baloxavir resulted in a significantly lower incidence of transmission of influenza virus from patients to household contacts than placebo.
Journal Article
Designing Large-Scale Conservation Corridors for Pattern and Process
A major challenge for conservation assessments is to identify priority areas that incorporate biological patterns and processes. Because large-scale processes are mostly oriented along environmental gradients, we propose to accommodate them by designing regional-scale corridors to capture these gradients. Based on systematic conservation planning principles such as representation and persistence, we identified large tracts of untransformed land (i.e., conservation corridors) for conservation that would achieve biodiversity targets for pattern and process in the Subtropical Thicket Biome of South Africa. We combined least-cost path analysis with a target-driven algorithm to identify the best option for capturing key environmental gradients while considering biodiversity targets and conservation opportunities and constraints. We identified seven conservation corridors on the basis of subtropical thicket representation, habitat transformation and degradation, wildlife suitability, irreplaceability of vegetation types, protected area networks, and future land-use pressures. These conservation corridors covered 21.1% of the planning region (ranging from 600 to $5200 km^2$) and successfully achieved targets for biological processes and to a lesser extent for vegetation types. The corridors we identified are intended to promote the persistence of ecological processes (gradients and fixed processes) and fulfill half of the biodiversity pattern target. We compared the conservation corridors with a simplified corridor design consisting of a fixed-width buffer along major rivers. Conservation corridors outperformed river buffers in seven out of eight criteria. Our corridor design can provide a tool for quantifying trade-offs between various criteria (biodiversity pattern and process, implementation constraints and opportunities). A land-use management model was developed to facilitate implementation of conservation actions within these corridors.
Journal Article
Five-year Impact of a Commercial Accountable Care Organization on Health Care Spending, Utilization, and Quality of Care
Supplemental Digital Content is available in the text.
Background:Accountable Care Organizations (ACOs) have proliferated after the passage of the Affordable Care Act in 2010. Few longitudinal ACO studies with continuous enrollees exist and most are short term.Objective:The objective of this study was to evaluate the long-term impact of a commercial ACO on health care spending, utilization, and quality outcomes among continuously enrolled members.Research Design:Retrospective cohort study design and propensity-weighted difference-in-differences approach were applied to examine performance changes in 2 ACO cohorts relative to 1 non-ACO cohort during the commercial ACO implementation in 2010-2014.Subjects:A total of 40,483 continuously enrolled members of a commercial health maintenance organization from 2008 to 2014.Measures:Cost, use, and quality metrics for various type of services in outpatient and inpatient settings.Results:The ACO cohorts had (1) increased inpatient and outpatient total spending in the first 2 years of ACO operation, but insignificant differential changes for the latter 3 years; (2) decreased outpatient spending in the latter 2 years through reduced primary care visits and lowered spending on specialists, testing, and imaging; (3) no differential changes in inpatient hospital spending, utilization, and quality measures for most of the 5 years; (4) favorable results for several quality measures in preventive and diabetes care domains in at least one of the 5 years.Conclusions:The commercial ACO improved outpatient process quality measures modestly and slowed outpatient spending growth by the fourth year of operation, but had a negligible impact on inpatient hospital cost, use, and quality measures.
Journal Article
Findings From a Commercial ACO Patient Experience Survey
Accountable care organizations (ACO) emerge each year aiming to improve care quality while controlling rising health care costs. This cross-sectional study examined whether ACO arrangements within a Preferred Provider Organization and a Health Maintenance Organization (HMO) effected patient experience. A modified Consumer Assessment of Healthcare Providers and Systems ACO survey was used to assess care domain differences overall and by product. The association between ACO and non-ACO populations and items in each significant care domain, flu vaccination, and delayed and emergency department care are explored using multivariable logistic regression. Accountable care organizations patients were more likely to report it was easy to get a specialist appointment (adjusted odds ratio [AOR], 1.54; 95% CI = 1.11-2.13), less likely to report visiting the emergency department for care (AOR, 0.70; 95% CI = 0.55-0.90) and communicating with their provider using technology (AOR, 0.79; 95% CI = 0.65-0.96). Reported experience differed for Access to Specialists between ACO and non-ACO groups among overall and HMO respondents (79.4% vs 74.7% and 79.9% vs 75.5%, P < .05, respectively). The ACO patient experience was not substantially better. Strategies incorporating satisfaction and experience, whether linked to contracts or not, should be encouraged given ACOs goal to optimize patient care. Survey instruments must be improved to capture nuances of provider care and patient bond that is vital in ACO integrated systems.
Journal Article