In order to achieve the stated goal of reducing the final closing procedure time cycle for construction projects at the Texas Department of Transportation (TxDOT) Odessa District, several standard operating procedures (SOPs) for project construction control and management had to be revised. Seemingly unrelated tasks created posterior chains of events that resulted in bottlenecks in the process and delayed final project closing. Four specific SOPs were identified and analyzed to determine which tasks required modification and what was expected from these modifications. A mission for each specified SOP was conceived and written to give a clear view of the intent of the procedure. Afterwards, district policies were drafted to provide the means to fulfill the intent. The procedural changes, compatible with TxDOT statewide procedures, allowed the time spent in the processes to remain the same but redistributed it to reduce the end-loading of the control process. The new SOPs require an even time distribution cyclically throughout the project. Control procedures are done only once, shortening the final closing procedure for projects by doing one-time, short, cyclical, consecutive control tasks of the same procedure throughout the life of the project, rather than doing some of them once cyclically and then again at the closing procedure and others just at the closing procedure. These changes resulted in a shorter end-cycle time, which substantially reduced the final closing procedure time for each project, without affecting the integrity and safeguards of the project. The changes resulted in more efficient and timely financial, managerial, and engineering control of projects. The procedures revised were (1) Review and Approval of Change Orders; (2) Review and Approval of Monthly Progress Estimates; (3) Review and Approval of Interim and Final Audits and Final Estimate; and (4) Storm Water Pollution Prevention Plans (SW3P) Records Management and Auditing Procedures.

<p>Det har länge varit känt att patientens perioperativa position kan orsaka symtom som förmodas uppstå genom tryck och sträckningar. Positionen vid laparosko-piska operationer anses öka risken för symtom och därför är perioperativ om-vårdnad av betydelse. Syftet var därför att undersöka hur frekvent positions- relaterade symtom förekommer vid laparoskopiska ingrepp och vilken betydelse de har för patienten. Studien genomfördes som en deskriptiv tvärsnittstudie och datainsamlingen gjordes med hjälp av symtomskattning och semistrukturerade intervjuer. Totalt 60 respondenter i åldern 19 till 75 år deltog i studien som pågick under åtta månader. Resultatet visade att en fjärdedel av respondenterna drab-bades av nytillkomna eller förvärrade symtom. Dessa uppmärksammades postoperativt eller några dagar efter operationen och var oberoende av ingrepp, perioperativ tid eller armarnas position. Några av respondenterna upplevde smärta och domningar i nacke, axlar och händer som ledde till inskränkningar i det dagliga livet och krävde hjälp av närstående. Det är viktigt att fortsätta arbetet med att förebygga positionsrelaterade skador, för att förhindra postoperativa symtom, genom att placera patienten så nära ett neutralläge som möjligt och ge denne möjlighet att känna efter hur det känns före nedsövning.</p> / <p>It has long been assumed that a patient’s perioperative position can cause symp-toms which appear from pressure and strains on the body. The position in lapa-roscopic surgery is considered to increase the risk of symptoms, perioperative care is therefore important. The scope of this study was therefore to survey how frequent symptoms associated with the patient’s position occur and why they are important to the patient. The survey was made as a descriptive cross-section study. The data collection was made by way of patients own estimates of their symptoms and by semistructured interviews. 60 respondents aged between 19 and 75 took part in the study. The result showed that a fourth of the respondents experienced new or aggravated symptoms. These were observed postoperatively or a few days after surgery and were independent of operations, perioperative time or position of the arms. Some of the respondents felt pain and numbness in the neck, shoulders and hands which led to restrictions in their daily life and required help from someone close. It is important to continue working with preventing postoperative symptoms, by placing the patient as close to a neutral position as possible and give her the possibility to feel comfortable before the anesthetization.</p>

Det har länge varit känt att patientens perioperativa position kan orsaka symtom som förmodas uppstå genom tryck och sträckningar. Positionen vid laparosko-piska operationer anses öka risken för symtom och därför är perioperativ om-vårdnad av betydelse. Syftet var därför att undersöka hur frekvent positions- relaterade symtom förekommer vid laparoskopiska ingrepp och vilken betydelse de har för patienten. Studien genomfördes som en deskriptiv tvärsnittstudie och datainsamlingen gjordes med hjälp av symtomskattning och semistrukturerade intervjuer. Totalt 60 respondenter i åldern 19 till 75 år deltog i studien som pågick under åtta månader. Resultatet visade att en fjärdedel av respondenterna drab-bades av nytillkomna eller förvärrade symtom. Dessa uppmärksammades postoperativt eller några dagar efter operationen och var oberoende av ingrepp, perioperativ tid eller armarnas position. Några av respondenterna upplevde smärta och domningar i nacke, axlar och händer som ledde till inskränkningar i det dagliga livet och krävde hjälp av närstående. Det är viktigt att fortsätta arbetet med att förebygga positionsrelaterade skador, för att förhindra postoperativa symtom, genom att placera patienten så nära ett neutralläge som möjligt och ge denne möjlighet att känna efter hur det känns före nedsövning. / It has long been assumed that a patient’s perioperative position can cause symp-toms which appear from pressure and strains on the body. The position in lapa-roscopic surgery is considered to increase the risk of symptoms, perioperative care is therefore important. The scope of this study was therefore to survey how frequent symptoms associated with the patient’s position occur and why they are important to the patient. The survey was made as a descriptive cross-section study. The data collection was made by way of patients own estimates of their symptoms and by semistructured interviews. 60 respondents aged between 19 and 75 took part in the study. The result showed that a fourth of the respondents experienced new or aggravated symptoms. These were observed postoperatively or a few days after surgery and were independent of operations, perioperative time or position of the arms. Some of the respondents felt pain and numbness in the neck, shoulders and hands which led to restrictions in their daily life and required help from someone close. It is important to continue working with preventing postoperative symptoms, by placing the patient as close to a neutral position as possible and give her the possibility to feel comfortable before the anesthetization.

The construction industry has faced severe criticism against its inefficiency, high costs and insufficient quality. Besides, the building branch is one of the most dangerous occupations.Skanska Sverige AB runs an international project focused mainly on improving safety, increasing overall process efficiency and providing customers higher value. A part of this project are Standard operating procedures. These are supposed to be the best practices known at the company and should be used on sites as stepwise work instructions.The purpose of this study was to study the creation of Standard operating procedures and to propose a model for continuous improvement of the Standard operating procedures.A theoretical review concerning standards, standardization and continuous improvement is presented.Four case studies were conducted in the thesis in order to clarify what and how to improve. The case studies show that inspiration can be taken from organizations within or outside the building trade. An important new element in Standard operating procedures would be a risk analysis. The risk evaluation corresponds with Skanska´s safety strives. In order to guarantee that a Standard operating procedure really contains the best practice, the process of continuous improvement has to be well managed. The process can be stimulated by the implementation and improvement management at “Väg och anläggning” Skanska.Based on the empirical study and the theoretical framework, a model illustrating continuous improvement is proposed. The never ending life spiral of a Standard operating procedure involves all the organizational levels. The model demonstrates that small stepwise improvements are more cost efficient than large radical changes.Advantages and risks connected to the continuous improvement are described. The benefits would be both monetary and non-monetary. The key success factor of continuous improvement is the proper implementation of Standard operating procedures since it is up to individuals to keep continuous improvement alive. Both the managers on different levels and workmen must be trained and their importance in continuous improvement process must be deep rooted in their thinking. Proper training and excellent leadership would diminish worker´s resistance and prevent an unwanted phase-out.Finally, Skanska is encouraged to trust its own research. The formal content of Standard operating procedures is good enough for launching.

The emergency response readiness of the public health and emergency management systems have become increasingly important topics for research, development and action in the United States. Senior citizens represent a large and growing population group in the United States. Older persons are likely to be disproportionately vulnerable during disasters because they are more likely to have chronic illnesses, functional limitations, and sensory, physical and cognitive disabilities than those of younger ages. Elderly health and safety have become the responsibility of the elderly themselves, of the community in which they live, and the various agencies and organizations charged with preparedness planning. The goal of this study was to assess the emergency operations plans (EOPs) of emergency relief agencies and organizations in the Atlanta area for the provision of emergency relief services utilized by senior citizens as a special needs population. The research and analysis performed was completed in two steps: a review of collected disaster and emergency operations plans (EOPs) and standard operating procedures (SOPs), and a qualitative analysis of a survey submitted to the agencies. Although many EOPs and SOPs referred to emergency relief services for special needs populations, the plans were not functional and did not fully outline the ‘who, what, when, where and how” to provide disaster relief services. Public health agencies must endeavor to better address the disaster related needs of elderly persons who have physical disabilities, special medical needs and communication disabilities. Disaster preparedness plans must ensure the availability of all items necessary to control and prevent complications related to chronic diseases, prevent acute events and promote functionality and independence.

M.Tech (Department of Accountancy, Faculty of Management Sciences), Vaal University of Technology. / The provision of infrastructure delivery programmes in Limpopo province is an important agent in the reduction of poverty, unemployment and strengthening of social capital. The infrastructure development programmes create opportunities for job creation through approaches such as maintenance of existing infrastructure in order to retain resources in the local areas. However, the provision of basic infrastructure still faces serious challenges, notwithstanding the fact that the PFMA and Treasury Regulations (issued by the National Treasury in terms of Section 76 of the PFMA) provide for control measures government has put in place for effective and efficient service delivery in general. The objective of this study was to scrutinise management of finances in the planning, implementation and monitoring of infrastructure programmes and further seek to propose measures to strengthen financial management controls in the implementation of infrastructure programmes to bolster service delivery in the Limpopo province. The literature reviewed indicated that successful implementation of infrastructure development in the province depends on skills and knowledge of the players and financial resources. This study used qualitative research methodology in examining the management of finances in the planning, implementation and monitoring of infrastructure programmes in the Limpopo provincial government. An open-ended questionnaire was used to collect data from the participants. The researcher utilised purposive selection method to obtain information from relevant participants who are directly involved in infrastructure management. The study revealed that Limpopo government departments do not utilise capital budgeting models to appropriately plan and fund infrastructure projects. There are challenges, including procurement processes, lack of appropriate skills to monitor and implement infrastructure projects and lack of standard operating procedures to encourage a culture of uniformity, responsibility and accountability in the processing of payments.

In forensic toxicology, opioids are frequently associated with drug abuse or drug-related death cases. An optimal method for use in the identification and quantification of opioids in a complex blood matrix is of paramount importance. Along with the ability to identify and quantitate opioids, this method should be accurate, sensitive, and selective. The application of sample pre-treatment and solid-phase extraction are common to purify and concentrate the target analytes before analyzing with liquid chromatography-tandem mass spectrometry. The purpose of this study was to compare the performance of two standard operating procedures, adopted by the Massachusetts State Police Crime Laboratory Toxicology and the Biomedical Forensic Sciences– Toxicology Laboratory at Boston University School of Medicine, for detecting opioids in blood. A total of eight drugs were analyzed: 6-monoacetylmorphine, codeine, fentanyl, hydrocodone, morphine, norhydrocodone, oxycodone, and oxymorphone. Comparison was performed using the parameters studied as part of method validation, including calibration model, bias, precision, carryover, interferences, ionization suppression/enhancement, and recovery. The results indicated that the method from Massachusetts State Police provided a better performance with between-run precision, interferences from matrix and other commonly encountered drugs, matrix effect at high concentration (250 ng/mL) and matrix recovery. Meanwhile, the method from Biomedical Forensic Sciences showed less bias, within-run precision, and matrix effect at low concentrations. Carryover and internal standard interference were comparable in both standard operating procedures. The calibration models were adjusted by altering the selection of regression model for improved quantification method performance. The volume of solvents, sample matrix, as well as time, were taken into consideration in accessing the overall performance of identification and quantitation. Both procedures were comparable yet the one from Massachusetts State Police was more beneficial in identifying the target analytes with greater sensitivity and selectivity and the one from Biomedical Forensic Sciences was more economical and efficient.

The objects of the South African Pharmacy Council in terms of the Pharmacy Act, 1974 (5311974) as amended are, inter alia, "to uphold and safeguard the rights of the general public to universally acceptable standards of pharmacy practice in both the private and the public sector" as well as "to establish, develop, maintain and control universally acceptable standards of practice of the various categories of persons required to be registered.. ." One of the major difficulties health care providers worldwide are faced with is how to maintain a proper balance between the trio goals of health care, namely adequate access, high quality and acceptable costs (Li, 2003:192-193). Relatively little is known about such problems as do exist for patients regarding access to pharmaceutical services (Doucette et al., 1999:1268). Two main objectives were identified for this study, namely to investigate the demographic profile of community and institutional pharmacies registered with the South African Pharmacy Council; and to determine the standard of pharmaceutical services provided by these pharmacies. Inspection results of community and institutional pharmacies were obtained from the South African Pharmacy Council and extracted for the time period 1 January 2004 to 31 May 2005. To determine the demographic and geographic profile of these pharmacies, data of the Register of Pharmacies of the South African Pharmacy Council for August 2003, 2004 and 2005 were merged with the Census data of South Africa of 2001. It was found that the total number of pharmacies in both the public and private sectors increased with 2.1% (n=68) from August 2003 to August 2005. Public and private pharmacies that provided services directly to patients increased with 6.3% (n=33) and 1.3% (n=35) from August 2003 to 2005. It was found that the Gauteng province was the best provided with registered pharmacies in South Africa, as only 0.06% (n=5 783) of the population did not have any registered pharmacy available on municipality level. It was also revealed that the majority of inspections were carried out in Gauteng, whilst this province accounts for only 19.7% of the total population of South Africa. During the study period a total of 1178 community pharmacy inspections were carried out in 1103 community pharmacies (one or more inspections per pharmacy) representing 43% (n=2 550) of the total number of community pharmacies registered with the South African Pharmacy Council during May 2005. Nationally community pharmacies achieved a score of 92.27 (+ 6.65 per cent) for compliance with Good Pharmacy Practice guidelines. The lowest compliance score (73.34 + 27.49 per cent) was obtained for the availability of written standard operating procedures and the highest was for the promotion of public health (99.02 + 6.30 per cent). No practical significant differences (dc0.8) were found between the overall compliance scores obtained by community pharmacies of the different provinces. The highest compliance score was obtained by community pharmacies in the Free State (93.09 + 4.90 per cent), followed by Western Cape, Eastern Cape, Kwazulu Natal, Limpopo, Northern Cape, Gauteng, Mpumalanga and the North West. A total of 343 institutional pharmacy inspections (one or more inspections per pharmacy) were carried out in public and state subsidised institutions (n=245), private institutions (n=90) and mine hospitals (n=5). These pharmacies represented 46% of the total number of institutional pharmacies registered with the South African Pharmacy Council during May 2005. Nationally all institutional pharmacies (both private and public) achieved a score of 92.49 + 8.33 per cent for compliance with Good Pharmacy Practice guidelines for all above-mentioned aspects. Nationally public and state subsidised institutional pharmacies obtained a lower compliance score (91.02 + 9.08 per cent) than private institutional pharmacies (96.39 + 3.91 per cent). Lastly, a grading system was developed that was based on the results obtained through this study, in order to quantify the standard of pharmaceutical services provided by pharmacies in South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

The objects of the South African Pharmacy Council in terms of the Pharmacy Act, 1974 (5311974) as amended are, inter alia, "to uphold and safeguard the rights of the general public to universally acceptable standards of pharmacy practice in both the private and the public sector" as well as "to establish, develop, maintain and control universally acceptable standards of practice of the various categories of persons required to be registered.. ." One of the major difficulties health care providers worldwide are faced with is how to maintain a proper balance between the trio goals of health care, namely adequate access, high quality and acceptable costs (Li, 2003:192-193). Relatively little is known about such problems as do exist for patients regarding access to pharmaceutical services (Doucette et al., 1999:1268). Two main objectives were identified for this study, namely to investigate the demographic profile of community and institutional pharmacies registered with the South African Pharmacy Council; and to determine the standard of pharmaceutical services provided by these pharmacies. Inspection results of community and institutional pharmacies were obtained from the South African Pharmacy Council and extracted for the time period 1 January 2004 to 31 May 2005. To determine the demographic and geographic profile of these pharmacies, data of the Register of Pharmacies of the South African Pharmacy Council for August 2003, 2004 and 2005 were merged with the Census data of South Africa of 2001. It was found that the total number of pharmacies in both the public and private sectors increased with 2.1% (n=68) from August 2003 to August 2005. Public and private pharmacies that provided services directly to patients increased with 6.3% (n=33) and 1.3% (n=35) from August 2003 to 2005. It was found that the Gauteng province was the best provided with registered pharmacies in South Africa, as only 0.06% (n=5 783) of the population did not have any registered pharmacy available on municipality level. It was also revealed that the majority of inspections were carried out in Gauteng, whilst this province accounts for only 19.7% of the total population of South Africa. During the study period a total of 1178 community pharmacy inspections were carried out in 1103 community pharmacies (one or more inspections per pharmacy) representing 43% (n=2 550) of the total number of community pharmacies registered with the South African Pharmacy Council during May 2005. Nationally community pharmacies achieved a score of 92.27 (+ 6.65 per cent) for compliance with Good Pharmacy Practice guidelines. The lowest compliance score (73.34 + 27.49 per cent) was obtained for the availability of written standard operating procedures and the highest was for the promotion of public health (99.02 + 6.30 per cent). No practical significant differences (dc0.8) were found between the overall compliance scores obtained by community pharmacies of the different provinces. The highest compliance score was obtained by community pharmacies in the Free State (93.09 + 4.90 per cent), followed by Western Cape, Eastern Cape, Kwazulu Natal, Limpopo, Northern Cape, Gauteng, Mpumalanga and the North West. A total of 343 institutional pharmacy inspections (one or more inspections per pharmacy) were carried out in public and state subsidised institutions (n=245), private institutions (n=90) and mine hospitals (n=5). These pharmacies represented 46% of the total number of institutional pharmacies registered with the South African Pharmacy Council during May 2005. Nationally all institutional pharmacies (both private and public) achieved a score of 92.49 + 8.33 per cent for compliance with Good Pharmacy Practice guidelines for all above-mentioned aspects. Nationally public and state subsidised institutional pharmacies obtained a lower compliance score (91.02 + 9.08 per cent) than private institutional pharmacies (96.39 + 3.91 per cent). Lastly, a grading system was developed that was based on the results obtained through this study, in order to quantify the standard of pharmaceutical services provided by pharmacies in South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

Made available in DSpace on 2015-03-26T13:58:37Z (GMT). No. of bitstreams: 1 texto completo.pdf: 904859 bytes, checksum: 818ef8bd958bac77d3e6400dba52155c (MD5) Previous issue date: 2013-09-19 / Brazil is among the greatest world producers and traders of agricultural products. The inevitable growth of international trade, combined with the country s huge borders contributes, nevertheless, to increased risk of entrance and establishment of pests that may cause significant economic, social and environmental impact. The Ministry of Agriculture, Livestock and Food Supply s (MAPA) decentralized plant protection units, although operating in line with legal regulation and guidelines, and within the limits of its regimental competencies, do not have a procedural manual. The objective of this dissertation is to develop a procedural manual to guide the performance of the plant protection activities. The methodology used in planning, research, mapping and construction of the manual is the one developed and adopted by MAPA s Planning and Management Coordination, through its Mapping, Improvement and Implementation of Service Processes Manual (MAIPS). As a result of field research, twenty-four sub-processes have been mapped, comprised in three service processes that compose the macro-process Plant Health of MAPA s decentralized plant protection units. In general, research demonstrated that there are no written standard operational procedures in place and that the forms are not standardized. Throughout the improvement stage, a Procedural Manual has been built, composed by flowcharts, activity descriptions, tasks, rules and forms. / O Brasil ocupa posição de destaque no mundo como produtor e exportador de produtos agropecuários. O incremento do comércio internacional, aliado às dimensões do país, contribui, entretanto, para maior risco da entrada e estabelecimento de pragas que podem causar significativo impacto econômico, social e ambiental. As unidades de sanidade vegetal das Superintendências Federais de Agricultura, Pecuária e Abastecimento (SFAs), embora atuem embasadas nas normas legais e diretrizes emanadas pelo Departamento de Sanidade Vegetal da Secretaria de Defesa Agropecuária do Ministério da Agricultura, Pecuária e Abastecimento (DSV/SDA/MAPA) e no escopo de suas competências regimentais, não dispõem de um manual de procedimentos e de formulários que estabeleça padrões para execução de suas atividades. Esta dissertação teve por objetivo desenvolver um manual de procedimentos para a realização dessas atividades. A metodologia empregada no planejamento, pesquisa, mapeamento e elaboração do manual foi aquela desenvolvida e adotada pela Coordenação de Planejamento e Gestão do MAPA, por meio de seu Manual de Mapeamento, Aprimoramento e Implementação de Processo de Serviço (MAIPS). Como resultado da pesquisa de campo, foram mapeados vinte e quatro subprocessos, compreendidos em três processos de serviço que compõem o macroprocesso Sanidade Vegetal das SFAs. Verificou-se ainda que, regra geral, não existem procedimentos operacionais padrão escritos e que os formulários utilizados não são uniformizados. Como resultado da fase de aprimoramento, foi construído o Manual de Procedimentos para as Unidades de Sanidade Vegetal das SFAs, composto de fluxogramas, descrições de atividades, tarefas, regras e formulários.