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ABSTRACT Background: Diabetes has become an epidemic in the United States, affecting nearly 30 million people per year (National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], 2014). Type 2 Diabetes Mellitus (T2DM) disproportionately affects Hispanics. The American Diabetes Association (ADA) has established diabetes care guidelines that focus on improving diabetes care and patient outcomes. Quality improvement (QI) efforts have been developed and proven effective at targeting specific diabetes care indicators. Problem: Wesley Health Center (WHC) has identified deficiencies in select ADA diabetes quality care indicators of ophthalmologist referral, annual foot exam, smoking cessation counseling and pneumococcal vaccines for all patients with T2DM (ADA,2015). Design: A QI project applying the Plan-Do-Study-Act (PDSA) cycle was implemented to improve the select diabetes quality care indicators of ophthalmologist referral, annual foot exam, smoking cessation counseling and pneumococcal vaccines for all patients with T2DM. Setting: WHC, a community health center located in Phoenix, Arizona, services mostly uninsured and underinsured Hispanic patients. Intervention: One PDSA cycle was carried out utilizing the fishbone diagram in an effort to identify root cause of the stated problem. The team of stakeholders identified modifications of the current electronic adult template as a key contributing factor. Workflow process changes that complemented the new modifications to the template were also made. The intervention was carried out for six (6) weeks with weekly stakeholder meetings. Expected Outcome: To improve select ADA diabetes quality care indicators for adult patients with T2DM within six (6) weeks of implementation by at least 10% from baseline. Results: Errors in data querying parameters limited data accuracy and interpretation thus the impact of the intervention was not able to be evaluated. Significance: QI interventions are important to nursing practice because they emphasize the importance of a doctorally prepared Advanced Practice Nurse (APRN) to be able to identify a problem in clinical practice and carry out a QI intervention in an effort to improve patient care and outcomes. A QI intervention provides the DNP prepared APRN an opportunity to synthesize into one project the skills and knowledge learned throughout their DNP program.

In axial flow compressors and fans, the stable working range is restricted by the so called stall line where operation may become unstable and simultaneously a short fall in compressor performance appears. Stall margin improvement has been a major task and experimental observations over the last two decades have shown that modifying the shape of the outer annulus wall, above the tips of rotor blades, is effective in delaying the onset of stall to lower mass flow rates. A wide variety of wall modifications or casing treatments have been tried with a range of stall flow improvement which can amount to about 20% .(of the stalled flow) An alternative technique for stall margin improvement in a single stage axial flow machine has been studied and results will be described in the present thesis. The technique for delaying stall involves a large scale treatment to the outer casing of the compressor which extends partly over and mainly upstream of the rotor. The operating principle appears to be that as the flow is reduced towards the stall point some radially unbalanced cells are transported from the blade tips where they are collected in the treatment , turned by the treatment vanes , and re-introduced to the main flow upstream of the rotor. A rotor with and without outlet stators has been tested ( and also with and without casing treatment) over a range of speeds and flow conditions. Also the flow condition inside the recessed casing has been simulated by means of an existing computer code known as PHOENICS.

With the progress of the semiconductor technology, the devices scaling down to submicron range leads to increase I/Os number and very fine pitch IC package type; such as BGA, Flip Chip and CSP type packages. For Flip chip packaging, the solder bumping process act as the role of I/O interconnection instead of conventational wirebonding process. The ball mounted process is defined as the solder ball mounted on the Flip Chip Ball Grad Array (FC-BGA) substrate for solder bumping. In this study, how to improve the strength of ball-shear; residual tin capability and capability of process kit are the main issues to be investigated for the ball mounted process. To analyze the root cause and to implement the corrective action are the important purpose for solving the failures occurred on the ball mounted process. The following technologies included as (1) engineering ststictic methodology; JMP (statistical software) (2) Problem solving methodology (PSM) (3) Optimizing the process window (4) Set up the main parameters to analyse in machinery (5) how to monitor the CPK capability & material properties analysis, are used for these issues. Finally, the ball mounted process has been successfully investigated and results in solving the failure of Flip Chip ball mounted process and surface mounted technology (SMT) process for assembly packaging manufacture completely.

The purpose of this study was to identify the major school improvement needs and related strategies for two Bangladeshi secondary public schools based upon the perceptions of in-school professionals, parents, and students. To implement the study, I employed the constructivist/interpretive paradigm with a case study as my research design. The data collection techniques of document analysis, Nominal Group Technique (NGT) meetings, and individual interviews were utilized. For the purpose of NGT meetings, from each school, one teacher group, one parent group, and one student group were interviewed. After the completion of NGT meetings, individual interviews were held with one participant selected from each NGT group. I also interviewed the headmasters of the two schools. This study revealed that in a Bangladeshi educational context, major catalysts for improvement were market mechanisms and educational policies. The most significant finding of this study was that considering contextual applicability before implementing new initiatives was a critical strategy toward achieving sustainable school improvement in Bangladesh. The data indicated that in these schools, desired improvement efforts mainly consisted of two clusters: identifying the key school improvement needs and developing the strategies to meet those needs. The data revealed that the identified school improvement needs can be grouped into providing the resources and improving the school culture. To enhance school effectiveness, these Bangladeshi schools need to recruit more specialized teachers, implement effective instructional methodologies, elevate the image of teaching profession, and provide teacher-led professional development. Participants identified other suggested school improvement needs to be: low student-teacher ratio, good textbooks, more extracurricular activities, and more instructional materials (such as, computers, projectors, televisions, sound system, and so on). This study also revealed a strong perception that the role of collaboration in improving school culture is crucial. Participants explained that in order to successfully implement improvement initiatives, major challenges to the process need to be addressed. Participants identified three important barriers to implementation. These included lack of attention to the voices of all stakeholders during policymaking, the misuses of private tutoring or coaching, and lack of commitment among some of the teachers in their teaching. Findings affirmed that these barriers could be addressed by including all stakeholders voices in educational policy-making, addressing the misuses of private tutoring or coaching, and making teachers more accountable. A number of implications for theory, practice, policy, and further research arose from this study. Participants noted that teachers, parents, students, teacher-training authority, Bangladeshi Government, Non Government Organizations, school administrators, and district administrators were co-responsible within their own capacities to provide the necessary support and resources for school improvement in Bangladeshi context.

Despite the ongoing initiatives of quality improvement collaboratives in healthcare which reflect various multifaceted intervention packages, clear evidence of the effectiveness of the model itself is lacking. Little is known about the true impact of the collaborative approach on improvement outcomes or how specific components are actually implemented within participating organizations. This dissertation reports on empirical qualitative research undertaken to investigate “how” healthcare providers and management describe the experience of being involved in a collaborative network for quality improvement. Using a process evaluation of a sample QI collaborative, this research reveals that frontline staff do not feel the need to conform or be identical to their peer organizations; rather they feel that by participating with them that their high level of care is finally recognized. In addition, the existing communication structure is ineffective for staff engagement and a “QI bubble” seems to exist in terms of knowledge transfer and the idea of collaboration bears out more internally in increased intra-team cooperation than externally between organizations or units. Selected theoretical perspectives from the fields of sociology and organizational behaviour are used as an analytic framework from which the author posits that based on the findings from this case study that in fact collaboratives may not actually function by any of the commonly held assumptions of legitimization, communication and collaboration. A conceptual framework for how these constructs are related in terms of QI collaborative design is proposed for future testing. With further work and on-the-ground testing of this model and relational hypotheses, this research can help the QI community develop a more functional theory of collaborative improvement and use mixed methods evaluation to better understand complex QI implementation.