Addressing Barriers to Colorectal Cancer Screening in a Federally Qualified Health Center: A Quality Improvement Project

Abstract Background: Colorectal cancer (CRC) is a leading cause of death from cancer in the United States, despite the availability of several high-quality screening options. Multiple barriers to CRC screening have been identified, including cost (non-insured), younger age, racial or ethnic minority, recent immigration to the U.S. (non-English speaking), fear or distrust of the healthcare system and rural residence. Addressing health equity within underserved populations requires improved access to CRC screenings per evidence-based guidelines. Local Problem: The mean CRC screening rate for the designated Federally Qualified Health Center (FQHC) was 33.7% for the 5 months preceding this quality improvement (QI) project. The Community Health Access Network Unified Data System (CHAN UDS) benchmark target for CRC screening was 60.1%. Methods: Multiple targeted interventions were implemented over a 4-month period that emphasized a strong provider recommendation, a team-based approach to identify and offer CRC screening options to patients who were overdue for testing, and accurate documentation of results in the electronic medical record (EMR). A chart audit was followed by a mailed fecal immunochemical test (FIT) and colonoscopy reminder letter initiative. Results: The CHAN UDS performance metric for CRC screening reached 40% within 4 months. The second chart audit (2 months after the first) confirmed the CRC screening rate improved to 41.5% among FQHC patients aged 50 to 75 years. An overall 55% return rate was achieved with the mailed FIT initiative within 2 months. Conclusions: Despite an improvement in the CRC screening rate, continued quality improvement initiatives are needed to achieve the CHAN UDS benchmark target for this FQHC. The global aim of this QI project, to reduce or remove barriers to CRC screening test completion, was demonstrated in the results. These team-based interventions can be utilized within other underserved patient populations to improve health equity for CRC screening

The quality of work dimensions. Results of a multivariate analysis from the Third Isfol Survey on Quality of work in Italy

This paper starts with an overview of the theoretical framework on quality of work and identifies five relevant dimensions, in line with Gallino & La Rosa: ergonomic, complexity, autonomy, control and economic dimensions. The above dimensions are described and measured by means of multivariate analysis to detect differences in terms of the factors affecting the level of the quality of work dimensions achieved. The data set that we use for this purpose is the Third Isfol Survey on Quality of Work (IsfolQdL) that has been carried out in 2010 on a sample of 5,000 workers and operationalizes the five dimensions of the quality of work. The results of the multivariate analysis confirm the worse achievements in terms of quality of work by temporary workers and lower skilled workers and lower level of achievements by women in the economic and autonomy dimensions. Women are also more likely to be found in part-time work positions and the latter show an improvement in the ergonomic dimension (that includes also work life balance) at the expenses of the economic and autonomy dimensions

Design and Analysis Rolling Press Mechanism for producing Banana Stem as Natural Fiber

Materials for structural engineering are divided into four types, including ceramics, polymers, and composites. Composite material is a combination of reinforcement and matrix. Composite technology has progressed so rapidly. The development was mainly triggered by the demand for high quality materials. In its development, the fiber used is not only synthetic fiber (glass fiber) but also natural fiber (natural fiber). The advantage of natural fibers compared to synthetic fibers is that natural fibers are more environmentally friendly because natural fibers are able to decompose naturally, while synthetic fibers are more difficult to decompose. In this paper, banana midrib fiber is used and taken from the kepok banana tree (Musa paradisiaca) is a fiber that has good mechanical properties. Banana midrib fiber has a density of 1.35 g/cm3, the cellulose content is 63-64%, hemicellulose 20%, lignin content is 5%, the average tensile strength is 600 MPa, the tensile modulus is 17.85 GPa and the fracture strain is 3, 36%. Because of the advantages of the banana midrib fiber, hence this paper is made for support the production of the banana midrib fiber by designing and analyzing concept design of the machine for processing natural fibers, especially when the material is banana stems, it is called ZEUS MACHINE: Banana Stem Rolling Press Machine as Natural Fiber by Using Manual Power from Pedaling. This machine can help increase the productivity of natural fiber manufacture and can support the development of technology engaged in industry

Dimensions Underlying Student Ratings of Instruction: A Multidimensional Scaling Analysis

↵MARTHA L. BANZ, Graduate Student, Department of Psychology, University of Oklahoma, Norman, OK 73019.Specializations:Quantitative methods, educational psychology.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline