We hypothesize that effective projects should support surgeons performing cancer operations, and avoid the prevalent tendency to focus on identifying ‘bad apples’ or surgeons not meeting a pre-set bar of performance. As well, the overall quality effort must be data driven. A useful framework to assist in developing a quality improvement project includes the following steps: 1) debate and select values and goals that will selleck kinase inhibitor inform the effort; 2) select a clinical area for improvement; 3) select team members; 4) select relevant quality markers for improvement; 5)

collect data for selected markers; 6) select and operationalize interventions; and, 7) re-evaluate, potentially modify, and potentially repeat the above steps. Common sense, a well thought out process, and good will, will likely lead to improvements in the outcomes of patients. (C) 2011 Elsevier Ltd. All rights reserved.”
“The present study investigated occurrence of environmental estrogens (EEs) in waterways managed by the Metropolitan Water Reclamation District of Greater Chicago (‘District’) – one of the largest and most complex water districts in the United States. The objectives

of the study were: selleck chemicals llc (i) to document spatial and temporal occurrence of EEs in the Chicago Area Waterways (CAWs); (ii) to determine whether water reclamation plant (WRP) effluents contribute to estrogenic pollution of the receiving streams; (iii) to determine whether the mandated water quality monitoring data could be used to predict estrogenic pollution in the receiving streams; and (iv) to determine whether snow melt, storm runoff and combined sewer overflows may also be contributors of estrogenic activity to these systems. The estrogenic potency of the waterways was assessed using a cell-based reporter gene assay. The water

quality data was readily available as part of the District’s regular monitoring program. Our findings indicate that EEs are commonly found in the CAWs, and that WRP effluents are one of, but not the only important contributor to estrogenic activity. Mean estrogenic activities in CAWs (11 ng estradiol equivalents (EEQs/L)) are well within the values reported for other urban areas and WRP effluents. The Apoptosis inhibitor estrogenic activity exhibited significant seasonal variation with highest values noted during the spring and summer months. When comparing the mean estrogenic activity of general use waters, secondary contact waters and WRP effluents, we found that general use waters had significantly lower estrogenic activity (ca 5 ng EEQ/L) than the other two matrices (ca 15 and 17 ng EEQ/L respectively). Our analyses indicate that estrogenic activity of the waterways was not reliably associated with mandated water quality parameters, and that such measurements may not be useful for predicting estrogenic activity, especially so in the complex urban systems.