In this study, we attempted to improve hospital food delivery service quality and customer satisfaction by using FMEA (Failure Mode and Effect Analysis), which is applied to the quality control of products in manufacturing plants. Subjective food delivery service quality improvement was judged based on a 5-point likert scale. Traditional FMEA uses an RPN (Risk priority number) to evaluate the risk level of a component or process. The RPN index was determined by calculating the product of severity, occurrence, and detection indexes. In our results, total RPN value (P<0.01) significantly decreased after FMEA introduction, whereas customer satisfaction (P<0.001) and food delivery service quality (P<0.001) significantly increased. Specifically, foodservice errors (P<0.01) and loss cost (P<0.01) were significantly improved by FMEA introduction. Taken together, we suggest that FMEA reduces critical activities and errors in foodservice delivery caused by simple priority selection.
Quality Control ; Quality Improvement

No abstract available.
Quality of Life*

A new method for qualitative and quantitative analysis of Rhodobryum giganteum by using the nonlinear oscillating chemical was established for improving the quality control standard of R. giganteum. Its potential(E)/time(t) curve was recorded by electrochemical workstation in the oscillation reaction system of BrO~-_3-Ce(SO_4)_2-H_2SO_4-malonic acid/tartaric acid. The nonlinear oscillating chemical fingerprints were investigated for repeatability, and it was found that the RSD values of the four characteristic parameters of R. giganteum were less than 4.1%, indicating a good repeatability and high precision of this experiment. After optimizing the experimental parameters such as particle size, rotation speed and temperature, a new method based on nonlinear oscillating chemical was used for qualitative and quantitative analysis of R. giganteum. The results showed that there was a good linear relationship between the induction time/the period of oscillation and the dosage of herbs(0.1-1.1 g), with the relative coefficients of 0.978 and 0.975, respectively. Besides, the highest potential showed a nonlinear relationship with the dosage of herbs, with the relative coefficient of 0.999. This method was also used to discriminate the R. giganteum and R. roseum. They were similar in appearance, but their fingerprints were quite different. Independent sample t test results showed that there were significant differences in the oscillation time, the maximum amplitude and the induction time, providing a basis for the identification of the basic sources of Herba Rhodobryi Rasei.
Quality Control

Automotive industry in Malaysia is one of the booming industries which encompass the design, development and manufacturing of motor vehicles. However, it has its own setback as the interaction between complex tools, machines, and instruments, coupled with humans as workers pose several health hazards. A cross-sectional study was conducted to determine the prevalence of musculoskeletal disorders (MSD) and the association with awkward posture among automotive assembly line workers. A simple random sampling method was adopted and data were collected based on Standardized Nordic Questionnaire (SNQ) and Rapid Upper Limb Assessment (RULA) method for analysing awkward posture. With a response rate of 83%, a total of 232 assembly line workers with at least one year job tenure participated in this study. The fi ndings revealed that 78.4% of workers reported MSD while the highest percentage of complaints concerned the lower back (50.9%). Three factors were found to be signifi cantly associated with MSD: age (χ2 =5.61, p=0.018), job tenure (χ2 = 8.26, p=0.004) and awkward posture (χ2 = 65.37, p < 0.001). Logistic regression analysis indicated that signifi cant risk factors for MSD symptoms were workers aged ≥ 25 years old (OR= 2.25, 95%CI 1.14-4.46) and those workers with equal and more than three years job tenure (OR= 2.44, 95%CI 1.04-5.63). In addition, workers in the very high and high RULA action level who were 69 times (OR = 69.38, 95%CI 14.51- 331.73) and 12 times (OR = 12.42, 95%CI 5.21-29.58), respectively, also had higher odds of complaints of MSD. The high prevalence of MSD shows that MSD symptoms is a signifi cant problem among automotive assembly line workers while age, job tenure and awkward posture based on RULA action level are the signifi cant factors for MSD. In particular, this study proves that the prevalence of MSD increases as the RULA action level and job tenure increases. Thus, this problem could be reduced by decreasing RULA action level through appropriate ergonomic workstation design and ergonomic training for workers.
Quality of Life

Introduction: This study aims to quantify the concentrations of Cu, Cr, Zn, Ni, Pb, As and Cd in paddy soil and water and assess their potential dermal health risk to the farmers at Kampung Sawah Sempadan, Malaysia. Methods: 72 water samples and 72 soil samples were collected and analysed using inductively coupled plasma mass spectrometry (ICP-MS). 117 respondents were interviewed using a questionnaire to obtain the exposure information for dermal health risk assessments. Results: All elements in water did not exceed the recommended concentration by Malaysia National Water Quality Standard (NWQS) and Food and Agriculture Organization (FAO). Nevertheless, the maximum concentration of As (31.49 mg/kg) in paddy soil exceeded the Dutch Target Value for soil protection (29 mg/ kg). There was no significant chronic non-carcinogenic health risk for farmers working in the paddy soil and water (HQ<1, HI<1). The carcinogenic health risk of As was in the acceptable risk level (10-6 to 10-4). Conclusion: The contamination of the selected heavy metals in the paddy soil and water at Kampung Sawah Sempadan were lower than the available standards except for As in soil which exceeds the recommended value by Dutch target value. The health risk to these heavy metals were also minimal and within the acceptable level.
Water Quality

Introduction: Extensive agriculture activities in the upstream area causes pollutants flow to the downstream area and contaminate the drinking water resources. Methods: Water samples were collected from 27 sampling points of Bertam River in Cameron Highlands, during wet season in September 2017 for physicochemical properties and heavy metals analyses. Potential health risk was calculated based on the heavy metals concentration detected. Results: The pH value of the river ranged from neutral to slightly acidic (6.15-7.01). The overall mean level of turbidity (109.94 ± 160.73 NTU), DO (7.86 ± 0.71 mg/L), E. coli (5191.00 ± 14937.42 CFU/100 mL), and NH3-N (0.85 ± 0.54 mg/L) were exceeded the National Standard for Drinking Water Quality (NSDWQ) (Ministry of Health Malaysia). The concentration of heavy metals were in the following order; Fe>Al>Cu>Zn>Pb>Cd. The overall mean concentration of Cd (0.015 ± 0.007 mg/L), Fe (0.442 ± 0.191 mg/L) and Pb (0.021 ± 0.005 mg/L) were exceeded the national standard (NSDWQ). The non-carcinogenic health risk for adult and children from daily water consumption was within an acceptable risk. There is a potential cancer risk through Cd exposure in the drinking water where the risk higher among children (4.92 x 10-3), followed by adult male (3.06 x 10-3) and adult female (2.98 x 10-3). Conclusion: Significant heavy metals contamination and health risk through water consumption were observed in the highland river watershed, possibly due to the anthropogenic activities.
Water quality

No abstract available.
Quality Improvement

Introduction: The evolution of cardiac pacing is expected to decrease the cardiovascular morbidity and mortality but this type of intervention might affect the health-related quality of life (HRQOL) and eventually the overall prognosis of the patient. This study assessed the HRQOL in patients with permanent pacemaker using Philippines (Tagalog) Short Form (SF)-36v2 health survey.Introduction:The evolution of cardiac pacing is expected to decrease the cardiovascular morbidity and mortality but this type of intervention might affect the health-related quality of life (HRQOL) and eventually the overall prognosis of the patient. This study assessed the HRQOL in patients with permanent pacemaker using Philippines (Tagalog) Short Form (SF)-36v2 health survey. Methods: A cross-sectional correlation study was conducted. Philippines (Tagalog) SF-36v2 health survey was administered among patients with permanent pacemaker who had their pacemaker analysis at the University of Santo Tomas Hospital from October to December 2015. The higher the score the better HRQOL and many studies used a cut-off point of 50. Pearson Correlation and Non-Parametric Mann-Whitney Tests were used in this study. Results: Forty-two patients were enrolled in this study. There were 24 male and 18 females with mean interval of age 71.48+12.3. Most of the HRQOL scores were lower than 50. The highest HRQOL scores were vitality and mental health aspect while the worst were role emotional and physical functional aspect. Age, educational attainment, type of permanent pacemaker, pacemaker dependency, NYHA (New York Heart Association) functional capacity and presence of co-morbidities particularly diabetes mellitus type 2 were significant factors for poor HRQOL. Conclusion This study showed that overall the HRQOL in patients with permanent pacemaker was below average. A comprehensive management in order to improve the HRQOL should be considered among patients with permanent pacemaker.
Quality of Life

Aims: Water is described as safe and wholesome when it is free from pathogenic microorganisms and chemical substances that are hazardous to human health. This study aimed to investigate the microbial quality of water used for drinking, cooking, bathing and other purposes at universities in Nigeria. Methodology and results: Water samples were collected from forty-four storage tanks across four selected universities. Total viable bacteria in the water samples were cultivated using the plate count agar. The isolation of total coliform and Escherichia coli were carried out on Harlequin™ E. coli/coliform agar (HA) medium, while media-faecal coliform was used for faecal coliform employing the membrane filtration technique. Physicochemical parameters such as alkalinity, pH, total alkalinity, total dissolved solid, total suspended solid, electrical conductivity, total hardness, fluoride and chloride ion concentrations, were evaluated in accordance with standard procedures. Data were compared statistically using MedCalc statistical software. Considering the heterotrophic bacterial counts, all water samples were unsatisfactory. For the total coliform counts, 50% of samples were satisfactory but suspicious, while remaining 50% were unsatisfactory. Faecal coliforms results showed that 50% of samples gave excellent quality, 25% showed satisfactory but suspicious quality, while 25% showed unsatisfactory result. There were no significant differences in the total viable, total coliform and E. coli counts of water sampled from universities A and D (p>0.05). The predominant bacterial species was Pseudomonas aeruginosa (23.17%), while the least encountered was Salmonella typhimurium (2.44%). All physicochemical parameters tested were within the acceptable limit. Water samples were collected from forty-four storage tanks across four selected universities. Total viable bacteria in the water samples were cultivated using the plate count agar. The isolation of total coliform and Escherichia coli were carried out on Harlequin™ E. coli/coliform agar (HA) medium, while media-faecal coliform was used for faecal coliform employing the membrane filtration technique. Physicochemical parameters such as alkalinity, pH, total alkalinity, total dissolved solid, total suspended solid, electrical conductivity, total hardness, fluoride and chloride ion concentrations, were evaluated in accordance with standard procedures. Data were compared statistically using MedCalc statistical software. Considering the heterotrophic bacterial counts, all water samples were unsatisfactory. For the total coliform counts, 50% of samples were satisfactory but suspicious, while remaining 50% were unsatisfactory. Faecal coliforms results showed that 50% of samples gave excellent quality, 25% showed satisfactory but suspicious quality, while 25% showed unsatisfactory result. There were no significant differences in the total viable, total coliform and E. coli counts of water sampled from universities A and D (p>0.05). The predominant bacterial species was Pseudomonas aeruginosa (23.17%), while the least encountered was Salmonella typhimurium (2.44%). All physicochemical parameters tested were within the acceptable limit. This study revealed that the water used by students of studied universities was contaminated with potential bacterial pathogens. However, all physicochemical parameters tested were within the permissible standard limits and satisfied the requirements for domestic utility.
Water Quality

Background: Even though innumerable quality of life (QOL) questionnaires have been developed in palliative care, there is no gold standard assessment tool for QOL and no single questionnaire that fits all purposes and individuals. An important challenge to QOL assessments in palliative care is the highly diverse patient population with different diagnoses, disease states/prognosis, and languages. In an outpatient palliative care clinic population, FACIT-Pal-14 proved to be a valid and reliable scale in palliative care patients. Objectives: We aimed to (i) determine the psychometric properties of the Tagalog version of the Functional Assessment of Chronic Illness Therapy – Palliative Care – 14 (FACIT-Pal-14) and (ii) measure the Quality of Life (QOL) of Filipino cancer patients. Methods: This was a cross-sectional study. License for the use of the Tagalog version 4 of the FACIT-Pal-14 was requested from FACIT.org. To know the psychometric properties of the scales, Cronbach’s alpha coefficient was used to assess reliability, and exploratory factor analysis, Pearson correlations, and independent samples T-test were used to determine validity. Results: The Tagalog FACIT-Pal-14 was administered to 500 Filipino cancer patients consulting at the outpatient department of a training and regional medical center. The participants were mostly female (65.5%), aged 64 years and younger (82.6%), and had breast cancer (53.2%), colorectal cancer (19.2%), and lung cancer (9.4%). The mean Tagalog FACIT-Pal-14 score was 47.35 out of 56 (SD=7.14). The Cronbach's alpha coefficient of the Tagalog version of FACIT-Pal-14 was 0.784. Significantly lower mean Tagalog FACIT-Pal-14 scores were found in patients with Karnofsky Performance Status (KPS) 70 and lower, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 2 and above compared with patients with KPS 80 and higher and ECOG-PS 0-1. (t=3.439, p<.001). While the Tagalog FACIT-Pal-14 scores, KPS, and ECOG scores only revealed a very weak, positive correlation (r=0.095; p <0.05), this ability to distinguish between groups known to differ regarding performance status showed the construct validity of the Tagalog FACIT-Pal-14. Conclusions In an outpatient oncology clinic population, the FACIT-Pal 14 showed evidence of reliability and construct validity for evaluating palliative care-specific QOL in Filipino cancer patients. Using this measure, Filipino cancer patients have a good QOL. Therefore, it is recommended that the Tagalog FACIT-Pal-14 be used on subsequent patient follow-ups to assess how their QOL would change over time so that the palliative care services provided will be suited to their needs.
Quality of Life