It has been well-documented that significant difficulties arise when conducting field research in... more It has been well-documented that significant difficulties arise when conducting field research in conflict areas. 1 This article documents the process of collecting nutritional, anthropometric, and spatial data in a conflict region. Specifically, data were collected from more than 1,000 participants in the city of Erbil, Kurdistan, Iraq in the summer of 2011.
Objective: To examine the impact of a family-based nutrition education program on nutrition knowl... more Objective: To examine the impact of a family-based nutrition education program on nutrition knowledge, diet, physical activity, and food purchasing behaviors of Latina mothers and children participating in Northern Virginia Women, Infant, Children (WIC) programs. Methods: Surveys were administered to mothers (n=15) using a pre-test/post-test design. The family-based nutrition intervention included 1) Discussion and lecture on food labels, food purchasing, portion sizes, and healthy meals, 2) Experiential learning focused on preparation and storage of low-cost, healthy meals incorporating WIC foods, and 3) A Zumba class and discussion on physical activity. Results: The data revealed improved diet such that mothers reported increased fruit and vegetable consumption, decreased juice consumption among their children. Mothers reported their children were more physically active. Further, mothers prepared more meals at home using raw ingredients.
In recent years, there has been a rise in obesity-related diseases in transitional countries. The... more In recent years, there has been a rise in obesity-related diseases in transitional countries. These countries, once plagued with problems related to infectious disease and poverty, now face a dual burden of both chronic and infectious diseases. Thailand has recently experienced significant economic growth, and as a result, the numbers related to obesity and obesity-related diseases have risen significantly. Thailand is an important region to examine the timely issue of obesity-related policy because Thailand has been a model for successful public health interventions and policies throughout Asia. Further, such policies have significant implications for other regions of the world experiencing similar health transitions.
Cross-sectional data have previously indicated poor growth and development among adolescent girls... more Cross-sectional data have previously indicated poor growth and development among adolescent girls in Mali. These data have shown that Malian girls are shorter and lighter than their United States female counterparts. Many studies suggest that this evidence of poor growth and development is due to a combination of poor nutrient intake, high-energy expenditure, and poor access to health care. At adolescence, individuals rarely follow a standard pattern of growth due to different biological timetables and expressions of pubertal growth. By examining velocity of growth, researchers can recognize developmental patterns such as compensatory gain. This study examines the growth rates of Malian girls over a 6-month period. Anthropometric data were collected from a total of 1,045 adolescent girls ages 10-17 years. Height and weights were collected twice from the Segou Coura community in the town of Segou and from the Dioro Arrondissement in 1997. From these data, mixed longitudinal analyses were conducted. Both the height and weight velocity data showed patterns of delayed growth rates when compared with American girls. Although Malian girls are similar to American girls in that they tend to reach their peak height velocity at age 12, the Malian girls demonstrate a longer growth spurt than the American girls. This evidence of greater height velocity may be an indication of compensatory growth, or compensatory gain, and is partially supported from crosssectional data. While these Malian data do not show much evidence that certain stressors are relieved during adolescence, only more extensive longitudinal data can more fairly examine the issue. Am.
Exercise promotes health. Exercise improves metabolic status and function. Exercise is useful in ... more Exercise promotes health. Exercise improves metabolic status and function. Exercise is useful in maintaining weight loss. Exercise has been shown to reduce visceral fat. The American College of Sports Medicine recommendations for exercise are appropriate for people with NAFLD.
Although nursing students are educated about the importance of healthy diets and the benefits of ... more Although nursing students are educated about the importance of healthy diets and the benefits of exercise, many do not engage in health promotion behaviors. This study longitudinally examined specific indicators of obesity among a group of female nursing students who incorporated an exercise program into their normal weekly routine. Indicators for obesity were identified using anthropometric data that included weight, body mass index (BMI), and percentage of body fat. Blood pressure, pulse data, and a physical activity level assessment were performed at the beginning and at the conclusion of the study period. Results indicated improvement in overall body composition, including a reduction in percent body fat and BMI. Students also showed improved physical activity levels. Since nurses need to counsel clients on primary prevention issues such as physical activity and maintaining ideal body weight and lean mass, the importance of positive health behaviors for nursing students and nurses cannot be stressed enough.
ABSTRACT Growth data from Bambara and Fulani girls are compared from those born and raised in Fra... more ABSTRACT Growth data from Bambara and Fulani girls are compared from those born and raised in France and those born and raised in Mali. The data reveal that Bambara and Fulani girls born in France are taller and heavier than their female counterparts born and raised in Mali. No indicators of obesity are evident among this sample. The sample's heights and weights match the U.S. reference data such that mean height-for-age z-score is −.02 ± .84, and the mean WAZ is 03 ± .96. Based on the conceptual framework of the brocultural model of human adaptation, these findings have implications regarding the environmental impacts affecting the growth status of Malian adolescent girls. The data suggest that improved growth may be due to improved environmental and cultural factors including increased food availability, safe food and water, a reduction in manual labor, and access to affordable and reliable healthcare. While this sample is relatively small, it appears that U.S. reference data are appropriate for use in non-U.S. populations to determine over and undernutrition.
factors for controlling childhood weight problems and curbing rising obesity rates. This study co... more factors for controlling childhood weight problems and curbing rising obesity rates. This study compares children's self-reported food intake to their parents' reported consumption preferences for their children. Parents play an important role in preventing childhood overweight and obesity. When parents model good dietary habits, encourage proper nutrition, and ensure that healthy foods are available and accessible in the home, children are more likely to consume nutritious foods.[4-7] Parental preferences are especially important because eating behaviors during childhood form habits and food choices that persist in adulthood [8]. The goal of this study was to explore the relationship between Chilean children's reported dietary practices and their parents' preferences for their consumption.
Journal of Hunger & Environmental Nutrition, Apr 3, 2014
Haiti is considered the poorest country in the Western Hemisphere. Rural settings are particularl... more Haiti is considered the poorest country in the Western Hemisphere. Rural settings are particularly vulnerable to inadequate access to food, clean water, and shelter. Research has shown that chronic malnutrition is one of the underlying problems affecting the overall status and stability of Haiti. In an attempt to understand food security in a rural town in northwest Haiti, a cross-sectional design using an interviewer-administered questionnaire was used to gather information on food availability and general health status. By assessing the food sources in the community, better understandings of the nutritional needs prevalent in this area were assessed. Further research needs to be completed to understand how to effectively implement a sustainable, long-term approach to fight food security issues and subsequent chronic malnutrition.
International journal of healthcare management, Sep 22, 2014
Abstract This research aims to examine the relationships between internal and external determinan... more Abstract This research aims to examine the relationships between internal and external determinants of the Vietnamese hospital and healthcare system and (a) the health service system and (b) the perceived health status of healthcare providers and clients from the Socialist Republic of Vietnam. Participants included 42 healthcare providers and 240 patients from Hue Central Hospital, Hue City Hospital, and Danang Hospital. Data were collected over a 4-week period in June 2012. The results revealed greatest predictors for clients’ perceptions about the health service system and health status in Vietnam were concerns about society and cultural values, medical information and technology, and the strengths and weaknesses of the hospital system were only society and cultural values, and the strengths and weaknesses of the hospital system were co-effective factors that predicted health status. Further, regarding the healthcare providers’ perception of health status, the only determinant, living, and working environment, was an effective factor in predicting the health status. These findings may be used as the basis for the analysis and application of health policy planning and appropriate strategies within Vietnam for promoting health and improving the performance of health service systems to meet the healthcare needs of its people. The findings suggest that Vietnamese do have concerns on the impact of trade and investment and medical information and technology on the quality of the health service system. Moreover, these findings will be further beneficial for knowledge development and application to regional study for the countries in the Greater Mekong Subregion.
American Journal of Physical Anthropology, Mar 14, 2002
In Mali, adolescent girls face many physical stresses which, with a history of poor nutrition, ca... more In Mali, adolescent girls face many physical stresses which, with a history of poor nutrition, can result in delayed growth and development. Despite the fact that adolescent girls encounter nutritional demands, most research in Mali has focused only on young children. This study examines anthropometric and reproductive data on 1,056 adolescent girls (aged 10-17 years) from the Segou Region of Mali. When compared to the reference population, the Malian girls exhibited poorer indicators of growth and development. Z-scores for height-forage and weight-forage were below 0 at all ages. Urban girls had better indicators of growth than rural girls. The body composition data show that the Malian girls have lower body fat than reference girls. Menarche was delayed by about 1.5 years compared to girls from the United States and Europe. Delayed growth and development may be due to many factors, including a history of undernutrition, poor socioeconomic status, and increased energy demands.
Journal of Maternal-fetal & Neonatal Medicine, 2009
The purpose of this study was to determine whether maternal prepregnancy overweight/obesity has i... more The purpose of this study was to determine whether maternal prepregnancy overweight/obesity has independent effects on breastfeeding initiation and duration and whether these effects are different for women who experience medical problems during pregnancy or labor/delivery complications in comparison with those who have no medical or labor/delivery complications. We used the early childhood longitudinal study-birth cohort data. Kaplan-Meier survival functions, logistic, and Cox regression modeling were used in the analyses. Findings indicate that overweight/obese women with medical or labor/delivery complications were less likely to initiate breastfeeding in comparison with their counterparts of normal weight. We did not find an independent effect of prepregnancy overweight/obesity on breastfeeding initiation among women with no medical problems. This group of women, however, had an 11% increased risk of stopping breastfeeding with each additional month of breastfeeding duration in comparison to those of normal weight. It is important to evaluate the health history and pregnancy complications among overweight/obese mothers in developing interventions for successful initiation and duration of breastfeeding.
Few studies have examined growth data from adolescent girls in Latin America and almost none have... more Few studies have examined growth data from adolescent girls in Latin America and almost none have been conducted in Nicaragua. Thus this study examines growth data from Nicaraguan adolescent girls. This study describes cross-sectional growth data from a sample of Nicaraguan girls. These data are compared with data from Mexican-US and Guatemalan girls. It is hypothesized that (a) Mexican-US and Guatemalan wealthy ladina girls will show better indicators of nutritional status when compared with the Nicaraguan girls, and (b) the Nicaraguan girls will show similar anthropometric indicators when compared with poor Guatemalan girls. Anthropometric and age at menarche data were collected from a sample of 154 adolescent girls ages 10-17 years living in Managua, Nicaragua. The findings revealed that these girls are significantly shorter and lighter than US, Mexican-US and wealthy Guatemalan adolescent girls. These girls are also significantly taller and heavier than their poor Guatemalan counterparts. This study reveals that the Nicaraguan girls are undernourished when compared with other Latin American girls living in an improved overall environment. The data also reveal that the Nicaraguan girls have better indicators of nutritional status when compared with a cohort of poor Guatemalan girls.
Objective: Mali is one of the poorest countries in Africa, with 72 % of its population surviving ... more Objective: Mali is one of the poorest countries in Africa, with 72 % of its population surviving on less than $US 1?00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women's anthropometric status and use of adequately iodized salt among households in Mali. Design: Demographic and Health Survey data, multistage-stratified cluster sampling methodology. Setting: Rural and urban areas of Mali. Subjects: Non-pregnant women (n 6015) between the ages of 19 and 44 years. Results: Nineteen per cent of the women were overweight or obese while 11 % were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the northeast and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women's BMI or households' use of adequately iodized salt. Conclusions: The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.
People can create positive environments so that their chances of relapse to poor habits are reduc... more People can create positive environments so that their chances of relapse to poor habits are reduced and their likelihood of success is increased. Continuous quality improvement (CQI) suggests that this can be accomplished by making systemwide changes and deemphasizing personal effort. This article provides a 7-step approach to system thinking in a personal context. It offers a case study and other examples that show how to lose weight by making systemic changes in lifestyles. Learning about system thinking in a personal context also may help healthcare professionals understand the application of CQI within organizations.
It has been well-documented that significant difficulties arise when conducting field research in... more It has been well-documented that significant difficulties arise when conducting field research in conflict areas. 1 This article documents the process of collecting nutritional, anthropometric, and spatial data in a conflict region. Specifically, data were collected from more than 1,000 participants in the city of Erbil, Kurdistan, Iraq in the summer of 2011.
Objective: To examine the impact of a family-based nutrition education program on nutrition knowl... more Objective: To examine the impact of a family-based nutrition education program on nutrition knowledge, diet, physical activity, and food purchasing behaviors of Latina mothers and children participating in Northern Virginia Women, Infant, Children (WIC) programs. Methods: Surveys were administered to mothers (n=15) using a pre-test/post-test design. The family-based nutrition intervention included 1) Discussion and lecture on food labels, food purchasing, portion sizes, and healthy meals, 2) Experiential learning focused on preparation and storage of low-cost, healthy meals incorporating WIC foods, and 3) A Zumba class and discussion on physical activity. Results: The data revealed improved diet such that mothers reported increased fruit and vegetable consumption, decreased juice consumption among their children. Mothers reported their children were more physically active. Further, mothers prepared more meals at home using raw ingredients.
In recent years, there has been a rise in obesity-related diseases in transitional countries. The... more In recent years, there has been a rise in obesity-related diseases in transitional countries. These countries, once plagued with problems related to infectious disease and poverty, now face a dual burden of both chronic and infectious diseases. Thailand has recently experienced significant economic growth, and as a result, the numbers related to obesity and obesity-related diseases have risen significantly. Thailand is an important region to examine the timely issue of obesity-related policy because Thailand has been a model for successful public health interventions and policies throughout Asia. Further, such policies have significant implications for other regions of the world experiencing similar health transitions.
Cross-sectional data have previously indicated poor growth and development among adolescent girls... more Cross-sectional data have previously indicated poor growth and development among adolescent girls in Mali. These data have shown that Malian girls are shorter and lighter than their United States female counterparts. Many studies suggest that this evidence of poor growth and development is due to a combination of poor nutrient intake, high-energy expenditure, and poor access to health care. At adolescence, individuals rarely follow a standard pattern of growth due to different biological timetables and expressions of pubertal growth. By examining velocity of growth, researchers can recognize developmental patterns such as compensatory gain. This study examines the growth rates of Malian girls over a 6-month period. Anthropometric data were collected from a total of 1,045 adolescent girls ages 10-17 years. Height and weights were collected twice from the Segou Coura community in the town of Segou and from the Dioro Arrondissement in 1997. From these data, mixed longitudinal analyses were conducted. Both the height and weight velocity data showed patterns of delayed growth rates when compared with American girls. Although Malian girls are similar to American girls in that they tend to reach their peak height velocity at age 12, the Malian girls demonstrate a longer growth spurt than the American girls. This evidence of greater height velocity may be an indication of compensatory growth, or compensatory gain, and is partially supported from crosssectional data. While these Malian data do not show much evidence that certain stressors are relieved during adolescence, only more extensive longitudinal data can more fairly examine the issue. Am.
Exercise promotes health. Exercise improves metabolic status and function. Exercise is useful in ... more Exercise promotes health. Exercise improves metabolic status and function. Exercise is useful in maintaining weight loss. Exercise has been shown to reduce visceral fat. The American College of Sports Medicine recommendations for exercise are appropriate for people with NAFLD.
Although nursing students are educated about the importance of healthy diets and the benefits of ... more Although nursing students are educated about the importance of healthy diets and the benefits of exercise, many do not engage in health promotion behaviors. This study longitudinally examined specific indicators of obesity among a group of female nursing students who incorporated an exercise program into their normal weekly routine. Indicators for obesity were identified using anthropometric data that included weight, body mass index (BMI), and percentage of body fat. Blood pressure, pulse data, and a physical activity level assessment were performed at the beginning and at the conclusion of the study period. Results indicated improvement in overall body composition, including a reduction in percent body fat and BMI. Students also showed improved physical activity levels. Since nurses need to counsel clients on primary prevention issues such as physical activity and maintaining ideal body weight and lean mass, the importance of positive health behaviors for nursing students and nurses cannot be stressed enough.
ABSTRACT Growth data from Bambara and Fulani girls are compared from those born and raised in Fra... more ABSTRACT Growth data from Bambara and Fulani girls are compared from those born and raised in France and those born and raised in Mali. The data reveal that Bambara and Fulani girls born in France are taller and heavier than their female counterparts born and raised in Mali. No indicators of obesity are evident among this sample. The sample's heights and weights match the U.S. reference data such that mean height-for-age z-score is −.02 ± .84, and the mean WAZ is 03 ± .96. Based on the conceptual framework of the brocultural model of human adaptation, these findings have implications regarding the environmental impacts affecting the growth status of Malian adolescent girls. The data suggest that improved growth may be due to improved environmental and cultural factors including increased food availability, safe food and water, a reduction in manual labor, and access to affordable and reliable healthcare. While this sample is relatively small, it appears that U.S. reference data are appropriate for use in non-U.S. populations to determine over and undernutrition.
factors for controlling childhood weight problems and curbing rising obesity rates. This study co... more factors for controlling childhood weight problems and curbing rising obesity rates. This study compares children's self-reported food intake to their parents' reported consumption preferences for their children. Parents play an important role in preventing childhood overweight and obesity. When parents model good dietary habits, encourage proper nutrition, and ensure that healthy foods are available and accessible in the home, children are more likely to consume nutritious foods.[4-7] Parental preferences are especially important because eating behaviors during childhood form habits and food choices that persist in adulthood [8]. The goal of this study was to explore the relationship between Chilean children's reported dietary practices and their parents' preferences for their consumption.
Journal of Hunger & Environmental Nutrition, Apr 3, 2014
Haiti is considered the poorest country in the Western Hemisphere. Rural settings are particularl... more Haiti is considered the poorest country in the Western Hemisphere. Rural settings are particularly vulnerable to inadequate access to food, clean water, and shelter. Research has shown that chronic malnutrition is one of the underlying problems affecting the overall status and stability of Haiti. In an attempt to understand food security in a rural town in northwest Haiti, a cross-sectional design using an interviewer-administered questionnaire was used to gather information on food availability and general health status. By assessing the food sources in the community, better understandings of the nutritional needs prevalent in this area were assessed. Further research needs to be completed to understand how to effectively implement a sustainable, long-term approach to fight food security issues and subsequent chronic malnutrition.
International journal of healthcare management, Sep 22, 2014
Abstract This research aims to examine the relationships between internal and external determinan... more Abstract This research aims to examine the relationships between internal and external determinants of the Vietnamese hospital and healthcare system and (a) the health service system and (b) the perceived health status of healthcare providers and clients from the Socialist Republic of Vietnam. Participants included 42 healthcare providers and 240 patients from Hue Central Hospital, Hue City Hospital, and Danang Hospital. Data were collected over a 4-week period in June 2012. The results revealed greatest predictors for clients’ perceptions about the health service system and health status in Vietnam were concerns about society and cultural values, medical information and technology, and the strengths and weaknesses of the hospital system were only society and cultural values, and the strengths and weaknesses of the hospital system were co-effective factors that predicted health status. Further, regarding the healthcare providers’ perception of health status, the only determinant, living, and working environment, was an effective factor in predicting the health status. These findings may be used as the basis for the analysis and application of health policy planning and appropriate strategies within Vietnam for promoting health and improving the performance of health service systems to meet the healthcare needs of its people. The findings suggest that Vietnamese do have concerns on the impact of trade and investment and medical information and technology on the quality of the health service system. Moreover, these findings will be further beneficial for knowledge development and application to regional study for the countries in the Greater Mekong Subregion.
American Journal of Physical Anthropology, Mar 14, 2002
In Mali, adolescent girls face many physical stresses which, with a history of poor nutrition, ca... more In Mali, adolescent girls face many physical stresses which, with a history of poor nutrition, can result in delayed growth and development. Despite the fact that adolescent girls encounter nutritional demands, most research in Mali has focused only on young children. This study examines anthropometric and reproductive data on 1,056 adolescent girls (aged 10-17 years) from the Segou Region of Mali. When compared to the reference population, the Malian girls exhibited poorer indicators of growth and development. Z-scores for height-forage and weight-forage were below 0 at all ages. Urban girls had better indicators of growth than rural girls. The body composition data show that the Malian girls have lower body fat than reference girls. Menarche was delayed by about 1.5 years compared to girls from the United States and Europe. Delayed growth and development may be due to many factors, including a history of undernutrition, poor socioeconomic status, and increased energy demands.
Journal of Maternal-fetal & Neonatal Medicine, 2009
The purpose of this study was to determine whether maternal prepregnancy overweight/obesity has i... more The purpose of this study was to determine whether maternal prepregnancy overweight/obesity has independent effects on breastfeeding initiation and duration and whether these effects are different for women who experience medical problems during pregnancy or labor/delivery complications in comparison with those who have no medical or labor/delivery complications. We used the early childhood longitudinal study-birth cohort data. Kaplan-Meier survival functions, logistic, and Cox regression modeling were used in the analyses. Findings indicate that overweight/obese women with medical or labor/delivery complications were less likely to initiate breastfeeding in comparison with their counterparts of normal weight. We did not find an independent effect of prepregnancy overweight/obesity on breastfeeding initiation among women with no medical problems. This group of women, however, had an 11% increased risk of stopping breastfeeding with each additional month of breastfeeding duration in comparison to those of normal weight. It is important to evaluate the health history and pregnancy complications among overweight/obese mothers in developing interventions for successful initiation and duration of breastfeeding.
Few studies have examined growth data from adolescent girls in Latin America and almost none have... more Few studies have examined growth data from adolescent girls in Latin America and almost none have been conducted in Nicaragua. Thus this study examines growth data from Nicaraguan adolescent girls. This study describes cross-sectional growth data from a sample of Nicaraguan girls. These data are compared with data from Mexican-US and Guatemalan girls. It is hypothesized that (a) Mexican-US and Guatemalan wealthy ladina girls will show better indicators of nutritional status when compared with the Nicaraguan girls, and (b) the Nicaraguan girls will show similar anthropometric indicators when compared with poor Guatemalan girls. Anthropometric and age at menarche data were collected from a sample of 154 adolescent girls ages 10-17 years living in Managua, Nicaragua. The findings revealed that these girls are significantly shorter and lighter than US, Mexican-US and wealthy Guatemalan adolescent girls. These girls are also significantly taller and heavier than their poor Guatemalan counterparts. This study reveals that the Nicaraguan girls are undernourished when compared with other Latin American girls living in an improved overall environment. The data also reveal that the Nicaraguan girls have better indicators of nutritional status when compared with a cohort of poor Guatemalan girls.
Objective: Mali is one of the poorest countries in Africa, with 72 % of its population surviving ... more Objective: Mali is one of the poorest countries in Africa, with 72 % of its population surviving on less than $US 1?00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women's anthropometric status and use of adequately iodized salt among households in Mali. Design: Demographic and Health Survey data, multistage-stratified cluster sampling methodology. Setting: Rural and urban areas of Mali. Subjects: Non-pregnant women (n 6015) between the ages of 19 and 44 years. Results: Nineteen per cent of the women were overweight or obese while 11 % were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the northeast and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women's BMI or households' use of adequately iodized salt. Conclusions: The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.
People can create positive environments so that their chances of relapse to poor habits are reduc... more People can create positive environments so that their chances of relapse to poor habits are reduced and their likelihood of success is increased. Continuous quality improvement (CQI) suggests that this can be accomplished by making systemwide changes and deemphasizing personal effort. This article provides a 7-step approach to system thinking in a personal context. It offers a case study and other examples that show how to lose weight by making systemic changes in lifestyles. Learning about system thinking in a personal context also may help healthcare professionals understand the application of CQI within organizations.
Uploads
Papers by Lisa Pawloski