Design, construction and evaluation of systems to predict risk in obstetrics.

We present a systematic, practical approach to developing risk prediction systems, suitable for use with large databases of medical information. An important part of this approach is a novel feature selection algorithm which uses the area under the receiver operating characteristic (ROC) curve to measure the expected discriminative power of different sets of predictor variables. We describe this algorithm and use it to select variables to predict risk of a specific adverse pregnancy outcome: failure to progress in labour. Neural network, logistic regression and hierarchical Bayesian risk prediction models are constructed, all of which achieve close to the limit of performance attainable on this prediction task. We show that better prediction performance requires more discriminative clinical information rather than improved modelling techniques. It is also shown that better diagnostic criteria in clinical records would greatly assist the development of systems to predict risk in pregnancy.

Design-phase-specific selection of user research methods

For increasing the usability of a medical device the usability engineering standards IEC 60601-1-6 and IEC 62366 suggest incorporating user information in the design and development process. However, practice shows that integrating user information and the related investigation of users, called user research, is difficult in the field of medical devices. In particular, identifying the most appropriate user research methods is a difficult process. This difficulty results from the complexity of the medical device industry, especially with respect to regulations and standards, the characteristics of this market and the broad range of potential user research methods available from various research disciplines. Against this background, this study aimed at guiding designers and engineers in selecting effective user research methods according to their stage in the design process. Two approaches are described which reduce the complexity of method selection by summarizing the high number of methods into homogenous method classes. These approaches are closely connected to the medical device industry characteristic design phases and therefore provide the possibility of selecting design-phase- specific user research methods. In the first approach potential user research methods are classified after their characteristics in the design process. The second approach suggests a method summarization according to their similarity in the data collection techniques and provides an additional linkage to design phase characteristics. Both approaches have been tested in practice and the results show that both approaches facilitate user research method selection. © 2009 Springer-Verlag.

Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Detailed design of242mAm breeding in pressurized water reactors

There is growing interest in the use of 242mAm as a nuclear fuel. Because of its very high thermal fission cross section and its large number of neutrons released per fission, it can be used for various unique applications, such as space propulsion, medical applications, and compact energy sources. Since the thermal absorption cross section of 242mAm is very high, the best way to obtain 242mAm is by the capture of fast or epithermal neutrons in 241Am. However, fast spectrum reactors are not readily available. In this paper, we explore the possibility of producing 242mAm in existing pressurized water reactors (PWRs) with minimal interference in reactor performance. As suggested in previous studies on the subject, the 242mAm breeding targets are shielded with strong thermal absorbers in order to suppress the thermal neutron flux that causes 242mAm destruction. Since 242mAm enrichment within the Am target mainly depends on the neutron energy distribution, which in turn depends on the Am target thickness and on the neutron filter cutoff energy (thermal absorber type), this unique Am target design was developed. In our study, Cd, Sm, and Gd were considered as thermal neutron filters, as suggested by Cesana et al. The most favorable results were obtained by irradiating Am targets covered either with Gd or Cd. In these cases, up to 8.65% enrichment of 242mAm is obtained after 4.5 yr (three successive PWR fuel cycles) of irradiation. It was also found that significant quantities [up to 1.3 kg/GW (electric)-yr] of 242mAm can be obtained in PWR reactors without notable interference with reactor performance. However, in order to maintain the original fuel cycle length, the enrichment of the driver (UO2) fuel must be increased by ∼1%, raised from the conventional 4.5 to 5.5%, depending on the thermal neutron filter used. The most important reactivity feedback coefficients for fuel assemblies containing the 242mAm breeding targets were evaluated and found to be close to those of a standard PWR. Another product of neutron capture in the 241Am reaction is 238Pu. It was found that in a typical 1000 MW (electric) PWR core with one-third of the fuel assemblies containing 241Am targets, up to 15.1 kg of 238Pu enriched to 80% can be produced per year.