Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments

Objectives The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). Methods A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. Results In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. Conclusions This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions to improve any suboptimal processes of care. Further validation and utility of the indicators in a wider population is now indicated.

Effect and process evaluations of an early childhood obesity prevention intervention

The thesis develops a summative evaluation framework of the NOURISH Randomised Controlled Trial, and applies this to a selection of maternal feeding choice outcomes of the programme. The research is based on an ecological model of the complex set of factors that need to be acted upon to address childhood obesity. The novel approach extends the standard RCT effect evaluation, while also conducting an in-depth evaluation of the process of programme development and implementation. Research findings identify adaptations of intervention delivery that could improve its effectiveness and translatability, in a new cycle of the programme.

Design and evaluation of intentionally enriched awareness

In this chapter we introduce and explore the notion of “intentionally enriched awareness”. Intentional enrichment refers to the process of actively engaging users in the awareness process by enabling them to express intentions. We initially look at the phenomenon if sharing intentional information in related collaborative systems. We then explore the concept of intentional enrichment through designing and evaluating the AnyBiff system which allows users to freely create, share and use a variety of biff applications. Biffs are simple representation of pre-defined activities. Users can select biffs to indicate that they are engaged in an activity. We summarise the results of a trial which allowed us to gain insights into the potential of the AnyBiff prototype and the underlying biff concept to implement intentionally enriched awareness. Our findings show that intentional disclosure mechanisms in the form of biffs were successfully used in a variety of contexts. Users actively engaged in the design of a large variety of biffs and explored many different uses of the concept. The study revealed a whole host of issues with regard to intentionally enriched awareness which give valuable insight into the conception and design of future applications in this area.

Evaluation of object detection proposals under condition variations

Object detection is a fundamental task in many computer vision applications, therefore the importance of evaluating the quality of object detection is well acknowledged in this domain. This process gives insight into the capabilities of methods in handling environmental changes. In this paper, a new method for object detection is introduced that combines the Selective Search and EdgeBoxes. We tested these three methods under environmental variations. Our experiments demonstrate the outperformance of the combination method under illumination and view point variations.

Revising history for cost-informed process improvement

Organisations are constantly seeking new ways to improve operational efficiencies. This study investigates a novel way to identify potential efficiency gains in business operations by observing how they were carried out in the past and then exploring better ways of executing them by taking into account trade-offs between time, cost and resource utilisation. This paper demonstrates how these trade-offs can be incorporated in the assessment of alternative process execution scenarios by making use of a cost environment. A number of optimisation techniques are proposed to explore and assess alternative execution scenarios. The objective function is represented by a cost structure that captures different process dimensions. An experimental evaluation is conducted to analyse the performance and scalability of the optimisation techniques: integer linear programming (ILP), hill climbing, tabu search, and our earlier proposed hybrid genetic algorithm approach. The findings demonstrate that the hybrid genetic algorithm is scalable and performs better compared to other techniques. Moreover, we argue that the use of ILP is unrealistic in this setup and cannot handle complex cost functions such as the ones we propose. Finally, we show how cost-related insights can be gained from improved execution scenarios and how these can be utilised to put forward recommendations for reducing process-related cost and overhead within organisations.

Evaluating and predicting overall process risk using event logs

Companies standardise and automate their business processes in order to improve process eff ciency and minimise operational risks. However, it is di fficult to eliminate all process risks during the process design stage due to the fact that processes often run in complex and changeable environments and rely on human resources. Timely identification of process risks is crucial in order to insure the achievement of process goals. Business processes are often supported by information systems that record information about their executions in event logs. In this article we present an approach and a supporting tool for the evaluation of the overall process risk and for the prediction of process outcomes based on the analysis of information recorded in event logs. It can help managers evaluate the overall risk exposure of their business processes, track the evolution of overall process risk, identify changes and predict process outcomes based on the current value of overall process risk. The approach was implemented and validated using synthetic event logs and through a case study with a real event log.

[await full-text]Evaluation of QAS Workplace Health and Safety Action Plan

This report identifies the outcomes of a program evaluation of the five year Workplace Health and Safety Strategy (2012-2017), specifically, the engagement component within the Queensland Ambulance Service. As part of the former Department of Community Safety, their objective was to work towards harmonising the occupational health and safety policies and process to improve the workplace culture. The report examines and assess the process paths and resource inputs into the strategy, provides feedback on progress to achieving identified goals as well as identify opportunities for improvements and barriers to progress. Consultations were held with key stakeholders within QAS and focus groups were facilitated with managers and health and safety representatives of each Local Area Service Network.

Mining process risks and resource profiles

This research contributes novel techniques for identifying and evaluating business process risks and analysing human resource behaviour. The developed techniques use predefined indicators to identify process risks in individual process instances, evaluate overall process risk, predict process outcomes and analyse human resource behaviour based on the analysis of information about process executions recorded in event logs by information systems. The results of this research can help managers to more accurately evaluate the risk exposure of their business processes, to more objectively evaluate the performance of their employees, and to identify opportunities for improvement of resource and process performance.

‘Appreciate A Mate’ Helping others to feel good about themselves. Safe and Well Online: A report on the development and evaluation of a positive messaging social marketing campaign for young people.

This report describes the Year Two/Campaign Two processes, and articulates findings from the major project components designed to address the challenges noted above (see Figure 1). Three major components comprise the Safe and Well Online project: 1) A participatory design (PD) process involving young people and sector partners (UWS) for; 2) campaign development (Zuni & Digital Arts Network); and 3) a cohort study (University of South Australia) to evaluate campaign effectiveness and attitude and behaviour change. Each sub-study comprehensively considered the ethical requirements of conducting online research with minors. The theoretical and methodological framework for measuring campaign engagement and efficacy (Sub-studies 3, 4 and 5) drew on the Model of Goal Directed Behaviour (MGB) (Perugini & Bagozzi 2001) and Nudge Theory (Thaler & Sunstein, 2008). This report extends the findings and conclusions of the Year One Pilot Study ‘‘Keep it Tame’’ (Spears et.al, 2015), and details the development and evaluation of the second of four Safe and Well Online Campaigns—‘‘Appreciate A Mate’: Helping others feel good about themselves’.

Implementing a holistic process for embedding sustainability: A case study in first year engineering, Monash University, Australia

While there is clear recognition of the need to incorporate sustainable development into university curricula, there is limited research that examines how to achieve that integration or evaluates its impacts on student learning. This paper responds to these knowledge gaps through a case study of curriculum renewal that involved embedding sustainability into a first year engineering curriculum. The initiative was guided by a deliberative and dynamic model for curriculum renewal that brought together internal and external stakeholders through a structured sequence of facilitated workshops and meetings. That process identified sustainability-related knowledge and skills relevant for first year engineering, and faculty members teaching in the first year program were guided through a process of curriculum renewal to meet those needs. The process through which the whole of curriculum renewal was undertaken is innovative and provides a case study of precedent in the field of education for sustainability. The study demonstrates the contribution that can be made by a web-based sustainability portal in supporting curriculum renewal. Learning and teaching outcomes were evaluated through ‘before and after surveys’ of the first year engineering students. Statistically significant increases in student's self-reported knowledge of sustainability were measured as a result of exposure to the renewed first year curriculum and this confirmed the value of the initiative in terms of enhancing student learning. While applied in this case to engineering, the process to achieve integration of sustainability into the curriculum approach is likely to have value for other academic disciplines. Considering student performance on assignments and exam questions relating to sustainability would provide a stronger basis for future research to understand the impact of initiatives like this on student learning.

Hampson type heat-exchanger technology and economic evaluation for LNG re- gasification and power generation At LNG receiving terminals

The system for high utilization of LNG cold energy is proposed by use of process simulator. The proposed design is a closed loop system, and composed by a Hampson type heat exchanger, turbines, pumps and advanced humid air turbine (AHAT) or Gas turbine combined cycle (GTCC). Its heat sources are Boil-off gas and cooling water for AHAT or GTCC. The higher cold exergy recovery to power can be about 38 to 56% as compared to the existing cold power generation of about 20% with a Rankine cycle of a single component. The advantage of the proposed system is to reduce the number of heat exchangers. Furthermore, the environmental impact is minimized because the proposed design is a closed loop system. A life cycle comparative cost is calculated to demonstrate feasibility of the proposed design. The development of the Hampson type exchangers is expected to meet the key functional requirements and will result in much higher LNG cold exergy recovery and the overall system performance i.e. re-gasification. Additionally, the proposed design is expected to provide flexibility to meet different gas pressure suited for the deregulation of energy system in Japan and higher reliability for an integrated boil-off gas system.

Measuring impact: Positioning evaluation in the Australian arts and culture landscape

Arts culture organisations and funding authorities increasingly need to evaluate the impact of festivals, events and performances. Economic impacts are often privileged over 'soft data' about community experience and engagement. This new book offers a timely and scholarly demonstration of how cultural value and impact can be evaluated. It offers an innovative approach whereby the relationship developed between the researchers/evaluator and the commissioning arts and cultural producer provides an opportunity to rethink the traditional process of reporting back on value and impact through the singular entity of funds acquittal. Using three commissioned evaluations undertaken at an Australian university as an extended case study, the book investigates the two positions most often adopted by researchers/evaluators - embedded and collaborative, or external and distanced - and argues the merits and deficiencies of the two approaches. Offering an examination of how arts evaluation 'works' in theory and practice and more importantly, why it is needed now and in the future to demonstrate the reach and cultural gains from arts and cultural projects, this will be essential reading for students in arts management, professionals working in arts and cultural organisations, scholars working in association with creative industries and cultural development.

Moving from evaluation to trial: The case of cloud ERP adoption in SMEs

This study proposes that the adoption process of complex-wide systems (e.g. cloud ERP) should be observed as multi-stage actions. Two theoretical lenses were utilised for this study with critical adoption factors identified through the theory of planned behaviour and the progression of each adoption factor observed through Ettlie's (1980) multi-stage adoption model. Together with a survey method, this study has employed data gathered from 162 decision-makers of small and medium-sized enterprises (SMEs). Using both linear and non-linear approaches for the data analysis, the study findings have shown that the level of importance for adoption factors changes across different adoption stages.

Educational interventions for preventing vascular catheter bloodstream infections in critical care: Evidence map, systematic review and economic evaluation

Background Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually £19.1–36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking. Objective To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England. Data sources Sixteen electronic bibliographic databases – including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases – were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references. Review methods References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI. Results Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year. Limitations Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data. Conclusions Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

Evaluation of electrocoagulation for the pre-treatment of coal seam water

This work explored the applicability of electrocoagulation (EC) using aluminium electrodes for the removal of contaminants which can scale and foul reverse osmosis membranes from a coal seam (CS) water sample, predominantly comprising sodium chloride, and sodium bicarbonate. In general, the removal efficiency of species responsible for scaling and fouling was enhanced by increasing the applied current density/voltage and contact times (30–60 s) in the EC chamber. High removal efficiencies of species potentially responsible for scale formation in reverse osmosis units such as calcium (100%), magnesium (87.9%), strontium (99.3%), barium (100%) and silicates (98.3%) were achieved. Boron was more difficult to eliminate (13.3%) and this was postulated to be due to the elevated solution pH. Similarly, fluoride removal from solution (44%) was also inhibited by the presence of hydroxide ions in the pH range 9–10. Analysis of produced flocs suggested the dominant presence of relatively amorphous boehmite (AlOOH), albeit the formation of Al(OH)3 was not ruled out as the drying process employed may have converted aluminium hydroxide to aluminium oxyhydroxide species. Evidence for adsorption of contaminants on floc surface sites was determined from FTIR studies. The quantity of aluminium released during the electrocoagulation process was higher than the Faradaic amount which suggested that the high salt concentrations in the coal seam water had chemically reacted with the aluminium electrodes.