Evaluating the effect of a patient education brochure on patients’ expectations and satisfaction with emergency department service

Introduction: The purpose of this study was to assess the capacity of a written intervention, in this case a patient information brochure, to improve patient satisfaction during an Emergency Department (ED) visit. For the purpose of measuring the effect of the intervention the ED journey was conceptualised as a series of distinct areas of service comprising waiting time, service by the triage nurse, care from doctors and nurses and information giving Background of study: Research into patient satisfaction has become a widespread activity endorsed by both governments and hospital administrations. The literature on ED patient satisfaction has consistently indicated three primary areas of patient dissatisfaction: waiting time, nursing care and communication. Recent developments in the literature on patient satisfaction studies however have highlighted the relationship between patients. expectations of a service encounter and their consequent assessment of the experience as dissatisfying or satisfying. Disconfirmation theory posits that the degree to which expectations are confirmed will affect subsequent levels of satisfaction. The conceptual framework utilised in this study is Coye.s (2004) model of disconfirmation. Coye while reiterating satisfaction is a consequence of the degree expectations are either confirmed or disconfirmed also posits that expectations can be modified by interventions. Coye.s work conceptualises these interventions as intra encounter experiences (cues) which function to adjust expectations. Coye suggests some cues are unintended and may have a negative impact which also reinforces the value of planned cues intended to meet or exceed consumer expectations. Consequently the brochure can be characterized as a potentially positive cue, encouraging the patient to understand processes and to orient them in what can be a confronting environment. Only a limited number of studies have examined the effect of written interventions within an ED. No studies could be located which have tested the effect of ED interventions using a conceptual framework which relates the effect of the degree to which expectations are confirmed or disconfirmed in terms of satisfaction with services. Method: Two studies were conducted. Study One used qualitative methods to explore patients. expectations of the ED from the perspective of both patients and health care professionals. Study One was used in part to direct the development of the intervention (brochure) in Study Two. The brochure was an intervention designed to modify patients. expectations thus increasing their satisfaction with the provision of ED service. As there was no existing tools to measure ED patients. expectations and satisfaction a new tool was also developed based on the findings and the literature of Study One. Study Two used a non-randomised, quasi-experimental approach using a non-equivalent post-test only comparison group design used to investigate the effect of the patient education brochure (Stommel and Wills, 2004). The brochure was disseminated to one of two study groups (the intervention group). The effect of the brochure was assessed by comparing the data obtained from both the intervention and control group. These two groups consisted of 150 participants each. It was expected that any differences in the relevant domains selected for examination would indicate the effect of the brochure both on expectation and potentially satisfaction. Results: Study One revealed several areas of common ground between patients and nurses in terms of relevant content for the written intervention, including the need for information on the triage system and waiting times. Areas of difference were also found with patients emphasizing communication issues, whereas focus group members expressed concern that patients were often unable to assimilate verbal information. The findings suggested the potential utility of written material to reinforce verbal communication particularly in terms of the triage process and other ED protocols. This material was synthesized within the final version of the written intervention. Overall the results of Study Two indicated no significant differences between the two groups. The intervention group did indicate a significant number of participants who viewed the brochure of having changed their expectations. The effect of the brochure may have been obscured by a lack of parity between the two groups as the control group presented with statistically significantly higher levels of acuity and experienced significantly shorter waiting times. In terms of disconfirmation theory this would suggest expectations that had been met or exceeded. The results confirmed the correlation of expectations with satisfaction. Several domains also indicated age as a significant predictor with older patients tending to score higher satisfaction results. Other significant predictors of satisfaction established were waiting time and care from nurses, reinforcing the combination of efficient service and positive interpersonal experiences as being valued by patients. Conclusions: Information presented in written form appears to benefit a significant number of ED users in terms of orientation and explaining systems and procedures. The degree to which these effects may interact with other dimensions of satisfaction however is likely to be limited. Waiting time and interpersonal behaviours from staff also provide influential cues in determining satisfaction. Written material is likely to be one element in a series of coordinated strategies to improve patient satisfaction during periods of peak demand.

A prioritised fuzzy constraint satisfaction approach to model agent negotiation for railway scheduling

With the recent regulatory reforms in a number of countries, railways resources are no longer managed by a single party but are distributed among different stakeholders. To facilitate the operation of train services, a train service provider (SP) has to negotiate with the infrastructure provider (IP) for a train schedule and the associated track access charge. This paper models the SP and IP as software agents and the negotiation as a prioritized fuzzy constraint satisfaction (PFCS) problem. Computer simulations have been conducted to demonstrate the effects on the train schedule when the SP has different optimization criteria. The results show that by assigning different priorities on the fuzzy constraints, agents can represent SPs with different operational objectives.

Sustainability performance of construction : conceptual models of satisfaction levels in construction projects

In general, the performance of construction projects, including their sustainability performance, does not meet optimal expectations. One aspect of this is the performance of the participants who are independent and make a significance impact on overall project outcomes. Of these participants, the client is traditionally the owner of the project, the architect or engineer is engaged as the lead designer and a contractor is selected to construct the facilities. Generally, the performance of the participants is gauged by considering three main factors, namely, time, cost and quality. As the level of satisfaction is a subjective issue, it is rarely used in the performance evaluation of construction work. Recently, various approaches to the measurement of satisfaction have been made in an attempt to determine the performance of construction project outcomes - for instance, client satisfaction, customer satisfaction, contractor satisfaction, occupant satisfaction and home buyer satisfaction. These not only identify the performance of the construction project but are also used to improve and maintain relationships. In addition, these assessments are necessary for the continuous improvement and enhanced cooperation of participants. The measurement of satisfaction levels primarily involves expectations and perceptions. An expectation can be regarded as a comparative standard of different needs, motives and beliefs, while a perception is a subjective interpretation that is influenced by moods, experiences and values. This suggests that the disparity between perceptions and expectations may possibly be used to represent different levels of satisfaction. However, this concept is rather new and in need of further investigation. This chapter examines the methods commonly practised in measuring satisfaction levels today and the advantages of promoting these methods. The results provide a preliminary review of the advantages of satisfaction measurement in the construction industry and recommendations are made concerning the most appropriate methods to use in identifying the performance of project outcomes.

Decoupled image-based visual servoing for cameras obeying the unified projection model

This paper proposes a generic decoupled imagebased control scheme for cameras obeying the unified projection model. The scheme is based on the spherical projection model. Invariants to rotational motion are computed from this projection and used to control the translational degrees of freedom. Importantly we form invariants which decrease the sensitivity of the interaction matrix to object depth variation. Finally, the proposed results are validated with experiments using a classical perspective camera as well as a fisheye camera mounted on a 6-DOF robotic platform.

Empirical comparison of machine learning algorithms for image texture classification with application to vegetation management in power line corridors

This paper reports on the empirical comparison of seven machine learning algorithms in texture classification with application to vegetation management in power line corridors. Aiming at classifying tree species in power line corridors, object-based method is employed. Individual tree crowns are segmented as the basic classification units and three classic texture features are extracted as the input to the classification algorithms. Several widely used performance metrics are used to evaluate the classification algorithms. The experimental results demonstrate that the classification performance depends on the performance matrix, the characteristics of datasets and the feature used.

"Re-imagining animation : the changing face of the moving image by Paul Wells and Johnny Hardstaff" (Book Review)

Advances in digital technology have caused a radical shift in moving image culture. This has occurred in both modes of production and sites of exhibition, resulting in a blurring of boundaries that previously defined a range of creative disciplines. Re-Imagining Animation: The Changing Face of the Moving Image, by Paul Wells and Johnny Hardstaff, argues that as a result of these blurred disciplinary boundaries, the term “animation” has become a “catch all” for describing any form of manipulated moving image practice. Understanding animation predicates the need to (re)define the medium within contemporary moving image culture. Via a series of case studies, the book engages with a range of moving image works, interrogating “how the many and varied approaches to making film, graphics, visual artefacts, multimedia and other intimations of motion pictures can now be delineated and understood” (p. 7). The structure and clarity of content make this book ideally suited to any serious study of contemporary animation which accepts animation as a truly interdisciplinary medium.

Longitudinal evaluations of student satisfaction with a postgraduate unit using importance-performance analysis

The Australian tourism tertiary education sector operates in a competitive and dynamic environment, which necessitates a market orientation to be successful. Academic staff and management in the sector must regularly assess the perceptions of prospective and current students and monitor the satisfaction levels of current students. This study is concerned with the setting and monitoring of satisfaction levels of current students, reporting the results of three longitudinal investigations of student satisfaction in a postgraduate unit. The study also addresses a limitation of a university’s generic teaching evaluation instrument. Importance-Performance Analysis (IPA) has been recommended as a simple but effective tool for overcoming the deficiencies of many student evaluation studies, which have generally measured only attribute performance at the end of a semester. IPA was used to compare student expectations of the unit at the beginning of a semester with their perceptions of performance 10 weeks later. The first stage documented key benchmarks for which amendments to the unit based on student feedback could be evaluated during subsequent teaching periods.

Attraction and image for the Australian rail industry

Despite the global financial downturn, the Australian rail industry is in a period of expansion. Reports indicate that the industry is not attracting sufficient entry level and mid-career engineers and skilled technicians from within the Australian labour market and is facing widespread retirements from an ageing workforce. This paper reports on a completed qualitative study that explores the perceptions of engineering students, their lecturers, careers advisors and recruitment consultants regarding rail as a brand and of careers in the rail industry. Findings are presented about career knowledge, job characteristic preferences, branding and image and indicate that rail as a brand has a dated image, that young people and their influencers have little knowledge of rail careers and that rail could better focus its image and recruitment strategies. Conclusions include suggestions for more effective attraction and image strategies for the industry and for further research.

Conceptual models of satisfaction level in construction

It is recognized that, in general, the performance of construction projects does not meet optimal expectations. One aspect of this is the performance of each participant, which is interdependent and makes a significance impact on overall project outcomes. Of these, the client is traditionally the owner of the project, the architect or engineer is engaged as the lead designer and a contractor is selected to construct the facilities. Generally, the performance of the participants is gauged by considering three main factors, namely time, cost and quality. As the level of satisfaction is a subjective measurement, it is rarely used in the performance evaluation of construction work. Recently, various approaches to the measurement of satisfaction have been made in attempting to determine the performance of construction project outcomes – for instance client satisfaction, consultant satisfaction, contractor satisfaction, customer satisfaction and home buyer satisfaction. These not only identify the performance of the construction project, but are also used to improve and maintain relationships. In addition, these assessments are necessary for continuous improvement and enhanced cooperation between participants. The measurement of satisfaction levels primarily involves expectations and perceptions. An expectation can be regarded as a comparison standard of different needs, motives and beliefs, while a perception is a subjective interpretation that is influenced by moods, experiences and values. This suggests that the disparity between perceptions and expectations may be used to represent different levels of satisfaction. However, this concept is rather new and in need of further investigation. This paper examines the current methods commonly practiced in measuring satisfaction level and the advantages of promoting these methods. The results provided are a preliminary review of the advantages of satisfaction measurement in the construction industry and recommendations are made concerning the most appropriate methods for use in identifying the performance of project outcomes.

The impact of contractor’s characteristics in gauging level satisfaction

The outcomes of the construction projects can be evaluated in numerous ways. One method is to measure the satisfaction of participants as represented by the differences between their expectations and perceptions. This measurement is used widely in construction as it promises benefits, such as the improvement of product delivery, and enhances services quality by identifying some necessary changes. Commonly satisfaction measurement is gauged by evaluating the level of client satisfaction of construction performance. The measurement of customer satisfaction on the other hand, is based on the quality of the end product. This evaluation is used to encourage contractors to improve their performance to a required level and to ensure that the projects are delivered as expected- in terms of time, budget and quality. Several studies of performance measurement have indicated that contractor performance is still not satisfactory, as the outcome delivered is not as required (because of cost overruns, time overruns or because it is generally unsatisfactory). This drawback may be due to the contractors’ lack of expertise, motivation and/or satisfaction. The measurement of performance based on contractor satisfaction levels is still new and very few studies have yet taken place in the construction industry. This paper examines how the characteristics of a contracting organisation – namely its experience in the industry, background, past performance, size of organisation and financial stability- may influence its satisfaction levels with regards to project performance. Previous literature reviews and interviews are used as research tools in the preliminary investigation. The outcome is expected to present a basic understanding of contractor satisfaction measurement and its potential for improving the performance of project outcomes.

Ontology-based image annotation

With regard to the long-standing problem of the semantic gap between low-level image features and high-level human knowledge, the image retrieval community has recently shifted its emphasis from low-level features analysis to high-level image semantics extrac- tion. User studies reveal that users tend to seek information using high-level semantics. Therefore, image semantics extraction is of great importance to content-based image retrieval because it allows the users to freely express what images they want. Semantic content annotation is the basis for semantic content retrieval. The aim of image anno- tation is to automatically obtain keywords that can be used to represent the content of images. The major research challenges in image semantic annotation are: what is the basic unit of semantic representation? how can the semantic unit be linked to high-level image knowledge? how can the contextual information be stored and utilized for image annotation? In this thesis, the Semantic Web technology (i.e. ontology) is introduced to the image semantic annotation problem. Semantic Web, the next generation web, aims at mak- ing the content of whatever type of media not only understandable to humans but also to machines. Due to the large amounts of multimedia data prevalent on the Web, re- searchers and industries are beginning to pay more attention to the Multimedia Semantic Web. The Semantic Web technology provides a new opportunity for multimedia-based applications, but the research in this area is still in its infancy. Whether ontology can be used to improve image annotation and how to best use ontology in semantic repre- sentation and extraction is still a worth-while investigation. This thesis deals with the problem of image semantic annotation using ontology and machine learning techniques in four phases as below. 1) Salient object extraction. A salient object servers as the basic unit in image semantic extraction as it captures the common visual property of the objects. Image segmen- tation is often used as the �rst step for detecting salient objects, but most segmenta- tion algorithms often fail to generate meaningful regions due to over-segmentation and under-segmentation. We develop a new salient object detection algorithm by combining multiple homogeneity criteria in a region merging framework. 2) Ontology construction. Since real-world objects tend to exist in a context within their environment, contextual information has been increasingly used for improving object recognition. In the ontology construction phase, visual-contextual ontologies are built from a large set of fully segmented and annotated images. The ontologies are composed of several types of concepts (i.e. mid-level and high-level concepts), and domain contextual knowledge. The visual-contextual ontologies stand as a user-friendly interface between low-level features and high-level concepts. 3) Image objects annotation. In this phase, each object is labelled with a mid-level concept in ontologies. First, a set of candidate labels are obtained by training Support Vectors Machines with features extracted from salient objects. After that, contextual knowledge contained in ontologies is used to obtain the �nal labels by removing the ambiguity concepts. 4) Scene semantic annotation. The scene semantic extraction phase is to get the scene type by using both mid-level concepts and domain contextual knowledge in ontologies. Domain contextual knowledge is used to create scene con�guration that describes which objects co-exist with which scene type more frequently. The scene con�guration is represented in a probabilistic graph model, and probabilistic inference is employed to calculate the scene type given an annotated image. To evaluate the proposed methods, a series of experiments have been conducted in a large set of fully annotated outdoor scene images. These include a subset of the Corel database, a subset of the LabelMe dataset, the evaluation dataset of localized semantics in images, the spatial context evaluation dataset, and the segmented and annotated IAPR TC-12 benchmark.

A Taxonomy of image matching techniques for stereo vision

Stereo vision is a method of depth perception, in which depth information is inferred from two (or more) images of a scene, taken from different perspectives. Applications of stereo vision include aerial photogrammetry, autonomous vehicle guidance, robotics, industrial automation and stereomicroscopy. A key issue in stereo vision is that of image matching, or identifying corresponding points in a stereo pair. The difference in the positions of corresponding points in image coordinates is termed the parallax or disparity. When the orientation of the two cameras is known, corresponding points may be projected back to find the location of the original object point in world coordinates. Matching techniques are typically categorised according to the nature of the matching primitives they use and the matching strategy they employ. This report provides a detailed taxonomy of image matching techniques, including area based, transform based, feature based, phase based, hybrid, relaxation based, dynamic programming and object space methods. A number of area based matching metrics as well as the rank and census transforms were implemented, in order to investigate their suitability for a real-time stereo sensor for mining automation applications. The requirements of this sensor were speed, robustness, and the ability to produce a dense depth map. The Sum of Absolute Differences matching metric was the least computationally expensive; however, this metric was the most sensitive to radiometric distortion. Metrics such as the Zero Mean Sum of Absolute Differences and Normalised Cross Correlation were the most robust to this type of distortion but introduced additional computational complexity. The rank and census transforms were found to be robust to radiometric distortion, in addition to having low computational complexity. They are therefore prime candidates for a matching algorithm for a stereo sensor for real-time mining applications. A number of issues came to light during this investigation which may merit further work. These include devising a means to evaluate and compare disparity results of different matching algorithms, and finding a method of assigning a level of confidence to a match. Another issue of interest is the possibility of statistically combining the results of different matching algorithms, in order to improve robustness.

Applying ISOMAP to the learning of hyperspectral image

In this paper, we present the application of a non-linear dimensionality reduction technique for the learning and probabilistic classification of hyperspectral image. Hyperspectral image spectroscopy is an emerging technique for geological investigations from airborne or orbital sensors. It gives much greater information content per pixel on the image than a normal colour image. This should greatly help with the autonomous identification of natural and manmade objects in unfamiliar terrains for robotic vehicles. However, the large information content of such data makes interpretation of hyperspectral images time-consuming and userintensive. We propose the use of Isomap, a non-linear manifold learning technique combined with Expectation Maximisation in graphical probabilistic models for learning and classification. Isomap is used to find the underlying manifold of the training data. This low dimensional representation of the hyperspectral data facilitates the learning of a Gaussian Mixture Model representation, whose joint probability distributions can be calculated offline. The learnt model is then applied to the hyperspectral image at runtime and data classification can be performed.

The identification of Malaysian contractor satisfaction dimensions : a strategy for continuous improvement

The unique characteristics of the construction industry - such as the fragmentation of its processes, varied scope of works and diversity of its participants - are contributory factors to poor project performance. Several issues are unresolved due to the lack of a comprehensive technique to measure project outcomes including: inefficient decision making, insufficient communication, uncertain site conditions, a continuously changing environment, inharmonious working relationships, mismatched objectives within the project team and a blame culture. One approach to overcoming these problems appears to be to measure performance by gauging contractor satisfaction (Co-S) levels, but this has not been widely investigated as yet. Additionally, the key Co-S dimensions at the project level are still not fully identified. ----- ----- This paper concerns a study of satisfaction dimensions, primarily by a postal questionnaire survey of construction contractors registered by the Malaysian Construction Industry Development Board (CIDB). Eight satisfaction dimensions are identified that are significantly and substantially relate to these contractors - comprising: project cost performance, schedule performance, product performance, design satisfaction, site safety, project profitability, business performance and relationships between participants. -Each of these dimensions is accorded different priority levels of satisfaction by different contractors. ----- ----- The output of this study will be useful in raising the awareness and understanding of project teams regarding contractors’ needs, mutual objectives and open communication to help to deliver a successful project.