The framework for REVIEWS: an exploration into design principles for an electronic medical early warning system observation chart

The observation chart is for many health professionals (HPs) the primary source of objective information relating to the health of a patient. Information Systems (IS) research has demonstrated the positive impact of good interface design on decision making and it is logical that good observation chart design can positively impact healthcare decision making. Despite the potential for good observation chart design, there is a paucity of observation chart design literature, with the primary source of literature leveraging Human Computer Interaction (HCI) literature to design better charts. While this approach has been successful, this design approach introduces a gap between understanding of the tasks performed by HPs when using charts and the design features implemented in the chart. Good IS allow for the collection and manipulation of data so that it can be presented in a timely manner that support specific tasks. Good interface design should therefore consider the specific tasks being performed prior to designing the interface. This research adopts a Design Science Research (DSR) approach to formalise a framework of design principles that incorporates knowledge of the tasks performed by HPs when using observation charts and knowledge pertaining to visual representations of data and semiology of graphics. This research is presented in three phases, the initial two phases seek to discover and formalise design knowledge embedded in two situated observation charts: the paper-based NEWS chart developed by the Health Service Executive in Ireland and the electronically generated eNEWS chart developed by the Health Information Systems Research Centre in University College Cork. A comparative evaluation of each chart is also presented in the respective phases. Throughout each of these phases, tentative versions of a design framework for electronic vital sign observation charts are presented, with each subsequent iteration of the framework (versions Alpha, Beta, V0.1 and V1.0) representing a refinement of the design knowledge. The design framework will be named the framework for the Retrospective Evaluation of Vital Sign Information from Early Warning Systems (REVIEWS). Phase 3 of the research presents the deductive process for designing and implementing V0.1 of the framework, with evaluation of the instantiation allowing for the final iteration V1.0 of the framework. This study makes a number of contributions to academic research. First the research demonstrates that the cognitive tasks performed by nurses during clinical reasoning can be supported through good observation chart design. Secondly the research establishes the utility of electronic vital sign observation charts in terms of supporting the cognitive tasks performed by nurses during clinical reasoning. Third the framework for REVIEWS represents a comprehensive set of design principles which if applied to chart design will improve the usefulness of the chart in terms of supporting clinical reasoning. Fourth the electronic observation chart that emerges from this research is demonstrated to be significantly more useful than previously designed charts and represents a significant contribution to practice. Finally the research presents a research design that employs a combination of inductive and deductive design activities to iterate on the design of situated artefacts.

Life history of a native emydid turtle (Malaclemys terrapin centrata) on the remote oceanic islands of Bermuda

Diamondback terrapins (Malaclemys terrapin) are native to the remote oceanic islands of Bermuda and presently inhabit only four small brackish water ponds on a private golf course. The life history of this species is poorly understood on Bermuda and so the aim of this study was to fill these knowledge gaps, to compare the results with what is known from other areas in the North American range, and to inform the development of a local management plan. The results of a mark-recapture census revealed that ca. 100 individuals ≥81 mm straight carapace length live on Bermuda, of which nearly half (48.5%) were considered sexually mature. The population is dominated by females (sex ratio 2.9:1) and annual recruitment over the three year period was found to be extremely low (approximately two terrapins). Female diamondback terrapins in Bermuda nest almost exclusively within a limited number of sand bunkers on the golf course. Nesting commenced in late March or early April and ended in late August. Peak oviposition was observed in May and June. Clutch size averaged 5.1 eggs (range 0-10; SD 2.4) and the incubation period averaged 61.8 days (range 49-83; SD 10.5). Delayed emergence was documented, with 43.8% of the hatchlings remaining in their natal nests over the winter months. The mean annual hatching success rate was determined to be 19% (range 17.6-21; SD 1.9). Radio-telemetry was used to investigate the movements and survivorship of postemergent hatchling diamondback terrapins. The results indicated that mangrove swamps and grass-dominated marshes adjacent to the ponds are important developmental habitats for hatchlings. Yellow-crowned night herons (Nyctanassa violacea) were found to be significant predators of small terrapins during spring emergence. Small aquatic gastropods comprised 66.7% of the faecal samples analysed from the Bermudian population. Scavenged fish and vertebrate animal remains, terrestrial arthropods, polychaete worms and bivalves were consumed in lesser amounts. Sediment from the pond environment was found in 74% of the faecal samples analysed and is believed to have been incidentally ingested while foraging for the small benthic gastropods. Eco-toxicological analyses of the pond sediment, prey and terrapin eggs showed that the Bermudian diamondback terrapins live and feed in wetland habitats characterised by chronic, multifactorial contamination; principally total petroleum hydrocarbons, polycyclic aromatic hydrocarbons and a variety of heavy metals. This study found that some of those contaminants are accumulating in the gastropod prey as well as being transferred to terrapin eggs. This may be reducing the incidence of successful embryonic development for this species in Bermuda and may likely contribute to the observed low hatching rates. These collective findings indicate that the Bermudian population is very vulnerable to local extirpation.