Early warning systems: problems, pragmatics and potential

Symposium Chair: Dr Jennifer McGaughey

Title: Early Warning Systems: problems, pragmatics and potential

Early Warning Systems (EWS) provide a mechanism for staff to recognise, refer and manage deteriorating patients on general hospital wards. Implementation of EWS in practice has required considerable change in the delivery of critical care across hospitals. Drawing their experience of these changes the authors will demonstrate the problems and potential of using EWS to improve patient outcomes.

The first paper (Dr Jennifer McGaughey: Early Warning Systems: what works?) reviews the research evidence regarding the factors that support or constrain the implementation of Early Warning System (EWS) in practice. These findings explain those processes which impact on the successful achievement of patient outcomes. In order to improve detection and standardise practice National EWS have been implemented in the United Kingdom. The second paper (Catherine Plowright: The implementation of the National EWS in a District General Hospital) focuses on the process of implementing and auditing a National EWS. This process improvement is essential to contribute to future collaborative research and collection of robust datasets to improve patient safety as recommended by the Royal College of Physicians (RCP 2012). To successfully implement NEWS in practice requires strategic planning and staff education. The practical issues of training staff is discussed in the third paper. This paper (Collette Laws-Chapman: Simulation as a modality to embed the use of Early Warning Systems) focuses on using simulation and structured debrief to enhance learning in the early recognition and management of deteriorating patients. This session emphasises the importance of cognitive and social skills developed alongside practical skills in the simulated setting.

Traumatic brain injury and co-occurring problems in prison populations: a systematic review.

Background: A growing body of epidemiological research suggests high rates of traumatic brain injury (TBI) in prisoners. The aim of this review is to systematically explore the literature surrounding the rates of TBI and their co-occurrences in a prison population.
Methods: Six electronic databases were systematically searched for articles published between 1980 and 2014. Studies were screened for inclusion based on predetermined criteria by two researchers who independently performed data extraction. Study quality was appraised based on a modified quality assessment tool.
Results: Twenty six studies were included in this review. Quality assessment ranged from 20% (poor) to 80% (good) with an overall average of 60%. Twenty four papers included TBI prevalence rates, which ranged from 5.69%-88%. Seventeen studies explored co-occurring factors including rates of aggression (n=7), substance abuse (n=9), anxiety and depression (n=5), neurocognitive deficits (n=4), and psychiatric conditions (n=3).
Conclusions: The high degree of variation in TBI rates may be attributed to the inconsistent way in which TBI was measured with only seven studies using valid and reliable screening tools. Additionally, gaps in the literature surrounding personality outcomes in prisoners with TBI, female prisoners with TBI, and qualitative outcomes were found.

The Reliability of the Arc-Length Method in the Analysis of Mode-Jumping Problems

The Arc-Length Method is a solution procedure that enables a generic non-linear problem to pass limit points. Some examples are provided of mode-jumping problems solutions using a commercial nite element package, and other investigations are carried out on a simple structure of which the numerical solution can be compared with an analytical one. It is shown that Arc-Length Method is not reliable when bifurcations are present in the primary equilibrium path; also the presence of very sharp snap-backs or special boundary conditions may cause convergence diÆculty at limit points. An improvement to the predictor used in the incremental procedure is suggested, together with a reliable criteria for selecting either solution of the quadratic arc-length constraint. The gap that is sometimes observed between the experimantal load level of mode-jumping and its arc-length prediction is explained through an example.

Interpretable and Reconfigurable Clustering of Document Datasets by Deriving Word-based Rules

Clusters of text documents output by clustering algorithms are often hard to interpret. We describe motivating real-world scenarios that necessitate reconfigurability and high interpretability of clusters and outline the problem of generating clusterings with interpretable and reconfigurable cluster models. We develop two clustering algorithms toward the outlined goal of building interpretable and reconfigurable cluster models. They generate clusters with associated rules that are composed of conditions on word occurrences or nonoccurrences. The proposed approaches vary in the complexity of the format of the rules; RGC employs disjunctions and conjunctions in rule generation whereas RGC-D rules are simple disjunctions of conditions signifying presence of various words. In both the cases, each cluster is comprised of precisely the set of documents that satisfy the corresponding rule. Rules of the latter kind are easy to interpret, whereas the former leads to more accurate clustering. We show that our approaches outperform the unsupervised decision tree approach for rule-generating clustering and also an approach we provide for generating interpretable models for general clusterings, both by significant margins. We empirically show that the purity and f-measure losses to achieve interpretability can be as little as 3 and 5%, respectively using the algorithms presented herein.

Generating a Word-Emotion Lexicon from #Emotional Tweets

Research in emotion analysis of text suggest that emotion lexicon based features are superior to corpus based n-gram features. However the static nature of the general purpose emotion lexicons make them less suited to social media analysis, where the need to adopt to changes in vocabulary usage and context is crucial. In this paper we propose a set of methods to extract a word-emotion lexicon automatically from an emotion labelled corpus of tweets. Our results confirm that the features derived from these lexicons outperform the standard Bag-of-words features when applied to an emotion classification task. Furthermore, a comparative analysis with both manually crafted lexicons and a state-of-the-art lexicon generated using Point-Wise Mutual Information, show that the lexicons generated from the proposed methods lead to significantly better classi- fication performance.

International Coordination in Cross-Border Bank Bail-ins: Problems and Prospects

Bail-in is quickly becoming a predominant approach to banking resolution. The EU Bank Recovery Resolution Directive and the US Federal Deposit Insurance Corporation’s single point of entry strategy envisage creditors’ recapitalisations
to resolve a failing financial institution. However, this legislation focuses on the domestic aspects of bail-in, leaving the question of how it is applied
to a cross-border banking group open. Cross-border banking resolution has been historically subject to coordination failures, which have resulted in disorderly resolutions with dangerous systemic effects. The goal of this article is to assess whether bail-in is subject to the same coordination problems that affect other resolution tools, and to discuss the logic of international legal cooperation in bail-in policies. We demonstrate that, in spite of the evident benefit in terms of fiscal sustainability, bail-in suffers from complex coordination problems which, if not addressed, might lead to regulatory arbitrage and lengthy court battles, and, ultimately, may disrupt resolutions. We argue that only a binding legal regime can address those problems. In doing so, we discuss the recent Financial Stability
Board’s proposal on cross-border recognition of resolution action, and the role of international law in promoting cooperation in banking resolution.

A Hybrid Swarm Based Approach in Addressing University Timetabling Problems

This paper is concerned with the application of an automated hybrid approach in addressing the university timetabling problem. The approach described is based on the nature-inspired artificial bee colony (ABC) algorithm. An ABC algorithm is a biologically-inspired optimization approach, which has been widely implemented in solving a range of optimization problems in recent years such as job shop scheduling and machine timetabling problems. Although the approach has proven to be robust across a range of problems, it is acknowledged within the literature that there currently exist a number of inefficiencies regarding the exploration and exploitation abilities. These inefficiencies can often lead to a slow convergence speed within the search process. Hence, this paper introduces a variant of the algorithm which utilizes a global best model inspired from particle swarm optimization to enhance the global exploration ability while hybridizing with the great deluge (GD) algorithm in order to improve the local exploitation ability. Using this approach, an effective balance between exploration and exploitation is attained. In addition, a traditional local search approach is incorporated within the GD algorithm with the aim of further enhancing the performance of the overall hybrid method. To evaluate the performance of the proposed approach, two diverse university timetabling datasets are investigated, i.e., Carter's examination timetabling and Socha course timetabling datasets. It should be noted that both problems have differing complexity and different solution landscapes. Experimental results demonstrate that the proposed method is capable of producing high quality solutions across both these benchmark problems, showing a good degree of generality in the approach. Moreover, the proposed method produces best results on some instances as compared with other approaches presented in the literature.

An investigation of vision problems and the vision care system in Rural China

This paper examines the prevalence of vision problems and the accessibility to and quality of vision care in rural China. We obtained data from 4 sources: 1) the National Rural Vision Care Survey; 2) the Private Optometrists Survey; 3) the County Hospital Eye Care Survey; and 4) the Rural School Vision Care Survey. The data from each of the surveys were collected by the authors during 2012. Thirty-three percent of the rural population surveyed self-reported vision problems. Twenty-two percent of subjects surveyed had ever had a vision exam. Among those who self-reported having vision problems, 34% did not wear eyeglasses. Fifty-four percent of those with vision problems who had eyeglasses did not have a vision exam prior to receiving glasses. However, having a vision exam did not always guarantee access to quality vision care. Four channels of vision care service were assessed. The school vision examination program did not increase the usage rate of eyeglasses. Each county-hospital was staffed with three eye-doctors having one year of education beyond high school, serving more than 400,000 residents. Private optometrists often had low levels of education and professional certification. In conclusion, our findings shows that the vision care system in rural China is inadequate and ineffective in meeting the needs of the rural population sampled.

A Hybrid Imperialist Approach in Solving University Timetabling Problems. Information Sciences. Vol. 283, 1-21

Generating timetables for an institution is a challenging and time consuming task due to different demands on the overall structure of the timetable. In this paper, a new hybrid method which is a combination of a great deluge and artificial bee colony algorithm (INMGD-ABC) is proposed to address the university timetabling problem. Artificial bee colony algorithm (ABC) is a population based method that has been introduced in recent years and has proven successful in solving various optimization problems effectively. However, as with many search based approaches, there exist weaknesses in the exploration and exploitation abilities which tend to induce slow convergence of the overall search process. Therefore, hybridization is proposed to compensate for the identified weaknesses of the ABC. Also, inspired from imperialist competitive algorithms, an assimilation policy is implemented in order to improve the global exploration ability of the ABC algorithm. In addition, Nelder–Mead simplex search method is incorporated within the great deluge algorithm (NMGD) with the aim of enhancing the exploitation ability of the hybrid method in fine-tuning the problem search region. The proposed method is tested on two differing benchmark datasets i.e. examination and course timetabling datasets. A statistical analysis t-test has been conducted and shows the performance of the proposed approach as significantly better than basic ABC algorithm. Finally, the experimental results are compared against state-of-the art methods in the literature, with results obtained that are competitive and in certain cases achieving some of the current best results to those in the literature.