A proposed systems approach to the evaluation of integrated palliative care

Background. There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care. Methods. In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors. Results. The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network. Conclusions. Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations. © 2010 Bainbridge et al; licensee BioMed Central Ltd.

Distributed Adaptive Learning Framework for Wide Area Monitoring of Power Systems Integrated with Distributed Generations

This paper presents a preliminary study of developing a novel distributed adaptive real-time learning framework for wide area monitoring of power systems integrated with distributed generations using synchrophasor technology. The framework comprises distributed agents (synchrophasors) for autonomous local condition monitoring and fault detection, and a central unit for generating global view for situation awareness and decision making. Key technologies that can be integrated into this hierarchical distributed learning scheme are discussed to enable real-time information extraction and knowledge discovery for decision making, without explicitly accumulating and storing all raw data by the central unit. Based on this, the configuration of a wide area monitoring system of power systems using synchrophasor technology, and the functionalities for locally installed open-phasor-measurement-units (OpenPMUs) and a central unit are presented. Initial results on anti-islanding protection using the proposed approach are given to illustrate the effectiveness.

A Reliability Assessment Approach For Integrated Transportation and Electrical Power Systems Incorporating Electric Vehicles

With the increasing utilization of electric vehicles (EVs), transportation systems and electrical power systems are becoming increasingly coupled. However, the interaction between these two kinds of systems are not well captured, especially from the perspective of transportation systems. This paper studies the reliability of integrated transportation and electrical power system (ITES). A bidirectional EV charging control strategy is first demonstrated to model the interaction between the two systems. Thereafter, a simplified transportation system model is developed, whose high efficiency makes the reliability assessment of the ITES realizable with an acceptable accuracy. Novel transportation system reliability indices are then defined from the view point of EV’s driver. Based on the charging control model and the transportation simulation method, a daily periodic quasi sequential reliability assessment method is proposed for the ITES system. Case studies based on RBTS system demonstrate that bidirectional charging controls of EVs will benefit the reliability of power systems, while decrease the reliability of EVs travelling. Also, the optimal control strategy can be obtained based on the proposed method. Finally, case studies are performed based on a large scale test system to verify the practicability of the proposed method.

A case for facade integrated solar thermal systems.

This paper explores the potential for façade located solar thermal collectors. Building typologies with limited roof space area are highlighted. A relationship exists between hot water consumption and the solar collector area; hence, a literature review of the hot water consumption of different building typologies is conducted. The review showed that there is a paucity of information on the hot water consumption of buildings, primarily attributed to the difficulty in quantifying it. The hot water consumption is typically describedusing liters per capita per day (Lcd) units, with a broad range of values existing, dependent, primarily on the building's function and location. Asimulation-based study is conducted to size solar thermal systems for different buildings and their associated hot water loads. High solar fractions,for buildings with high levels of hot water consumption, could only be achievedby using significantly largercollector surface areas. As a result, façade located solar thermal collectors are required for certain high-rise buildings that aim to provide for their hot water needs using a considerable portion of solar energy.

Optimal day-ahead scheduling of integrated urban energy systems

An optimal day-ahead scheduling method (ODSM) for the integrated urban energy system (IUES) is introduced, which considers the reconfigurable capability of an electric distribution network. The hourly topology of a distribution network, a natural gas network, the energy centers including the combined heat and power (CHP) units, different energy conversion devices and demand responsive loads (DRLs), are optimized to minimize the day-ahead operation cost of the IUES. The hourly reconfigurable capability of the electric distribution network utilizing remotely controlled switches (RCSs) is explored and discussed. The operational constraints from the unbalanced three-phase electric distribution network, the natural gas network, and the energy centers are considered. The interactions between the electric distribution network and the natural gas network take place through conversion of energy among different energy vectors in the energy centers. An energy conversion analysis model for the energy center was developed based on the energy hub model. A hybrid optimization method based on genetic algorithm (GA) and a nonlinear interior point method (IPM) is utilized to solve the ODSM model. Numerical studies demonstrate that the proposed ODSM is able to provide the IUES with an effective and economical day-ahead scheduling scheme and reduce the operational cost of the IUES.

The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems

Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.

Methods: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis.

Results: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change.

Conclusion: Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.

Aircraft Cost Modelling using the Genetic Causal Technique within a Systems Engineering Approach

The paper is primarily concerned with the modelling of aircraft manufacturing cost. The aim is to establish an integrated life cycle balanced design process through a systems engineering approach to interdisciplinary analysis and control. The cost modelling is achieved using the genetic causal approach that enforces product family categorisation and the subsequent generation of causal relationships between deterministic cost components and their design source. This utilises causal parametric cost drivers and the definition of the physical architecture from the Work Breakdown Structure (WBS) to identify product families. The paper presents applications to the overall aircraft design with a particular focus on the fuselage as a subsystem of the aircraft, including fuselage panels and localised detail, as well as engine nacelles. The higher level application to aircraft requirements and functional analysis is investigated and verified relative to life cycle design issues for the relationship between acquisition cost and Direct Operational Cost (DOC), for a range of both metal and composite subsystems. Maintenance is considered in some detail as an important contributor to DOC and life cycle cost. The lower level application to aircraft physical architecture is investigated and verified for the WBS of an engine nacelle, including a sequential build stage investigation of the materials, fabrication and assembly costs. The studies are then extended by investigating the acquisition cost of aircraft fuselages, including the recurring unit cost and the non-recurring design cost of the airframe sub-system. The systems costing methodology is facilitated by the genetic causal cost modeling technique as the latter is highly generic, interdisciplinary, flexible, multilevel and recursive in nature, and can be applied at the various analysis levels required of systems engineering. Therefore, the main contribution of paper is a methodology for applying systems engineering costing, supported by the genetic causal cost modeling approach, whether at a requirements, functional or physical level.

Antioxidant activity of coffee model systems

Coffee model systems prepared from combinations of chlorogenic acid (CGA), N-alpha-acetyl-1-arginine (A), sucrose (S), and cellulose (C) were roasted at 240 degreesC for 4 min prior to analysis by UV-visible spectrophotometry, capillary zone electrophoresis (CZE), and the ABTS radical cation decolorization assay. The A/CGA/S/C and A/S/C systems were also fractionated by gel filtration chromatography. Antioxidant activity of the systems showed a positive, nonlinear relationship with the amount of CGA remaining after roasting. Sucrose degradation was a major source of color in the heated systems. There was no relationship between antioxidant activity and color generation.

Effect of pH, temperature, and moisture on the formation of volatile compounds in glycine/glucose model systems

Mixtures of glycine, glucose, and starch were extrusion cooked using sodium hydroxide at 0, 3, and 6 g/L of extruder water feed, 18% moisture, and 120, 150, and 180 degreesC target die temperatures, giving extrudates with pH values of 5.6, 6.8, and 7.4. Freeze-dried equimolar solutions of glucose and glycine were heated either dry or after equilibration to similar to 13% moisture at 180 degreesC in a reaction-tube system designed to mimic the heating profile in an extruder. Volatile compounds were isolated onto Tenax and analyzed by gas chromatography-mass spectrometry. For the extrudates, total yields of volatiles increased with decreasing pH at 180 degreesC, reached a maximum at pH 6.S at 150 degreesC, and increased with increasing pH at 120 degreesC. Amounts increased with temperature at all pH values. Pyrazines were the most abundant class for all sets of conditions (54-79% of total volatiles). Pyrroles, ketones, furans, oxazoles, and pyridines were also identified. Yields of volatiles from the reaction-tube samples increased by > 60% in the moist system. Levels of individual classes also increased in the presence of moisture, except pyrazines, which decreased similar to3.5-fold. Twenty-one of the compounds were common to the reaction-tube samples and the extrudates.