Normative modeling for personalized clinical pathway using organizational semiotics methods

Clinical pathways are widely adopted by many large hospitals around the world in order to provide high-quality patient treatment and reduce the length and cost of hospital stay. However, nowadays most of them are static and nonpersonalized. Our objective is to capture and represent clinical pathway using organizational semiotics method including Semantic Analysis which determines semantic units in clinical pathway, their relationship and their patterns of behavior, and Norm Analysis which extracts and specifies the norms that establish how and when these medical behaviors will occur. Finally, we propose a method to develop clinical pathway ontology based on the results of Semantic Analysis and Norm analysis. This approach will give a contribution to design personalized clinical pathway by defining a set of possible patterns of behavior and theClinical pathways are widely adopted by many large hospitals around the world in order to provide high-quality patient treatment and reduce the length and cost of hospital stay. However, nowadays most of them are static and nonpersonalized. Our objective is to capture and represent clinical pathway using organizational semiotics method including Semantic Analysis which determines semantic units in clinical pathway, their relationship and their patterns of behavior, and Norm Analysis which extracts and specifies the norms that establish how and when these medical behaviors will occur. Finally, we propose a method to develop clinical pathway ontology based on the results of Semantic Analysis and Norm analysis. This approach will give a contribution to design personalized clinical pathway by defining a set of possible patterns of behavior and the norms that govern the behavior based on patient’s condition.

Comparing the fit between BREEAM assessment and design processes

This paper explores the mapping of the environmental assessment process onto design and construction processes. A comparative case study method is used to identify and account for variations in the ‘fit’ between these two processes. The analysis compares eight BREEAM projects (although relevant to LEED, GreenStar, etc.) and distinguishes project-level characteristics and dynamics. Drawing on insights from literature on sustainable construction and assessment methods, an analytic framework is developed to examine the effect of clusters of project and assessment level elements on different types of fit (tight, punctual and bolt-on). Key elements distinguishing between types include: prior working experience with project team members, individual commitment to sustainable construction, experience with sustainable construction, project continuity, project-level ownership of the assessment process, and the nature and continuity of assessor involvement. Professionals with ‘sustainable’ experience used BREEAM judiciously to support their designs (along with other frameworks), but less committed professionals tended to treat it purely as an assessment method. More attention needs to be paid to individual levels of engagement with, and understanding of, sustainability in general (rather than knowledge of technical solutions to individual credits), to ownership of the assessment process and to the potential effect of discontinuities at the project level on sustainable design.

Stakeholder interpretations of design: Semiotic insights into the briefing process

Briefing phase interactions between clients and designers are recognized as social engagements, characterized by communicative sign use, where conceptual ideas are gradually transformed into potential design solutions. A semiotic analysis of briefing communications between client stakeholders and designers provides evidence of the significance and importance of stakeholder interpretation and understanding of design, empirical data being drawn from a qualitative study of NHS hospital construction projects in the UK. It is contended that stakeholders engage with a project through communicative signs and artefacts of design, referencing personal cognitive knowledge in acts of interpretation that may be different from those of designers and externally appointed client advisers. Such interpretations occur in addition to NHS client and design team efforts to ‘engage’ with and ‘understand’ stakeholders using a variety of methods. Social semiotic theorizations indicate how narrative strategies motivate the formulation of signs and artefacts in briefing work, the role of sign authors and sign readers being elucidated as a result. Findings are contextualized against current understandings of briefing communications and stakeholder management practices, a more socially attuned understanding of briefing countering some of the process-led improvement models that have characterized much of the post-Egan report literature. A stakeholder interpretation model is presented as one potential method to safeguard against unforeseen interpretations occurring, the model aligning with the proposal for a more measured recognition of how designs can trigger interpretations among client stakeholders.

Infection Control in design and construction work

Objective: To clarify how infection control requirements are represented, communicated, and understood in work interactions through the medical facility construction project life cycle. To assist project participants with effective infection control management by highlighting the nature of such requirements and presenting recommendations to aid practice. Background: A 4-year study regarding client requirement representation and use on National Health Service construction projects in the United Kingdom provided empirical evidence of infection control requirement communication and understanding through design and construction work interactions. Methods: An analysis of construction project resources (e.g., infection control regulations and room data sheets) was combined with semi-structured interviews with hospital client employees and design and construction professionals to provide valuable insights into the management of infection control issues. Results: Infection control requirements are representationally indistinct but also omnipresent through all phases of the construction project life cycle: Failure to recognize their nature, relevance, and significance can result in delays, stoppages, and redesign work. Construction project resources (e.g., regulatory guidance and room data sheets) can mask or obscure the meaning of infection control issues. Conclusions: A preemptive identification of issues combined with knowledge sharing activities among project stakeholders can enable infection control requirements to be properly understood and addressed. Such initiatives should also reference existing infection control regulatory guidance and advice.

Energy consistent discontinuous Galerkin methods for the Navier–Stokes–Korteweg system

We design consistent discontinuous Galerkin finite element schemes for the approximation of the Euler-Korteweg and the Navier-Stokes-Korteweg systems. We show that the scheme for the Euler-Korteweg system is energy and mass conservative and that the scheme for the Navier-Stokes-Korteweg system is mass conservative and monotonically energy dissipative. In this case the dissipation is isolated to viscous effects, that is, there is no numerical dissipation. In this sense the methods are consistent with the energy dissipation of the continuous PDE systems. - See more at: http://www.ams.org/journals/mcom/2014-83-289/S0025-5718-2014-02792-0/home.html#sthash.rwTIhNWi.dpuf

Energy consistent discontinuous Galerkin methods for a quasi-incompressible diffuse two phase flow model

We design consistent discontinuous Galerkin finite element schemes for the approximation of a quasi-incompressible two phase flow model of Allen–Cahn/Cahn–Hilliard/Navier–Stokes–Korteweg type which allows for phase transitions. We show that the scheme is mass conservative and monotonically energy dissipative. In this case the dissipation is isolated to discrete equivalents of those effects already causing dissipation on the continuous level, that is, there is no artificial numerical dissipation added into the scheme. In this sense the methods are consistent with the energy dissipation of the continuous PDE system.

Methods to assess the effectiveness of naturally ventilated classrooms in Gauteng, South Africa

There is a tendency to reduce ventilation rates and natural or hybrid ventilation systems to ensure the conservation of energy in school buildings. However, high indoor pollutant concentration, due to natural or hybrid ventilation systems may have a significant adverse impact on the health and academic performance of pupils and students. Reviewed evidence shows that this can be detrimental to health and wellbeing in schools because of the learner density within a small area, eventually indicating that CO2 concentrations can rise to very high levels (about 4000 ppm) in classrooms during occupancy periods. In South Africa’s naturally ventilated classrooms, it is not clear whether the environmental conditions are conducive for learning. In addition, natural ventilation will be minimized given the fact that in cold, wet or windy weather, doors and windows will commonly remain closed. Evidence from literature based studies indicates that the significance of ventilation techniques is not understood satisfactorily and additional information concerning naturally ventilated schools has to be provided for better design and policy formulation. To develop a thorough understanding of the environments in classrooms, many other parameters have to be considered as well, such as outdoor air quality, CO2 concentrations, temperature and relative humidity and safety issues that may be important drawbacks for naturally ventilated schools. The aim of this paper is to develop a conceptual understanding of methods that can be implemented to assess the effectiveness of naturally ventilated classrooms in Gauteng, South Africa. A theoretical concept with an embedded practical methodology have been proposed for the research programme to investigate the relationship between ventilation rates and learning in schools in Gauteng , a province in South Africa. It is important that existing and future school buildings must include adequate outdoor ventilation, control of moisture, and avoidance of indoor exposures to microbiologic and chemical substances considered likely to have adverse effects in South Africa. Adequate ventilation in classrooms is necessary to reduce and/or eradicate the transmission of indoor pollutants.

Using the Technology Acceptance Model to explore community dwelling older adults’ perceptions of a 3D interior design application to facilitate pre-discharge home adaptations

Background In the UK occupational therapy pre-discharge home visits are routinely carried out as a means of facilitating safe transfer from the hospital to home. Whilst they are an integral part of practice, there is little evidence to demonstrate they have a positive outcome on the discharge process. Current issues for patients are around the speed of home visits and the lack of shared decision making in the process, resulting in less than 50 % of the specialist equipment installed actually being used by patients on follow-up. To improve practice there is an urgent need to examine other ways of conducting home visits to facilitate safe discharge. We believe that Computerised 3D Interior Design Applications (CIDAs) could be a means to support more efficient, effective and collaborative practice. A previous study explored practitioners perceptions of using CIDAs; however it is important to ascertain older adult’s views about the usability of technology and to compare findings. This study explores the perceptions of community dwelling older adults with regards to adopting and using CIDAs as an assistive tool for the home adaptations process. Methods Ten community dwelling older adults participated in individual interactive task-focused usability sessions with a customised CIDA, utilising the think-aloud protocol and individual semi-structured interviews. Template analysis was used to carry out both deductive and inductive analysis of the think-aloud and interview data. Initially, a deductive stance was adopted, using the three pre-determined high-level themes of the technology acceptance model (TAM): Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Actual Use (AU). Inductive template analysis was then carried out on the data within these themes, from which a number of sub-thmes emerged. Results Regarding PU, participants believed CIDAs served as a useful visual tool and saw clear potential to facilitate shared understanding and partnership in care delivery. For PEOU, participants were able to create 3D home environments however a number of usability issues must still be addressed. The AU theme revealed the most likely usage scenario would be collaborative involving both patient and practitioner, as many participants did not feel confident or see sufficient value in using the application autonomously. Conclusions This research found that older adults perceived that CIDAs were likely to serve as a valuable tool which facilitates and enhances levels of patient/practitioner collaboration and empowerment. Older adults also suggested a redesign of the interface so that less sophisticated dexterity and motor functions are required. However, older adults were not confident, or did not see sufficient value in using the application autonomously. Future research is needed to further customise the CIDA software, in line with the outcomes of this study, and to explore the potential of collaborative application patient/practitioner-based deployment.

Designing in caves: using immersive visualisations in design practice

This paper describes a study of the use of immersive Virtual reality technologies in the design of a new hospital. It uses Schön’s concept of reflective practice and video-based methods to analyse the ways design teams approach and employ a full scale 3D immersive environment – a CAVE – in collaborative design work. The analysis describes four themes relating to reflective practice occurring in the setting: orienting to the CAVE technology itself, orienting to the representation of the specific design within the CAVE, activities accounting for, or exploring alternatives within the design for the use and users of the space, and more strategic interactions around how to best represent the design and model to the client within the CAVE setting. The analysis also reveals some unique aspects of design work in this environment. Perhaps most significantly, rather than enhancing or adding to an existing understanding of design through paper based or non-immersive digital representations, it is often acting to challenge or surprise the participants as they experience the immersive, full scale version of their own design.

Using developmental evaluation methods with communities of practice

Purpose This research explored the use of developmental evaluation methods with community of practice programmes experiencing change or transition to better understand how to target support resources. Design / methodology / approach The practical use of a number of developmental evaluation methods was explored in three organisations over a nine month period using an action research design. The research was a collaborative process involving all the company participants and the academic (the author) with the intention of developing the practices of the participants as well as contributing to scholarship. Findings The developmental evaluation activities achieved the objectives of the knowledge managers concerned: they developed a better understanding of the contribution and performance of their communities of practice, allowing support resources to be better targeted. Three methods (fundamental evaluative thinking, actual-ideal comparative method and focus on strengths and assets) were found to be useful. Cross-case analysis led to the proposition that developmental evaluation methods act as a structural mechanism that develops the discourse of the organisation in ways that enhance the climate for learning, potentially helping develop a learning organization. Practical implications Developmental evaluation methods add to the options available to evaluate community of practice programmes. These supplement the commonly used activity indicators and impact story methods. 2 Originality / value Developmental evaluation methods are often used in social change initiatives, informing public policy and funding decisions. The contribution here is to extend their use to organisational community of practice programmes.