Is there a trade-off between quality and productivity? The case of diagnostic technologies in Portugal

The purpose of this paper is twofold: first, we compute quality-adjusted measures of productivity change for the three most important diagnostic technologies (i.e., the Computerised Tomography Scan, Electrocardiogram and Echocardiogram) in the major Portuguese hospitals. We use the Malmquist–Luenberger index, which allows to measure productivity growth while controlling for the quality of the production. Second, using non-parametric tests, we analyse whether the implementation of the Prospective Payment System may have had a positive impact on the movements of productivity over time. The results show that the PPS has helped hospitals to use these tools more efficiently and to improve their effectiveness.

Anterior ophthalmic imaging

Improvements in imaging chips and computer processing power have brought major advances in imaging of the anterior eye. Digitally captured images can be visualised immediately and can be stored and retrieved easily. Anterior ocular imaging techniques using slitlamp biomicroscopy, corneal topography, confocal microscopy, optical coherence tomography (OCT), ultrasonic biomicroscopy, computerised tomography (CT) and magnetic resonance imaging (MRI) are reviewed. Conventional photographic imaging can be used to quantify corneal topography, corneal thickness and transparency, anterior chamber depth and lateral angle and crystalline lens position, curvature, thickness and transparency. Additionally, the effects of tumours, foreign bodies and trauma can be localised, the corneal layers can be examined and the tear film thickness assessed. © 2006 The Authors.

Developments in contact lens measurement:a comparative study of industry standard geometric inspection and optical coherence tomography

Purpose: The aim of this study was to compare a developmental optical coherence tomography (OCT) based contact lens inspection instrument to a widely used geometric inspection instrument (Optimec JCF), to establish the capability of a market focused OCT system. Methods: Measurements of 27 soft spherical contact lenses were made using the Optimec JCF and a new OCT based instrument, the Optimec is830. Twelve of the lenses analysed were specially commissioned from a traditional hydrogel (Contamac GM Advance 49%) and 12 from a silicone hydrogel (Contamac Definitive 65), each set with a range of back optic zone radius (BOZR) and centre thickness (CT) values. Three commercial lenses were also measured; CooperVision MyDay (Stenfilcon A) in −10D, −3D and +6D powers. Two measurements of BOZR, CT and total diameter were made for each lens in temperature controlled saline on both instruments. Results: The results showed that the is830 and JCF measurements were comparable, but that the is830 had a better repeatability coefficient for BOZR (0.065 mm compared to 0.151 mm) and CT (0.008 mm compared to 0.027 mm). Both instruments had similar results for total diameter (0.041 mm compared to 0.044 mm). Conclusions: The OCT based instrument assessed in this study is able to match and improve on the JCF instrument for the measurement of total diameter, back optic zone radius and centre thickness for soft contact lenses in temperature controlled saline.

Reproducibility-repeatability of choroidal thickness calculation using optical coherence tomography

Purpose. To evaluate the repeatability and reproducibility of subfoveal choroidal thickness (CT) calculations performed manually using optical coherence tomography (OCT). Methods. The CT was imaged in vivo at each of two visits on 11 healthy volunteers (mean age, 35.72 ± 13.19 years) using the spectral domain OCT. CT was manually measured after applying ImageJ processing filters on 15 radial subfoveal scans. Each radial scan was spaced 12° from each other and contained 2500 A-scans. The coefficient of variability, coefficient of repeatability (CoR), coefficient of reproducibility, and intraclass correlation coefficient determined the reproducibility and repeatability of the calculation. Axial length (AL) and mean spherical equivalent refractive error were measured with the IOLMaster and an open view autorefractor to study their potential relationship with CT. Results. The within-visit and between-visit coefficient of variability, CoR, coefficient of reproducibility, and intraclass correlation coefficient were 0.80, 2.97% 2.44%, and 99%, respectively. The subfoveal CT correlated significantly with AL (R = -0.60, p = 0.05). Conclusions. The subfoveal CT could be measured manually in vivo using OCT and the readings obtained from the healthy subjects evaluated were repeatable and reproducible. It is proposed that OCT could be a useful instrument to perform in vivo assessment and monitoring of CT changes in retinal disease. The preliminary results suggest a negative correlation between subfoveal CT and AL in such a way that it decreases with increasing AL but not with refractive error.

Accuracy of cornea and lens biometry using anterior segment optical coherence tomography

We assess the accuracy of the Visante anterior segment optical coherence tomographer (AS-OCT) and present improved formulas for measurement of surface curvature and axial separation. Measurements are made in physical model eyes. Accuracy is compared for measurements of corneal thickness (d1) and anterior chamber depth (d2) using-built-in AS-OCT software versus the improved scheme. The improved scheme enables measurements of lens thickness (d 3) and surface curvature, in the form of conic sections specified by vertex radii and conic constants. These parameters are converted to surface coordinates for error analysis. The built-in AS-OCT software typically overestimates (mean±standard deviation(SD)]d1 by +62±4 μm and d2 by +4±88μm. The improved scheme reduces d1 (-0.4±4 μm) and d2 (0±49 μm) errors while also reducing d3 errors from +218±90 (uncorrected) to +14±123 μm (corrected). Surface x coordinate errors gradually increase toward the periphery. Considering the central 6-mm zone of each surface, the x coordinate errors for anterior and posterior corneal surfaces reached +3±10 and 0±23 μm, respectively, with the improved scheme. Those of the anterior and posterior lens surfaces reached +2±22 and +11±71 μm, respectively. Our improved scheme reduced AS-OCT errors and could, therefore, enhance pre- and postoperative assessments of keratorefractive or cataract surgery, including measurement of accommodating intraocular lenses. © 2007 Society of Photo-Optical Instrumentation Engineers.

Service to an interdisciplinary need-group from computerised secondary services

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

Computerised control of cellular manufacturing systems

This thesis reviews the existing manufacturing control techniques and identifies their practical drawbacks when applied in a high variety, low and medium volume environment. It advocates that the significant drawbacks inherent in such systems, could impair their applications under such manufacturing environment. The key weaknesses identified in the system were: capacity insensitive nature of Material Requirements Planning (MRP); the centralised approach to planning and control applied in Manufacturing Resources Planning (MRP IT); the fact that Kanban can only be used in repetitive environments; Optimised Productivity Techniques's (OPT) inability to deal with transient bottlenecks, etc. On the other hand, cellular systems offer advantages in simplifying the control problems of manufacturing and the thesis reviews systems designed for cellular manufacturing including Distributed Manufacturing Resources Planning (DMRP) and Flexible Manufacturing System (FMS) controllers. It advocates that a newly developed cellular manufacturing control methodology, which is fully automatic, capacity sensitive and responsive, has the potential to resolve the core manufacturing control problems discussed above. It's development is envisaged within the framework of a DMRP environment, in which each cell is provided with its own MRP II system and decision making capability. It is a cellular based closed loop control system, which revolves on single level Bill-Of-Materials (BOM) structure and hence provides better linkage between shop level scheduling activities and relevant entries in the MPS. This provides a better prospect of undertaking rapid response to changes in the status of manufacturing resources and incoming enquiries. Moreover, it also permits automatic evaluation of capacity and due date constraints and hence facilitates the automation of MPS within such system. A prototype cellular manufacturing control model, was developed to demonstrate the underlying principles and operational logic of the cellular manufacturing control methodology, based on the above concept. This was shown to offer significant advantages from the prospective of operational planning and control. Results of relevant tests proved that the model is capable of producing reasonable due date and undertake automation of MPS. The overall performance of the model proved satisfactory and acceptable.

The application of computerised modelling techniques in manufacturing system design

The absence of a definitive approach to the design of manufacturing systems signifies the importance of a control mechanism to ensure the timely application of relevant design techniques. To provide effective control, design development needs to be continually assessed in relation to the required system performance, which can only be achieved analytically through computer simulation. The technique providing the only method of accurately replicating the highly complex and dynamic interrelationships inherent within manufacturing facilities and realistically predicting system behaviour. Owing to the unique capabilities of computer simulation, its application should support and encourage a thorough investigation of all alternative designs. Allowing attention to focus specifically on critical design areas and enabling continuous assessment of system evolution. To achieve this system analysis needs to efficient, in terms of data requirements and both speed and accuracy of evaluation. To provide an effective control mechanism a hierarchical or multi-level modelling procedure has therefore been developed, specifying the appropriate degree of evaluation support necessary at each phase of design. An underlying assumption of the proposal being that evaluation is quick, easy and allows models to expand in line with design developments. However, current approaches to computer simulation are totally inappropriate to support the hierarchical evaluation. Implementation of computer simulation through traditional approaches is typically characterized by a requirement for very specialist expertise, a lengthy model development phase, and a correspondingly high expenditure. Resulting in very little and rather inappropriate use of the technique. Simulation, when used, is generally only applied to check or verify a final design proposal. Rarely is the full potential of computer simulation utilized to aid, support or complement the manufacturing system design procedure. To implement the proposed modelling procedure therefore the concept of a generic simulator was adopted, as such systems require no specialist expertise, instead facilitating quick and easy model creation, execution and modification, through simple data inputs. Previously generic simulators have tended to be too restricted, lacking the necessary flexibility to be generally applicable to manufacturing systems. Development of the ATOMS manufacturing simulator, however, has proven that such systems can be relevant to a wide range of applications, besides verifying the benefits of multi-level modelling.

Spatially structured cognitve models of semantic information:the implications for computerised databases

Existing theories of semantic cognition propose models of cognitive processing occurring in a conceptual space, where ‘meaning’ is derived from the spatial relationships between concepts’ mapped locations within the space. Information visualisation is a growing area of research within the field of information retrieval, and methods for presenting database contents visually in the form of spatial data management systems (SDMSs) are being developed. This thesis combined these two areas of research to investigate the benefits associated with employing spatial-semantic mapping (documents represented as objects in two- and three-dimensional virtual environments are proximally mapped dependent on the semantic similarity of their content) as a tool for improving retrieval performance and navigational efficiency when browsing for information within such systems. Positive effects associated with the quality of document mapping were observed; improved retrieval performance and browsing behaviour were witnessed when mapping was optimal. It was also shown using a third dimension for virtual environment (VE) presentation provides sufficient additional information regarding the semantic structure of the environment that performance is increased in comparison to using two-dimensions for mapping. A model that describes the relationship between retrieval performance and browsing behaviour was proposed on the basis of findings. Individual differences were not found to have any observable influence on retrieval performance or browsing behaviour when mapping quality was good. The findings from this work have implications for both cognitive modelling of semantic information, and for designing and testing information visualisation systems. These implications are discussed in the conclusions of this work.

Development of a computerised library system in the construction industry

This thesis examines the ways that libraries have employed computers to assist with housekeeping operations. It considers the relevance of such applications to company libraries in the construction industry, and describes more specifically the development of an integrated cataloguing and loan system. A review of the main features in the development of computerised ordering, cataloguing and circulation control systems shows that fully integrated packages are beginning to be completed, and that some libraries are introducing second generation programs. Cataloguing is the most common activity to be computerised, both at national and company level. Results from a sample of libraries in the construction industry suggest that the only computerised housekeeping system is at Taylor Woodrow. Most of the firms have access to an in-house computer, and some of the libraries, particularly those in firms of consulting engineers, might benefit from computerisation, but there are differing attitudes amongst the librarians towards the computer. A detailed study of the library at Taylor Woodrow resulted in a feasibility report covering all the areas of its activities. One of the main suggestions was the possible use of a computerised loans and cataloguing system. An integrated system to cover these two areas was programmed in Fortran and implemented. This new system provides certain benefits and saves staff time, but at the cost of time on the computer. Some improvements could be made by reprogramming, but it provides a general system for small technical libraries. A general equation comparing costs for manual and computerised operations is progressively simplified to a form where the annual saving from the computerised system is expressed in terms of staff and computer costs and the size of the library. This equation gives any library an indication of the savings or extra cost which would result from using the computerised system.