Designing care bundle documentation to support the recognition and treatment of acute kidney injury: a route to quality improvement

The chapter describes development of care bundle documentation, through an iterative, user-centred design process, to support the recognition and treatment of acute kidney injury (AKI). The chapter details stages of user and stakeholder consultation, employed to develop a design response that was sensitive to user experience and need, culminating in simulation testing of a near final prototype. The development of supplementary awareness-raising materials, relating to the main care bundle tool is also discussed. This information design response to a complex clinical decision-making process is contrasted to other approaches to promoting AKI care. The need for different but related approaches to the working tool itself and the tool’s communication are discussed. More general recommendations are made for the development of communication tools to support complex clinical processes.

Willingness-to-pay for a probabilistic flood forecast: a risk-based decision-making game

Probabilistic hydro-meteorological forecasts have over the last decades been used more frequently to communicate forecastuncertainty. This uncertainty is twofold, as it constitutes both an added value and a challenge for the forecaster and the user of the forecasts. Many authors have demonstrated the added (economic) value of probabilistic over deterministic forecasts across the water sector (e.g. flood protection, hydroelectric power management and navigation). However, the richness of the information is also a source of challenges for operational uses, due partially to the difficulty to transform the probability of occurrence of an event into a binary decision. This paper presents the results of a risk-based decision-making game on the topic of flood protection mitigation, called “How much are you prepared to pay for a forecast?”. The game was played at several workshops in 2015, which were attended by operational forecasters and academics working in the field of hydrometeorology. The aim of this game was to better understand the role of probabilistic forecasts in decision-making processes and their perceived value by decision-makers. Based on the participants’ willingness-to-pay for a forecast, the results of the game show that the value (or the usefulness) of a forecast depends on several factors, including the way users perceive the quality of their forecasts and link it to the perception of their own performances as decision-makers.

Importance of estimating matrix quality for modeling species distribution in complex tropical landscapes: a test with Atlantic forest small mammals

Information to guide decision making is especially urgent in human dominated landscapes in the tropics, where urban and agricultural frontiers are still expanding in an unplanned manner. Nevertheless, most studies that have investigated the influence of landscape structure on species distribution have not considered the heterogeneity of altered habitats of the matrix, which is usually high in human dominated landscapes. Using the distribution of small mammals in forest remnants and in the four main altered habitats in an Atlantic forest landscape, we investigated 1) how explanatory power of models describing species distribution in forest remnants varies between landscape structure variables that do or do not incorporate matrix quality and 2) the importance of spatial scale for analyzing the influence of landscape structure. We used standardized sampling in remnants and altered habitats to generate two indices of habitat quality, corresponding to the abundance and to the occurrence of small mammals. For each remnant, we calculated habitat quantity and connectivity in different spatial scales, considering or not the quality of surrounding habitats. The incorporation of matrix quality increased model explanatory power across all spatial scales for half the species that occurred in the matrix, but only when taking into account the distance between habitat patches (connectivity). These connectivity models were also less affected by spatial scale than habitat quantity models. The few consistent responses to the variation in spatial scales indicate that despite their small size, small mammals perceive landscape features at large spatial scales. Matrix quality index corresponding to species occurrence presented a better or similar performance compared to that of species abundance. Results indicate the importance of the matrix for the dynamics of fragmented landscapes and suggest that relatively simple indices can improve our understanding of species distribution, and could be applied in modeling, monitoring and managing complex tropical landscapes.

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Incumbency Reconsidered: Prospects, Strategic Entry, and Incumbent Quality in U.S. House Elections

Efforts to estimate the magnitude of the incumbency effect in U.S. House elections and assess its political meaning have been complicated by two omitted-variables problems. First, in the absence of an adequate measure of incumbent prospects, estimates of the magnitude of the incumbency effect fail to control for selection effects associated with the decision incumbents make about whether to run for reelection. Strategic incumbents enter races they think they can win and withdraw when they expect to lose. The consequence is an upward bias in estimates of incumbents’ electoral advantages. Second, the normative implications of high reelection rates cannot be assessed without measuring incumbent quality, since a possible explanation for their electoral success is that incumbents are of high quality and doing a good job. We propose a strategy for measuring incumbent prospects and quality, demonstrate the strategic nature of incumbent and challenger entry, re-estimate the incumbency effect, and show that incumbent quality has an impact on electoral outcomes. Our conclusion is that incumbents’ advantages in House elections have been over estimated while the positive basis of incumbent safety is typically under appreciated.

The brazilian education quality index (Ideb): measurement and incentives upgrades

The increasing availability of social statistics in Latin America opens new possibilities in terms of accountability and incentive mechanisms for policy makers. This paper addresses these issues within the institutional context of the Brazilian educational system. We build a theoretical model based on the theory of incentives to analyze the role of the recently launched Basic Education Development Index (Ideb) in the provision of incentives at the sub-national level. The first result is to demonstrate that an education target system has the potential to improve the allocation of resources to education through conditional transfers to municipalities and schools. Second, we analyze the local government’s decision about how to allocate its education budget when seeking to accomplish the different objectives contemplated by the index, which involves the interaction between its two components, average proficiency and the passing rate. We discuss as well policy issues concerning the implementation of the synthetic education index in the light of this model arguing that there is room for improving the Ideb’s methodology itself. In addition, we analyze the desirable properties of an ideal education index and we argue in favor of an ex-post relative learning evaluation system for different municipalities (schools) based on the value added across different grades

How national culture on consumers' decision-making styles: a comparative study among Americans, Brazilians, Chinese, and japanese in the purchase of cell phones.

The influence of the national culture on consumer decision-making styles is investigated using a sample of Americans, Brazilians, Chinese, and Japanese consumers who have purchased a cell phone in the past three years. To make the research possible, a survey was used as a method of data collection. It relates Hofstede’s cultural classification typology with Sproles and Kendall’s consumer style inventory (CSI). The multivariate analysis of variance (MANOVA) results indicate six decision-making styles together with other consumer behavioral characteristics that can be used to distinguish and profile consumers who purchase cell phones. Empirical findings reveal that among Americans, Brazilians, and Japanese; Americans are the most quality conscious, brand conscious, innovative, and hedonistic shoppers; Brazilians are the most loyal, and Japanese, the most confused by overchoice consumers. Conceptual contributions and managerial implications are discussed.

Faecal bacteria in Perna perna (Linnaeus, 1758) (Mollusca: Bivalvia) for biomonitoring coastal waters and seafood quality

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Some reflections on the future of the water quality of the corumbataí River basin, São Paulo state, Brazil

The waters of Corumbataí River in the middle and eastern part of São Paulo State, Brazil, are extensively used for human consumption; their water quality has been modified mainly due to increasing pressure caused by population growth, accompanied by a more accentuated industrial development for the whole São Paulo State in the early 1970s. The Corumbataí River basin has, over time, received significant emissions of municipal waste products and discharges of wastewater, sludge, sewage, sanitary and industrial effluents, but the first effluent treatment plant at Rio Claro city was only inaugurated at the end of the 1990s. Data on river water quality from two widely spaced locations in the Corumbataí River basin are reported in this paper; they indicate the need for continuous initiatives and efforts by decision makers in order to improve and preserve the water quality in the basin for the 21st century. Copyright © 2007 IAHS Press.

Fuzzy environmental quality index

This paper presents the construction of a fuzzy environmental quality index for decision support in municipal environmental management. Five groups of indicators were selected in order to obtain an equation that best represented reality in terms of environmental quality. The calculation was carried out using fuzzy mathematical concepts, with the aid of the package Fuzzy Logical Toolbox 2.1 for Matlab ® 6.1, which provides functions and some applications of the theory of fuzzy sets. The work seeks to create a method of inference concerning the nature of urban areas that are unsustainable with respect to the environment, an issue that is often relegated to the background during public policy discussions. The development of this index, together with its implementation and dissemination, could improve public awareness of environmental issues, and promote mobilization towards the use of best practices in local development. © 2010 IEEE.

Achieving educational quality: what schools teach us: learning from Chile's P900 primary schools

Includes bibliography

Characterization and impact of the sugarcane borer on sugarcane yield and quality

The sugarcane borer, Diatraea saccharalis (F.) (Lepidoptera: Crambidae), is a key pest of sugarcane (Saccharum spp.). While damage caused by this pest has increased in the past 20 yr, studies investigating the insect-plant interactions are still lacking. Moreover, there is no information about the consequences of borer damage on the parameters of sugar quality. Therefore, two field experiments were performed during the 2010 and 2011 growing seasons in Brazil to compare the raw material and sugar quality of SP80-3280 sugarcane plants with and without the sugarcane borer. Plants were protected within screen cages and infested weekly during the 2010 and 2011 seasons, using egg masses starting at the second and third internode stage. At harvest, 25.77 and 19.01% of the internodes were bored by larvae (infestation intensity, II) in the first and second seasons, respectively. There was no correlation between the borer gallery total volume and II. The fiber content significantly increased with increasing II. The stalk biometric parameters, such as length, diameter, and yield, were not correlated with II. The sucrose yield significantly decreased with increasing II. Consequently, sugar yield losses were estimated at 8.83 and 19.80% per 1% bored internode for the first and second seasons, respectively. The concentration of phenolic compounds increased, and unclarified juice color quality decreased, with increasing II. Significant differences were detected in the quality of the sugar. These results should be confirmed for other sugarcane cultivars and incorporated into an economic injury level to enhance decision-making strategies for borer management. © 2013 by the American Society of Agronomy, 5585 Guilford Road, Madison, WI 53711. All rights reserved.

Cross-layer optimizations for multimedia distribution over Wireless Multimedia Sensor Networks and Flying Ad-Hoc Networks with quality of experience support

The proliferation of multimedia content and the demand for new audio or video services have fostered the development of a new era based on multimedia information, which allowed the evolution of Wireless Multimedia Sensor Networks (WMSNs) and also Flying Ad-Hoc Networks (FANETs). In this way, live multimedia services require realtime video transmissions with a low frame loss rate, tolerable end-to-end delay, and jitter to support video dissemination with Quality of Experience (QoE) support. Hence, a key principle in a QoE-aware approach is the transmission of high priority frames (protect them) with a minimum packet loss ratio, as well as network overhead. Moreover, multimedia content must be transmitted from a given source to the destination via intermediate nodes with high reliability in a large scale scenario. The routing service must cope with dynamic topologies caused by node failure or mobility, as well as wireless channel changes, in order to continue to operate despite dynamic topologies during multimedia transmission. Finally, understanding user satisfaction on watching a video sequence is becoming a key requirement for delivery of multimedia content with QoE support. With this goal in mind, solutions involving multimedia transmissions must take into account the video characteristics to improve video quality delivery. The main research contributions of this thesis are driven by the research question how to provide multimedia distribution with high energy-efficiency, reliability, robustness, scalability, and QoE support over wireless ad hoc networks. The thesis addresses several problem domains with contributions on different layers of the communication stack. At the application layer, we introduce a QoE-aware packet redundancy mechanism to reduce the impact of the unreliable and lossy nature of wireless environment to disseminate live multimedia content. At the network layer, we introduce two routing protocols, namely video-aware Multi-hop and multi-path hierarchical routing protocol for Efficient VIdeo transmission for static WMSN scenarios (MEVI), and cross-layer link quality and geographical-aware beaconless OR protocol for multimedia FANET scenarios (XLinGO). Both protocols enable multimedia dissemination with energy-efficiency, reliability and QoE support. This is achieved by combining multiple cross-layer metrics for routing decision in order to establish reliable routes.

Reconstruction of the Environmental Quality Fuzzy Index

In the world stage, the environmental condition has been a big public policies issue. A clear understanding of the parameters that determine the state of the environment is essential for estimation of the quality of life of the population, not least since ecosystems are highly complex. Consequently, definition of public policies demands the use of evaluation tools that can combine and quantify information in a clear way. The use of indicators and indices that are able to translate the complexity of environmental conditions in cities into simpler terms has been increasingly effective in decision-making, since they assist in general evaluation of the situation in question, identification of priority actions and anticipation of future trends. In an attempt to evaluate the environmental conditions of the Brazilian city, Sorocaba, an Environmental Quality Fuzzy Index (IFQAmb) was proposed. In this work this methodology is improved. After reviewing the IFQAmb methodology, a number of changes in the index are proposed. Additional variables are suggested, derived from a State Environment Department program whose objective is to grant municipalities the title of Municipio Verde e Azul (Green and Blue City). In addition, a new rule base is being drafted to enable consideration of all possibilities, since in the existing version the use of specific criteria eliminates a significant number of rules. The changes seek to define with clarity and precision the conceptual aspects and structure of the IFQAmb, so that it can provide an even more effective evaluation of environmental performance, guiding future actions in order to improve the living conditions of the population of Sorocaba.

Novel expert system for defining power quality compensators

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)