Patient-centered Care in Maternity Services: A Critical Appraisal and Synthesis of the Literature.

BACKGROUND: Patient-centered care (PCC) has been recognized as a marker of quality in health service delivery. In policy documents, PCC is often used interchangeably with other models of care. There is a wide literature about PCC, but there is a lack of evidence about which model is the most appropriate for maternity services specifically. AIM: We sought to identify and critically appraise the literature to identify which definition of PCC is most relevant for maternity services. METHODS: The four-step approach used to identify definitions of PCC was to 1) search electronic databases using key terms (1995-2011), 2) cross-reference key papers, 3) search of specific journals, and 4) search the grey literature. Four papers and two books met our inclusion criteria. ANALYSIS: A four-criteria critical appraisal tool developed for the review was used to appraise the papers and books. MAIN RESULTS: From the six identified definitions, the Shaller's definition met the majority of the four criteria outlined and seems to be the most relevant to maternity services because it includes physiologic conditions as well as pathology, psychological aspects, a nonmedical approach to care, the greater involvement of family and friends, and strategies to implement PCC. CONCLUSION: This review highlights Shaller's definitions of PCC as the one that would be the most inclusive of all women using maternity services. Future research should concentrate on evaluating programs that support PCC in maternity services, and testing/validating this model of care.

A practical guide for the formulation of propositions in the bayesian approach to DNA evidence interpretation in an adversarial environment

The interpretation of complex DNA profiles is facilitated by a Bayesian approach. This approach requires the development of a pair of propositions: one aligned to the prosecution case and one to the defense case. This note explores the issue of proposition setting in an adversarial environment by a series of examples. A set of guidelines generalize how to formulate propositions when there is a single person of interest and when there are multiple individuals of interest. Additional explanations cover how to handle multiple defense propositions, relatives, and the transition from subsource level to activity level propositions. The propositions depend on case information and the allegations of each of the parties. The prosecution proposition is usually known. The authors suggest that a sensible proposition is selected for the defense that is consistent with their stance, if available, and consistent with a realistic defense if their position is not known.

A study of the facial aging - a multidisciplinary approach

This paper describes a mathematical and graphical model for face aging. It considers the possibility of predicting the aging process by offering an initial quantification of this process as it applies to the face. It is concerned with physical measurements and a general law of time dependence. After measuring and normalizing a photograph of a person, one could predict, with a known amount of error, the appearance of that person at a different age. The technique described has served its purpose successfully, with a representative amount of patient data behaving sufficiently near the general aging curve of each parameter. That model uses a warping technique to emulate the aging changes on the face of women. Frequently the warping methods are based on the interpolation between images or general mathematical functions to calculate the pixel attributes. The implemented process considers the age features of selected parts of a face such as the face outline and the shape of the lips. These age features were obtained by measuring the facial regions of women that have been photographed throughout their lives. The present work is first concerned with discussing a methodology to define the aging parameters that can be measured, and second with representing the age effects graphically.

An Alternative American Approach to Repositories

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Examining human-centered design practice in the mobile apps era

Human-Centered Design (HCD) is a well-recognized approach to the design of interactive computing systems that supports everyday and professional lives of people. To that end, the HCD approach put central emphasis on the explicit understanding of users and context of use by involving users throughout the entire design and development process. With mobile computing, the diversity of users as well as the variety in the spatial, temporal, and social settings of the context of use has notably expanded, which affect the effort of interaction designers to understand users and context of use. The emergence of the mobile apps era in 2008 as a result of structural changes in the mobile industry and the profound enhanced capabilities of mobile devices, further intensify the embeddedness of technology in the daily life of people and the challenges that interaction designers face to cost-efficiently understand users and context of use. Supporting interaction designers in this challenge requires understanding of their existing practice, rationality, and work environment. The main objective of this dissertation is to contribute to interaction design theories by generating understanding on the HCD practice of mobile systems in the mobile apps era, as well as to explain the rationality of interaction designers in attending to users and context of use. To achieve that, a literature study is carried out, followed by a mixed-methods research that combines multiple qualitative interview studies and a quantitative questionnaire study. The dissertation contributes new insights regarding the evolving HCD practice at an important time of transition from stationary computing to mobile computing. Firstly, a gap is identified between interaction design as practiced in research and in the industry regarding the involvement of users in context; whereas the utilization of field evaluations, i.e. in real-life environments, has become more common in academic projects, interaction designers in the industry still rely, by large, on lab evaluations. Secondly, the findings indicate on new aspects that can explain this gap and the rationality of interaction designers in the industry in attending to users and context; essentially, the professional-client relationship was found to inhibit the involvement of users, while the mental distance between practitioners and users as well as the perceived innovativeness of the designed system are suggested in explaining the inclination to study users in situ. Thirdly, the research contributes the first explanatory model on the relation between the organizational context and HCD; essentially, innovation-focused organizational strategies greatly affect the cost-effective usage of data on users and context of use. Last, the findings suggest a change in the nature of HCD in the mobile apps era, at least with universal consumer systems; evidently, the central attention on the explicit understanding of users and context of use shifts from an early requirements phase and continual activities during design and development to follow-up activities. That is, the main effort to understand users is by collecting data on their actual usage of the system, either before or after the system is deployed. The findings inform both researchers and practitioners in interaction design. In particular, the dissertation suggest on action research as a useful approach to support interaction designers and further inform theories on interaction design. With regard to the interaction design practice, the dissertation highlights strategies that encourage a more cost-effective user- and context-informed interaction design process. With the continual embeddedness of computing into people’s life, e.g. with wearable devices and connected car systems, the dissertation provides a timely and valuable view on the evolving humancentered design.

Religion and Clothing: the Capabilities Approach Considered

Proponents of the capabilities approach claim that it should be used to give guidance for the implementation of good constitutional laws. This suggests that it also gives us grounds to support attempts to create or protect constitutions based on something like the capabilities approach. The Turkish Republic claims that in order to protect secularism and the equal status of women, it needs to keep certain Islamic practices away from the public domain. The wearing of the headscarf has been singled out as such a practice, and the Turkish Republic has therefore legislated against headscarf wearing in schools, universities, and government buildings. In consequence many women are forced to choose between religion over education and politics in a way that curtails central human capabilities. Nussbaum claims that the best way to help states resolve the dilemma presented by the conflict between religious choice and other central capabilities is to refer to principles embodied in to the US Religious Freedom Restoration Act 1993, which states that a law can burden a person's exercise of religion only when the burden is a furtherance of a compelling state interest. In this paper I consider how this advice partly vindicates the Turkish case and how the solution it yields is in many ways more satisfactory than that of more traditional approaches in political philosophy.

Des typologies mécaniques à l'expérience esthétique : fonctions et mutations du genre dans le jeu vidéo

Cette thèse examine en profondeur la nature et l’application du concept de genre en jeu vidéo. Elle se divise en trois parties. La première fait l’inventaire des théories des genres en littérature et en études cinématographiques. Les propriétés essentielles du genre comme concept sont identifiées : il s’agit d’une catégorisation intuitive et irraisonnée, de nature discursive, qui découle d’un consensus culturel commun plutôt que de systèmes théoriques, et qui repose sur les notions de tradition, d’innovation et d’hybridité. Dans la deuxième partie, ces constats sont appliqués au cas du genre vidéoludique. Quelques typologies sont décortiquées pour montrer l’impossibilité d’une classification autoritaire. Un modèle du développement des genres est avancé, lequel s’appuie sur trois modalités : l’imitation, la réitération et l’innovation. Par l’examen de l’histoire du genre du first-person shooter, la conception traditionnelle du genre vidéoludique basée sur des mécanismes formels est remplacée par une nouvelle définition centrée sur l’expérience du joueur. La troisième partie développe l’expérience comme concept théorique et la place au centre d’une nouvelle conception du genre, la pragmatique des effets génériques. Dans cette optique, tout objet est une suite d’amorces génériques, d’effets en puissance qui peuvent se réaliser pourvu que le joueur dispose des compétences génériques nécessaires pour les reconnaître. Cette nouvelle approche est démontrée à travers une étude approfondie d’un genre vidéoludique : le survival horror. Cette étude de cas témoigne de l’applicabilité plus large de la pragmatique des effets génériques, et de la récursivité des questions de genre entre le jeu vidéo, la littérature et le cinéma.

Relations entre les orthophonistes et les proches de personnes aphasiques en contexte de réadaptation

Le rôle que jouent les services orthophoniques dans l’ajustement des proches de personnes aphasiques ainsi que le contexte dans lequel les orthophonistes mettent en place des interventions auprès de ces proches ne sont actuellement pas connus. La présente thèse a donc pour but de comprendre de quelle manière les relations entre les orthophonistes et les proches de personnes aphasiques, développées en contexte de réadaptation, s’inscrivent dans la trajectoire dynamique des proches et dans la pratique des orthophonistes. Une approche qualitative par théorisation ancrée a été utilisée dans quatre études pour analyser les entrevues effectuées auprès de proches de personnes aphasiques et d’orthophonistes. Dans l’étude 1, les entrevues menées à trois reprises dans la première année suivant l’accident vasculaire-cérébral (AVC), et ce, auprès de quatre filles dont la mère est aphasique, ont été analysées. Un modèle théorique représentant la relation mère-fille a été développé. Ce modèle illustre que les perceptions de fragilité, de difficultés et de compétence, qu’ont les filles à l’égard de leur mère, les amènent à adopter des comportements de protection ou de confiance, ce qui génère des réactions de satisfaction ou d’insatisfaction chez la mère, renforçant alors les perceptions initiales des filles. Quatre patterns relationnels peuvent donc coexister au sein d’une même dyade. L’aphasie complexifierait cet ajustement relationnel. Dans l’étude 2, les entrevues effectuées à trois reprises durant la première année suivant l’AVC, auprès d’une fille dont la mère est sévèrement aphasique, ont été analysées. Un modèle théorique représentant l’expérience d’aider a été élaboré. Selon ce modèle, percevoir des difficultés chez sa mère et ressentir que leur relation antérieure est menacée a déclenché le processus d’aide chez la fille. Parallèlement, la reconnaissance de la compétence de sa mère a motivé la fille à offrir de l’aide visant à rendre sa mère heureuse et à favoriser son indépendance. Ce type d’aide a contribué à augmenter l’indépendance de sa mère, à retrouver une relation satisfaisante avec celle-ci et à s’adapter à l’aphasie. Dans l’étude 3, les entrevues de 12 proches de personnes aphasiques ont été analysées. Un modèle théorique représentant l’expérience de l’aphasie et de la réadaptation post-AVC a été développé et illustre que les proches sont centrés sur la personne aphasique et participent à la réadaptation dans le rôle d’aidant. Cette disposition influence alors leurs attentes envers la réadaptation, leurs interactions avec les professionnels, dont les orthophonistes, et leur appréciation de la réadaptation. Dans l’étude 4, les entrevues effectuées auprès de huit orthophonistes travaillant en réadaptation ont été analysées. Un modèle théorique illustrant le processus d’intervention des orthophonistes auprès des proches de personnes aphasiques a été construit. Pour les orthophonistes, le travail avec les proches est majoritairement perçu comme un ajout positif, mais exigeant, à leur pratique de base centrée sur la personne aphasique. Une satisfaction professionnelle peut en découler, mais des idéaux non-atteints peuvent persister. La relation proche-orthophoniste serait donc principalement axée sur le rôle d’aidant que joue le proche, et ce, en raison de leur expérience respective. Un agrandissement du territoire de rencontre entre les orthophonistes et les proches pourrait soutenir les proches dans les ajustements relationnels induits par l’AVC avec aphasie ainsi que permettre aux orthophonistes d’atteindre leurs idéaux.

A New Model For Reliability Centered Maintenance In Petroleum Refineries

Refiners today operate their equipment for prolonged periods without shutdown. This is primarily due to the increased pressures of the market resulting in extended shutdown-to-shutdown intervals. This places extreme demands on the reliability of the plant equipment. The traditional methods of reliability assurance, like Preventive Maintenance, Predictive Maintenance and Condition Based Maintenance become inadequate in the face of such demands. The alternate approaches to reliability improvement, being adopted the world over are implementation of RCFA programs and Reliability Centered Maintenance. However refiners and process plants find it difficult to adopt this standardized methodology of RCM mainly due to the complexity and the large amount of analysis that needs to be done, resulting in a long drawn out implementation, requiring the services of a number of skilled people. These results in either an implementation restricted to only few equipment or alternately, one that is non-standard. The paper presents the current models in use, the core requirements of a standard RCM model, the alternatives to classical RCM, limitations in the existing model, classical RCM and available alternatives to RCM and will then go on to present an ‗Accelerated‘ approach to RCM implementation, that, while ensuring close conformance to the standard, does not place a large burden on the implementers

Aitchison Geometry for Probability and Likelihood as a new approach to mathematical statistics

The Aitchison vector space structure for the simplex is generalized to a Hilbert space structure A2(P) for distributions and likelihoods on arbitrary spaces. Central notations of statistics, such as Information or Likelihood, can be identified in the algebraical structure of A2(P) and their corresponding notions in compositional data analysis, such as Aitchison distance or centered log ratio transform. In this way very elaborated aspects of mathematical statistics can be understood easily in the light of a simple vector space structure and of compositional data analysis. E.g. combination of statistical information such as Bayesian updating, combination of likelihood and robust M-estimation functions are simple additions/ perturbations in A2(Pprior). Weighting observations corresponds to a weighted addition of the corresponding evidence. Likelihood based statistics for general exponential families turns out to have a particularly easy interpretation in terms of A2(P). Regular exponential families form finite dimensional linear subspaces of A2(P) and they correspond to finite dimensional subspaces formed by their posterior in the dual information space A2(Pprior). The Aitchison norm can identified with mean Fisher information. The closing constant itself is identified with a generalization of the cummulant function and shown to be Kullback Leiblers directed information. Fisher information is the local geometry of the manifold induced by the A2(P) derivative of the Kullback Leibler information and the space A2(P) can therefore be seen as the tangential geometry of statistical inference at the distribution P. The discussion of A2(P) valued random variables, such as estimation functions or likelihoods, give a further interpretation of Fisher information as the expected squared norm of evidence and a scale free understanding of unbiased reasoning

Separation of performance-approach and performance-avoidance achievement goals: A broader analysis

In the literature on achievement goals, performance-approach goals (striving to do better than others) and performance-avoidance goals (striving to avoid doing worse than others) tend to exhibit a moderate to high correlation, raising questions about whether the 2 goals represent distinct constructs. In the current article, we sought to examine the separability of these 2 goals using a broad factor-analytic approach that attended to issues that have been overlooked or underexamined in prior research. Five studies provided strong evidence for the separation of these 2 goal constructs: Separation was observed not only with exploratory factor analysis across different age groups and countries (Studies 1a and 1b) but also with change analysis (Study 2), ipsative factor analysis (Study 3), within-person analysis (Study 4), and behavioral genetics analysis (Study 5). We conclude by discussing the implications of the present research for the achievement goal literature, as well as the psychological literature in general.

Within-person analyses of situational interest and boredom: Interactions between task-specific perceptions and achievement goals

Despite the increasing number of studies examining the correlates of interest and boredom, surprisingly little research has focused on within-person fluctuations in these emotions, making it difficult to describe their situational nature. To address this gap in the literature, this study conducted repeated measurements (12 times) on a sample of 158 undergraduate students using a variety of self-report assessments, and examined the within-person relationships between task-specific perceptions (expectancy, utility, and difficulty) and interest and boredom. This study further explored the role of achievement goals in predicting between-person differences in these within-person relationships. Utilizing hierarchical-linear modeling, we found that, on average, a higher perception of both expectancy and utility, as well as a lower perception of difficulty, was associated with higher interest and lower boredom levels within individuals. Moreover, mastery-approach goals weakened the negative within-person relationship between difficulty and interest and the negative within-person relationship between utility and boredom. Mastery-avoidance and performance-avoidance goals strengthened the negative relationship between expectancy and boredom. These results suggest how educators can more effectively instruct students with different types of goals, minimizing boredom and maximizing interest and learning.

A scalable expressive ensemble learning using Random Prism: a MapReduce approach

The induction of classification rules from previously unseen examples is one of the most important data mining tasks in science as well as commercial applications. In order to reduce the influence of noise in the data, ensemble learners are often applied. However, most ensemble learners are based on decision tree classifiers which are affected by noise. The Random Prism classifier has recently been proposed as an alternative to the popular Random Forests classifier, which is based on decision trees. Random Prism is based on the Prism family of algorithms, which is more robust to noise. However, like most ensemble classification approaches, Random Prism also does not scale well on large training data. This paper presents a thorough discussion of Random Prism and a recently proposed parallel version of it called Parallel Random Prism. Parallel Random Prism is based on the MapReduce programming paradigm. The paper provides, for the first time, novel theoretical analysis of the proposed technique and in-depth experimental study that show that Parallel Random Prism scales well on a large number of training examples, a large number of data features and a large number of processors. Expressiveness of decision rules that our technique produces makes it a natural choice for Big Data applications where informed decision making increases the user’s trust in the system.

A unified approach to the recognition of complex actions from sequences of zone-crossings

We present a method for the recognition of complex actions. Our method combines automatic learning of simple actions and manual definition of complex actions in a single grammar. Contrary to the general trend in complex action recognition that consists in dividing recognition into two stages, our method performs recognition of simple and complex actions in a unified way. This is performed by encoding simple action HMMs within the stochastic grammar that models complex actions. This unified approach enables a more effective influence of the higher activity layers into the recognition of simple actions which leads to a substantial improvement in the classification of complex actions. We consider the recognition of complex actions based on person transits between areas in the scene. As input, our method receives crossings of tracks along a set of zones which are derived using unsupervised learning of the movement patterns of the objects in the scene. We evaluate our method on a large dataset showing normal, suspicious and threat behaviour on a parking lot. Experiments show an improvement of ~ 30% in the recognition of both high-level scenarios and their composing simple actions with respect to a two-stage approach. Experiments with synthetic noise simulating the most common tracking failures show that our method only experiences a limited decrease in performance when moderate amounts of noise are added.

Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development

Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.