Annual progress report /

In November 2006, a multi-disciplinary statewide Illinois State Diabetes Commission was established by legislation to be house[d] within the Department of Human Services (DHS) as a means of addressing issues presented by the growing number of children and adults being diagnosed with Diabetes Mellitus.

Empathy and Its Potential in Museum Practice

Thesis (Master's)--University of Washington, 2016-06

Heart failure management programmes in Europe

Background The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. Method A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme. Results Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Conclusion Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

High-performance liquid chromatography and pharmacokinetics of some antibiotics

The principles of High Performance Liquid Chromatography (HPLC) and pharmacokinetics were applied to the use of several clinically-important drugs at the East Birmingham Hospital. Amongst these was gentamicin, which was investigated over a two-year period by a multi-disciplinary team. It was found that there was considerable intra- and inter-patient variation that had not previously been reported and the causes and consequences of such variation were considered. A detailed evaluation of available pharmacokinetic techniques was undertaken and 1- and 2-compartment models were optimised with regard to sampling procedures, analytical error and model-error. The implications for control of therapy are discussed and an improved sampling regime is proposed for routine usage. Similar techniques were applied to trimethoprim, assayed by HPLC, in patients with normal renal function and investigations were also commenced into the penetration of drug into peritoneal dialysate. Novel assay techniques were also developed for a range of drugs including 4-aminopyridine, chloramphenicol, metronidazole and a series of penicillins and cephalosporins. Stability studies on cysteamine, reaction-rate studies on creatinine-picrate and structure-activity relationships in HPLC of aminopyridines are also reported.

Semantic linking through spaces for cyber-physical-socio intelligence:a methodology

Humans consciously and subconsciously establish various links, emerge semantic images and reason in mind, learn linking effect and rules, select linked individuals to interact, and form closed loops through links while co-experiencing in multiple spaces in lifetime. Machines are limited in these abilities although various graph-based models have been used to link resources in the cyber space. The following are fundamental limitations of machine intelligence: (1) machines know few links and rules in the physical space, physiological space, psychological space, socio space and mental space, so it is not realistic to expect machines to discover laws and solve problems in these spaces; and, (2) machines can only process pre-designed algorithms and data structures in the cyber space. They are limited in ability to go beyond the cyber space, to learn linking rules, to know the effect of linking, and to explain computing results according to physical, physiological, psychological and socio laws. Linking various spaces will create a complex space — the Cyber-Physical-Physiological-Psychological-Socio-Mental Environment CP3SME. Diverse spaces will emerge, evolve, compete and cooperate with each other to extend machine intelligence and human intelligence. From multi-disciplinary perspective, this paper reviews previous ideas on various links, introduces the concept of cyber-physical society, proposes the ideal of the CP3SME including its definition, characteristics, and multi-disciplinary revolution, and explores the methodology of linking through spaces for cyber-physical-socio intelligence. The methodology includes new models, principles, mechanisms, scientific issues, and philosophical explanation. The CP3SME aims at an ideal environment for humans to live and work. Exploration will go beyond previous ideals on intelligence and computing.

Patients’ and physicians’ experiences of atrial fibrillation and anticoagulation therapy:a qualitative journey

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF) however it is often underutilized and sometimes refused by patients. This programme of work included a meta-synthesis and two inter-linking studies aiming to explore patients’ and physicians’ experiences of AF and OAC. Methods: A meta-synthesis of qualitative evidence was conducted which informed the empirical work. Semi-structured individual interviews were utilised. Study 1: Three AF patient sub-groups were interviewed; accepted (n=4), refused (n=4), or discontinued (n=3) warfarin. Study 2: Four physician sub-groups (n=4 each group) prescribing OAC to AF patients were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Data was analysed using interpretative phenomenological analysis. Results: Study 1: Three over-arching themes comprised patients’ experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients’ reflections. Patients commented on the relief and reassurance experienced during the consultation but they perceived the decision making process mostly led by the physician. Lack of education and take-home materials distributed during the initial consultation was highlighted. Patients who had experienced stroke themselves or were caregivers, were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Warfarin monitoring was challenging for patients, however some patients perceived it as beneficial as it served to enhance patient-physician relationship. Study 2: Two over-arching themes emerged from physicians’ experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians’ approach to the consultation style shifted through a continuum of compliance-adherence-concordance during the consultation. They aimed for concordance, however challenges such as time and the perceived patient trust in them as the expert, led to physicians adopting a paternalistic approach. Physicians also pointed out challenges associated with guideline adherence and the need to adopt a multi-disciplinary approach, where other health professionals could provide on-going education. Conclusion: This programme of work has illustrated the benefit of taking an in depth phenomenological approach to understanding the lived experience of the physician-patient consultation. Together with the meta-synthesis, this work has strengthened the evidence base and demonstrated that there is a need to target patients' and physicians' ability to communicate with each other in a comprehensible way.

An interdisciplinary approach to designing and evaluating a hybrid solar-biomass power plant

Purpose: Energy security is a major concern for India and many rural areas remain un-electrified. Thus, innovations in sustainable technologies to provide energy services are required. Biomass and solar energy in particular are resources that are widely available and underutilised in India. This paper aims to provide an overview of a methodology that was developed for designing and assessing the feasibility of a hybrid solar-biomass power plant in Gujarat. Design/methodology/approach: The methodology described is a combination of engineering and business management studies used to evaluate and design solar thermal collectors for specific applications and locations. For the scenario of a hybrid plant, the methodology involved: the analytical hierarchy process, for solar thermal technology selection; a cost-exergy approach, for design optimisation; quality function deployment, for designing and evaluating a novel collector - termed the elevation linear Fresnel reflector (ELFR); and case study simulations, for analysing alternative hybrid plant configurations. Findings: The paper recommended that for a hybrid plant in Gujarat, a linear Fresnel reflector of 14,000 m2 aperture is integrated with a 3 tonne per hour biomass boiler, generating 815 MWh per annum of electricity for nearby villages and 12,450 tonnes of ice per annum for local fisheries and food industries. However, at the expense of a 0.3 ¢/kWh increase in levelised energy costs, the ELFR can increase savings of biomass (100 t/a) and land (9 ha/a). Research limitations/implications: The research reviewed in this paper is primarily theoretical and further work will need to be undertaken to specify plant details such as piping layout, pump sizing and structure, and assess plant performance during real operational conditions. Originality/value: The paper considers the methodology adopted proved to be a powerful tool for integrating technology selection, optimisation, design and evaluation and promotes interdisciplinary methods for improving sustainable engineering design and energy management. © Emerald Group Publishing Limited.

Psychological cue use and implications for a clinical decision support system

Effective clinical decision making depends upon identifying possible outcomes for a patient, selecting relevant cues, and processing the cues to arrive at accurate judgements of each outcome's probability of occurrence. These activities can be considered as classification tasks. This paper describes a new model of psychological classification that explains how people use cues to determine class or outcome likelihoods. It proposes that clinicians respond to conditional probabilities of outcomes given cues and that these probabilities compete with each other for influence on classification. The model explains why people appear to respond to base rates inappropriately, thereby overestimating the occurrence of rare categories, and a clinical example is provided for predicting suicide risk. The model makes an effective representation for expert clinical judgements and its psychological validity enables it to generate explanations in a form that is comprehensible to clinicians. It is a strong candidate for incorporation within a decision support system for mental-health risk assessment, where it can link with statistical and pattern recognition tools applied to a database of patients. The symbiotic combination of empirical evidence and clinical expertise can provide an important web-based resource for risk assessment, including multi-disciplinary education and training. © 2002 Informa UK Ltd All rights reserved.

An exploratory analysis of corporate social responsibility:definitions, motives and values

Corporate Social Responsibility (CSR) is a multi-disciplinary subject and definitions vary with regard to the perceived scope or boundaries of the corporation’s responsibility. In this paper, corporate motives for CSR are explored, along with the notion of an altruistic ethical impulse among business leaders or managers, perhaps motivated by religious beliefs. It is suggested that the formal adoption of CSR by corporations could be associated with the changing personal values of managers and that there may be an association between different industries, the personal values of the managers who work in them and their commitment to CSR. This paper is preparatory to an empirical investigation that will address how corporate social responsibility (CSR) is interpreted and institutionalised by organisations, including an analysis of firms’ perceptions of the boundaries regarding where and to whom their corporate social responsibilities lie.

A corpus-assisted study of the discourse marker well as an indicator of judges' institutional roles in court cases with litigants in person

In this paper, I concentrate on court cases with litigants in person (lay people who act on their own behalf in legal proceedings without a counsel or solicitor) and discuss the challenges of building a corpus of courtroom discourse where it is crucial to distinguish between speakers due to their distinct institutional roles. The corpus incorporates seven sub-corpora of verbatim transcripts from different court cases with litigants in person and comprises over eleven-million tokens. The focus of this paper is on the interplay between the legal and lay discourse types and how judges project their institutional roles through well-initiated turns directed at litigants in person and counsels. As a versatile discourse marker, well provides a good opportunity to explore how judges have to adapt their roles to ensure lay litigants in person receive the necessary support and that their lack of competence does not impede on the fairness of the proceedings. Given the breadth and importance of the topic of litigation in person, I discuss how the tools and approaches of corpus linguistics can be helpful in this multi-disciplinary area where multiple functions and uses of individual linguistic features need to be explored in depth.

Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects

Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability. Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population. Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health. Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.

Applicability of non-modular assessment in construction management and allied undergraduate programmes:perspective of the academics involved

Undergraduate programmes on construction management and other closely related built environment disciplines are currently taught and assessed on a modular basis. This is the case in the UK and in many other countries globally. However, it can be argued that professionally oriented programmes like these are better assessed on a non-modular basis, in order to produce graduates who can apply knowledge on different subject contents in cohesion to solve complex practical scenarios in their work environments. The examples of medical programmes where students are assessed on a non-modular basis can be cited as areas where this is already being done. A preliminary study was undertaken to explore the applicability of non-modular assessment within construction management undergraduate education. A selected sample of university academics was interviewed to gather their perspectives on applicability of non-modular assessment. General acceptance was observed among the academics involved that integrating non-modular assessment is applicable and will be beneficial. All academics stated that at least some form of non-modular assessment as being currently used in their programmes. Examples where cross-modular knowledge is assessed included comprehensive/multi-disciplinary project modules and creating larger modules to amalgamate a number of related subject areas. As opposed to a complete shift from modular to non-modular, an approach where non-modular assessment is integrated and its use further expanded within the current system is therefore suggested. This is due to the potential benefits associated with this form of assessment to professionally aligned built environment programmes

Advancing the psychology of entrepreneurship:a review of the psychological literature and an introduction

This article provides a narrative review of psychology of entrepreneurship research published in leading psychology journals, based on which we develop an organising framework for future psychological contributions to this field. Furthermore, we introduce the manuscripts collected in this special issue. Our review identified five research areas, broadly corresponding with basic psychological domains, namely personal differences; careers; health and well-being; cognition and behaviour; and leadership; as well as three cross-cutting themes: gender issues; genetic and biological foundations; and context. With the aim to stimulate integration across different approaches and disciplines, we propose a framework to understand how psychologists can offer innovative contributions to the multi-disciplinary entrepreneurship literature. This includes a focus on the entrepreneur embedded in and in interaction with his or her immediate and wider context; attention to different types of entrepreneurs; and a focus on dynamic within-person processes evolving over time.

Leader trustworthy behavior and organizational trust:the role of the immediate manager for cultivating trust

Drawing from both trust-building theory and interpersonal trust literature, we investigate how trust between a leader and follower may be leveraged to influence organizational trust. We also explore the mediating mechanisms of this link and test a potential moderator. A cross-sectional, multi-foci design was adopted and participants were 201 employees within a public sector organization. Leader trustworthy behavior was found to predict organizational trust, mediated by trustworthiness perceptions and trust in the leader. Support for the boundary condition was found; namely, when leaders were more senior, the relationship between trustworthy behavior and organizational trust was stronger. The findings suggest that leaders can meaningfully influence organizational trust perceptions through the enactment of trustworthy behavior, although the strength of this effect varied as a function of their position.