Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

Data mining and visualization for anomaly detection and diagnosis in civil structures

Peer reviewed

An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients.

In Western industrialized countries, it is well established that legally competent individuals may choose a surrogate healthcare decision-maker to represent their interests should they lose the capacity to do so themselves. There are few limitations on who they may select to fulfill this function. However, many jurisdictions place restrictions on or prohibit the patient's attending physician or other provider involved with an individual's care to serve in this role. Several authors have previously suggested that respect for the autonomy of patients requires that there be few (if any) constraints on whomever they may appoint as a proxy. In this essay we revisit this topic by first providing a survey of current state laws governing this activity. We then analyze the clinical and ethical circumstances in which potential difficulties could arise. We take a more nuanced and circumspect view of prior suggestions that patients should have virtually unfettered liberty to choose their healthcare proxies. We suggest a strategy to balance the freedom of patients' right to choose their surrogates with fiduciary duty of the state as regulator of medical practice. We identify six domains of possible concern with such relationships and suggest straightforward methods of mitigating their potential negative effects that could be plausibly be incorporated into physician practice.

Study of Worker’s Exposure to Tantalum-bearing Particles in a Mining and Metallurgical Plant

The objective of this study was to assess worker exposure to mineral dust particles and a metabolic model, based on the model adopted by ICRP, was applied to assess human exposure to Ta, and predicted values of Ta concentrations in excreta. The occupational exposure to Th, U, Nb, and Ta bearing particles during routine tasks to obtain Fe-Nb alloys was estimated using air samplers and excreta samples. Ta concentrations in food samples and in drinking water were also determined. The results support that workers were occupationally exposed to Ta bearing particles, and also indicate that a source of Ta exposure for both workers and the control group was the ingestion of drinking water containing soluble compounds of Ta. Therefore, some Ta compounds should be considered soluble compounds in gastrointestinal tract. Consequently the metabolic model based on ICRP metabolic model and/or the transfer factor f1 for Ta should be reviewed and the solubility of Ta compounds in gastrointestinal should be determined.

A social-ecological impact assessment for public lands management: application of a conceptual and methodological framework

According to the U.S. National Environmental Policy Act of 1969 (NEPA), federal action to manipulate habitat for species conservation requires an environmental impact statement, which should integrate natural, physical, economic, and social sciences in planning and decision making. Nonetheless, most impact assessments focus disproportionately on physical or ecological impacts rather than integrating ecological and socioeconomic components. We developed a participatory social-ecological impact assessment (SEIA) that addresses the requirements of NEPA and integrates social and ecological concepts for impact assessments. We cooperated with the Bureau of Land Management in Idaho, USA on a project designed to restore habitat for the Greater Sage-Grouse (Centrocercus urophasianus). We employed questionnaires, workshop dialogue, and participatory mapping exercises with stakeholders to identify potential environmental changes and subsequent impacts expected to result from the removal of western juniper (Juniperus occidentalis). Via questionnaires and workshop dialogue, stakeholders identified 46 environmental changes and associated positive or negative impacts to people and communities in Owyhee County, Idaho. Results of the participatory mapping exercises showed that the spatial distribution of social, economic, and ecological values throughout Owyhee County are highly associated with the two main watersheds, wilderness areas, and the historic town of Silver City. Altogether, the SEIA process revealed that perceptions of project scale varied among participants, highlighting the need for specificity about spatial and temporal scales. Overall, the SEIA generated substantial information concerning potential impacts associated with habitat treatments for Greater Sage-Grouse. The SEIA is transferable to other land management and conservation contexts because it supports holistic understanding and framing of connections between humans and ecosystems. By applying this SEIA framework, land managers and affected people have an opportunity to fulfill NEPA requirements and develop more comprehensive management plans that better reflect the linkages of social-ecological systems.

Mining and Energy Boom, Dutch Disease and Informality in Colombia: a DSGE Approach

The paper develops a Dynamic Stochastic General Equilibrium (DSGE) model, which assesses the macroeconomic and labor market effects derived from simulating a positive shock to the stochastic component of the mining-energy sector productivity. Calibrating the model for the Colombian economy, this shock generates a whole increase in formal wages and a raise in tax revenues, expanding total consumption of the household members. These facts increase non-tradable goods prices relative to tradable goods prices, then real exchange rate decreases (appreciation) and occurs a displacement of productive resources from the tradable (manufacturing) sector to the non-tradable sector, followed by an increase in formal GDP and formal job gains. This situation makes the formal sector to absorb workers from the informal sector through the non-tradable formal subsector, which causes informal GDP to go down. As a consequence, in the net consumption falls for informal workers, which leads some members of the household not to offer their labor force in the informal sector but instead they prefer to keep unemployed. Therefore, the final result on the labor market is a decrease in the number of informal workers, of which a part are in the formal sector and the rest are unemployed.

Multi-sensor Cloud and Aerosol Retrieval Simulator and Its Applications

Executing a cloud or aerosol physical properties retrieval algorithm from controlled synthetic data is an important step in retrieval algorithm development. Synthetic data can help answer questions about the sensitivity and performance of the algorithm or aid in determining how an existing retrieval algorithm may perform with a planned sensor. Synthetic data can also help in solving issues that may have surfaced in the retrieval results. Synthetic data become very important when other validation methods, such as field campaigns,are of limited scope. These tend to be of relatively short duration and often are costly. Ground stations have limited spatial coverage whilesynthetic data can cover large spatial and temporal scales and a wide variety of conditions at a low cost. In this work I develop an advanced cloud and aerosol retrieval simulator for the MODIS instrument, also known as Multi-sensor Cloud and Aerosol Retrieval Simulator (MCARS). In a close collaboration with the modeling community I have seamlessly combined the GEOS-5 global climate model with the DISORT radiative transfer code, widely used by the remote sensing community, with the observations from the MODIS instrument to create the simulator. With the MCARS simulator it was then possible to solve the long standing issue with the MODIS aerosol optical depth retrievals that had a low bias for smoke aerosols. MODIS aerosol retrieval did not account for effects of humidity on smoke aerosols. The MCARS simulator also revealed an issue that has not been recognized previously, namely,the value of fine mode fraction could create a linear dependence between retrieved aerosol optical depth and land surface reflectance. MCARS provided the ability to examine aerosol retrievals against “ground truth” for hundreds of thousands of simultaneous samples for an area covered by only three AERONET ground stations. Findings from MCARS are already being used to improve the performance of operational MODIS aerosol properties retrieval algorithms. The modeling community will use the MCARS data to create new parameterizations for aerosol properties as a function of properties of the atmospheric column and gain the ability to correct any assimilated retrieval data that may display similar dependencies in comparisons with ground measurements.

User interaction monitoring and analysis framework

An overview is given of a user interaction monitoring and analysis framework called BaranC. Monitoring and analysing human-digital interaction is an essential part of developing a user model as the basis for investigating user experience. The primary human-digital interaction, such as on a laptop or smartphone, is best understood and modelled in the wider context of the user and their environment. The BaranC framework provides monitoring and analysis capabilities that not only records all user interaction with a digital device (e.g. smartphone), but also collects all available context data (such as from sensors in the digital device itself, a fitness band or a smart appliances). The data collected by BaranC is recorded as a User Digital Imprint (UDI) which is, in effect, the user model and provides the basis for data analysis. BaranC provides functionality that is useful for user experience studies, user interface design evaluation, and providing user assistance services. An important concern for personal data is privacy, and the framework gives the user full control over the monitoring, storing and sharing of their data.

Epistemology, Theory, and Methodology in Knowledge Organization: Toward a Classification, Metatheory, and Research Framework

This paper proposes a preliminary classification of knowledge organization research, divided among epistemology, theory, and methodology plus three spheres of research: design, study, and critique. This work is situated in a metatheoretical framework, drawn from sociological thought. Example works are presented along with preliminary classification. The classification is then briefly described as a comparison tool which can be used to demonstrate overlap and divergence in cognate discourses of knowledge organization (such as ontology engineering).

Mining the online social network data: Influence, summarization, and organization

Online Social Network (OSN) services provided by Internet companies bring people together to chat, share the information, and enjoy the information. Meanwhile, huge amounts of data are generated by those services (they can be regarded as the social media ) every day, every hour, even every minute, and every second. Currently, researchers are interested in analyzing the OSN data, extracting interesting patterns from it, and applying those patterns to real-world applications. However, due to the large-scale property of the OSN data, it is difficult to effectively analyze it. This dissertation focuses on applying data mining and information retrieval techniques to mine two key components in the social media data — users and user-generated contents. Specifically, it aims at addressing three problems related to the social media users and contents: (1) how does one organize the users and the contents? (2) how does one summarize the textual contents so that users do not have to go over every post to capture the general idea? (3) how does one identify the influential users in the social media to benefit other applications, e.g., Marketing Campaign? The contribution of this dissertation is briefly summarized as follows. (1) It provides a comprehensive and versatile data mining framework to analyze the users and user-generated contents from the social media. (2) It designs a hierarchical co-clustering algorithm to organize the users and contents. (3) It proposes multi-document summarization methods to extract core information from the social network contents. (4) It introduces three important dimensions of social influence, and a dynamic influence model for identifying influential users.