Complexity and the science of implementation in health IT — knowledge gaps and future visions

Objectives The intent of this paper is in the examination of health IT implementation processes – the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommendations for future study and application. Methods A literature review resulted in the identification of six health IT related implementation best practices which were subsequently debated and clarified by participants attending the NI2012 Research Post Conference held in Montreal in the summer of 2012. Using the framework for implementation research (CFIR) to guide their application, the six best practices were applied to two distinct health IT implementation studies to assess their applicability. Results Assessing the implementation processes from two markedly diverse settings illustrated both the challenges and potentials of using standardized implementation processes. In support of what was discovered in the review of the literature, “one size fits all” in health IT implementation is a fallacy, particularly when global diversity is added into the mix. At the same time, several frameworks show promise for use as “scaffolding” to begin to assess best practices, their distinct dimensions, and their applicability for use. Conclusions Health IT innovations, regardless of the implementation setting, requires a close assessment of many dimensions. While there is no “one size fits all”, there are commonalities and best practices that can be blended, adapted, and utilized to improve the process of implementation. This paper examines health IT implementation processes and identifies a beginning set of implementation best practices, which could begin to address gaps in the health IT implementation body of knowledge.

Awareness of risky behaviour among Chinese drivers

Background In China, as in many developing countries, rapid increases in car ownership and new drivers have been coupled with a large trauma burden. The World Health Organization has identified key risk factors including speeding, drink-driving, helmet and restraint non-use, overloaded vehicles, and fatigued-driving in many rapidly motorising countries, including China. Levels of awareness of these risk factors among road users are not well understood. Although research identifies speeding as the major factor contributing to road crashes in China, there appears to be widespread acceptance of it among the broader community. Purpose To assess self-reported speeding and awareness of crash risk factors among Chinese drivers in Beijing. Methods Car drivers (n=299) were recruited from car washing locations and car parks to complete an anonymous questionnaire. Perceptions of the relative risk of drink-driving, fatigued-driving and speeding, and attitudes towards speeding and self-reported driving speeds were assessed. Results Overall, driving speeds of >10km/hr above posted limits on two road types (60 and 80 km/hour zones) were reported by more than one third of drivers. High-range speeding (i.e., >30 km/hour in a 60 km/hour zone and >40 km/hour in an 80 km/hour zone) was reported by approximately 5% of the sample. Attitudinal measures indicated that approximately three quarters of drivers reported attitudes that were not supportive of speeding. Drink-driving was identified as the most risky behaviour; 18% reported the perception that drink-driving had the same level of danger as speeding and 82% reported it as more dangerous. For fatigued-driving, 1% reported the perception that it was not as dangerous as speeding; 27.4% reported it as the same level and 71.6% perceived it as more dangerous. Conclusion Driving speeds well above posted speed limits were commonly reported by drivers. Speeding was rated as the least dangerous on-road behaviour, compared to drink-driving and fatigued-driving. One third of drivers reported regularly engaging in speeds at least 10km/hr above posted limits, despite speeding being the major reported contributor to crashes. Greater awareness of the risks associated with speeding is needed to help reduce the road trauma burden in China and promote greater speed limit compliance.

Performance of new-generation portable water-filled road safety barriers under vehicular impact

Portable water-filled barriers (PWFB) are roadside structures used to enhance safety at roadside work-zones. Ideally, a PWFB system is expected to protect persons and objects behind it and redirect the errant vehicle. The performance criteria of a road safety barrier system are (i) redirection of the vehicle after impact and (ii) lateral deflection within allowable limits. Since its inception, the PWFB has received criticism due to its underperformance compared to the heavier portable concrete barrier. A new generation composite high energy absorbing road safety barrier was recently developed by the authors.

Learning the learning rate for prediction with expert advice

Most standard algorithms for prediction with expert advice depend on a parameter called the learning rate. This learning rate needs to be large enough to fit the data well, but small enough to prevent overfitting. For the exponential weights algorithm, a sequence of prior work has established theoretical guarantees for higher and higher data-dependent tunings of the learning rate, which allow for increasingly aggressive learning. But in practice such theoretical tunings often still perform worse (as measured by their regret) than ad hoc tuning with an even higher learning rate. To close the gap between theory and practice we introduce an approach to learn the learning rate. Up to a factor that is at most (poly)logarithmic in the number of experts and the inverse of the learning rate, our method performs as well as if we would know the empirically best learning rate from a large range that includes both conservative small values and values that are much higher than those for which formal guarantees were previously available. Our method employs a grid of learning rates, yet runs in linear time regardless of the size of the grid.

Efficient minimax strategies for square loss games

We consider online prediction problems where the loss between the prediction and the outcome is measured by the squared Euclidean distance and its generalization, the squared Mahalanobis distance. We derive the minimax solutions for the case where the prediction and action spaces are the simplex (this setup is sometimes called the Brier game) and the \ell_2 ball (this setup is related to Gaussian density estimation). We show that in both cases the value of each sub-game is a quadratic function of a simple statistic of the state, with coefficients that can be efficiently computed using an explicit recurrence relation. The resulting deterministic minimax strategy and randomized maximin strategy are linear functions of the statistic.

Phobos and deimos on Mars - two autonomous robots for the DLR SpaceBot Cup

In 2013, ten teams from German universities and research institutes participated in a national robot competition called SpaceBot Cup organized by the DLR Space Administration. The robots had one hour to autonomously explore and map a challenging Mars-like environment, find, transport, and manipulate two objects, and navigate back to the landing site. Localization without GPS in an unstructured environment was a major issue as was mobile manipulation and very restricted communication. This paper describes our system of two rovers operating on the ground plus a quadrotor UAV simulating an observing orbiting satellite. We relied on ROS (robot operating system) as the software infrastructure and describe the main ROS components utilized in performing the tasks. Despite (or because of) faults, communication loss and breakdowns, it was a valuable experience with many lessons learned.

Teleoperation of a 7 DOF humanoid robot arm using human arm accelerations and EMG signals

We present our work on tele-operating a complex humanoid robot with the help of bio-signals collected from the operator. The frameworks (for robot vision, collision avoidance and machine learning), developed in our lab, allow for a safe interaction with the environment, when combined. This even works with noisy control signals, such as, the operator’s hand acceleration and their electromyography (EMG) signals. These bio-signals are used to execute equivalent actions (such as, reaching and grasping of objects) on the 7 DOF arm.

DNA molecules and future blockbuster therapeutics

Deoxyribonucleic acid molecules are heralding a new generation of reverse - engineered biopharmaceuticals. In terms of potential application in gene medicine, plasmid DNA (pDNA) vectors have exceptional therapeutic and immunological profiles as they are free from safety concerns associated with viral vectors, display non-toxicity and are simpler to develop. This presentation will discuss the potential applications of pDNA molecules in vaccine development and gene therapy, pilot-scale production of pDNA-based biopharmaceuticals and the controlled delivery of therapeutic sequences in biodegradable polymers to different target cells via the nasal route.

Temporal and spatial gait characteristics of transfemoral amputees fitted with osseointegrated fixation: preliminary data

The conventional method of attachment of prosthesis involves on a socket. A new method relying on osseointegrated fixation is emerging. It has significant prosthetic benefits. Only a few studies demonstrated the biomechanical benefits. The ultimate aim of this study was to characterise the functional outcome of transfemoral amputees fitted with osseointegrated fixation, which can be assess through temporal and spatial gait characteristics. The specific objective of this preliminary study was to present the key temporal and spatial gait characteristics.

Drug accumulation into single drug-sensitive and drug-resistant prostate cancer cells conducted on the single cell bioanalyzer

Multidrug resistance (MDR) occurs in prostate cancer, and this happens when the cancer cells resist chemotherapeutic drugs by pumping them out of the cells. MDR inhibitors such as cyclosporin A (CsA) can stop the pumping and enhance the drugs accumulated in the cells. The cellular drug accumulation is monitored using a microfluidic chip mounted on a single cell bioanalyzer. This equipment has been developed to measure accumulation of drugs such as doxorubicin (DOX) and fluorescently labeled paclitaxel (PTX) in single prostate cancer cells. The inhibition of drug efflux on the same prostate cell was examined in drug-sensitive and drug-resistant cells. Accumulation of these drug molecules was not found in the MDR cells, PC-3 RX-DT2R cells. Enhanced drug accumulation was observed only after treating the MDR cell in the presence of 5 μM of CsA as the MDR inhibitor. We envision this monitoring of the accumulation of fluorescent molecules (drug or fluorescent molecules), if conducted on single patient cancer cells, can provide information for clinical monitoring of patients undergoing chemotherapy in the future.

Fuzzy-DL perception for multi-robot systems

For future planetary robot missions, multi-robot-systems can be considered as a suitable platform to perform space mission faster and more reliable. In heterogeneous robot teams, each robot can have different abilities and sensor equipment. In this paper we describe a lunar demonstration scenario where a team of mobile robots explores an unknown area and identifies a set of objects belonging to a lunar infrastructure. Our robot team consists of two exploring scout robots and a mobile manipulator. The mission goal is to locate the objects within a certain area, to identify the objects, and to transport the objects to a base station. The robots have a different sensor setup and different capabilities. In order to classify parts of the lunar infrastructure, the robots have to share the knowledge about the objects. Based on the different sensing capabilities, several information modalities have to be shared and combined by the robots. In this work we propose an approach using spatial features and a fuzzy logic based reasoning for distributed object classification.

An autonomous mobile manipulator for collecting sample containers

In this work we present an autonomous mobile ma- nipulator that is used to collect sample containers in an unknown environment. The manipulator is part of a team of heterogeneous mobile robots that are to search and identify sample containers in an unknown environment. A map of the environment along with possible positions of sample containers are shared between the robots in the team by using a cloud-based communication interface. To grasp a container with its manipulator arm the robot has to place itself in a position suitable for the manipulation task. This optimal base placement pose is selected by querying a precomputed inverse reachability database.

Insolvency academics contributing to the review of insolvency laws: An Australian perspective

Introduction 1 It gives me great pleasure to contribute to this publication to honour Professor Ian Fletcher on his retirement as Foundation Chair of the INSOL International Academic Group. A collection of essays that include topics on domestic, cross-border and international insolvency appropriately reflects the breadth of Professor Fletcher’s impact on the scholarship of insolvency law – not only in his “home” jurisdiction of England and Wales and closer to home in Europe, but also stretching around the globe, in this case, to Australia. 2 In the early 1990s when I first began to research in the area of cross-border insolvency law, a colleague mentioned that they had recently attended the XIIIth International Congress of Comparative Law in Montreal in August 1990 and heard the Cross-border Insolvency: General Report expertly delivered by an English academic, Ian Fletcher, who was widely regarded as an authority in the area. This was my first introduction to Professor Fletcher’s work and over the intervening years I have referred often to his scholarship....

Preliminary work on the detection of partial discharges in SF6 under impulse voltages

This paper presents preliminary results of an investigation into the detection of partial discharges on the rise of impulse voltages from a point-to-plane gap in SF6. A parallel RC detection impedance is placed in the earth path of a point. Computer simulations are done to determine the values of R and C that will result in the smallest impulse voltage signal and the largest discharge signal across the detection impedance. These simulations and the experimental work show that the impulse voltage signal can not be sufficiently attenuated during the rise time of the applied voltage impulse using the RC detection impedance alone. An alternative discharge detection method is proposed in which a resonant partial discharge coupler is used. Elimination of noise and the impulse voltage signal can be achieved by shorting the coupler plate to the ground plane in the middle of the disk. However, due to the bandwidth of the measuring equipment and noise from the impulse generator it was not possible to detect discharges on the rising edge of a 1.5s voltage impulse using a coupler shorted in the middle. It was found that for this particular coupler, with no shorting points, and if the rising edge of the voltage impulse is longer than 5us, (10us) PD activity can be detected on the rising edge.

On the biomechanical significance of inter-lamellar interfaces in the intervertebral disc

The intervertebral disc (IVD) is a unique soft tissue structure which provides structural support and flexibility in the axial skeleton of vertebrates. From a structural perspective, the disc behaves somewhat like a thick walled pressure vessel, where the walls are comprised of a series of composite annular rings (lamellae). However, a prior study (Marchand and Ahmed, 1990) found a high proportion of circumferentially discontinuous lamellae in human lumbar IVDs. The presence of these discontinuities raises important structural questions, because discontinuous lamellae cannot withstand high nucleus pressures via the generation of circumferential (hoop) stress. A possible alternative mechanism may be that inter-lamellar cohesion allows shear stress transfer between adjacent annular layers. The aim of the present study was therefore to investigate the importance of inter-lamellar shear resistance in the intervertebral disc. This work found that inter-lamellar shear resistance has a strong influence on the compressive stiffness of the intervertebral disc, with a change in interface condition from tied (no slip) to frictionless (no shear resistance) reducing disc compressive stiffness by 40%. However, it appears that substantial inter-lamellar shear resistance is present in the bovine tail disc. Decreases in inter-lamellar shear resistance due to degradation of bridging collagenous or elastic fibre structures could therefore be an important part of the process of disc degeneration.