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.

The effect of very small air gaps on small field dosimetry

The purpose of this study was to investigate the effect of very small air gaps (less than 1 mm) on the dosimetry of small photon fields used for stereotactic treatments. Measurements were performed with optically stimulated luminescent dosimeters (OSLDs) for 6 MV photons on a Varian 21iX linear accelerator with a Brainlab lMLC attachment for square field sizes down to 6 mm 9 6 mm. Monte Carlo simulations were performed using EGSnrc C++ user code cavity. It was found that the Monte Carlo model used in this study accurately simulated the OSLD measurements on the linear accelerator. For the 6 mm field size, the 0.5 mm air gap upstream to the active area of the OSLD caused a 5.3 % dose reduction relative to a Monte Carlo simulation with no air gap...

Structural identification of a laboratory-based steel through truss cantilevered bridge with suspended span using a layered genetic algorithm with patternsearch step (GAPS)

Structural identification (St-Id) can be considered as the process of updating a finite element (FE) model of a structural system to match the measured response of the structure. This paper presents the St-Id of a laboratory-based steel through-truss cantilevered bridge with suspended span. There are a total of 600 degrees of freedom (DOFs) in the superstructure plus additional DOFs in the substructure. The St-Id of the bridge model used the modal parameters from a preliminary modal test in the objective function of a global optimisation technique using a layered genetic algorithm with patternsearch step (GAPS). Each layer of the St-Id process involved grouping of the structural parameters into a number of updating parameters and running parallel optimisations. The number of updating parameters was increased at each layer of the process. In order to accelerate the optimisation and ensure improved diversity within the population, a patternsearch step was applied to the fittest individuals at the end of each generation of the GA. The GAPS process was able to replicate the mode shapes for the first two lateral sway modes and the first vertical bending mode to a high degree of accuracy and, to a lesser degree, the mode shape of the first lateral bending mode. The mode shape and frequency of the torsional mode did not match very well. The frequencies of the first lateral bending mode, the first longitudinal mode and the first vertical mode matched very well. The frequency of the first sway mode was lower and that of the second sway mode was higher than the true values, indicating a possible problem with the FE model. Improvements to the model and the St-Id process will be presented at the upcoming conference and compared to the results presented in this paper. These improvements will include the use of multiple FE models in a multi-layered, multi-solution, GAPS St-Id approach.

Engineered nanomaterials: Knowledge gaps in fate, exposure, toxicity, and future directions

The aim of this study is to identify current knowledge gaps in fate, exposure, and toxicity of engineered nanomaterials (ENMs), highlight research gaps, and suggest future research directions. Humans and other living organisms are exposed to ENMs during production or use of products containing them. To assess the hazards of ENMs, it is important to assess their physiochemical properties and try to relate them to any observed hazard. However, the full determination of these relationships is currently limited by the lack of empirical data. Moreover, most toxicity studies do not use realistic environmental exposure conditions for determining dose-response parameters, affecting the accurate estimation of health risks associated with the exposure to ENMs. Regulatory aspects of nanotechnology are still developing and are currently the subject of much debate. Synthesis of available studies suggests a number of open questions. These include (i) developing a combination of different analytical methods for determining ENM concentration, size, shape, surface properties, and morphology in different environmental media, (ii) conducting toxicity studies using environmentally relevant exposure conditions and obtaining data relevant to developing quantitative nanostructure-toxicity relationships (QNTR), and (iii) developing guidelines for regulating exposure of ENMs in the environment.

Organisational driving safety systems analysis: Fleet safety situational issues and system gaps

The identification of safety hazards and risks and their associated control measures provides the foundation for any safety program and essentially determines the scope, content and complexity of an effective occupational health and safety management system. In the case of work-related road safety (WRRS), there is a gap within current knowledge, research and practice regarding the holistic assessment of WRRS safety systems and practice. In order to mitigate this gap, a multi-level process tool for assessing WRRS safety systems was developed from extensive consultation, practice and informed by theoretical models and frameworks. Data collection for the Organisational Driving Safety Systems Analysis (ODSSA) tool utilised a case study methodology and included multiple information sources: such as documents, archival records, interviews, direct observations, participant observations, and physical artefacts. Previous trials and application of the ODSSA has indicated that the tool is applicable to a wide range of organisational fleet environments and settings. This paper reports on the research results and effectiveness of the ODSSA tool to assess WRRS systems across a large organisation that recently underwent considerable organisational change, including amalgamation of multiple organisations. The outcomes of this project identified considerable differences in the degree by which the organisation addressed WRRS across their vehicle fleet operations and provided guidelines for improving organisations’ WRRS systems. The ODSSA tool was pivotal in determining WRRS system deficiencies and provided a platform to inform mitigation and improvement strategies.

Chemical bond approach to determining conductivity band gaps in amorphous chalcogenides and pnictides

The minimum energy required for the formation of conjugate pair of charged defects is found to be approximately equal to the experimental activation energy for d.c. conductivity in a number of amorphous chalcoganides and pnictides. This observation implies that the defect pair formation energy represents an intrinsic gap for transport in amorphous chalcogenides.

Minding the gaps: Disability culture + cultural competence in interior design

Despite the increased attention to the relationship of disability and design, this area still suffers from terminological confusion, oversimplification and a positivist bias that continues to produce ableist space. Here, I am suggesting that space is not a fixed container or a pochéd plan that needs to be ‘altered’ in order to accommodate, but that space is a fundamental element of social life and that space continually reproduces the social and cultural relations of its production. This paper serves as a critical foundation for ongoing explorations into how disability culture is situated within interior design. A shift towards disability as culture is necessary to move our understanding of how to design for those with disabilities out of the objective realm (prescriptive codes and guidelines) and into a subjective realm (the lived experience and embodied know-how of those with disabilities). By framing disability around a cultural model rather than a medical model it allows for epistemological and pedagogical shifts in our ways of knowing in interior design. In defining culture as “a way of life” it is important to look at disability as both a diverse way of living and a diverse way of knowing. Most significant, is that the everyday expertise of people with disabilities is recognized as knowledge that can inform the field of interior design. The urgency for defining disability culture is essential to our understanding of cultural competence in interior design education and practice. The aim of this paper is to challenge our current understanding of how to design for those with disabilities and to shift our ways of knowing in interior design towards a deep understanding of the lived experience, embodied know-how and culture of those with disabilities. This paper will begin by analysing the different models of disability and how interior design education and practice has shifted to reflect these different models. Defining disability culture and all of its complexities is also an essential component of this paper. Finally, this paper will present best practices and case studies of how a cultural model of disability can shape interior environments and interior design pedagogy.

NAPLAN, achievement gaps and embedding Indigenous perspectives in schooling: Disrupting the decolonial option

In 2004, the Queensland State Government rolled out the Embedding Aboriginal and Torres Strait Islander Perspectives in Schooling (EATSIPS) program. The policy was relaunched in 2009. This initiative aimed to improve Indigenous student learning outcomes, improve relationships between schools and Indigenous communities, and to develop a deeper understanding and respect for traditional and contemporary Aboriginal and Torres Strait Islander cultures amongst all students (EATSIPS 2011: 13). We are interested in the social justice possibilities of EATSIPS and its potential contribution to Reconciliation between Indigenous and non-Indigenous Australia. We are also interested in whether schooling practices informed by EAT-SIPS could reflect decolonising opportunities. This point is illustrated by the fact that, from 2009, it was mandatory for all state-school teachers to undergo professional development in EATSIPS, and all state schools underwent an EATSIPS audit of their policy, curriculum and pedagogical practices...

Impulse Voltage Breakdown Characteristics of Point-Plane Gaps at Low Pressures

Practical applications of vacuum as an insulator necessitated determining the low-pressure breakdown characteristics of long gap lengths of a point-plane electrode system. The breakdown voltage has been found to vary as the square root of the gap length. Further, with the point electrode as the anode, the values of the breakdown voltages obtained have been found to be larger than those obtained with a plane-parallel electrode system at a corresponding gap length. By applying the theory of the anode heating mechanism as the cause for breakdown, the results have been justified, and by utilizing a field efficiency factor which is the ratio of the average to maximum field, an empirical criterion has been developed. This criterion helps in calculating the breakdown voltage of a nonuniform gap system by the knowledge of the breakdown voltage of a plane-parallel electrode system.

A computer study of the miscibility limits of Sb1bTe1bBi

The quaternary system Sb1bTe1bBi1bSe with small amounts of suitable dopants is of interest for the manufacture of thermoelectric modules which exhibit the Peltier and Seebeck effects. This property could be useful in the production of energy from the thermoelectric effect. Other substances are bismuth telluride (Bi2Te3) and Sb1bTe1bBi and compounds such as ZnIn2Se4. In the present paper the application of computer programs such as MIGAP of Kaufman is used to indicate the stability of the ternary limits of Sb1bTe1bBi within the temperature ranges of interest, namely 273 K to 300 K.

Anode Phenomena in Triggered Vacuum Gaps

Arc voltage - current characteristics and threshold current densities occuring during the formation of anode spots in triggered vacuum gaps are reported. Single pulses of 1.65 ms arcing time, which correspond to switching surge currents, are used in the study with copper and aluminum anodes. The threshold values are 1.75 times the values reported earlier using the longer, 8 mis, arcing time. They are found to depend upon the duration of arcing time as well as upon electrode material, surface conditions, electrode size and contact separation. Lateral inhomogenity in the electrode geometry appears to reduce the threshold value by promoting early formation of anode spots.

General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

Impulse-voltage breakdown characteristics of large gaps at low pressures

A study of the gap breakdown voltage characteristic at a low pressure of 7×10-5 Torr with a standard (1/50)-μsec impulse-voltage wave reveals an agreement with the criterion Vb=Cd0.5 suggested by Cranberg. Voltage-time-to-breakdown characteristics has also been determined. From these studies, it is concluded that impulse breakdown in vacuum is initiated by an electron current heating an anode spot and thereby liberating a clump which causes breakdown.