Assessing distractors and teamwork during surgery: developing an event-based method for direct observation

OBJECTIVE: To develop a behavioural observation method to simultaneously assess distractors and communication/teamwork during surgical procedures through direct, on-site observations; to establish the reliability of the method for long (>3 h) procedures. METHODS: Observational categories for an event-based coding system were developed based on expert interviews, observations and a literature review. Using Cohen's κ and the intraclass correlation coefficient, interobserver agreement was assessed for 29 procedures. Agreement was calculated for the entire surgery, and for the 1st hour. In addition, interobserver agreement was assessed between two tired observers and between a tired and a non-tired observer after 3 h of surgery. RESULTS: The observational system has five codes for distractors (door openings, noise distractors, technical distractors, side conversations and interruptions), eight codes for communication/teamwork (case-relevant communication, teaching, leadership, problem solving, case-irrelevant communication, laughter, tension and communication with external visitors) and five contextual codes (incision, last stitch, personnel changes in the sterile team, location changes around the table and incidents). Based on 5-min intervals, Cohen's κ was good to excellent for distractors (0.74-0.98) and for communication/teamwork (0.70-1). Based on frequency counts, intraclass correlation coefficient was excellent for distractors (0.86-0.99) and good to excellent for communication/teamwork (0.45-0.99). After 3 h of surgery, Cohen's κ was 0.78-0.93 for distractors, and 0.79-1 for communication/teamwork. DISCUSSION: The observational method developed allows a single observer to simultaneously assess distractors and communication/teamwork. Even for long procedures, high interobserver agreement can be achieved. Data collected with this method allow for investigating separate or combined effects of distractions and communication/teamwork on surgical performance and patient outcomes.

On the Lp-Norm Regression Models for Estimating Value-at-Risk

Analysis of risk measures associated with price series data movements and its predictions are of strategic importance in the financial markets as well as to policy makers in particular for short- and longterm planning for setting up economic growth targets. For example, oilprice risk-management focuses primarily on when and how an organization can best prevent the costly exposure to price risk. Value-at-Risk (VaR) is the commonly practised instrument to measure risk and is evaluated by analysing the negative/positive tail of the probability distributions of the returns (profit or loss). In modelling applications, least-squares estimation (LSE)-based linear regression models are often employed for modeling and analyzing correlated data. These linear models are optimal and perform relatively well under conditions such as errors following normal or approximately normal distributions, being free of large size outliers and satisfying the Gauss-Markov assumptions. However, often in practical situations, the LSE-based linear regression models fail to provide optimal results, for instance, in non-Gaussian situations especially when the errors follow distributions with fat tails and error terms possess a finite variance. This is the situation in case of risk analysis which involves analyzing tail distributions. Thus, applications of the LSE-based regression models may be questioned for appropriateness and may have limited applicability. We have carried out the risk analysis of Iranian crude oil price data based on the Lp-norm regression models and have noted that the LSE-based models do not always perform the best. We discuss results from the L1, L2 and L∞-norm based linear regression models. ACM Computing Classification System (1998): B.1.2, F.1.3, F.2.3, G.3, J.2.

Robust tensor analysis with L1-norm

Tensor analysis plays an important role in modern image and vision computing problems. Most of the existing tensor analysis approaches are based on the Frobenius norm, which makes them sensitive to outliers. In this paper, we propose L1-norm-based tensor analysis (TPCA-L1), which is robust to outliers. Experimental results upon face and other datasets demonstrate the advantages of the proposed approach. © 2006 IEEE.

A normative approach to multi-agent systems for intelligent buildings

Building Management Systems (BMS) are widely adopted in modern buildings around the world in order to provide high-quality building services, and reduce the running cost of the building. However, most BMS are functionality-oriented and do not consider user personalization. The aim of this research is to capture and represent building management rules using organizational semiotics methods. We implement Semantic Analysis, which determines semantic units in building management and their relationship patterns of behaviour, and Norm Analysis, which extracts and specifies the norms that establish how and when these management actions occur. Finally, we propose a multi-agent framework for norm based building management. This framework contributes to the design domain of intelligent building management system by defining a set of behaviour patterns, and the norms that govern the real-time behaviour in a building.

Towards a life-event oriented G2C e-service provision: the NoBLE Framework

One of the primary features of modern government-to-citizen (G2C) service provision is the ability to offer a citizen-centric view of the e-government portal. Life-event approach is one of the most widely adopted paradigms supporting the idea of solving a complex event in a citizen’s life through a single service provision. Several studies have used this approach to design e-government portals. However, they were limited in terms of use and scalability. There were no mechanisms that show how to specify a life-event for structuring public e-services, or how to systematically match life-events with these services taking into consideration the citizen needs. We introduce the NOrm-Based Life-Event (NoBLE) framework for G2C e-service provision with a set of mechanisms as a guide for designing active life-event oriented e-government portals.

A radial basis function network classifier to maximise leave-one-out mutual information

tWe develop an orthogonal forward selection (OFS) approach to construct radial basis function (RBF)network classifiers for two-class problems. Our approach integrates several concepts in probabilisticmodelling, including cross validation, mutual information and Bayesian hyperparameter fitting. At eachstage of the OFS procedure, one model term is selected by maximising the leave-one-out mutual infor-mation (LOOMI) between the classifier’s predicted class labels and the true class labels. We derive theformula of LOOMI within the OFS framework so that the LOOMI can be evaluated efficiently for modelterm selection. Furthermore, a Bayesian procedure of hyperparameter fitting is also integrated into theeach stage of the OFS to infer the l2-norm based local regularisation parameter from the data. Since eachforward stage is effectively fitting of a one-variable model, this task is very fast. The classifier construc-tion procedure is automatically terminated without the need of using additional stopping criterion toyield very sparse RBF classifiers with excellent classification generalisation performance, which is par-ticular useful for the noisy data sets with highly overlapping class distribution. A number of benchmarkexamples are employed to demonstrate the effectiveness of our proposed approach.

Caracterização de Efluente Têxtil e Proposta de Tratamento

Textile industry deals with a high diversity of processes and generation of wastewaters with a high content of pollutant material. Before being disposed of in water bodies, a pre-treatment of the effluent is carried out, which is sometimes ineffective. In order to be properly treated, physical and chemical properties of the effluent must be known, as well as the pollutant agents that might be present in it. This has turned out to be a great problem in the textile industry, for there is a variety of processes and the pollutant load is very diversified. The characterization of the effluent allows the identification of most critical points and, as a consequence, the most appropriate treatment procedure to be employed, may be chosen. This study presents the results obtained after characterizing the effluent of a textile industry that comprises knitting, dyeing and apparel sections, processing mainly polyester/cotton articles. In this work, twenty samples of the effluent were collected, and related to the changes in production. From the results, a statistical evaluation was applied, determined in function of the rate of flow. The following properties and pollutants agents were quantitatively analysed: temperature; pH; sulfides; chlorine; alcalinity; chlorides; cianides; phenols; color; COD (Chemical Oxygen Demand); TOC (Total Organic Carbon); oil and grease; total, fixed and volatile solids; dissolved, fixed and volatile solids; suspended, fixed and volatile solids; setteable solids and heavy metals such as cadmium, copper, lead, chromium, tin, iron, zinc and nickel. Analyses were carried out according to ABNT NBR 13402 norm, based upon Standard Methods for the Examination of Water and Wastewater. As a consequence, a global treatment proposal is presented, involving clean production practices as contaminant load reducer, followed by conventional (biological) treatment

Optimum-Path Forest Classifier for Large Scale Biometric Applications

This paper addresses biometric identification using large databases, in particular, iris databases. In such applications, it is critical to have low response time, while maintaining an acceptable recognition rate. Thus, the trade-off between speed and accuracy must be evaluated for processing and recognition parts of an identification system. In this paper, a graph-based framework for pattern recognition, called Optimum-Path Forest (OPF), is utilized as a classifier in a pre-developed iris recognition system. The aim of this paper is to verify the effectiveness of OPF in the field of iris recognition, and its performance for various scale iris databases. The existing Gauss-Laguerre Wavelet based coding scheme is used for iris encoding. The performance of the OPF and two other - Hamming and Bayesian - classifiers, is compared using small, medium, and large-scale databases. Such a comparison shows that the OPF has faster response for large-scale databases, thus performing better than the more accurate, but slower, classifiers.

Exercise for osteoarthritis of the hip.

BACKGROUND Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip osteoarthritis (OA) report are based on limited evidence. OBJECTIVES To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and improved physical function and quality of life. SEARCH METHODS We searched five databases from inception up to February 2013. SELECTION CRITERIA All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in water) with a non-exercise group. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. We resolved disagreements through consensus. Two review authors independently extracted data, assessed risk of bias and the quality of the body of evidence for each outcome using the GRADE approach. We conducted analyses on continuous outcomes (pain, physical function and quality of life) and dichotomous outcomes (proportion of study withdrawals). MAIN RESULTS We considered that seven of the 10 included RCTs had a low risk of bias. However, the results may be vulnerable to performance and detection bias as none of the RCTs were able to blind participants to treatment allocation and, while most RCTs reported blinded outcome assessment, pain, physical function and quality of life were participant self reported. One of the 10 RCTs was only reported as a conference abstract and did not provide sufficient data for the evaluation of bias risk.High-quality evidence from nine trials (549 participants) indicated that exercise reduced pain (standardised mean difference (SMD) -0.38, 95% confidence interval (CI) -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment. Pain and physical function were estimated to be 29 points on a 0- to 100-point scale (0 was no pain or loss of physical function) in the control group; exercise reduced pain by an equivalent of 8 points (95% CI 4 to 11 points; number needed to treat for an additional beneficial outcome (NNTB) 6) and improved physical function by an equivalent of 7 points (95% CI 1 to 12 points; NNTB 6). Only three small studies (183 participants) evaluated quality of life, with overall low quality evidence, with no benefit of exercise demonstrated (SMD -0.07, 95% CI -0.23 to 0.36). Quality of life was estimated to be 50 points on a norm-based mean (standard deviation (SD)) score of 50 (10) in the general population in the control group; exercise improved quality of life by 0 points. Moderate-quality evidence from seven trials (715 participants) indicated an increased likelihood of withdrawal from the exercise allocation (event rate 6%) compared with the control group (event rate 3%), but this difference was not significant (risk difference 1%; 95% CI -1% to 4%). Of the five studies reporting adverse events, each study reported only one or two events and all were related to increased pain attributed to the exercise programme.The reduction in pain was sustained at least three to six months after ceasing monitored treatment (five RCTs, 391 participants): pain (SMD -0.38, 95% CI -0.58 to -0.18). Pain was estimated to be 29 points on a 0- to 100-point scale (0 was no pain) in the control group, the improvement in pain translated to a sustained reduction in pain intensity of 8 points (95% CI 4 to 12 points) compared with the control group (0 to 100 scale). The improvement in physical function was also sustained (five RCTs, 367 participants): physical function (SMD -0.37, 95% CI -0.57 to -0.16). Physical function was estimated to be 24 points on a 0- to 100-point scale (0 was no loss of physical function) in the control group, the improvement translated to a mean of 7 points (95% CI 4 to 13) compared with the control group.Only five of the 10 RCTs exclusively recruited people with symptomatic hip OA (419 participants). There was no significant difference in pain or physical function outcomes compared with five studies recruiting participants with hip or knee OA (130 participants). AUTHORS' CONCLUSIONS Pooling the results of these 10 RCTs demonstrated that land-based therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA.

The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey.

STUDY QUESTION To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease? SUMMARY ANSWER Many women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres. WHAT IS KNOWN ALREADY The existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only. STUDY DESIGN, SIZE, DURATION A cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries. PARTICIPANTS/MATERIALS, SETTING, METHODS Women diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women's Health) and the Short Form 36 version 2 (SF-36v2). MAIN RESULTS AND THE ROLE OF CHANCE Of 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosis had affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2. LIMITATIONS, REASONS FOR CAUTION The fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population. WIDER IMPLICATIONS OF THE FINDINGS This international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The WERF EndoCost study is funded by the World Endometriosis Research Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto.

Parent modeling and child food consumption

Obesity, among both children and adults, is a growing public health epidemic. One area of interest relates to how and why obesity is developing at such a rapid pace among children. Despite a broad consensus about how controlling feeding practices relate to child food consumption and obesity prevalence, much less is known about how non-controlling feeding practices, including modeling, relate to child food consumption. This study investigates how different forms of parent modeling (no modeling, simple modeling, and enthusiastic modeling) and parent adiposity relate to child food consumption, food preferences, and behaviors towards foods. Participants in this experimental study were 65 children (25 boys and 40 girls) aged 3-9 and their parents. Each parent was trained on how to perform their assigned modeling behavior towards a food identified as neutral (not liked, nor disliked) by their child during a pre-session food-rating task. Parents performed their assigned modeling behavior when cued during a ten-minute observation period with their child. Child food consumption (pieces eaten, grams eaten, and calories consumed) was measured and food behaviors (positive comments toward food and food requests) were recorded by event-based coding. After the session, parents self-reported on their height and weight, and children completed a post-session food-rating task. Results indicate that parent modeling (both simple and enthusiastic forms) did not significantly relate to child food consumption, food preferences, or food requests. However, enthusiastic modeling significantly increased the number of positive food comments made by children. Children's food consumption in response to parent modeling did not differ based on parent obesity status. The practical implications of this study are discussed, along with its strengths and limitations, and directions for future research.^

Goal-oriented self-adaptive hp-strategies for finite element analysis of electromagnetic scattering and radiation problems

In this paper, a fully automatic goal-oriented hp-adaptive finite element strategy for open region electromagnetic problems (radiation and scattering) is presented. The methodology leads to exponential rates of convergence in terms of an upper bound of an user-prescribed quantity of interest. Thus, the adaptivity may be guided to provide an optimal error, not globally for the field in the whole finite element domain, but for specific parameters of engineering interest. For instance, the error on the numerical computation of the S-parameters of an antenna array, the field radiated by an antenna, or the Radar Cross Section on given directions, can be minimized. The efficiency of the approach is illustrated with several numerical simulations with two dimensional problem domains. Results include the comparison with the previously developed energy-norm based hp-adaptivity.

Debating the European debt crisis: Government leadership, party ideology and supranational integration as focal points of parliamentary debates in Austria, Germany and the United Kingdom. ACES Cases No. 2012.3

Parliamentary debates about the resolution of the EU debt crisis seem to provide a good example for the frequently assumed “politicizationˮ of European governance. Against this background, the paper argues that in order to make sense of this assumption, a clearer differentiation of three thematic focal points of controversies – with regard to the assessment of government leadership, concerning the debate between competing party ideologies within the left/right dimension, and with regard to the assessment of supranational integration – is needed. Applying this threefold distinction, the paper uses a theory of differential Europeanization to explain differences in the thematic structure of debates in the Austrian Nationalrat, the British House of Commons, and the German Bundestag. Empirically, the paper is based on data gained from the computer-based coding of plenary debates about the resolution of the European debt crisis between 2010 and 2011.

Translation and norms

Translation norms are understood as internalized behavioural constraints which embody the values shared by a community. In the two main contributions it is argued that all decisions in the translation process are primarily governed by norms. The explanatory power of a norm-based theory of translation is then critically reflected upon in the debates and the responses.

Examining the process of regime change in the North Atlantic Treaty Organization: The divide between rhetoric and reality

The North Atlantic Treaty Organization (NATO) is a product of the Cold War through which its members organized their military forces for the purpose of collective defense against the common threat of Soviet-backed aggression. Employing the terminology of regime theory, the creation of NATO can be viewed as the introduction of an international security regime. Throughout the Cold War, NATO member states preserved their commitment to mutual defense while increasingly engaging in activities aimed at overcoming the division of Europe and promoting regional stability. The end of the Cold War has served as the catalyst for a new period of regime change as the Alliance introduced elements of a collective security regime by expanding its mandate to address new security challenges and reorganizing both its political and military organizational structures. ^ This research involves an interpretive analysis of NATO's evolution applying ideal theoretical constructs associated with distinct approaches to regime analysis. The process of regime change is investigated over several periods throughout the history of the Alliance in an effort to understand the Alliance's changing commitment to collective security. This research involves a review of regime theory literature, consisting of an examination of primary source documentation, including official documents and treaties, as well as a review of numerous secondary sources. This review is organized around a typology of power-based, organization-based, and norm-based approaches to regime analysis. This dissertation argues that the process of regime change within NATO is best understood by examining factors associated with multiple theoretical constructs. Relevant factors provide insights into the practice of collective security among NATO member states within Europe, while accounting for the inability of the NATO allies to build on the experience gained within Europe to play a more central role in operations outside of this region. This research contributes to a greater understanding of the nature of international regimes and the process of regime change, while offering recommendations aimed at increasing NATO's viability as a source of greater security and more meaningful international cooperation.^