Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults

Objective: To identify agreement levels between conventional longitudinal evaluation of change (post–pre) and patient-perceived change (post–then test) in health-related quality of life. Design: A prospective cohort investigation with two assessment points (baseline and six-month follow-up) was implemented. Setting: Community rehabilitation setting. Subjects: Frail older adults accessing community-based rehabilitation services. Intervention: Nil as part of this investigation. Main measures: Conventional longitudinal change in health-related quality of life was considered the difference between standard EQ-5D assessments completed at baseline and follow-up. To evaluate patient-perceived change a ‘then test’ was also completed at the follow-up assessment. This required participants to report (from their current perspective) how they believe their health-related quality of life was at baseline (using the EQ-5D). Patient-perceived change was considered the difference between ‘then test’ and standard follow-up EQ-5D assessments. Results: The mean (SD) age of participants was 78.8 (7.3). Of the 70 participants 62 (89%) of data sets were complete and included in analysis. Agreement between conventional (post–pre) and patient-perceived (post–then test) change was low to moderate (EQ-5D utility intraclass correlation coefficient (ICC)¼0.41, EQ-5D visual analogue scale (VAS) ICC¼0.21). Neither approach inferred greater change than the other (utility P¼0.925, VAS P¼0.506). Mean (95% confidence interval (CI)) conventional change in EQ-5D utility and VAS were 0.140 (0.045,0.236) and 8.8 (3.3,14.3) respectively, while patient-perceived change was 0.147 (0.055,0.238) and 6.4 (1.7,11.1) respectively. Conclusions: Substantial disagreement exists between conventional longitudinal evaluation of change in health-related quality of life and patient-perceived change in health-related quality of life (as measured using a then test) within individuals.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation : how strong is the association?

The purpose of this research is to report preliminary empirical evidence regarding the association between common physical performance measures and health-related quality of life (HRQoL) of hospitalized older adults recovering from illness and injury. Frequently, these patients do not return to premorbid levels of independence and physical ability. Rehabilitation for this population often focuses on improving physical functioning and mobility with the intention of maximizing their HRQoL for discharge and thereafter. For this reason, longitudinal use of physical performance measures as an indicator of improvement in physical functioning (and thus HRQoL) is common. Although this is a logical approach, there have been mixed results from previous investigations into the association between common measures of physical function and HRQoL amongst other adult patient populations.1,2 There has been no previous investigation reporting the association between HRQoL and a variety of common physical performance measures in hospitalized older adults.

Challenges of Malaysian developers in creating good interfaces for interactive courseware

There are many reasons why interface design for interactive courseware fails to support quality of learning experiences. The causes such as the level of interactivity, the availability of the interfaces to interact with the end users and a lack of deep knowledge about the role of interface design by the designers in the development process are most acknowledged. Related to this, as a creator for the interactive courseware, generally the developers expect the resources that they produced are effective, accurate and robust. However, rarely do the developers have the opportunity to create good interfaces with the emphasis on time consuming, money and skill. Thus, some challenges faces by them in the interface design development can’t be underestimated as well. Therefore, their perspective of the interactive courseware is important to ensure the material and also the features of the interactive courseware can facilitate teaching and learning activity. Within this context in mind, this paper highlights the challenges that faces by the Malaysian developer from the ten face to face interviewed data gathered. It discusses from the Malaysian developer perspectives that involved in the development of interface design for interactive courseware for the Smart School Project. Particularly, in creating such a great interfaces, the highlights challenges will present within the constraints of time, curriculum demand, and competencies of the development team.

Preparing quality teachers : making learning visible

Teacher quality is recognised as a lynchpin for education reforms internationally, and both Federal and State governments in Australia have turned their attention to teacher education institutions: the starting point for preparing quality teachers. Changes to policy and shifts in expectations impact on Faculties of Education, despite the fact that little is known about what makes a quality teacher preparation program effective. New accountability measures, mandated Professional Standards, and proposals to test all graduates before registration, mean that teacher preparation programs need capacity for flexibility and responsiveness. The risk is that undergraduate degree programs can become ‘patchwork quilts’ with traces of the old and new stitched together, sometimes at the expense of coherence and integrity. This paper provides a roadmap used by one large Faculty of Education in Queensland for reforming and reconceptualising the curriculum for a 4-year undergraduate program, in response to new demands from government and the professional bodies.

Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Variability of input parameters related to pollutants build-up in stormwater quality modelling

The variability of input parameters is the most important source of overall model uncertainty. Therefore, an in-depth understanding of the variability is essential for uncertainty analysis of stormwater quality model outputs. This paper presents the outcomes of a research study which investigated the variability of pollutants build-up characteristics on road surfaces in residential, commercial and industrial land uses. It was found that build-up characteristics vary highly even within the same land use. Additionally, industrial land use showed relatively higher variability of maximum build-up, build-up rate and particle size distribution, whilst the commercial land use displayed a relatively higher variability of pollutant-solid ratio. Among the various build-up parameters analysed, D50 (volume-median-diameter) displayed the relatively highest variability for all three land uses.

Discovering characteristics of stochastic collections of process models

Process models in organizational collections are typically modeled by the same team and using the same conventions. As such, these models share many characteristic features like size range, type and frequency of errors. In most cases merely small samples of these collections are available due to e.g. the sensitive information they contain. Because of their sizes, these samples may not provide an accurate representation of the characteristics of the originating collection. This paper deals with the problem of constructing collections of process models, in the form of Petri nets, from small samples of a collection for accurate estimations of the characteristics of this collection. Given a small sample of process models drawn from a real-life collection, we mine a set of generation parameters that we use to generate arbitrary-large collections that feature the same characteristics of the original collection. In this way we can estimate the characteristics of the original collection on the generated collections.We extensively evaluate the quality of our technique on various sample datasets drawn from both research and industry.

Establishing a quality franchise relationship in Taiwan : Investigating relationships between relationship quality, loyalty and cooperation

Franchised convenience stores successfully operate throughout Taiwan, but the convenience store market is approaching saturation point. Creating a cooperative long-term franchising relationship between franchisors and franchisees is essential to maintain the proportion of convenience stores...

Re-engineering project planning processes : a best practice model for managing project phase integration issues

Competitive markets are increasingly driving new initiatives for shorter cycle times resulting in increased overlapping of project phases. This, in turn, necessitates improving the interfaces between the different phases to be overlapped (integrated), thus allowing transfer of processes, information and knowledge from one individual or team to another. This transfer between phases, within and between projects, is one of the basic challenges to the philosophy of project management. To make the process transfer more transparent with minimal loss of momentum and project knowledge, this paper draws upon Total Quality Management (TQM) and Business Process Re-engineering (BPR) philosophies to develop a Best Practice Model for managing project phase integration. The paper presents the rationale behind the model development and outlines its two key parts; (1) Strategic Framework and (2) Implementation Plan. Key components of both the Strategic Framework and the Implementation Plan are presented and discussed.

Evaluating the influences of stakeholder management on construction project quality

The issue of ensuring that construction projects achieve high quality outcomes continues to be an important consideration for key project stakeholders. Although a lot of quality practices have been done within the industry, establishment and achievement of reasonable levels of quality in construction projects continues to be a problem. While some studies into the introduction and development of quality practices and stakeholder management in the construction industry have been undertaken separately, no major studies have so far been completed that examine in depth how quality management practices that specifically address stakeholders’ perspectives of quality can be utilised to contribute to the ultimate constructed quality of projects. This paper encompasses and summarizes a review of the literature related to previous research undertaken on quality within the industry, focuses on the benefits and shortcomings, together with examining the concept of integrating stakeholder perspectives of project quality for improvement of outcomes throughout the project lifecycle. Findings discussed in this paper reveal a pressing need for investigation, development and testing of a framework to facilitate better implementation of quality management practices and thus achievement of better quality outcomes within the construction industry. The framework will incorporate and integrate the views of stakeholders on what constitutes final project quality to be utilised in developing better quality management planning and systems aimed ultimately at achieving better project quality delivery.

Scaffolding large units for small group collaborative learning : a case study.

Undergraduates working in teams can be a problematic endeavour, sometimes exacerbated for the student by poor prior experiences, a predisposition to an individual orientation of assessment, and simply the busyness that now typifies the life of a student. But effort in pedagogical design is worthwhile where team work is often a prerequisite in terms of graduate capabilities, robust learning, increased motivation, and indeed in terms of equipping individuals for emergent knowledge-age work practice, often epitomised by collaborative effort in both blended and virtual contexts. Through an iterative approach, based extensively on the established literature, we have developed a successful scaffold which is workable with a large cohort group (n >800), such that it affords students the lived experience of being a part of a learning network. Individuals within teams work together, to develop individual components that are subsequently aggregated and reified to an overall team knowledge artefact. We describe our case and propose a pedagogical model of scaffolding based on three perspectives: conceptual, rule-based and community-driven. This model provides designers with guidelines for producing and refining assessment tasks for team-based learning.

Team role preference and online role play

Role play approaches have been used in online environments in an effort to create a mix of contested ideas and to promote participant engagement. While it is recognised that there is an aspect of ‘fun’ associated with role play there is a need to understand role assignment more rigorously than simply levels of reported participation and enjoyment. It is the contention of this paper that individuals are unlikely to be able to authentically play a role and, that in fact, there may be little purpose to contrived roles. Additionally, the literature has widely reported that personality factors, such as introversion and extroversion continue to be of significance in the way that individuals contribute in online contexts. The findings in the study reported in this paper confirm that introversion and extroversion do, indeed, play a role in the way individuals contribute in online environments. Thus, this paper argues that an active consideration needs to be given to individuals preferred (or natural) way of working even where use is made of online role play.

Building a software architecture for a human-robot team using the ORCA framework

This paper considers the problem of building a software architecture for a human-robot team. The objective of the team is to build a multi-attribute map of the world by performing information fusion. A decentralized approach to information fusion is adopted to achieve the system properties of scalability and survivability. Decentralization imposes constraints on the design of the architecture and its implementation. We show how a Component-Based Software Engineering approach can address these constraints. The architecture is implemented using Orca – a component-based software framework for robotic systems. Experimental results from a deployed system comprised of an unmanned air vehicle, a ground vehicle, and two human operators are presented. A section on the lessons learned is included which may be applicable to other distributed systems with complex algorithms. We also compare Orca to the Player software framework in the context of distributed systems.

Machine learning techniques to improve software quality

A significant proportion of the cost of software development is due to software testing and maintenance. This is in part the result of the inevitable imperfections due to human error, lack of quality during the design and coding of software, and the increasing need to reduce faults to improve customer satisfaction in a competitive marketplace. Given the cost and importance of removing errors improvements in fault detection and removal can be of significant benefit. The earlier in the development process faults can be found, the less it costs to correct them and the less likely other faults are to develop. This research aims to make the testing process more efficient and effective by identifying those software modules most likely to contain faults, allowing testing efforts to be carefully targeted. This is done with the use of machine learning algorithms which use examples of fault prone and not fault prone modules to develop predictive models of quality. In order to learn the numerical mapping between module and classification, a module is represented in terms of software metrics. A difficulty in this sort of problem is sourcing software engineering data of adequate quality. In this work, data is obtained from two sources, the NASA Metrics Data Program, and the open source Eclipse project. Feature selection before learning is applied, and in this area a number of different feature selection methods are applied to find which work best. Two machine learning algorithms are applied to the data - Naive Bayes and the Support Vector Machine - and predictive results are compared to those of previous efforts and found to be superior on selected data sets and comparable on others. In addition, a new classification method is proposed, Rank Sum, in which a ranking abstraction is laid over bin densities for each class, and a classification is determined based on the sum of ranks over features. A novel extension of this method is also described based on an observed polarising of points by class when rank sum is applied to training data to convert it into 2D rank sum space. SVM is applied to this transformed data to produce models the parameters of which can be set according to trade-off curves to obtain a particular performance trade-off.