Förändringsprogram i hälso- och sjukvården : Nätverkskonstruktioner som möjliggör och försvårar införandet av lean

Within the public sector great change efforts are currently made to meet future challenges. In the area of health care, change initiatives are implemented to enhance quality and efficiency. To this end, a lean change programme is being widely introduced in Sweden as well as internationally. The overriding aim of this study is to increase knowledge of what happens when change programmes, CP, such as lean are implemented in a healthcare organisation, HCO. Previous research has shown that the main obstacle to implementing CP in HCO:s is their complexity. However, the complexity has often been reduced, as different factors such as management, professions, organisation and control have been studied separately. To fully capture the complexity of the HCO the Actor Network Theory, ANT, was used in this study. In line with ANT, introducing lean can be described in terms of a translation process in which human and non-human actors are woven into a network. This approach allows for the incorporation of various factors in the study of a change process in a complex organisation. Drawing on ANT, this thesis explores how network constructions enable or impede change programmes. The approach is based on ethnographic monitoring of the implementation of lean in the Värmland county council public healthcare organisation. As a result of the holistic perspective, the study provides detailed descriptions of how complexity impacts on the implementation. It displays the relations enabling or impeding the implementation of CP and the methods actors use to establish and defend the relations. The contribution of the study is threefold. Empirically, the study monitors a HCO aiming to implement full-scale lean as philosophy, principle and tool. Methodologically, the study evaluates ANT as a methodological theory to study CP in a HCO. Finally, the domain-specific contribution of the study is its identification of the relations and methods that impact on lean deployment. 

Curricular training report: 7 months as a study coordinator at Blueclinical LTD

The present report describes in detail the activities undertaken under the coordination of clinical and observational studies during the curricular internship at Blueclinical Ltd., inserted in the Master of Pharmaceutical Biomedicine. Blueclinical Ltd.company operates in three different areas: R&D consultancy, management and coordination of trial centers, and a phase I unit. The curricular internship had the duration of seven months during which I was able to perform different tasks relating to coordination of clinical trials in Centro Hospitalar do Baixo Vouga, E.P.E., (CHBV) in Aveiro, Portugal. This academic internship allowed me to develop theoretical and practical skills in the field of clinical trials and observational studies. I also had the opportunity to further the knowledge I gained throughout my academic journey. During this internship, I had the opportunity to interact with different health professionals and develop my knowledge in the field of several therapeutic indications. I also could interact with distinct monitors and sponsors. This experience allowed me to improve time management, communication and problems resolution skills.

Percepção Ambiental em Museus Paisagens de Arte Contemporânea: a legibilidade dos museus Inhotim/Brasil e em Serralves/Portugal avaliada pelo público/visitante

This thesis nalyzes the wayfinding in Landscape Museum of Contemporary Art (MPAC), based on the Institute of Contemporary Art CACI, Minas Gerais, Brazil and the Museum of Contemporary Art of the Serralves Foundation, Porto, Portugal. The study focuses on the interrelationship of the public/visitors with the landscape, architecture and contemporary art museums in these, in order to understand visual perception and apprehension of such an environment for their users. For both were confronted documentation (visual and written) and people talk. The main hypothesis put forward is that the audience/visitor MPAC appreciates the interrelationship between the natural environment (park/garden) and built environment (the works of contemporary art and the galleries), giving equal value to both. To complement this, a second hypothesis is that during the visit to MPACS, visitors define their paths spontaneously, but strongly influenced by existing visual indicators (maps, signage and striking landscape elements), which facilitate the readability of space, which also contribute to the offered services and the experiences of similar institutions. The analytical basis of the research used the concepts of legibility (LYNCH, 2009), wayfinding (GIBSON, 2009; ARTHUR, PASSINI, 2002; WEISMAN, 1982), Experiential Cotinnum (TUAN, 1985), Space Bound (CRUZ PINTO, 2007) and habitus (BOURDIEU, 1992). Methodologically was used qualitative research (DEMO 2000) by means of a case study (YIN, 2005; STAKE, 1999) and participant observation (WHYTE, 2005). In the two institutions interviews with researchers and curators, behavior observation and questionnaires from employees, trainees, monitors and the public/visitor of the two museums were performed. Although partially referende the initial hypothesis, the research showed that the public/visitor value appears more natural environments, they experience a greater intensity and in addition to the factors listed in the second case, your perception and definition of paths suffer significant influence of emotional relations established with space. Generally the audience/visitor adapts easily to different demands of contemporary art exhibition in the two museums and the built environment (park/garden and museum) interferes with your reading path during the visit, perceived by the public/visitor condition as a factor that favors the enjoyment of works on different mounts (wayfinding), though often become a factor that hinders the legibility of the building and its built environment

Discurso científico na Rede Nacional de Educação e Ciência: modos de produzir ciência na atualidade

A ciência, alicerçada por seu método, suas técnicas, suas demonstrações e suas descobertas, desde sua emergência no século XVII, tem estado em pauta nas discussões sobre a produção do conhecimento. Por suas características – dogmática, quantificável, experimental e determinista –, a ciência constitui o campo de conhecimento que foi o grande regime de verdade na episteme da modernidade. Diferentes formas de conceber a ciência foram produzidas por estudiosos, filósofos e cientistas, como René Descartes, Francis Bacon, Paul Feyerabend, entre outros. Como campo teórico utilizamos os estudos de Michel Foucault. Partindo desses entendimentos, essa tese tem como objetivo investigar e problematizar o discurso de ciência produzido por seis grupos de cinco universidades do Rio Grande do Sul pertencentes à Rede Nacional de Educação e Ciência: Novos Talentos da Rede Pública (RNEC/NT). Essa Rede existe há quase 20 anos e é composta por grupos de pesquisadores de diferentes universidades, instituições de pesquisa e institutos federais do país e visa a melhoria das condições de ensino de ciências a jovens carentes de todo o país, desenvolvendo metodologias que facilitam o aprendizado e desmistifiquem a ciência. Os grupos dessa Rede desenvolvem atividades como cursos para professores e estudantes da Educação Básica e estágios em laboratórios de pesquisa para o mesmo público alvo. Para a produção dos dados, foram realizadas visitas aos seis grupos analisados, nas quais foram feitas entrevistas com coordenadores e monitores dos grupos e foi feito o acompanhamento de um curso para professores e/ou estudantes de Educação Básica de cada grupo. Essas entrevistas e o curso observado foram gravados em vídeo e transcritos na forma de texto. Como metodologia de análise utilizamos conceitos da análise de discurso foucaultiano como discurso, enunciado e enunciação. Verificamos que há um discurso inicial de ciência na emergência da RNEC/NT pautado em três enunciados: fazer ciência envolve um caminho e a geração de produtos “novos” publicáveis; a formação do cientista na díade inatismo e empirismo; formação de cientistas pela inclusão social. Esse discurso inicial é atualizado nos grupos pesquisados por meio de diferentes enunciações que enfocam tanto um entendimento de ciência pelo uso do método científico, do empirismo e da razão, quanto um afrouxamento no entendimento de ciência ao vinculá-la à educação e ao questionamento do que é dado como naturalizado e verdadeiro, o que parece ter afinidade com as configurações ditas líquidas da contemporaneidade. Em relação aos cursos, para a maioria dos grupos, o discurso científico é vinculado aquele produzido no espaço do laboratório com suas técnicas e padrões, típico do entendimento moderno. Nesses cursos vemos ainda aparecer um modo de trabalhar, ensinar e apresentar essa ciência para os professores ou estudantes participantes, mostrando a presença de um discurso pedagógico atrelado ao científico. Como resultado, defendemos a tese de que há uma diversidade discursiva sobre a ciência nos grupos do sul da RNEC/NT que, ao ser atualizada e colocada em operação, é interpelada por elementos de um discurso pedagógico.

Studies of Protein-Protein and Protein-Water Interactions by Small Angle X-Ray Scattering, Terahertz Spectroscopy, ASMOS, And Computer Simulation

The protein folding problem has been one of the most challenging subjects in biological physics due to its complexity. Energy landscape theory based on statistical mechanics provides a thermodynamic interpretation of the protein folding process. We have been working to answer fundamental questions about protein-protein and protein-water interactions, which are very important for describing the energy landscape surface of proteins correctly. At first, we present a new method for computing protein-protein interaction potentials of solvated proteins directly from SAXS data. An ensemble of proteins was modeled by Metropolis Monte Carlo and Molecular Dynamics simulations, and the global X-ray scattering of the whole model ensemble was computed at each snapshot of the simulation. The interaction potential model was optimized and iterated by a Levenberg-Marquardt algorithm. Secondly, we report that terahertz spectroscopy directly probes hydration dynamics around proteins and determines the size of the dynamical hydration shell. We also present the sequence and pH-dependence of the hydration shell and the effect of the hydrophobicity. On the other hand, kinetic terahertz absorption (KITA) spectroscopy is introduced to study the refolding kinetics of ubiquitin and its mutants. KITA results are compared to small angle X-ray scattering, tryptophan fluorescence, and circular dichroism results. We propose that KITA monitors the rearrangement of hydrogen bonding during secondary structure formation. Finally, we present development of the automated single molecule operating system (ASMOS) for a high throughput single molecule detector, which levitates a single protein molecule in a 10 µm diameter droplet by the laser guidance. I also have performed supporting calculations and simulations with my own program codes.

Real-time analytics on large dynamic graphs

In today's fast-paced and interconnected digital world, the data generated by an increasing number of applications is being modeled as dynamic graphs. The graph structure encodes relationships among data items, while the structural changes to the graphs as well as the continuous stream of information produced by the entities in these graphs make them dynamic in nature. Examples include social networks where users post status updates, images, videos, etc.; phone call networks where nodes may send text messages or place phone calls; road traffic networks where the traffic behavior of the road segments changes constantly, and so on. There is a tremendous value in storing, managing, and analyzing such dynamic graphs and deriving meaningful insights in real-time. However, a majority of the work in graph analytics assumes a static setting, and there is a lack of systematic study of the various dynamic scenarios, the complexity they impose on the analysis tasks, and the challenges in building efficient systems that can support such tasks at a large scale. In this dissertation, I design a unified streaming graph data management framework, and develop prototype systems to support increasingly complex tasks on dynamic graphs. In the first part, I focus on the management and querying of distributed graph data. I develop a hybrid replication policy that monitors the read-write frequencies of the nodes to decide dynamically what data to replicate, and whether to do eager or lazy replication in order to minimize network communication and support low-latency querying. In the second part, I study parallel execution of continuous neighborhood-driven aggregates, where each node aggregates the information generated in its neighborhoods. I build my system around the notion of an aggregation overlay graph, a pre-compiled data structure that enables sharing of partial aggregates across different queries, and also allows partial pre-computation of the aggregates to minimize the query latencies and increase throughput. Finally, I extend the framework to support continuous detection and analysis of activity-based subgraphs, where subgraphs could be specified using both graph structure as well as activity conditions on the nodes. The query specification tasks in my system are expressed using a set of active structural primitives, which allows the query evaluator to use a set of novel optimization techniques, thereby achieving high throughput. Overall, in this dissertation, I define and investigate a set of novel tasks on dynamic graphs, design scalable optimization techniques, build prototype systems, and show the effectiveness of the proposed techniques through extensive evaluation using large-scale real and synthetic datasets.

Optimization and improvement of NSCU 1.0. Universal Functional Tester produced by Evoleo Technologi

The aim of the project was to improve an existing testing machine that is produced by the company EVOLEO Technologies. New conceptions of each part have been invented in order to produce an innovative unit that combines optimal segments from the old construction with the new, improved ones. The machine is meant to be testing different kind of devices that use specific elements like: buttons, knobs, monitors. The main purpose is to create various concepts of components that could be changed in order to lower the cost, weight or to simplify the operating process. Figure 1. shows the already existing discussed device.

Understanding and validating accelerometry as a measure of physical activity in children with intellectual disabilities

Background Physical activity in children with intellectual disabilities is a neglected area of study, which is most apparent in relation to physical activity measurement research. Although objective measures, specifically accelerometers, are widely used in research involving children with intellectual disabilities, existing research is based on measurement methods and data interpretation techniques generalised from typically developing children. However, due to physiological and biomechanical differences between these populations, questions have been raised in the existing literature on the validity of generalising data interpretation techniques from typically developing children to children with intellectual disabilities. Therefore, there is a need to conduct population-specific measurement research for children with intellectual disabilities and develop valid methods to interpret accelerometer data, which will increase our understanding of physical activity in this population. Methods Study 1: A systematic review was initially conducted to increase the knowledge base on how accelerometers were used within existing physical activity research involving children with intellectual disabilities and to identify important areas for future research. A systematic search strategy was used to identify relevant articles which used accelerometry-based monitors to quantify activity levels in ambulatory children with intellectual disabilities. Based on best practice guidelines, a novel form was developed to extract data based on 17 research components of accelerometer use. Accelerometer use in relation to best practice guidelines was calculated using percentage scores on a study-by-study and component-by-component basis. Study 2: To investigate the effect of data interpretation methods on the estimation of physical activity intensity in children with intellectual disabilities, a secondary data analysis was conducted. Nine existing sets of child-specific ActiGraph intensity cut points were applied to accelerometer data collected from 10 children with intellectual disabilities during an activity session. Four one-way repeated measures ANOVAs were used to examine differences in estimated time spent in sedentary, moderate, vigorous, and moderate to vigorous intensity activity. Post-hoc pairwise comparisons with Bonferroni adjustments were additionally used to identify where significant differences occurred. Study 3: The feasibility on a laboratory-based calibration protocol developed for typically developing children was investigated in children with intellectual disabilities. Specifically, the feasibility of activities, measurements, and recruitment was investigated. Five children with intellectual disabilities and five typically developing children participated in 14 treadmill-based and free-living activities. In addition, resting energy expenditure was measured and a treadmill-based graded exercise test was used to assess cardiorespiratory fitness. Breath-by-breath respiratory gas exchange and accelerometry were continually measured during all activities. Feasibility was assessed using observations, activity completion rates, and respiratory data. Study 4: Thirty-six children with intellectual disabilities participated in a semi-structured school-based physical activity session to calibrate accelerometry for the estimation of physical activity intensity. Participants wore a hip-mounted ActiGraph wGT3X+ accelerometer, with direct observation (SOFIT) used as the criterion measure. Receiver operating characteristic curve analyses were conducted to determine the optimal accelerometer cut points for sedentary, moderate, and vigorous intensity physical activity. Study 5: To cross-validate the calibrated cut points and compare classification accuracy with existing cut points developed in typically developing children, a sub-sample of 14 children with intellectual disabilities who participated in the school-based sessions, as described in Study 4, were included in this study. To examine the validity, classification agreement was investigated between the criterion measure of SOFIT and each set of cut points using sensitivity, specificity, total agreement, and Cohen’s kappa scores. Results Study 1: Ten full text articles were included in this review. The percentage of review criteria met ranged from 12%−47%. Various methods of accelerometer use were reported, with most use decisions not based on population-specific research. A lack of measurement research, specifically the calibration/validation of accelerometers for children with intellectual disabilities, is limiting the ability of researchers to make appropriate and valid accelerometer use decisions. Study 2: The choice of cut points had significant and clinically meaningful effects on the estimation of physical activity intensity and sedentary behaviour. For the 71-minute session, estimations for time spent in each intensity between cut points ranged from: sedentary = 9.50 (± 4.97) to 31.90 (± 6.77) minutes; moderate = 8.10 (± 4.07) to 40.40 (± 5.74) minutes; vigorous = 0.00 (± .00) to 17.40 (± 6.54) minutes; and moderate to vigorous = 8.80 (± 4.64) to 46.50 (± 6.02) minutes. Study 3: All typically developing participants and one participant with intellectual disabilities completed the protocol. No participant met the maximal criteria for the graded exercise test or attained a steady state during the resting measurements. Limitations were identified with the usability of respiratory gas exchange equipment and the validity of measurements. The school-based recruitment strategy was not effective, with a participation rate of 6%. Therefore, a laboratory-based calibration protocol was not feasible for children with intellectual disabilities. Study 4: The optimal vertical axis cut points (cpm) were ≤ 507 (sedentary), 1008−2300 (moderate), and ≥ 2301 (vigorous). Sensitivity scores ranged from 81−88%, specificity 81−85%, and AUC .87−.94. The optimal vector magnitude cut points (cpm) were ≤ 1863 (sedentary), ≥ 2610 (moderate) and ≥ 4215 (vigorous). Sensitivity scores ranged from 80−86%, specificity 77−82%, and AUC .86−.92. Therefore, the vertical axis cut points provide a higher level of accuracy in comparison to the vector magnitude cut points. Study 5: Substantial to excellent classification agreement was found for the calibrated cut points. The calibrated sedentary cut point (ĸ =.66) provided comparable classification agreement with existing cut points (ĸ =.55−.67). However, the existing moderate and vigorous cut points demonstrated low sensitivity (0.33−33.33% and 1.33−53.00%, respectively) and disproportionately high specificity (75.44−.98.12% and 94.61−100.00%, respectively), indicating that cut points developed in typically developing children are too high to accurately classify physical activity intensity in children with intellectual disabilities. Conclusions The studies reported in this thesis are the first to calibrate and validate accelerometry for the estimation of physical activity intensity in children with intellectual disabilities. In comparison with typically developing children, children with intellectual disabilities require lower cut points for the classification of moderate and vigorous intensity activity. Therefore, generalising existing cut points to children with intellectual disabilities will underestimate physical activity and introduce systematic measurement error, which could be a contributing factor to the low levels of physical activity reported for children with intellectual disabilities in previous research.

Detecting Botnets Through Log Correlation

Botnets, which consist of thousands of compromised machines, can cause a significant threat to other systems by launching Distributed Denial of Service attacks, keylogging, and backdoors. In response to this threat, new effective techniques are needed to detect the presence of botnets. In this paper, we have used an interception technique to monitor Windows Application Programming Interface system calls made by communication applications. Existing approaches for botnet detection are based on finding bot traffic patterns. Our approach does not depend on finding patterns but rather monitors the change of behaviour in the system. In addition, we will present our idea of detecting botnet based on log correlations from different hosts.

Birth defects in South Carolina

Birth defects are a leading cause of infant mortality. Additionally, babies born with birth defects who survive infancy have a greater chance of illness and long term disability than babies without birth defects. The causes can involve genetic (such as chromosomal anomalies) or environmental (such as lead exposure during pregnancy) factors, or a combination of these factors. However, in about 70 percent of cases of birth defects, the causes are unknown. The South Carolina Birth Defects Program began in July 2006 after passage of the S.C. Birth Defects Act. This law mandates active surveillance of major structural birth defects identified prenatally through age two. South Carolina monitors over 50 birth defects recommended by the Centers for Disease Control and Prevention, National Birth Defects Prevention Network.