Integration of clinical information systems in Saudi Arabian health care contexts: A grounded theory exploration

This research examined the implementation of clinical information system technology in a large Saudi Arabian health care organisation. The research was underpinned by symbolic interactionism and grounded theory methods informed data collection and analysis. Observations, a review of policy documents and 38 interviews with registered nurses produced in-depth data. Analysis generated three abstracted concepts that explained how imported technology increased practice and health care complexity rather than enhance quality patient care. The core category, Disseminating Change, also depicted a hierarchical and patriarchal culture that shaped the implementation process at the levels of government, organisation and the individual.

Suunnittelunäkemys metsäorganisaatioissa ja sen vaikutus tietojärjestelmälle asetettaviin vaatimuksiin

Department of Forest Resource Management in the University of Helsinki has in years 2004?2007 carried out so-called SIMO -project to develop a new generation planning system for forest management. Project parties are organisations doing most of Finnish forest planning in government, industry and private owned forests. Aim of this study was to find out the needs and requirements for new forest planning system and to clarify how parties see targets and processes in today's forest planning. Representatives responsible for forest planning in each organisation were interviewed one by one. According to study the stand-based system for managing and treating forests continues in the future. Because of variable data acquisition methods with different accuracy and sources, and development of single tree interpretation, more and more forest data is collected without field work. The benefits of using more specific forest data also calls for use of information units smaller than tree stand. In Finland the traditional way to arrange forest planning computation is divided in two elements. After updating the forest data to present situation every stand unit's growth is simulated with different alternative treatment schedule. After simulation, optimisation selects for every stand one treatment schedule so that the management program satisfies the owner's goals in the best possible way. This arrangement will be maintained in the future system. The parties' requirements to add multi-criteria problem solving, group decision support methods as well as heuristic and spatial optimisation into system make the programming work more challenging. Generally the new system is expected to be adjustable and transparent. Strict documentation and free source code helps to bring these expectations into effect. Variable growing models and treatment schedules with different source information, accuracy, methods and the speed of processing are supposed to work easily in system. Also possibilities to calibrate models regionally and to set local parameters changing in time are required. In future the forest planning system will be integrated in comprehensive data management systems together with geographic, economic and work supervision information. This requires a modular method of implementing the system and the use of a simple data transmission interface between modules and together with other systems. No major differences in parties' view of the systems requirements were noticed in this study. Rather the interviews completed the full picture from slightly different angles. In organisation the forest management is considered quite inflexible and it only draws the strategic lines. It does not yet have a role in operative activity, although the need and benefits of team level forest planning are admitted. Demands and opportunities of variable forest data, new planning goals and development of information technology are known. Party organisations want to keep on track with development. One example is the engagement in extensive SIMO-project which connects the whole field of forest planning in Finland.

Vibrations of a periodic rail-sleeper system excited by an oscillating stationary transverse force

The rail-sleeper system is idealized as an infinite, periodic beam-mass system. Use is made of the periodicity principle for the semi-infinite halves on either side of the forcing point for evaluation of the wave propagation constants and the corresponding modal vectors. It is shown that the spread of acceleration away from the forcing point depends primarily upon one of the wave propagation constants. However, all the four modal vectors (two for the left-hand side and two for the right-hand side) determine the driving point impedance of the rail-sleeper system, which in combination with the driving point impedance of the wheel (which is adopted from the preceding companion paper) determines the forces generated by combined surface roughness and the resultant accelerations. The compound one-third octave acceleration levels generated by typical roughness spectra are generally of the same order as the observed levels.

Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: A quasi-experimental study

Background There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). Methods A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Results Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196). Conclusions Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Design challenges for electronic medication administration record systems in residential aged care facilities: A formative evaluation

Introduction Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Mapping of fuelwood trees using geoinformatics

Rural population of India constitutes about 70% of the total population and traditional fuels account for 75% of the rural energy needs. Depletion of woodlands coupled with the persistent dependency on fuel wood has posed a serious problem for household energy provision in many parts. This study highlights that the traditional fuels still meet 85-95% of fuel needs in rural areas of Kolar district: people prefer fuel wood for cooking and agriculture residues for water heating and other purposes. However, rapid changes in land cover and land use in recent times have affected these traditional fuels availability necessitating inventorying, mapping and monitoring of bioresources for sustainable management of bioresources. Remote sensing data (Multispectal and Panchromatic), Geographic Information System (GIS), field surveys and non-destructive sampling were used to assess spatially the availability and demand of energy. Field surveys indicate that rural household depends on species such as Prosopis juliflora, Acacia nilotica, Acacia auriculiformis to meet fuel wood requirement for domestic activities. Hence, to take stock of fuel wood availability, mapping was done at species level (with 88% accuracy) considering villages as sampling units using fused multispectral and panchromatic data. (C) 2009 Elsevier Ltd. All rights reserved.

Kirkkoon kuuluminen Helsingin osa-alueilla

In Helsinki's evangelical lutheran congregations, the share of the people being members of that church compared with all the people living in their specific geographical areas varies from 62,4 per cent in Paavali to 80,7 per cent in Munkkiniemi. The boundaries of the congregations are about to be redrawn to level the differences in the congregations. In this thesis, the reasons of the differences in Helsinki s districts were studied closer. The data consisted of statistical information gathered from the Population Information System of Finland. It included information by age groups about the population register keeper, marital status, native tongue, level of education and gender in the end of 2005. Additional data was gathered from Helsinki Region Statistics web service. It included information about the dwelling, level of income and main activities of the inhabitants in the districts. The main method was stepwise linear regression. Minor methods were crosstabulation and correlation matrixes. The result of the study was a statistical model that explains 72,2 per cent of the variation of the shares in the congregations. The dependent variable was the share of the people being members of evangelical lutheran church in the dirstricts. The independent variables were the share of the people having other than Finnish or Swedish as their native tongue, the share of rented apartments, the shares of apartments including four rooms and a kitchen, the share of detached houses in the districts and the shares of women and people with no income in the districts. The independent variables present in the model depict the amount of foreigners, dwellings, gender and the level of income of the population. The high share of foreigners, people with no income and rented apartments explain the low share of the people being members of evangelical lutheran church. On the contrary, the high share of the people being members of evangelical lutheran church in the district is explained by the large apartments, detached houses and amount of women living there.

Periglasiaalisten ilmiöiden alueellinen mallintaminen subarktisessa ympäristössä

Periglacial processes act on cold, non-glacial regions where the landscape deveploment is mainly controlled by frost activity. Circa 25 percent of Earth's surface can be considered as periglacial. Geographical Information System combined with advanced statistical modeling methods, provides an efficient tool and new theoretical perspective for study of cold environments. The aim of this study was to: 1) model and predict the abundance of periglacial phenomena in subarctic environment with statistical modeling, 2) investigate the most import factors affecting the occurence of these phenomena with hierarchical partitioning, 3) compare two widely used statistical modeling methods: Generalized Linear Models and Generalized Additive Models, 4) study modeling resolution's effect on prediction and 5) study how spatially continous prediction can be obtained from point data. The observational data of this study consist of 369 points that were collected during the summers of 2009 and 2010 at the study area in Kilpisjärvi northern Lapland. The periglacial phenomena of interest were cryoturbations, slope processes, weathering, deflation, nivation and fluvial processes. The features were modeled using Generalized Linear Models (GLM) and Generalized Additive Models (GAM) based on Poisson-errors. The abundance of periglacial features were predicted based on these models to a spatial grid with a resolution of one hectare. The most important environmental factors were examined with hierarchical partitioning. The effect of modeling resolution was investigated with in a small independent study area with a spatial resolution of 0,01 hectare. The models explained 45-70 % of the occurence of periglacial phenomena. When spatial variables were added to the models the amount of explained deviance was considerably higher, which signalled a geographical trend structure. The ability of the models to predict periglacial phenomena were assessed with independent evaluation data. Spearman's correlation varied 0,258 - 0,754 between the observed and predicted values. Based on explained deviance, and the results of hierarchical partitioning, the most important environmental variables were mean altitude, vegetation and mean slope angle. The effect of modeling resolution was clear, too coarse resolution caused a loss of information, while finer resolution brought out more localized variation. The models ability to explain and predict periglacial phenomena in the study area were mostly good and moderate respectively. Differences between modeling methods were small, although the explained deviance was higher with GLM-models than GAMs. In turn, GAMs produced more realistic spatial predictions. The single most important environmental variable controlling the occurence of periglacial phenomena was mean altitude, which had strong correlations with many other explanatory variables. The ongoing global warming will have great impact especially in cold environments on high latitudes, and for this reason, an important research topic in the near future will be the response of periglacial environments to a warming climate.

Geographic Resources Decision Support System – an Open Source GIS

Fully structured and matured open source spatial and temporal analysis technology seems to be the official carrier of the future for planning of the natural resources especially in the developing nations. This technology has gained enormous momentum because of technical superiority, affordability and ability to join expertise from all sections of the society. Sustainable development of a region depends on the integrated planning approaches adopted in decision making which requires timely and accurate spatial data. With the increased developmental programmes, the need for appropriate decision support system has increased in order to analyse and visualise the decisions associated with spatial and temporal aspects of natural resources. In this regard Geographic Information System (GIS) along with remote sensing data support the applications that involve spatial and temporal analysis on digital thematic maps and the remotely sensed images. Open source GIS would help in wide scale applications involving decisions at various hierarchical levels (for example from village panchayat to planning commission) on economic viability, social acceptance apart from technical feasibility. GRASS (Geographic Resources Analysis Support System, http://wgbis.ces.iisc.ernet.in/grass) is an open source GIS that works on Linux platform (freeware), but most of the applications are in command line argument, necessitating a user friendly and cost effective graphical user interface (GUI). Keeping these aspects in mind, Geographic Resources Decision Support System (GRDSS) has been developed with functionality such as raster, topological vector, image processing, statistical analysis, geographical analysis, graphics production, etc. This operates through a GUI developed in Tcltk (Tool command language / Tool kit) under Linux as well as with a shell in X-Windows. GRDSS include options such as Import /Export of different data formats, Display, Digital Image processing, Map editing, Raster Analysis, Vector Analysis, Point Analysis, Spatial Query, which are required for regional planning such as watershed Analysis, Landscape Analysis etc. This is customised to Indian context with an option to extract individual band from the IRS (Indian Remote Sensing Satellites) data, which is in BIL (Band Interleaved by Lines) format. The integration of PostgreSQL (a freeware) in GRDSS aids as an efficient database management system.

Comparative Assessment of Techniques for Bioresource Monitoring Using GIS and Remote Sensing

Growing concern over the status of global and regional bioenergy resources has necessitated the analysis and monitoring of land cover and land use parameters on spatial and temporal scales. The knowledge of land cover and land use is very important in understanding natural resources utilization, conversion and management. Land cover, land use intensity and land use diversity are land quality indicators for sustainable land management. Optimal management of resources aids in maintaining the ecosystem balance and thereby ensures the sustainable development of a region. Thus sustainable development of a region requires a synoptic ecosystem approach in the management of natural resources that relates to the dynamics of natural variability and the effects of human intervention on key indicators of biodiversity and productivity. Spatial and temporal tools such as remote sensing (RS), geographic information system (GIS) and global positioning system (GPS) provide spatial and attribute data at regular intervals with functionalities of a decision support system aid in visualisation, querying, analysis, etc., which would aid in sustainable management of natural resources. Remote sensing data and GIS technologies play an important role in spatially evaluating bioresource availability and demand. This paper explores various land cover and land use techniques that could be used for bioresources monitoring considering the spatial data of Kolar district, Karnataka state, India. Slope and distance based vegetation indices are computed for qualitative and quantitative assessment of land cover using remote spectral measurements. Differentscale mapping of land use pattern in Kolar district is done using supervised classification approaches. Slope based vegetation indices show area under vegetation range from 47.65 % to 49.05% while distance based vegetation indices shoes its range from 40.40% to 47.41%. Land use analyses using maximum likelihood classifier indicate that 46.69% is agricultural land, 42.33% is wasteland (barren land), 4.62% is built up, 3.07% of plantation, 2.77% natural forest and 0.53% water bodies. The comparative analysis of various classifiers, indicate that the Gaussian maximum likelihood classifier has least errors. The computation of talukwise bioresource status shows that Chikballapur Taluk has better availability of resources compared to other taluks in the district.

Vegetation Status in Uttara Kannada District

Uttara Kannada is the only district in Karnataka, which has a forested area of about 80% and falls in the region of the Western Ghats. It is considered to be a very resourceful in terms of abundant natural resources and constitutes an important district in Karnataka. The forest resources of the district are under pressure as a large portion of the forested area has been converted to non-forestry activities since independence owing to the increased demands from human and animal population resulting in degradation of the forest ecosystem. This has led to poor productivity and regenerative capacity which is evident in the form of barren hill tops, etc in Coastal taluks of Uttara Kannada, entailing regular monitoring of the forest resources very essential. The classification of forest is a prerequisite for managing forest resources. Geographical Information System (GIS), allows the spatial and temporal analysis of the features of interest, and helps in solving the problem of deforestation and associated environmental and ecological problems. Spatial and temporal tools such as GIS and remotely sensed data helps the planners and decision makers in evolving the sustainable strategies for management and conservation of natural resources. Uttara Kannada district was classified on the basis of the land-use using supervised hard classifiers. The land use categories identified were urban area, water bodies, agricultural land, forest cover, and waste land. Further classification was carried out on the basis of forest type. The types of forest categorised were semi-evergreen, evergreen, moist deciduous, dry deciduous, plantations and scrub, thorny and non-forested area. The identified classes were correlated with the ground data collected during field visits. The observed results were compared with the historic data and the changes in the forest cover were analysed. From the assessment made it was clear that there has been a considerable degree of forest loss in certain areas of the district. It was also observed that plantations and social forests have increased drastically over the last fifteen years, and natural forests have declined.

Solar energy potential assessment using GIS

Renewable energy resources are those having a cycling time less than 100 years and are renewed by the nature and their supply exceeds the rate of consumption. Renewable energy systems use resources that are constantly replaced in nature and are usually less polluting. In order to tap the potential of renewable energy sources, there is a need to assess the availability of resources spatially as well as temporally. Geographic Information Systems (GIS) along with Remote Sensing (RS) helps in mapping on spatial and temporal scales of the resources and demand. The spatial database of resource availability and the demand would help in the regional energy planning. This paper discusses the application of geographical information system (GIS) to map the solar potential in Karnataka state, India. Regions suitable for tapping solar energy are mapped on the basis of global solar radiation data, and this analysis provides a picture of the potential. The study identifies that Coastal parts of Karnataka with the higher global solar radiation is ideally suited for harvesting solar energy. The potential analysis reveals that, maximum global solar radiation is in districts such as Uttara Kannada and Dakshina Kannada. Global solar radiation in Uttara Kannada during summer, monsoon and winter are 6.31, 4.40 and 5.48 kWh/sq.m, respectively. Similarly, Dakshina Kannada has 6.16, 3.89 and 5.21 kWh/sq.m during summer, monsoon and winter.

Vegetation Analysis in Uttara Kannada District Using GIS and Remote Sensing Techniques

Uttara Kannada is the only district in Karnataka, which has a forested area of about 80% and falls in the region of the Western Ghats. It is considered to be a very resourceful in terms of abundant natural resources and constitutes an important district in Karnataka. The forest resources of the district are under pressure as a large portion of the forested area has been converted to non-forestry activities since independence owing to the increased demands from human and animal population resulting in degradation of the forest ecosystem. This has led to poor productivity and regenerative capacity which is evident in the form of barren hill tops, etc in Coastal taluks of Uttara Kannada, entailing regular monitoring of the forest resources very essential. The classification of forest is a prerequisite for managing forest resources. Geographical Information System (GIS), allows the spatial and temporal analysis of the features of interest, and helps in solving the problem of deforestation and associated environmental and ecological problems. Spatial and temporal tools such as GIS and remotely sensed data helps the planners and decision makers in evolving the sustainable strategies for management and conservation of natural resources. Uttara Kannada district was classified on the basis of the land-use using supervised hard classifiers. The land use categories identified were urban area, water bodies, agricultural land, forest cover, and waste land. Further classification was carried out on the basis of forest type. The types of forest categorised were semi-evergreen, evergreen, moist deciduous, dry deciduous, plantations and scrub, thorny and non-forested area. The identified classes were correlated with the ground data collected during field visits. The observed results were compared with the historic data and the changes in the forest cover were analysed. From the assessment made it was clear that there has been a considerable degree of forest loss in certain areas of the district. It was also observed that plantations and social forests have increased drastically over the last fifteen years,and natural forests have declined.

Characterisation of Landscape with Forest Fragmentation Dynamics

Land cover (LC) and land use (LU) dynamics induced by human and natural processes play a major role in global as well as regional patterns of landscapes influencing biodiversity, hydrology, ecology and climate. Changes in LC features resulting in forest fragmentations have posed direct threats to biodiversity, endangering the sustainability of ecological goods and services. Habitat fragmentation is of added concern as the residual spatial patterns mitigate or exacerbate edge effects. LU dynamics are obtained by classifying temporal remotely sensed satellite imagery of different spatial and spectral resolutions. This paper reviews five different image classification algorithms using spatio-temporal data of a temperate watershed in Himachal Pradesh, India. Gaussian Maximum Likelihood classifier was found to be apt for analysing spatial pattern at regional scale based on accuracy assessment through error matrix and ROC (receiver operating characteristic) curves. The LU information thus derived was then used to assess spatial changes from temporal data using principal component analysis and correspondence analysis based image differencing. The forest area dynamics was further studied by analysing the different types of fragmentation through forest fragmentation models. The computed forest fragmentation and landscape metrics show a decline of interior intact forests with a substantial increase in patch forest during 1972-2007.

Monograph on Essentials in Limnology and GIS

Aquatic ecosystems are dynamic and depend on various interdependent and inter-related factors that are vital for their existence and in maintaining the ecological balance. Various anthropogenic activities have impaired ecological conditions in many ecosystems. This monograph gives an account of the essentials in limnology, which helps in understanding the nature and extent of the problems and also provides an insight into the use of Geographic Information System as an effective tool for resource inventorying, monitoring and management. The monograph consists of four chapters, and the first one gives an overall view of the inland aquatic bodies as complex ecological systems. It begins with the formation of lakes, and the various physical, chemical and biological factors that determine these ecosystems. The physical factors covered include morphometry, density, light, etc., and the lake chemistry determined by various anions and cations are discussed in detail. The biological parameters include phytoplankton, zooplankton, waterfowl and fish communities that play an important role in freshwater biodiversity, and are presented with diagrams for easy understanding. The monograph gives an in depth view of the lake zones, productivity, and seasonal changes in the lake community with various energy relationships. The concept of food chain and food web in an aquatic ecosystem is also presented with illustrations. Lastly, the various anthropogenic activities that have deteriorated the quality of water are listed with the restoration strategies.