A KM perspective on implementing an electronic patient record within an NHS hospital

The Electronic Patient Record (EPR) is being developed by many hospitals in the UK and across the globe. We class an EPR system as a type of Knowledge Management System (KMS), in that it is a technological tool developed to support the process of knowledge management (KM). Healthcare organisations aim to use these systems to provide a vehicle for more informed and improved clinical decision making thereby delivering reduced errors and risks, enhanced quality and consequently offering enhanced patient safety. Finding an effective way for a healthcare organisation to practically implement these systems is essential. In this study we use the concept of the business process approach to KM as a theoretical lens to analyse and explore how a large NHS teaching hospital developed, executed and practically implemented an EPR system. This theory advocates the importance of taking into account all organizational activities - the business processes - in considering any KM initiatives. Approaching KM through business processes allows for a more holistic view of the requirements across a process: emphasis is placed on how particular activities are performed, how they are structured and what knowledge demanded and not just supplied across each process. This falls in line with the increased emphasis in healthcare on patient-centred approaches to care delivery. We have found in previous research that hospitals are happy with the delivery of patient care being referred to as their 'business'. A qualitative study was conducted over a two and half year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non- participant observation of meetings and documentary data. We believe that the inclusion of patients within the study may well be the first time this has been done in examining the implementation of a KMS. The theoretical propositions strategy was used as the overarching approach for data analysis. Here Initial theoretical research themes and propositions were used to help shape and organise the case study analysis. This paper will present preliminary findings about the hospital's business strategy and its links to the KMS strategy and process.

Do educators need educating?

Actual text: I was recently at the Spanish College of Optometry biennial conference and attended a meeting of contact lens lecturers from around Spain and Portugal. We discussed various ideas, mainly about how to share good practice and improve standards. What came to my mind was ‘is there a blueprint for training trainers?’ Well probably not but there are many things that we need to acknowledge such as the way students learn for example. Many educators themselves were taught by lecturers who would write on a blackboard or use acetate on an overhead projector, then came the 35 mm slide era followed by the Powerpoint era. More recently there is a move towards a much more integrated approach of various teaching methods. At my university our contact lens and anterior eye lectures generally follow a format where a narrated Powerpoint lecture is uploaded onto our internal virtual learning environment. This narrated version of the slides is designed to give the didactic element of the topic. The students listen to that before attending an interactive seminar on that topic. The seminar is also recorded so that students can listen to that afterwards. The seminar is designed to give additional information, such as case reports, or to clarify key points or for live demonstrations. It is a good way of doubling the contact time with the students without imposing further on an already packed formal timetable as the students can work in their own time. One problem that we noticed with this approach was that attendance can vary. If the students feel that they will gain something from the interactive seminar then they are more likely to attend – exam tips usually win them over! At the Spanish meeting the educators decided that they wanted to have regular meetings. The industry colleagues in attendance said that they were happy to help but could not necessarily give money, but they could offer meeting rooms, pay for lunch and evening meals. They even said that that they were happy to host meetings and invite other companies too (except to manufacturing plants). In the UK the British Committee of Contact Lens Educators (BUCCLE) meets for one day on three occasions in the year. The American Optometric Contact Lens Educators (AOCLE) meets annually at a three day event. Both these organisations get some help from industry. BUCCLE usually has one of its meetings at a university, one at a company training centre/manufacturing plant/national headquarters and one meeting the day before the BCLA annual conference. BUCCLE usually has its pre-BCLA meeting in conjunction with the International Association of Contact Lens Educators (IACLE). So when educators meet what would they discuss; well probably the focus should be on education rather than actual contact lens knowledge. For example sharing ideas on how to teach toric lens fitting would be better than discussing the actual topic of toric lenses itself. Most universities will have an education department with an expert who could share ideas on how to use the internet in teaching or how to structure lectures or assessments etc. In the past I have helped with similar training programmes in other countries and sharing good practice in pedagogy is always a popular topic. Anyone who is involved in education in the field of contact lenses should look at the IACLE web page and look out for the IACLE World Congress in 2015 in the days preceding the BCLA. Finally, IACLE, AOCLE and BUCCLE all exist as a result of generous educational grants from contact lens companies and anyone interested in finding out more about should refer to their respective web pages.

Editorial

Full text: Welcome to issue 1 of 2012 and a belated Happy New Year to all CLAE readers and BCLA members. The hardest job I had for this issue was to decide which papers to include and which papers to hang on to and save for issue 2 of 2012. At the end of December when I was choosing the content for this issue there were additional 5 papers that could have been included. The final choice came down to various factors; such as first come first served – i.e. which papers had been ready and waiting the longest; secondly which papers had been submitted the earliest; are there similar papers so that it may be beneficial to publish them alongside this paper; and also was the content something which needed to be out there quicker than other papers as it was a current hot topic? But it should be noted that once papers are proofed and deemed ready by authors they are published in the epub version and put online for others to see in their final version. An epub version is given a DOI number (digital object identifier) so that it can be cited by other authors. Apart from being on line the only other difference is that an epub version is essentially waiting to be assigned to a particular issue. So those papers that are being held off for issue 2 of this year are actually already available for you to read (and cite) on line. In this issue there is a paper related to the cost of different contact lens replacement schedules – this may be a topic that is debated more in the future since as a society we are thinking more ‘green’ and all trying to help by reducing our carbon footprint, whether that be by recycling or using less in the first place. A timely review paper on the management of allergic eye disease may help us to better manage those patients we see in the spring with pollen allergies. We have two papers looking at different aspects in keratoconus patients, another looking at a modified fluoret strip and its application in measuring tear break up time and a review paper on corneal erosions. Another interesting paper comes from Professor Harminder Dua and his team. Professor Dua is the UK Royal College of Ophthalmologists’ president and has been interested in corneal anatomy and physiology for much of his research career. Finally, an unusual case of an ocular injury related to a snake bite. Overall I would say there is enough to sink your ‘fangs’ into! Finally, it gives me great pleasure in announcing the newest person to join our Editorial Board, Dr Florence Malet. Dr Malet is an Ophthalmologist and since September 2000 she has been at the Bordeaux Hospital in France developing the Contact Lens Unit of in the Ophthalmology University Department. She is ex-president of the French Contact Lens Society and president of the European Contact Lens Society of Ophthalmologists.

A rule-based approach to implicit emotion detection in text

Most research in the area of emotion detection in written text focused on detecting explicit expressions of emotions in text. In this paper, we present a rule-based pipeline approach for detecting implicit emotions in written text without emotion-bearing words based on the OCC Model. We have evaluated our approach on three different datasets with five emotion categories. Our results show that the proposed approach outperforms the lexicon matching method consistently across all the three datasets by a large margin of 17–30% in F-measure and gives competitive performance compared to a supervised classifier. In particular, when dealing with formal text which follows grammatical rules strictly, our approach gives an average F-measure of 82.7% on “Happy”, “Angry-Disgust” and “Sad”, even outperforming the supervised baseline by nearly 17% in F-measure. Our preliminary results show the feasibility of the approach for the task of implicit emotion detection in written text.

The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample:an eye-tracking study

This study aimed to: i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; ii) examine if the bias occurs during initial orientation or later strategic processing; and iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional deployment was continuously monitored using an eye-tracker. They subsequently identified the emotion portrayed in a separate series of faces. The highest (n=18) and lowest scorers (n=17) on the Eating Disorders Inventory (EDI) were compared on the attention and facial emotion recognition tasks. Those with relatively high scores exhibited impaired facial emotion recognition, confirming previous findings in similar non-clinical samples. They also displayed biased attention away from emotional faces during later strategic processing, which is consistent with previously observed impairments in clinical samples. These differences were related to drive-for-thinness. Although we found no evidence of a bias towards angry faces, it is plausible that the observed impairments in emotion recognition and avoidance of emotional faces could disrupt social functioning and act as a risk factor for the development of eating disorders.

Dissociation of detection and evaluation of facial expressions in adolescence

Holistic face perception, i.e. the mandatory integration of featural information across the face, hasbeen considered to play a key role when recognizing emotional face expressions (e.g., Tanaka et al.,2002). However, despite their early onset holistic processing skills continue to improvethroughout adolescence (e.g., Schwarzer et al., 2010) and therefore might modulate theevaluation of facial expressions. We tested this hypothesis using an attentional blink (AB)paradigm to compare the impact of happy, fearful and neutral faces in adolescents (10–13 years)and adults on subsequently presented neutral target stimuli (animals, plants and objects) in a rapidserial visual presentation stream. Adolescents and adults were found to be equally reliable whenreporting the emotional expression of the face stimuli. However, the detection of emotional butnot neutral faces imposed a significantly stronger AB effect on the detection of the neutral targetsin adults compared to adolescents. In a control experiment we confirmed that adolescents ratedemotional faces lower in terms of valence and arousal than adults. The results suggest a protracteddevelopment of the ability to evaluate facial expressions that might be attributed to the latematuration of holistic processing skills.

The role of contingency and gaze direction in the emergence of social referencing

The current study assessed the importance of infant detection of contingency and head and eye gaze direction in the emergence of social referencing. Five- to six-month-old infants' detection of affect-object relations and subsequent manual preferences for objects paired with positive expressions were assessed. In particular, the role of contingency between toys' movements and an actress's emotional expressions as well as the role of gaze direction toward the toys' location were examined. Infants were habituated to alternating films of two toys each paired with an actress's affective expression (happy and fearful) under contingent or noncontingent and gaze congruent or gaze incongruent conditions. Results indicated that gaze congruence and contingency between toys' movements and a person's affective expressions were important for infant perception of affect-object relations. Furthermore, infant perception of the relation between affective expressions and toys translated to their manual preferences for the 3-dimensional toys. Infants who received contingent affective responses to the movements of the toys spent more time touching the toy that was previously paired with the positive expression. These findings demonstrate the role of contingency and gaze direction in the emergence of social referencing in the first half year of life.^

Adult Alternatives for Social Drinking: A Direction

In their survey/study - Adult Alternatives for Social Drinking: A Direction - by John Dienhart and Sandra Strick, Assistant Professors, Department of Restaurant, Hotel and Institutional Management, Purdue University, Dienhart and Strick begin with: “Changes in consumer habits have brought about a change in the business of selling alcoholic drinks and have impacted upon hotel food and beverage operations. The authors surveyed a sample of hotel corporate food and beverage directors to ascertain how they are handling this challenge.” Dienhart and Strick declare that the alcoholic beverage market, sale and consumption thereof, has taken a bit of a hit in contemporary society. “Even to the casual observer, it's obvious that the bar and beverage industry has undergone a great deal of change in the past few years,” say the authors. “Observations include a change in the types of drinks people are ordering, as well as a decrease in the number of drinks being sold,” they qualify. Dienhart and Strick allude to an increase in the federal excise tax, attacks from alcohol awareness groups, the diminished capacity of bars and restaurants to offer happy hours, increased liability insurance premiums as well as third-party liability issues, and people’s awareness of their own mortality as some of the reasons for the change. To quantify some empirical data on beverage consumption the Restaurant, Hotel, and Institutional Management Department of Purdue University conducted a study “… to determine if observed trends could be documented with hard data.” In regards to the subject, the study asks and answers a lot of interesting questions with the results presented to concerned followers via percentages. Typical of the results are: “When asked whether the corporation experienced a change in alcoholic sales in the past year, 67 percent reported a decrease in the amount of alcohol sold.” “Sixty-two percent of the respondents reported an increase in non-alcoholic sales over the past year. The average size of the increase was 8 percent. What Dienhart and Strick observe is that the decrease in alcoholic beverage consumption has resulted in a net increase for non-alcoholic beverage consumption. What are termed specialty drinks are gaining a foothold in the market, say the authors. “These include traditional cocktails made with alcohol-free products, as well as creative new juice based drinks, cream based drinks, carbonated beverages, and heated drinks,” say Dienhart and Strick by way of citation . Another result of the non-alcoholic consumption trend is the emergence of some novel marketing approaches by beer, wine, and spirits producers, including price increases on their alcohol based beverages as well as the introduction of faux alcoholic drinks like non-alcoholic beer and wine. Who or what is the big winner in all of this? That distinction might go to bottled water!

Perceivers' impressions of self -presentation tactics: The effects of age and gender

Eighty-four young and 84 older men and women participants, read scenarios in which a male or female target uses either a self-enhancement or a self-deprecation tactic to present him/herself in front of either a close friend or a new acquaintance. Then participants i.e., perceivers) rated their impressions of the self-enhancing or self-deprecating target on six scales: likable, self-knowledgeable, honest, depressed, happy, and anxious. Overall, both young and old perceivers gave more favorable ratings to self-enhancing targets than to self-deprecating targets. Both young and old perceivers' impressions did not differ for a target who presented him/herself in front of a friend or in front of an acquaintance. Also, perceivers completed Singelis' (1994) Self-Construal Measurement, which measures both interdependent and independent self-construals. As predicted, older perceivers had a higher level of interdependent self-construal than did young perceivers. Unexpectedly, female perceivers had a higher level of independent self-construal than did male perceivers. Neither the age-related nor gender-related differences in self-construals were associated with any age-related or gender-related differences in perceivers' impressions of the self-enhancing and self-deprecating targets. That is, the moderator effects of self-construals on the relationships between self-presentation tactic conditions and ratings of targets were not-significant. ^

The Enchanter's Spell: J.R.R. Tolkien's Mythopoetic Response to Modernism

J.R.R. Tolkien was not only an author of fantasy but also a philologist who theorized about myth. Theorists have employed various methods of analyzing myth, and this thesis integrates several analyses, including Tolkien’s. I address the roles of doctrine, ritual, cross-cultural patterns, mythic expressions in literature, the literary effect of myth, evolution of language and consciousness, and individual invention over inheritance and diffusion. Beyond Tolkien’s English and Catholic background, I argue for eclectic influence on Tolkien, including resonance with Buddhism. Tolkien views mythopoeia, literary mythmaking, in terms of sub-creation, human invention in the image of God as creator. Key mythopoetic tools include eucatastrophe, the happy ending’s sudden turn to poignant joy, and enchantment, the realization of imagined wonder, which is epitomized by the character of Tom Bombadil and contrasted with modernist techno-magic seeking to alter and dominate the world. I conclude by interpreting Tolkien’s mythmaking as a form of mysticism.

Awards

Charles Perry and Two Men Holding Happy Birthday Cake for Congressman Lehman. Charles Edward Perry (Chuck), 1937-1999, was the founding president of Florida International University in Miami, Florida. He grew up in Logan County, West Virginia and received his bachelor's and masters's degrees from Bowling Green State University. He married Betty Laird in 1960. In 1969, at the age of 32, Perry was the youngest president of any university in the nation. The name of the university reflects Perry’s desire for a title that would not limit the scope of the institution and would support his vision of having close ties to Latin America. Perry and a founding corps opened FIU to 5,667 students in 1972 with only one large building housing six different schools. Perry left the office of President of FIU in 1976 when the student body had grown to 10,000 students and the university had six buildings, offered 134 different degrees and was fully accredited. Charles Perry died on August 30, 1999 at his home in Rockwall, Texas. He is buried on the FIU campus in front of the Graham Center entrance.

The (Wo)Man in the Masque: Cross-Dressing as Disguise in Early Modern English Literature

Characters’ identities are integral to how audiences relate to them. But what happens when the character suddenly alters his or her outward appearance? Are they still the same person? This thesis seeks to argue that disguise does not alter a character’s true nature, as evidenced by Pyrocles in Sir Philip Sidney’s The Countess of Pembroke’s Arcadia and the Prince in Margaret Cavendish’s The Convent of Pleasure. Both Pyrocles’ suit of Philoclea and the Prince’s suit of Lady Happy are successful because, however subversive they appear at first, they ultimately adhere to societal norms of the time. The relationship between the cross-dressed prince and his love interest in both works only appears to subvert heteronormative expectations for the time, but ultimately adheres to these societal norms once the disguised character’s true identity is revealed to his chosen partner.

Das saudades que se tem: a representação paterna na escrita autobiográfica de Bartolomeu Campos de Queirós

In our work, we analyze some works of Bartolomeu Campos de Queirós that compose the “autobiographical cycle”, especially those ones that bring the image of father’s absence/presence, the relationship between life and writing, as well as the father’s figurations and his intermediates and substitutes. We especially investigated the aspect of repetition about how the family relations are articulated, highlighting those ones that happen between father and son and that appear in these texts. This problematic interested us as a research object, a priori, because the works of Bartholomeu Campos de Queirós are an exponent of literature for children field, as far as they show that the childhood is not always “colorful”, happy and perfect as several productions supposedly made “for children” seek to have us believe. In addition, the selected texts that have an autobiographical characteristic and put the issue of child suffering because of the father’s absence are configured as a very rich corpus for studies related to the relation between life/work and investigations in the dialogue between Literature and Psychoanalysis. These aspects will permit us to understand why the pain of missing father be repetitive and insistent in these books. Thus, we problematize, by the selected works for this study, the concept of literature for children and young people and the notion of literary reading. We also analyzed in the “statements” given by the author the relationship between life and writing and we investigated, based on psychoanalytic studies, the literary writing as a possibility of both unconscious development of memory marked by the father’s absence – remedy – as of a perpetuation of this same conflict – poison. Furthermore, we analyzed how the relationship between son and father are processed considering the mother’s absence, since the works that have this person’s presence, she seems to mediate such relationships in a certain way.

Differential activation in temporal, cingulate and prefrontal cortices during response inhibition in bipolar disorder

Background: Increased impulsivity and aberrant response inhibition have been observed in bipolar disorder (BD). This study examined the functional abnormalities and underlying neural processes during response inhibition in BD, and its relationship to impulsivity. Methods: We assessed impulsivity using the Barratt Impulsiveness Scale (BIS) and, using functional magnetic resonance imaging (fMRI), measured neural activity in response to an Affective Go-NoGo Task, consisting of emotional facial stimuli (fear, happy, anger faces) and non-emotional control stimuli (neutral female and male faces) in euthymic BD (n=23) and healthy individuals (HI; n=25). Results: BD patients were significantly more impulsive, yet did not differ from HI on accuracy or reaction time on the emotional go/no-go task. Comparing neural patterns of activation when processing emotional Go versus emotional NoGo trials yielded increased activation in BD within temporal and cingulate cortices and within prefrontal-cortical regions in HI. Furthermore, higher BIS scores for BD were associated with slower reaction times, and indicative of compensatory cognitive strategies to counter increased impulsivity. Conclusions: These findings illustrate cognition-emotion interference in BD and the observed differences in neural activation indicate potentially altered emotion modulation. Increased activation in brain regions previously shown in emotion regulation and response inhibition tasks could represent a disease-specific marker for BD

Facial affect processing inbipolar disorder:a magnetoencephalography study

Background: Identifying biological markers to aid diagnosis of bipolar disorder (BD) is critically important. To be considered a possible biological marker, neural patterns in BD should be discriminant from those in healthy individuals (HI). We examined patterns of neuromagnetic responses revealed by magnetoencephalography (MEG) during implicit emotion-processing using emotional (happy, fearful, sad) and neutral facial expressions, in sixteen BD and sixteen age- and gender-matched healthy individuals. Methods: Neuromagnetic data were recorded using a 306-channel whole-head MEG ELEKTA Neuromag System, and preprocessed using Signal Space Separation as implemented in MaxFilter (ELEKTA). Custom Matlab programs removed EOG and ECG signals from filtered MEG data, and computed means of epoched data (0-250ms, 250-500ms, 500-750ms). A generalized linear model with three factors (individual, emotion intensity and time) compared BD and HI. A principal component analysis of normalized mean channel data in selected brain regions identified principal components that explained 95% of data variation. These components were used in a quadratic support vector machine (SVM) pattern classifier. SVM classifier performance was assessed using the leave-one-out approach. Results: BD and HI showed significantly different patterns of activation for 0-250ms within both left occipital and temporal regions, specifically for neutral facial expressions. PCA analysis revealed significant differences between BD and HI for mild fearful, happy, and sad facial expressions within 250-500ms. SVM quadratic classifier showed greatest accuracy (84%) and sensitivity (92%) for neutral faces, in left occipital regions within 500-750ms. Conclusions: MEG responses may be used in the search for disease specific neural markers.