The framework for REVIEWS: an exploration into design principles for an electronic medical early warning system observation chart

The observation chart is for many health professionals (HPs) the primary source of objective information relating to the health of a patient. Information Systems (IS) research has demonstrated the positive impact of good interface design on decision making and it is logical that good observation chart design can positively impact healthcare decision making. Despite the potential for good observation chart design, there is a paucity of observation chart design literature, with the primary source of literature leveraging Human Computer Interaction (HCI) literature to design better charts. While this approach has been successful, this design approach introduces a gap between understanding of the tasks performed by HPs when using charts and the design features implemented in the chart. Good IS allow for the collection and manipulation of data so that it can be presented in a timely manner that support specific tasks. Good interface design should therefore consider the specific tasks being performed prior to designing the interface. This research adopts a Design Science Research (DSR) approach to formalise a framework of design principles that incorporates knowledge of the tasks performed by HPs when using observation charts and knowledge pertaining to visual representations of data and semiology of graphics. This research is presented in three phases, the initial two phases seek to discover and formalise design knowledge embedded in two situated observation charts: the paper-based NEWS chart developed by the Health Service Executive in Ireland and the electronically generated eNEWS chart developed by the Health Information Systems Research Centre in University College Cork. A comparative evaluation of each chart is also presented in the respective phases. Throughout each of these phases, tentative versions of a design framework for electronic vital sign observation charts are presented, with each subsequent iteration of the framework (versions Alpha, Beta, V0.1 and V1.0) representing a refinement of the design knowledge. The design framework will be named the framework for the Retrospective Evaluation of Vital Sign Information from Early Warning Systems (REVIEWS). Phase 3 of the research presents the deductive process for designing and implementing V0.1 of the framework, with evaluation of the instantiation allowing for the final iteration V1.0 of the framework. This study makes a number of contributions to academic research. First the research demonstrates that the cognitive tasks performed by nurses during clinical reasoning can be supported through good observation chart design. Secondly the research establishes the utility of electronic vital sign observation charts in terms of supporting the cognitive tasks performed by nurses during clinical reasoning. Third the framework for REVIEWS represents a comprehensive set of design principles which if applied to chart design will improve the usefulness of the chart in terms of supporting clinical reasoning. Fourth the electronic observation chart that emerges from this research is demonstrated to be significantly more useful than previously designed charts and represents a significant contribution to practice. Finally the research presents a research design that employs a combination of inductive and deductive design activities to iterate on the design of situated artefacts.

Artificial Neural Network and Neutron Aplication in a Volume Fraction Calculation in Annular and Stratified Multiphase System

Multiphase flows, type oil–water-gas are very common among different industrial activities, such as chemical industries and petroleum extraction, and its measurements show some difficulties to be taken. Precisely determining the volume fraction of each one of the elements that composes a multiphase flow is very important in chemical plants and petroleum industries. This work presents a methodology able to determine volume fraction on Annular and Stratified multiphase flow system with the use of neutrons and artificial intelligence, using the principles of transmission/scattering of fast neutrons from a 241Am-Be source and measurements of point flow that are influenced by variations of volume fractions. The proposed geometries used on the mathematical model was used to obtain a data set where the thicknesses referred of each material had been changed in order to obtain volume fraction of each phase providing 119 compositions that were used in the simulation with MCNP-X –computer code based on Monte Carlo Method that simulates the radiation transport. An artificial neural network (ANN) was trained with data obtained using the MCNP-X, and used to correlate such measurements with the respective real fractions. The ANN was able to correlate the data obtained on the simulation with MCNP-X with the volume fractions of the multiphase flows (oil-water-gas), both in the pattern of annular flow as stratified, resulting in a average relative error (%) for each production set of: annular (air= 3.85; water = 4.31; oil=1.08); stratified (air=3.10, water 2.01, oil = 1.45). The method demonstrated good efficiency in the determination of each material that composes the phases, thus demonstrating the feasibility of the technique.

Our Landscape, Ourselves: Integrating Process and Traditional food Principles for Wellbeing + Resilience in the Swinomish Tribal Community

Thesis (Master's)--University of Washington, 2016-08

Medication competence of nursing students in Finland

Lääkehoidon turvallinen toteuttaminen edellyttää sairaanhoitajalta hyvää lääkehoidon osaamisperustaa. Sairaanhoitajakoulutuksen tehtävänä on mahdollistaa tämän osaamisen kehittyminen. Kansainvälisissä tutkimuksissa on kuitenkin osoitettu, että lääkehoidon opetuksen laajuudessa, sisällössä ja toteutuksessa on vaihtelevuutta. Aikaisemmissa tutkimuksissa on raportoitu myös puutteita lääkehoidon osaamisessa sekä sairaanhoitajilla että sairaanhoitajaopiskelijoilla. Koulutuksen ja lääkehoidon osaamisen kehittämiseksi lääkehoidon opetuksen ja sairaanhoitajaopiskelijoiden lääkehoidon osaamisen monipuolinen arviointi ja osaamista selittävien tekijöiden tarkastelu on tarpeen. Tämän tutkimuksen tarkoituksena oli i) arvioida lääkehoidon opetusta suomalaisessa sairaanhoitajakoulutuksessa, ii) arvioida sairaanhoitajaopiskelijoiden lääkehoidon osaamista sekä iii) tunnistaa sairaanhoitajaopiskelijan lääkehoidon osaamiseen yhteydessä olevat tekijät. Tutkimus toteutettiin kolmessa vaiheessa. Ensimmäisessä vaiheessa kahden integroidun kirjallisuuskatsauksen kautta määriteltiin tutkimuksen kohteena oleva sairaanhoitajan lääkehoidon osaaminen ja aiemmin tunnistetut sairaanhoitajaopiskelijan lääkehoidon osaamiseen yhteydessä olevat tekijät. Toisessa vaiheessa toteutettiin valtakunnallinen lääkehoidon opetukseen liittyvä kysely hoitotyön koulutusohjelmasta vastaaville koulutuspäälliköille (n=22) ja opettajille (n=136). Tutkimuksen kolmannessa vaiheessa opintojensa alku‐ (n=328) ja loppuvaiheessa olevien sairaanhoitajaopiskelijoiden (n=338) lääkehoidon osaaminen arvioitiin ja osaamiseen yhteydessä olevat tekijät tunnistettiin. Aineistojen analyysissä käytettiin pääosin tilastollisia menetelmiä. Tulosten perusteella lääkehoidon opetuksen laajuus vaihteli eri ammattikorkeakouluissa, mutta opetuksen sisältö oli kuitenkin monipuolista. Lisää huomiota tulisi kiinnittää lääkehoidon teoreettiseen perustaan ja itsehoitoon sekä lääkehoidon ohjaukseen liittyviin sisältöalueisiin. Opiskelijoiden lääkehoidon osaamista arvioitiin säännöllisesti kaikissa ammattikorkeakouluissa. Sairaanhoitajaopiskelijan lääkehoidon osaamista arvioitiin tutkimuksessa tietotestillä, lääkelaskentatehtävillä ja lyhyiden potilastapausten ratkaisemisen avulla. Lääkehoidon osaamiseen yhteydessä olevia tekijöitä tarkasteltiin kolmesta näkökulmasta: 1) yksilölliset tekijät, 2) kliiniseen oppimisympäristöön ja 3) ammattikorkeakouluun liittyvät tekijät. Lääkehoidon teoreettista osaamista arvioivassa tietotestissä opiskelijat vastasivat keskimäärin 72 prosenttiin kysymyksistä täysin oikein; lääkelaskuista täysin oikein oli 74 % ja potilastapauksissa 57 % valitsi parhaan mahdollisen toimintatavan. Tulosten perusteella sairaanhoitajaopiskelijan osaamista selittivät eniten yksilölliset tekijät. Lääkehoidon osaamiseen yhteydessä olevien tekijöiden välillä oli eroa opintojen alussa ja lopussa. Opintojen alkuvaiheessa opiskelijan aikaisempi opintomenestys oli yhteydessä lääkehoidon osaamiseen, kun taas opintojen loppuvaiheessa siihen olivat yhteydessä opiskelijan kyky itseohjautuvaan oppimiseen sekä opiskelumotivaatio. Johtopäätöksenä voidaan todeta tutkimuksen tulosten olevan samansuuntaisia kuin aikaisemmissa tutkimuksissa. Lääkehoidon opetuksen laajuus vaihtelee opetussuunnitelmatasolla, mutta täsmällinen arviointi on vaikeaa opetuksen sisältöjen integroimisen takia. Sairaanhoitajaopiskelijoiden lääkehoidon osaaminen oli hieman parempaa kuin aikaisemmissa tutkimuksissa, mutta osaamisessa on edelleen puutteita. Lääkehoidon opetuksen ja osaamisen kehittäminen edellyttää kansallista ja kansainvälistä tutkimus‐ ja kehittämisyhteistyötä. Tutkimuksen tulokset tukevat lääkehoidon opetuksen sekä osaamisen tutkimusta ja kehittämistä.

Calculation of electric field strengths at a sharp edge

Sharp edges were first used for field ionisation mass spectrometry by Beckey. Although Cross and Robertson found that etched metal foils were more effective than razor blades for field ionisation, blades are very convenient for determination of field ionisation mass spectra, as reported by Robertson and Viney. The electric field at the vertex of a sharp edge can be calculated by the method of the conformal transformation. Here we give some equations for the field deduced with the assumption that the edge surface can be approximated by a hyperbola. We also compare two hyperbolae with radii of curvature at the vertex of 500 Angstrom and 1000 Angstrom with the profile of a commercial carbon-steel razor blade.

Pro‐poor tourism in a first world urban setting: case study of Glasgow Govan

This research investigates pro-poor tourism (PPT), which has only been considered in a third world context, in a first world country, determining whether PPT principles are being used to alleviate poverty in a developed location, Glasgow Govan, in Scotland. The research develops and applies a new PPT principles tool to regeneration projects in the area and reveals a significant level of PPT application there. The findings suggest that PPT can be an over-complication of a common sense development approach that any responsible government should promote. The results also question the validity of community based tourism initiatives.

Multi-body simulation of a canine hind limb: model development, experimental validation and calculation of ground reaction forces

Background: Among other causes the long-term result of hip prostheses in dogs is determined by aseptic loosening. A prevention of prosthesis complications can be achieved by an optimization of the tribological system which finally results in improved implant duration. In this context a computerized model for the calculation of hip joint loadings during different motions would be of benefit. In a first step in the development of such an inverse dynamic multi-body simulation (MBS-) model we here present the setup of a canine hind limb model applicable for the calculation of ground reaction forces. Methods: The anatomical geometries of the MBS-model have been established using computer tomography- (CT-) and magnetic resonance imaging- (MRI-) data. The CT-data were collected from the pelvis, femora, tibiae and pads of a mixed-breed adult dog. Geometric information about 22 muscles of the pelvic extremity of 4 mixed-breed adult dogs was determined using MRI. Kinematic and kinetic data obtained by motion analysis of a clinically healthy dog during a gait cycle (1 m/s) on an instrumented treadmill were used to drive the model in the multi-body simulation. Results and Discussion: As a result the vertical ground reaction forces (z-direction) calculated by the MBS-system show a maximum deviation of 1.75%BW for the left and 4.65%BW for the right hind limb from the treadmill measurements. The calculated peak ground reaction forces in z- and y-direction were found to be comparable to the treadmill measurements, whereas the curve characteristics of the forces in y-direction were not in complete alignment. Conclusion: In conclusion, it could be demonstrated that the developed MBS-model is suitable for simulating ground reaction forces of dogs during walking. In forthcoming investigations the model will be developed further for the calculation of forces and moments acting on the hip joint during different movements, which can be of help in context with the in silico development and testing of hip prostheses.

Sustainable deployment of QTLs conferring quantitative resistance to crops: first lessons from a stochastic model

International audience

Calculation of mutual information for nonlinear communication channel at large signal-to-noise ratio

Using the path-integral technique we examine the mutual information for the communication channel modeled by the nonlinear Schrödinger equation with additive Gaussian noise. The nonlinear Schrödinger equation is one of the fundamental models in nonlinear physics, and it has a broad range of applications, including fiber optical communications - the backbone of the internet. At large signal-to-noise ratio we present the mutual information through the path-integral, which is convenient for the perturbative expansion in nonlinearity. In the limit of small noise and small nonlinearity we derive analytically the first nonzero nonlinear correction to the mutual information for the channel.

The potential of symbolic approximation. Disentangling the effects of approximation vs. calculation demands in nonsymbolic and symbolic representations.

Mathematical skills that we acquire during formal education mostly entail exact numerical processing. Besides this specifically human faculty, an additional system exists to represent and manipulate quantities in an approximate manner. We share this innate approximate number system (ANS) with other nonhuman animals and are able to use it to process large numerosities long before we can master the formal algorithms taught in school. Dehaene´s (1992) Triple Code Model (TCM) states that also after the onset of formal education, approximate processing is carried out in this analogue magnitude code no matter if the original problem was presented nonsymbolically or symbolically. Despite the wide acceptance of the model, most research only uses nonsymbolic tasks to assess ANS acuity. Due to this silent assumption that genuine approximation can only be tested with nonsymbolic presentations, up to now important implications in research domains of high practical relevance remain unclear, and existing potential is not fully exploited. For instance, it has been found that nonsymbolic approximation can predict math achievement one year later (Gilmore, McCarthy, & Spelke, 2010), that it is robust against the detrimental influence of learners´ socioeconomic status (SES), and that it is suited to foster performance in exact arithmetic in the short-term (Hyde, Khanum, & Spelke, 2014). We provided evidence that symbolic approximation might be equally and in some cases even better suited to generate predictions and foster more formal math skills independently of SES. In two longitudinal studies, we realized exact and approximate arithmetic tasks in both a nonsymbolic and a symbolic format. With first graders, we demonstrated that performance in symbolic approximation at the beginning of term was the only measure consistently not varying according to children´s SES, and among both approximate tasks it was the better predictor for math achievement at the end of first grade. In part, the strong connection seems to come about from mediation through ordinal skills. In two further experiments, we tested the suitability of both approximation formats to induce an arithmetic principle in elementary school children. We found that symbolic approximation was equally effective in making children exploit the additive law of commutativity in a subsequent formal task as a direct instruction. Nonsymbolic approximation on the other hand had no beneficial effect. The positive influence of the symbolic approximate induction was strongest in children just starting school and decreased with age. However, even third graders still profited from the induction. The results show that also symbolic problems can be processed as genuine approximation, but that beyond that they have their own specific value with regard to didactic-educational concerns. Our findings furthermore demonstrate that the two often con-founded factors ꞌformatꞌ and ꞌdemanded accuracyꞌ cannot be disentangled easily in first graders numerical understanding, but that children´s SES also influences existing interrelations between the different abilities tested here.

Reconciling the Irreconcilable? Sovereign Debt Restructuring and the Principles of International Law. A Law and Economics Perspective

This Thesis focuses on the principles of international law relevant to the resolution of legal disputes arising from sovereign insolvency conflicts. It attempts to contribute to the “incremental” approach literature by identifying principles, justifying their application in litigation and assessing whether they may help to reconcile the trade-offs prevalent in that context. For that purpose, this Thesis distinguishes between two different types of principles. First, it investigates the “Principles of Public International Law” (henceforth, “PIL principles”). Said category refers to norms of the law of nations which can be considered functionally and structurally similar to domestic constitutional principles (i.e., that can be regarded as “optimization” or “prima facie” requirements). This Thesis underscores the PIL principles protecting the interests of the creditors and citizens as well as the “public interest”, arguing that decision makers face a trade-off between these principles in the context of restructurings. Secondly, this Thesis inquires into the “general principles of domestic law” (henceforth, “GPDs”) which can be applied in sovereign debt restructuring. Two GPDs are identified: a “stay” on litigation and a “cram down” on dissenting creditors’ claims. Although both principles have been identified by the prior literature, this work advances a small but significant “twist” in the methodology used for that purpose: it relies exclusively on functional and comparative analysis. Moreover, this work justifies the application of said GPDs for two jurisdictions: New York and Germany. Finally, it posits that those GPDs can help to mitigate the trade-offs between PIL principles, thus reconciling the interests at stake.

A next-to-leading order calculation of the impact of primordial magnetic fields into cosmological observables

In this thesis, we perform a next-to-leading order calculation of the impact of primordial magnetic fields (PMF) into the evolution of scalar cosmological perturbations and the cosmic microwave background (CMB) anisotropy. Magnetic fields are everywhere in the Universe at all scales probed so far, but their origin is still under debate. The current standard picture is that they originate from the amplification of initial seed fields, which could have been generated as PMFs in the early Universe. The most robust way to test their presence and constrain their features is to study how they impact on key cosmological observables, in particular the CMB anisotropies. The standard way to model a PMF is to consider its contribution (quadratic in the magnetic field) at the same footing of first order perturbations, under the assumptions of ideal magneto-hydrodynamics and compensated initial conditions. In the perspectives of ever increasing precision of CMB anisotropies measurements and of possible uncounted non-linear effects, in this thesis we study effects which go beyond the standard assumptions. We study the impact of PMFs on cosmological perturbations and CMB anisotropies with adiabatic initial conditions, the effect of Alfvén waves on the speed of sound of perturbations and possible non-linear behavior of baryon overdensity for PMFs with a blue spectral index, by modifying and improving the publicly available Einstein-Boltzmann code SONG, which has been written in order to take into account all second-order contributions in cosmological perturbation theory. One of the objectives of this thesis is to set the basis to verify by an independent fully numerical analysis the possibility to affect recombination and the Hubble constant.

[health Protection For Rural Workers: The Need To Standardize Techniques For Quantifying Dermal Exposure To Pesticides].

Quantification of dermal exposure to pesticides in rural workers, used in risk assessment, can be performed with different techniques such as patches or whole body evaluation. However, the wide variety of methods can jeopardize the process by producing disparate results, depending on the principles in sample collection. A critical review was thus performed on the main techniques for quantifying dermal exposure, calling attention to this issue and the need to establish a single methodology for quantification of dermal exposure in rural workers. Such harmonization of different techniques should help achieve safer and healthier working conditions. Techniques that can provide reliable exposure data are an essential first step towards avoiding harm to workers' health.

The Crystal-t Algorithm: A New Approach To Calculate The Sle Of Lipidic Mixtures Presenting Solid Solutions.

Lipidic mixtures present a particular phase change profile highly affected by their unique crystalline structure. However, classical solid-liquid equilibrium (SLE) thermodynamic modeling approaches, which assume the solid phase to be a pure component, sometimes fail in the correct description of the phase behavior. In addition, their inability increases with the complexity of the system. To overcome some of these problems, this study describes a new procedure to depict the SLE of fatty binary mixtures presenting solid solutions, namely the Crystal-T algorithm. Considering the non-ideality of both liquid and solid phases, this algorithm is aimed at the determination of the temperature in which the first and last crystal of the mixture melts. The evaluation is focused on experimental data measured and reported in this work for systems composed of triacylglycerols and fatty alcohols. The liquidus and solidus lines of the SLE phase diagrams were described by using excess Gibbs energy based equations, and the group contribution UNIFAC model for the calculation of the activity coefficients of both liquid and solid phases. Very low deviations of theoretical and experimental data evidenced the strength of the algorithm, contributing to the enlargement of the scope of the SLE modeling.

[principles Of Universality, Comprehensiveness And Equity In A Hearing Health Care Service].

This article analyzed whether the practices of hearing health care were consistent with the principles of universality, comprehensiveness and equity from the standpoint of professionals. It involved qualitative research conducted at a Medium Complexity Hearing Health Care Center. A social worker, three speech therapists, a physician and a psychologist constituted the study subjects. Interviews were conducted as well as observation registered in a field diary. The thematic analysis technique was used in the analysis of the material. The analysis of interviews resulted in the construction of the following themes: Universality and access to hearing health, Comprehensive Hearing Health Care and Hearing Health and Equity. The study identified issues that interfere with the quality of service and run counter to the principles of Brazilian Unified Health System. The conclusion reached was that a relatively simple investment in training and professional qualification can bring about significant changes in order to promote a more universal, comprehensive and equitable health service.