Integrated clinical pathway management for medical quality improvement-based on a semiotically inspired systems architecture

Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

Effects of temporal resolution of input precipitation on the performance of hydrological forecasting

Flood prediction systems rely on good quality precipitation input data and forecasts to drive hydrological models. Most precipitation data comes from daily stations with a good spatial coverage. However, some flood events occur on sub-daily time scales and flood prediction systems could benefit from using models calibrated on the same time scale. This study compares precipitation data aggregated from hourly stations (HP) and data disaggregated from daily stations (DP) with 6-hourly forecasts from ECMWF over the time period 1 October 2006–31 December 2009. The HP and DP data sets were then used to calibrate two hydrological models, LISFLOOD-RR and HBV, and the latter was used in a flood case study. The HP scored better than the DP when evaluated against the forecast for lead times up to 4 days. However, this was not translated in the same way to the hydrological modelling, where the models gave similar scores for simulated runoff with the two datasets. The flood forecasting study showed that both datasets gave similar hit rates whereas the HP data set gave much smaller false alarm rates (FAR). This indicates that using sub-daily precipitation in the calibration and initiation of hydrological models can improve flood forecasting.

The water quality of the River Enborne, UK: observations from high-frequency Monitoring in a rural, lowland river system

This paper reports the results of a 2-year study of water quality in the River Enborne, a rural river in lowland England. Concentrations of nitrogen and phosphorus species and other chemical determinands were monitored both at high-frequency (hourly), using automated in situ instrumentation, and by manual weekly sampling and laboratory analysis. The catchment land use is largely agricultural, with a population density of 123 persons km−2. The river water is largely derived from calcareous groundwater, and there are high nitrogen and phosphorus concentrations. Agricultural fertiliser is the dominant source of annual loads of both nitrogen and phosphorus. However, the data show that sewage effluent discharges have a disproportionate effect on the river nitrogen and phosphorus dynamics. At least 38% of the catchment population use septic tank systems, but the effects are hard to quantify as only 6% are officially registered, and the characteristics of the others are unknown. Only 4% of the phosphorus input and 9% of the nitrogen input is exported from the catchment by the river, highlighting the importance of catchment process understanding in predicting nutrient concentrations. High-frequency monitoring will be a key to developing this vital process understanding.

High-frequency water quality monitoring in an urban catchment: hydrochemical dynamics, primary production and implications for the Water Framework Directive

This paper describes the hydrochemistry of a lowland, urbanised river-system, The Cut in England, using in situ sub-daily sampling. The Cut receives effluent discharges from four major sewage treatment works serving around 190,000 people. These discharges consist largely of treated water, originally abstracted from the River Thames and returned via the water supply network, substantially increasing the natural flow. The hourly water quality data were supplemented by weekly manual sampling with laboratory analysis to check the hourly data and measure further determinands. Mean phosphorus and nitrate concentrations were very high, breaching standards set by EU legislation. Though 56% of the catchment area is agricultural, the hydrochemical dynamics were significantly impacted by effluent discharges which accounted for approximately 50% of the annual P catchment input loads and, on average, 59% of river flow at the monitoring point. Diurnal dissolved oxygen data demonstrated high in-stream productivity. From a comparison of high frequency and conventional monitoring data, it is inferred that much of the primary production was dominated by benthic algae, largely diatoms. Despite the high productivity and nutrient concentrations, the river water did not become anoxic and major phytoplankton blooms were not observed. The strong diurnal and annual variation observed showed that assessments of water quality made under the Water Framework Directive (WFD) are sensitive to the time and season of sampling. It is recommended that specific sampling time windows be specified for each determinand, and that WFD targets should be applied in combination to help identify periods of greatest ecological risk. This article is protected by copyright. All rights reserved.

The effects of dairy management and processing on quality characteristics of milk and dairy products

Studies within the QLIF project reviewed in this article suggest that organic or low-input management is more likely to result in milk with fatty acid profiles that are higher in α-linolenic acid and/or beneficial isomers of conjugated linoleic acid and antioxidants with up to a 2.5-fold increase in some cases, relative to milk from conventional production. These advantages are preserved during processing, resulting in elevated contents or concentrations of these constituents in processed dairy products of organic or low input origin. Much of the literature suggests that these benefits are very likely to be a result of a greater reliance on forages in the dairy diets (especially grazed grass). Since the adoption of alternative breeds or crosses is often an integral part sustaining these low-input systems, it is not possible to rule out an interaction with genotype in these monitored herds. The results suggest that milk fat composition with respect to human health can be optimized by exploiting grazing in the diet of dairy cows. However, in many European regions this may not be possible due to extremes in temperature, soil moisture levels or both. In such cases milk quality can be maintained by the inclusion of oil seeds in the dairy diets.

Dietary Quality Index and Associated Factors among Adolescents of the State of Sao Paulo, Brazil

Objective To assess dietary quality and associated factors in adolescents. Study design We conducted a population-based cross-sectional study in a sample of 1584 adolescents living in areas of the state of Sao Paulo, Brazil. Dietary intake was measured with the 24-hour recall method, and dietary quality was assessed by means of the Health Eating Index (HEI), adapted to fit to the local requirements. Linear regression analyses were performed to assess the association between the HEI and demographic, socioeconomic, and lifestyle variables. Results A total of 97.1% of the adolescents studied had an inadequate diet or a diet that needed improvement. The mean overall HEI score was 59.7. Lower mean HEI scores were found for fruits, dairy products, and vegetables. Male adolescents who were physically active and lived in a house or apartment had higher HEI scores. The multiple regression analyses showed that the quality of the diet improved as age decreased. Adolescents who lived in houses or apartments had higher HEI scores than adolescents living in shacks or slums, regardless of age and energy intake. Conclusions Dietary quality is associated with income and age. A better understanding of the factors associated can provide input to the formulation of policies and development of nutritional actions. (J Pediatr 2010; 156:456-60).

Generating Segmented Quality Meshes from Images

Techniques devoted to generating triangular meshes from intensity images either take as input a segmented image or generate a mesh without distinguishing individual structures contained in the image. These facts may cause difficulties in using such techniques in some applications, such as numerical simulations. In this work we reformulate a previously developed technique for mesh generation from intensity images called Imesh. This reformulation makes Imesh more versatile due to an unified framework that allows an easy change of refinement metric, rendering it effective for constructing meshes for applications with varied requirements, such as numerical simulation and image modeling. Furthermore, a deeper study about the point insertion problem and the development of geometrical criterion for segmentation is also reported in this paper. Meshes with theoretical guarantee of quality can also be obtained for each individual image structure as a post-processing step, a characteristic not usually found in other methods. The tests demonstrate the flexibility and the effectiveness of the approach.

ANFIS BASED MODELS FOR ACCESSING QUALITY OF WIKIPEDIA ARTICLES

Wikipedia is a free, web-based, collaborative, multilingual encyclopedia project supported by the non-profit Wikimedia Foundation. Due to the free nature of Wikipedia and allowing open access to everyone to edit articles the quality of articles may be affected. As all people don’t have equal level of knowledge and also different people have different opinions about a topic so there may be difference between the contributions made by different authors. To overcome this situation it is very important to classify the articles so that the articles of good quality can be separated from the poor quality articles and should be removed from the database. The aim of this study is to classify the articles of Wikipedia into two classes class 0 (poor quality) and class 1(good quality) using the Adaptive Neuro Fuzzy Inference System (ANFIS) and data mining techniques. Two ANFIS are built using the Fuzzy Logic Toolbox [1] available in Matlab. The first ANFIS is based on the rules obtained from J48 classifier in WEKA while the other one was built by using the expert’s knowledge. The data used for this research work contains 226 article’s records taken from the German version of Wikipedia. The dataset consists of 19 inputs and one output. The data was preprocessed to remove any similar attributes. The input variables are related to the editors, contributors, length of articles and the lifecycle of articles. In the end analysis of different methods implemented in this research is made to analyze the performance of each classification method used.

Children's Vocabulary Development : The role of parental input, vocabulary composition and early communicative skills

The aim of this thesis is to examine the early vocabulary development of a sample of Swedish children in relation to parental input and early communicative skills. Three studies are situated in an overall description of early language development in children. The data analyzed in the thesis was collected within a larger project at Stockholm University (SPRINT- “Effects of enhanced parental input on young children’s vocabulary development and subsequent literacy development” [VR 2008-5094]). Data analysis was based on parental report via SECDI, the Swedish version of the MacArthur-Bates Communicative Development Inventories, and audio recordings. One study examined parental verbal interaction characteristics in three groups of children with varying vocabulary size at 18 months. The stability of vocabulary development at 18 and 24 months was investigated in a larger study, with focus on children’s vocabulary composition and grammatical abilities. The third study examined interrelations among early gestures, receptive and productive vocabulary, and grammar measured with M3L, i.e. three longest utterances, from 12 to 30 months. Overall results of the thesis highlight the importance of early language development. Variability in different characteristics in parental input is associated with variability in child vocabulary size. Children with large early vocabularies exhibit the most stability in vocabulary composition and the earliest grammatical development. Children’s vocabulary composition may reflect individual stylistic variation. Use of early gestures is associated differentially with receptive and productive vocabulary. Results of the thesis have implications for parents, child- and healthcare personnel, as well as researchers and educational practitioners. The results underscore the importance of high quality in adult-child interaction, with rich input fine-tuned to children’s developmental levels and age, together with high awareness of early language development.

Validation of the use of input-output data for embodied energy analysis of the Australian construction industry

This paper evaluates a recently developed hybrid method for the embodied energy analysis of the Australian construction industry. It was found that the truncation associated with process analysis can be up to 80%, whilst the use of input-output analysis alone does not always provide a perfect model for replacing process data. There is also a considerable lack in the quantity and possibly quality of process data currently available. These findings suggest that current best-practice methods are sufficiently accurate for most typical applications, but this is heavily dependant upon data quality and availability. The hybrid method evaluated can be used for the optimisation of embodied energy and for identifying opportunities for improvements in energy efficiency.

Validation of the use of Australian input-output data for building embodied energy simulation

Traditional!y, the simulation of buildings has focused 011 operational energy consumption in an attempt to determine the potential for energy savings. Whilst operational energy of Australian buildings accounts for around 20% of total energy consumption nationally, embodied energy represents 20 to 50 times the annual operational energy of 1110st Australian buildings. Lower values have been shown through a number of studies that have analysed the embodied energy of buildings and their products, however these have now shown to be incomplete in system boundary. Many of these studies have used traditional embodied energy analysis methods, such as process analysis and input-output analysis, Hybrid embodied energy analysis methods have been developed, but these need to be compared and validated. This paper reports on preliminary work on this topic. The findings so far suggest that current best-practice methods are sufficiently accurate for most typical applications, but this is heavily dependant upon data quality and availability.

Analysis of stamping production data with view towards quality management

A quality analysis trial was undertaken at Ford Geelong Stamping Plant on a press line that was fitted with standard press sensors to measure press and binder force over the stamping cycle for each panel. The quality of randomly sampled panels was measured by obtaining the panel thicknesses at five points, for 135 panels in total. These points were chosen such that they exhibited different forming modes. This paper analyses the input force data and the output quality data from the trial to determine any potential relationships. The analysis of the production data was performed using statistical correlation techniques to determine initial potential relationships between input and output variables. An Active Shape Model was used to extract features when identifying the major sources of variation within the input data. However, the initial analysis of the data elicited no direct relationship between the input variables measured and the panel thicknesses. This result is significant as the data collected is from a standard sensor configuration found in many press lines through-out the world. The reason for the lack of a direct relationship is believed to come from the lack of sensitivity in the force measurements which are not able to identify small changes in the process, whereas gross geometric variations have in previous studies shown an obvious relationship with changes in the force press profile. This means that existing force sensors require augmentation by additional sensors if a detailed automatic quality control system for the press lines based on input sensors alone.

Quality of life indexes for national policy: review and agenda for research

A number of governments and public policy institutes have developed ldquoQuality of Life Indexesrdquo – statistics that attempt to measure the quality of life for entire states or regions. We develop 14 criteria for determining the validity and usefulness of such QOL indexes to public policy. We then review 22 of the most-used QOL indexes from around the world. We conclude that many of the indexes are successful in that they are reliable, have established time series measures, and can be disaggregated to study subpopulations. However, many fall short in four areas: (1) indexes vary greatly in their coverage and definitions of domains of QOL, (2) none of the indexes distinguish among the concepts of input, throughput, and output that are used by public policy analysts, (3) they fail to show how QOL outputs are sensitive to public policy inputs, and (4) none have examined convergent validity against each other. We conclude that many of these indexes are potentially very useful for public policy and recommend research to further improve them.

Is the quality of entrepreneurial business plans related to the outcome of a new venture?

The evaluation of new ventures often involves two key aspects of entrepreneurial business plans: how best to write them and how best to rate (evaluate) them. Ultimately the performance of the venture should be the definitive criterion of quality. Surprisingly, the writing, rating and performance effects of entrepreneurial business plans (EBPs) comprise three related but under researched areas. This paper empirically tested principles for writing and rating entrepreneurial business plans to draw inferences on how to improve the private equity investment evaluation process. A simplified perspective of General Systems Theory guided our empirical investigation of the input and outcome of the VC investment decision. Our empirical investigation reveals that entrepreneurial business plans that comport with the writing principles from the literature improve a new venture’s likelihood of success.