A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

British lesbian, gay and bisexual psychologies:theory, research and practice

Gain insight into crucial British mental health approaches for LGB individuals. There is very little collaborative literature between LGB-affirmative psychologists and psychotherapists in the United States and the United Kingdom. British Lesbian, Gay, and Bisexual Psychologies: Theory, Research, and Practice may well be a crucial beginning step in building dialogue between these two countries on important LGB psychotherapy developments. Leading authorities comprehensively examine the latest studies and effective therapies for LGB individuals in the United Kingdom. Practitioners will discover an extensive survey of the most current developments to supplement their own work, while educators and students will find diverse expert perspectives on which to consider and broaden their own viewpoints. This unique book offers an informative introduction to British psychosocial perspectives on theory, research, and practice. British Lesbian, Gay, and Bisexual Psychologies provides a critical exploration of the recent history of LGB psychology and psychotherapy in the United Kingdom, focusing on key publications and outlining the current terrain. Other chapters are organized into two thematic sections. The first section explores theoretical frameworks in United Kingdom therapeutic practice, while the second section examines sexual minority identities and their needs for support and community. Topics in British Lesbian, Gay, and Bisexual Psychologies include: - similarities and differences between LGBT psychology and psychotherapy in the United States and United Kingdom - gay affirmative therapy (GAT) as a positive framework - existential-phenomenological approach to psychotherapy - core issues in the anxiety about whether or not to “come out” - object relations theory - exploring homo-negativity in the therapeutic process - aspects of psychotherapy that lesbians and gay men find helpful - research into how the mainstreaming of lesbian and gay culture has affected the lives of LGB individuals - study into LGB youth issues - difficulties of gay men with learning disabilities—with suggestions on how to offer the best psychological service - a study on gay athletes’ experiences of coming out in a heterosexist world British Lesbian, Gay, and Bisexual Psychologies takes a needed step toward sharing valuable psychosocial perspectives between countries. This useful, enlightening text is perfect for educators, students, psychologists, psychotherapists, and counselors working in the field of sexuality.

Evaluation of the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): My Choice Weight Management Programme:report commissioned by Heart of Birmingham teaching Primary Care Trust

This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). Each participant attends weekly consultations over a twelve session period (the final iteration of these weekly sessions is referred to as ‘session twelve’ in this report). They are then offered up to three follow up appointments for up to six months at two monthly intervals (the final of these follow ups, taking place at approximately nine months post recruitment, is referred to as ‘session fifteen’ in this report). A review of the literature highlights the dearth of published research on the effectiveness of primary care- or community-based weight management interventions. This report may help to address this knowledge deficit. A total of 451 individuals were recruited on to the My Choice Weight Management Programme. More participants were recruited at GP surgeries (n=268) than at community pharmacies (n=183). In total, 204 participants (GP n=102; pharmacy n=102) attended session twelve and 82 participants (GP n=22; pharmacy 60) attended session fifteen. The unique demographic characteristics of My Choice Weight Management Programme participants – participants were recruited from areas with high levels of socioeconomic deprivation and over four-fifths of participants were from Black and Minority Ethnic groups; populations which are traditionally underserved by healthcare interventions – make the achievements of the Programme particularly notable. The mean weight loss at session 12 was 3.8 kg (equivalent to a reduction of 4.0% of initial weight) among GP surgery participants and 2.4 kg (2.8%) among pharmacy participants. At session 15 mean weight loss was 2.3 kg (2.2%) among GP surgery participants and 3.4 kg (4.0%) among pharmacy participants. The My Choice Weight Management Programme improved the general health status of participants between recruitment and session twelve as measured by the validated SF-12 questionnaire. While cost data is presented in this report, it is unclear which provider type delivered the Programme more cost-effectively. Attendance rates on the Programme were consistently better among pharmacy participants than among GP participants. The opinions of programme participants (both those who attended regularly and those who failed to attend as expected) and programme providers were explored via semi-structured interviews and, in the case of the participants, a selfcompletion postal questionnaire. These data suggest that the Programme was almost uniformly popular with both the deliverers of the Programme and participants on the Programme with 83% of questionnaire respondents indicating that they would be happy to recommend the Programme to other people looking to lose weight. Our recommendations, based on the evidence provided in this report, include: a. Any consideration of an extension to the study also giving comparable consideration to an extension of the Programme evaluation. The feasibility of assigning participants to a pharmacy provider or a GP provider via a central allocation system should also be examined. This would address imbalances in participant recruitment levels between provider type and allow for more accurate comparison of the effectiveness in the delivery of the Programme between GP surgeries and community pharmacies by increasing the homogeneity of participants at each type of site and increasing the number of Programme participants overall. b. Widespread dissemination of the findings from this review of the My Choice Weight Management Project should be undertaken through a variety of channels. c. Consideration of the inclusion of the following key aspects of the My Choice Weight Management Project in any extension to the Programme: i. The provision of training to staff in GP surgeries and community pharmacies responsible for delivery of the Programme prior to patient recruitment. ii. Maintaining the level of healthcare staff input to the Programme. iii. The regular schedule of appointments with Programme participants. iv. The provision of an increased variety of printed material. d. A simplification of the data collection method used by the Programme commissioners at the individual Programme delivery sites.

Study of management decision making by ward sisters in a hospital and the effects on decision making after the implementation of a decision support sytem

This thesis considers management decision making at the ward level in hospitals especially by ward sisters, and the effectiveness of the intervention of a decision support system. Nursing practice theories were related to organisation and management theories in order to conceptualise a decision making framework for nurse manpower planning and deployment at the ward level. Decision and systems theories were explored to understand the concepts of decision making and the realities of power in an organisation. In essence, the hypothesis was concerned with changes in patterns of decision making that could occur with the intervention of a decision support system and that the degree of change would be governed by a set of `difficulty' factors within wards in a hospital. During the course of the study, a classification of ward management decision making was created, together with the development and validation of measuring instruments to test the research hypothesis. The decision support system used was rigorously evaluated to test whether benefits did accrue from its implementation. Quantitative results from sample wards together with qualitative information collected, were used to test this hypothesis and the outcomes postulated were supported by these findings. The main conclusion from this research is that a more rational approach to management decision making is feasible, using information from a decision support system. However, wards and ward sisters that need the most assistance, where the `difficulty' factors in the organisation are highest, benefit the least from this type of system. Organisational reviews are needed on these identified wards, involving managers and doctors, to reduce the levels of un-coordinated activities and disruption.

A study of load support and other criteria appropriate to the selection of industrial conveyor belts

A study of conveying practice demonstrates that belt conveyors provide a versatile and. much-used method of transporting bulk materials, but a review of belting manufacturers' design procedures shows that belt design and selection rules are often based on experience with all-cotton belts no longer in common use, and are net completely relevant to modern synthetic constructions. In particular, provision of the property "load support", which was not critical with cotton belts, is shown to determine the outcome of most belt selection exercises and lead to gross over specification of other design properties in many cases. The results of an original experimental investigation into this property, carried out to determine the belt and conveyor parameters that affect it, how the major role that belt stiffness plays in its provision; the basis for a belt stiffness test relevant to service conditions is given. A proposal for a more rational method of specifying load support data results from the work, but correlation of the test results with service performance is necessary before the absolute toad support capability required from a belt for given working conditions can be quantified. A study to attain this correlation is the major proposal for future work resulting from the present investigation, but a full review of the literature on conveyor design and a study of present practice within the belting industry demonstrate other, less critical, factors that could profitably be investigated. It is suggested that the most suitable method of studying these would be a rational data collection system to provide information on various facets of belt service behaviour; a basis for such a system is proposed. In addition to the work above, proposals for simplifying the present belt selection methods are made and a strain transducer suitable for use in future experimental investigations is developed.

The design of a support department simulator for use in the design of manufacturing systems

Manufacturing firms are driven by competitive pressures to continually improve the effectiveness and efficiency of their organisations. For this reason, manufacturing engineers often implement changes to existing processes, or design new production facilities, with the expectation of making further gains in manufacturing system performance. This thesis relates to how the likely outcome of this type of decision should be predicted prior to its implementation. The thesis argues that since manufacturing systems must also interact with many other parts of an organisation, the expected performance improvements can often be significantly hampered by constraints that arise elsewhere in the business. As a result, decision-makers should attempt to predict just how well a proposed design will perform when these other factors, or 'support departments', are taken into consideration. However, the thesis also demonstrates that, in practice, where quantitative analysis is used to evaluate design decisions, the analysis model invariably ignores the potential impact of support functions on a system's overall performance. A more comprehensive modelling approach is therefore required. A study of how various business functions interact establishes that to properly represent the kind of delays that give rise to support department constraints, a model should actually portray the dynamic and stochastic behaviour of entities in both the manufacturing and non-manufacturing aspects of a business. This implies that computer simulation be used to model design decisions but current simulation software does not provide a sufficient range of functionality to enable the behaviour of all of these entities to be represented in this way. The main objective of the research has therefore been the development of a new simulator that will overcome limitations of existing software and so enable decision-makers to conduct a more holistic evaluation of design decisions. It is argued that the application of object-oriented techniques offers a potentially better way of fulfilling both the functional and ease-of-use issues relating to development of the new simulator. An object-oriented analysis and design of the system, called WBS/Office, are therefore presented that extends to modelling a firm's administrative and other support activities in the context of the manufacturing system design process. A particularly novel feature of the design is the ability for decision-makers to model how a firm's specific information and document processing requirements might hamper shop-floor performance. The simulator is primarily intended for modelling make-to-order batch manufacturing systems and the thesis presents example models created using a working version of WBS/Office that demonstrate the feasibility of using the system to analyse manufacturing system designs in this way.

User interface design support for the development of knowledge-based systems

The present scarcity of operational knowledge-based systems (KBS) has been attributed, in part, to an inadequate consideration shown to user interface design during development. From a human factors perspective the problem has stemmed from an overall lack of user-centred design principles. Consequently the integration of human factors principles and techniques is seen as a necessary and important precursor to ensuring the implementation of KBS which are useful to, and usable by, the end-users for whom they are intended. Focussing upon KBS work taking place within commercial and industrial environments, this research set out to assess both the extent to which human factors support was presently being utilised within development, and the future path for human factors integration. The assessment consisted of interviews conducted with a number of commercial and industrial organisations involved in KBS development; and a set of three detailed case studies of individual KBS projects. Two of the studies were carried out within a collaborative Alvey project, involving the Interdisciplinary Higher Degrees Scheme (IHD) at the University of Aston in Birmingham, BIS Applied Systems Ltd (BIS), and the British Steel Corporation. This project, which had provided the initial basis and funding for the research, was concerned with the application of KBS to the design of commercial data processing (DP) systems. The third study stemmed from involvement on a KBS project being carried out by the Technology Division of the Trustees Saving Bank Group plc. The preliminary research highlighted poor human factors integration. In particular, there was a lack of early consideration of end-user requirements definition and user-centred evaluation. Instead concentration was given to the construction of the knowledge base and prototype evaluation with the expert(s). In response to this identified problem, a set of methods was developed that was aimed at encouraging developers to consider user interface requirements early on in a project. These methods were then applied in the two further projects, and their uptake within the overall development process was monitored. Experience from the two studies demonstrated that early consideration of user interface requirements was both feasible, and instructive for guiding future development work. In particular, it was shown a user interface prototype could be used as a basis for capturing requirements at the functional (task) level, and at the interface dialogue level. Extrapolating from this experience, a KBS life-cycle model is proposed which incorporates user interface design (and within that, user evaluation) as a largely parallel, rather than subsequent, activity to knowledge base construction. Further to this, there is a discussion of several key elements which can be seen as inhibiting the integration of human factors within KBS development. These elements stem from characteristics of present KBS development practice; from constraints within the commercial and industrial development environments; and from the state of existing human factors support.

A tree-based decision model to support prediction of the severity of asthma exacerbations in children

This paper describes the development of a tree-based decision model to predict the severity of pediatric asthma exacerbations in the emergency department (ED) at 2 h following triage. The model was constructed from retrospective patient data abstracted from the ED charts. The original data was preprocessed to eliminate questionable patient records and to normalize values of age-dependent clinical attributes. The model uses attributes routinely collected in the ED and provides predictions even for incomplete observations. Its performance was verified on independent validating data (split-sample validation) where it demonstrated AUC (area under ROC curve) of 0.83, sensitivity of 84%, specificity of 71% and the Brier score of 0.18. The model is intended to supplement an asthma clinical practice guideline, however, it can be also used as a stand-alone decision tool.

Knowledge engineering for mental-health risk assessment and decision support

Mental-health risk assessment practice in the UK is mainly paper-based, with little standardisation in the tools that are used across the Services. The tools that are available tend to rely on minimal sets of items and unsophisticated scoring methods to identify at-risk individuals. This means the reasoning by which an outcome has been determined remains uncertain. Consequently, there is little provision for: including the patient as an active party in the assessment process, identifying underlying causes of risk, and eecting shared decision-making. This thesis develops a tool-chain for the formulation and deployment of a computerised clinical decision support system for mental-health risk assessment. The resultant tool, GRiST, will be based on consensual domain expert knowledge that will be validated as part of the research, and will incorporate a proven psychological model of classication for risk computation. GRiST will have an ambitious remit of being a platform that can be used over the Internet, by both the clinician and the layperson, in multiple settings, and in the assessment of patients with varying demographics. Flexibility will therefore be a guiding principle in the development of the platform, to the extent that GRiST will present an assessment environment that is tailored to the circumstances in which it nds itself. XML and XSLT will be the key technologies that help deliver this exibility.

Proof in the pedagogic pudding? The challenges of promoting evidence-based teaching practice in a research-focused institution

Drawing upon the findings of a mixed methodological study, this paper critically analyses the cultural, pedagogical, and organisational issues encountered by academics and support staff working within a newly established Centre for Learning Innovation and Professional Practice tasked with facilitating a new teaching-focused policy in a previously research-led institution. The aim of this policy is to assure that, across the institution, teaching is given the same priority and kudos as research. Focusing specifically staff perceptions of the impact of the new policy on various aspects of academic life including, pedagogic practice, student support, staff training, and organisational management, the paper critically addresses the cultural and attitudinal challenges of change management (Kotter, 1996) within a ‘grey-brick’ university. In doing so it makes a significant contribution to current academic theory and debate in the areas of pedagogic practice and organisational management.

Electronic commerce adoption:a study of business-to-business practice in Saudi Arabia

Electronic commerce (e-commerce) has become an increasingly important initiative among organisations. The factors affecting adoption decisions have been well-documented, but there is a paucity of empirical studies that examine the adoption of e-commerce in developing economies in the Arab world. The aim of this study is to provide insights into the salient e-commerce adoption issues by focusing on Saudi Arabian businesses. Based on the Technology-Organisational-Environmental framework, an integrated research model was developed that explains the relative influence of 19 known determinants. A measurement scale was developed from prior empirical studies and revised based on feedback from the pilot study. Non-interactive adoption, interactive adoption and stabilisation of e-commerce adoption were empirically investigated using survey data collected from Saudi manufacturing and service companies. Multiple discriminant function analysis (MDFA) was used to analyse the data and research hypotheses. The analysis demonstrates that (1) regarding the non-interactive adoption of e-commerce, IT readiness, management team support, learning orientation, strategic orientation, pressure from business partner, regulatory and legal environment, technology consultants‘ participation and economic downturn are the most important factors, (2) when e-commerce interactive adoption is investigated, IT readiness, management team support, regulatory environment and technology consultants‘ participation emerge as the strongest drivers, (3) pressure from customers may not have much effect on the non-interactive adoption of e-commerce by companies, but does significantly influence the stabilisation of e-commerce use by firms, and (4) Saudi Arabia has a strong ICT infrastructure for supporting e-commerce practices. Taken together, these findings on the multi-dimensionality of e-commerce adoption show that non-interactive adoption, interactive adoption and stabilisation of e-commerce are not only different measures of e-commerce adoption, but also have different determinants. Findings from this study may be valuable for both policy and practice as it can offer a substantial understanding of the factors that enhance the widespread use of B2B e-commerce. Also, the integrated model provides a more comprehensive explanation of e-commerce adoption in organisations and could serve as a foundation for future research on information systems.

Supervisor-subordinate age dissimilarity and performance ratings:the buffering effects of supervisory relationship practice

Using 394 pairs of employees and their immediate supervisors working in the Information and Communication Technology (ICT) sector in three northern European countries, this study examined the effect of workplace moderators on the link between relational demography and supervisor ratings of performance. Directional age differences between superior and subordinate (i.e., status incongruence caused when the supervisor is older or younger than his/her subordinate) and non-directional age differences were used as predictors of supervisor ratings of occupational expertise. The quality of the supervisor-subordinate relationship and the existence of positive age-related supervisory practices were examined as moderators of this relationship. The results provide no support for a relationship between directional age differences and age-related stereotyping by supervisors in ratings of performance, neither for the effects of age-related supervisory practices. However, high quality supervisor-subordinate relationships did moderate the effects of age dissimilarity on supervisory ratings. The implications of these findings for performance appraisal methodologies and recommendations for further research are discussed.

A review of research and practice for the industrial networks of the future

Academic researchers have followed closely the interest of companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? First, it appears that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example, in assembly operations. Second, the increased tendency towards specialisation has forced other, upstream, parts of industrial networks to introduce advanced manufacturing technologies for niche markets. Third, the capital market for investments in capacity, and the trade in manufacturing as a commodity, dominates resource allocation to a larger extent than was previously the case. Fourth, there is becoming a continuous move towards more loosely connected entities that comprise manufacturing networks. Finally, in these networks, concepts for supply chain management should address collaboration and information technology that supports decentralised decision-making, in particular to address sustainable and green supply chains. More traditional concepts, such as the keiretsu and chaibol networks of some Asian economies, do not sufficiently support the demands now being placed on networks. Research should address these five fundamental challenges to prepare for the industrial networks of 2020 and beyond. © 2010 Springer-Verlag London.