Large scale organisational intervention to improve patient safety in four UK hospitals:mixed method evaluation

Objectives: To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design: Mixed method evaluation involving five substudies, before and after design. Setting: NHS hospitals in United Kingdom. Participants: Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention: The SPI1 was a compound (multicomponent) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results: Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration - monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items) - there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from17%(63) to13%(49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening.

An adaptive code position modulation scheme for wireless sensor networks

In this letter, an energy-efficient adaptive code position modulation scheme is proposed for wireless sensor networks to provide the relatively stable bit error ratio (BER) performance expected by the upper layers. The system is designed with focus on the adaptive control of transmission power, which is adjusted based on the measured power density of background noise. Interfaces among the modulation module, packet scheduling module and upper layer are provided for flexible adjustments to adapt to the background noise and deliver expected application quality. Simulations with Signal Processing Worksystem (SPW) validate the effectiveness of the scheme. © 2005 IEEE.

Radio range adjustment for energy efficient wireless sensor networks

In wireless ad hoc sensor networks, energy use is in many cases the most important constraint since it corresponds directly to operational lifetime. Topology management schemes such as GAF put the redundant nodes for routing to sleep in order to save the energy. The radio range will affect the number of neighbouring nodes, which collaborate to forward data to a base station or sink. In this paper we study a simple linear network and deduce the relationship between optimal radio range and traffic. We find that half of the power can be saved if the radio range is adjusted appropriately compared with the best case where equal radio ranges are used.

Making motes intelligent:an agent-based approach to wireless sensor networks

In-Motes is a mobile agent middleware that generates an intelligent framework for deploying applications in Wireless Sensor Networks (WSNs). In-Motes is based on the injection of mobile agents into the network that can migrate or clone following specific rules and performing application specific tasks. By doing so, each mote is given a certain degree of perception, cognition and control, forming the basis for its intelligence. Our middleware incorporates technologies such as Linda-like tuplespaces and federated system architecture in order to obtain a high degree of collaboration and coordination for the agent society. A set of behavioral rules inspired by a community of bacterial strains is also generated as the means for robustness of the WSN. In this paper, we present In-Motes and provide a detailed evaluation of its implementation for MICA2 motes.

Coverage overlapping problems in applications of IEEE 802.15.4 wireless sensor networks

IEEE 802.15.4 standard is a relatively new standard designed for low power low data rate wireless sensor networks (WSN), which has a wide range of applications, e.g., environment monitoring, e-health, home and industry automation. In this paper, we investigate the problems of hidden devices in coverage overlapped IEEE 802.15.4 WSNs, which is likely to arise when multiple 802.15.4 WSNs are deployed closely and independently. We consider a typical scenario of two 802.15.4 WSNs with partial coverage overlapping and propose a Markov-chain based analytical model to reveal the performance degradation due to the hidden devices from the coverage overlapping. Impacts of the hidden devices and network sleeping modes on saturated throughput and energy consumption are modeled. The analytic model is verified by simulations, which can provide the insights to network design and planning when multiple 802.15.4 WSNs are deployed closely. © 2013 IEEE.

Local resources and procurement practices in humanitarian supply chains:an empirical examination of large-scale house reconstruction projects

Different procurement decisions taken by relief organizations can result in considerably different implications in regards to transport, storage, and distribution of humanitarian aid and ultimately can influence the performance of the humanitarian supply chain and the delivery of the humanitarian aid. In this article, we look into what resources are needed and how these resources evolve in the delivery of humanitarian aid. Drawing on the resource-based view of the firm, we develop a framework to categorize the impact of local resources on the configuration of humanitarian supply chains. In contrast to other papers, the importance of localizing the configuration of the humanitarian supply chain is not only conceptually recognized, but empirical investigations are also provided. In terms of methodology, this article is based on the analysis of secondary data from two housing reconstruction projects. Findings indicate that the use of local resources in humanitarian aid has positive effects on programs' overall supply chain performance and these effects are not only related to the macroeconomic perspective, but benefits expand to improvements related to the use of knowledge. At the same time, it was found that local sourcing often comes with a number of problems. For example, in one of the cases, significant problems existed, which were related to the scarcity of local supplies. Both housing reconstruction projects have indicated the continuous need for changes throughout the programs as a dynamic supply chain configuration is important for the long-term sustainability of reconstruction aid. © 2014 Decision Sciences Institute.

Energy efficient transmission protocol for distributed source coding in sensor networks

Distributed source coding (DSC) has recently been considered as an efficient approach to data compression in wireless sensor networks (WSN). Using this coding method multiple sensor nodes compress their correlated observations without inter-node communications. Therefore energy and bandwidth can be efficiently saved. In this paper, we investigate a randombinning based DSC scheme for remote source estimation in WSN and its performance of estimated signal to distortion ratio (SDR). With the introduction of a detailed power consumption model for wireless sensor communications, we quantitatively analyze the overall network energy consumption of the DSC scheme. We further propose a novel energy-aware transmission protocol for the DSC scheme, which flexibly optimizes the DSC performance in terms of either SDR or energy consumption, by adapting the source coding and transmission parameters to the network conditions. Simulations validate the energy efficiency of the proposed adaptive transmission protocol. © 2007 IEEE.

In-Motes Bins:a real time application for environmental monitoring in wireless sensor networks

In-Motes Bins is an agent based real time In-Motes application developed for sensing light and temperature variations in an environment. In-Motes is a mobile agent middleware that facilitates the rapid deployment of adaptive applications in Wireless Sensor Networks (WSN's). In-Motes Bins is based on the injection of mobile agents into the WSN that can migrate or clone following specific rules and performing application specific tasks. Using In-Motes we were able to create and rapidly deploy our application on a WSN consisting of 10 MICA2 motes. Our application was tested in a wine store for a period of four months. In this paper we present the In-Motes Bins application and provide a detailed evaluation of its implementation. © 2007 IEEE.

Hydrogen production by steam reforming of DME in a large scale CFB reactor. Part I:computational model and predictions

This study presents a computational fluid dynamic (CFD) study of Dimethyl Ether steam reforming (DME-SR) in a large scale Circulating Fluidized Bed (CFB) reactor. The CFD model is based on Eulerian-Eulerian dispersed flow and solved using commercial software (ANSYS FLUENT). The DME-SR reactions scheme and kinetics in the presence of a bifunctional catalyst of CuO/ZnO/Al2O3+ZSM-5 were incorporated in the model using in-house developed user-defined function. The model was validated by comparing the predictions with experimental data from the literature. The results revealed for the first time detailed CFB reactor hydrodynamics, gas residence time, temperature distribution and product gas composition at a selected operating condition of 300 °C and steam to DME mass ratio of 3 (molar ratio of 7.62). The spatial variation in the gas species concentrations suggests the existence of three distinct reaction zones but limited temperature variations. The DME conversion and hydrogen yield were found to be 87% and 59% respectively, resulting in a product gas consisting of 72 mol% hydrogen. In part II of this study, the model presented here will be used to optimize the reactor design and study the effect of operating conditions on the reactor performance and products.

Energy aware data gathering based on adaptive modulation scaling in wireless sensor networks

Energy consumption has been a key concern of data gathering in wireless sensor networks. Previous research works show that modulation scaling is an efficient technique to reduce energy consumption. However, such technique will also impact on both packet delivery latency and packet loss, therefore, may result in adverse effects on the qualities of applications. In this paper, we study the problem of modulation scaling and energy-optimization. A mathematical model is proposed to analyze the impact of modulation scaling on the overall energy consumption, end-to-end mean delivery latency and mean packet loss rate. A centralized optimal management mechanism is developed based on the model, which adaptively adjusts the modulation levels to minimize energy consumption while ensuring the QoS for data gathering. Experimental results show that the management mechanism saves significant energy in all the investigated scenarios. Some valuable results are also observed in the experiments. © 2004 IEEE.

Large-scale molecular dynamics simulations of HLA-A*0201 complexed with a tumor-specific antigenic peptide:can the α3 and β2m domains be neglected?

Large-scale massively parallel molecular dynamics (MD) simulations of the human class I major histo-compatibility complex (MHC) protein HLA-A*0201 bound to a decameric tumor-specific antigenic peptide GVY-DGREHTV were performed using a scalable MD code on high-performance computing platforms. Such computational capabilities put us in reach of simulations of various scales and complexities. The supercomputing resources available Large-scale massively parallel molecular dynamics (MD) simulations of the human class I major histocompatibility complex (MHC) protein HLA-A*0201 bound to a decameric tumor-specific antigenic peptide GVYDGREHTV were performed using a scalable MD code on high-performance computing platforms. Such computational capabilities put us in reach of simulations of various scales and complexities. The supercomputing resources available for this study allow us to compare directly differences in the behavior of very large molecular models; in this case, the entire extracellular portion of the peptide–MHC complex vs. the isolated peptide binding domain. Comparison of the results from the partial and the whole system simulations indicates that the peptide is less tightly bound in the partial system than in the whole system. From a detailed study of conformations, solvent-accessible surface area, the nature of the water network structure, and the binding energies, we conclude that, when considering the conformation of the α1–α2 domain, the α3 and β2m domains cannot be neglected. © 2004 Wiley Periodicals, Inc. J Comput Chem 25: 1803–1813, 2004

Energy hole mitigation through cooperative transmission in wireless sensor networks

The energy balancing capability of cooperative communication is utilized to solve the energy hole problem in wireless sensor networks. We first propose a cooperative transmission strategy, where intermediate nodes participate in two cooperative multi-input single-output (MISO) transmissions with the node at the previous hop and a selected node at the next hop, respectively. Then, we study the optimization problems for power allocation of the cooperative transmission strategy by examining two different approaches: network lifetime maximization (NLM) and energy consumption minimization (ECM). For NLM, the numerical optimal solution is derived and a searching algorithm for suboptimal solution is provided when the optimal solution does not exist. For ECM, a closed-form solution is obtained. Numerical and simulation results show that both the approaches have much longer network lifetime than SISO transmission strategies and other cooperative communication schemes. Moreover, NLM which features energy balancing outperforms ECM which focuses on energy efficiency, in the network lifetime sense.

Evaluation efficiency of large-scale data set with negative data:an artificial neural network approach

Data envelopment analysis (DEA) is the most widely used methods for measuring the efficiency and productivity of decision-making units (DMUs). The need for huge computer resources in terms of memory and CPU time in DEA is inevitable for a large-scale data set, especially with negative measures. In recent years, wide ranges of studies have been conducted in the area of artificial neural network and DEA combined methods. In this study, a supervised feed-forward neural network is proposed to evaluate the efficiency and productivity of large-scale data sets with negative values in contrast to the corresponding DEA method. Results indicate that the proposed network has some computational advantages over the corresponding DEA models; therefore, it can be considered as a useful tool for measuring the efficiency of DMUs with (large-scale) negative data.

An improved memory management scheme for large scale graph computing engine GraphChi

GraphChi is the first reported disk-based graph engine that can handle billion-scale graphs on a single PC efficiently. GraphChi is able to execute several advanced data mining, graph mining and machine learning algorithms on very large graphs. With the novel technique of parallel sliding windows (PSW) to load subgraph from disk to memory for vertices and edges updating, it can achieve data processing performance close to and even better than those of mainstream distributed graph engines. GraphChi mentioned that its memory is not effectively utilized with large dataset, which leads to suboptimal computation performances. In this paper we are motivated by the concepts of 'pin ' from TurboGraph and 'ghost' from GraphLab to propose a new memory utilization mode for GraphChi, which is called Part-in-memory mode, to improve the GraphChi algorithm performance. The main idea is to pin a fixed part of data inside the memory during the whole computing process. Part-in-memory mode is successfully implemented with only about 40 additional lines of code to the original GraphChi engine. Extensive experiments are performed with large real datasets (including Twitter graph with 1.4 billion edges). The preliminary results show that Part-in-memory mode memory management approach effectively reduces the GraphChi running time by up to 60% in PageRank algorithm. Interestingly it is found that a larger portion of data pinned in memory does not always lead to better performance in the case that the whole dataset cannot be fitted in memory. There exists an optimal portion of data which should be kept in the memory to achieve the best computational performance.