The Quality of Reporting of Diagnostic Accuracy Studies of Optical Coherence Tomography in Glaucoma

Objective: To evaluate the quality of reporting of diagnostic accuracy studies using optical coherence tomography (OCT) in glaucoma. Design: Descriptive series of published studies. Participants: Published studies reporting a measure of the diagnostic accuracy of OCT for glaucoma. Methods: Review of English language papers reporting measures of diagnostic accuracy of OCT for glaucoma. Papers were identified from a Medline literature search performed in June 2006. Articles were appraised using the 25 items provided by the Standards for Reporting of Diagnostic Accuracy (STARD) initiative. Each item was recorded as full, partially, or not reported. Main Outcome Measures: Degree of compliance with the STARD guidelines. Results: Thirty papers were appraised. Eight papers (26.7%) fully reported more than half of the STARD items. The lowest number of fully reported items in a study was 5 and the highest was 17. Descriptions of key aspects of methodology frequently were missing. For example, details of participant sampling (e.g., consecutive or random selection) were described in only 8 (26.7%) of 30 publications. Measures of statistical uncertainty were reported in 18 (60%) of 30 publications. No single STARD item was fully reported by all the papers. Conclusions: The standard of reporting of diagnostic accuracy studies in glaucoma using OCT was suboptimal. It is hoped that adoption of the STARD guidelines will lead to an improvement in reporting of diagnostic accuracy studies, enabling clearer evidence to be produced for the usefulness of OCT for the diagnosis of glaucoma. © 2007 American Academy of Ophthalmology.

Impact of counselling on quality of life and sleep in cancer patients

It has been acknowledged that poor quality of sleep significantly correlates with poor quality of life; evidence suggests that counselling has a positive impact not only on the cancer patient's quality of life, but also on family members and friends. The aim of this service evaluation was to determine if there was an improvement in clients’ quality of life and sleep patterns following counselling as offered by a local cancer charity. A total of 60 matched pre- and post-counselling questionnaires were completed and subjected to statistical analysis. When considering quality of life, in the domains of Role Emotional, Mental Health and Mental Component Summary Score, it can be concluded that counselling has a positive effect on emotional health and mental wellbeing. The mean total number of hours sleep per night significantly increased from 6 hours sleep per night at baseline to 6.8 hours sleep per night at the completion of counselling (p=0.005) showing clients gained an extra 48 minutes sleep per night. The improved emotional and mental wellbeing alongside the extra 48 minutes sleep per night provides evidence that there is a positive outcome for those patients and families who use counselling services. Nurses and other members of the multidisciplinary team should be encouraged to discuss supportive therapies with patients and those affected by cancer at all stages of the cancer trajectory, regardless of social status, gender or cancer type.

Is Early Warning Effective for the Improvement of Problem Solving and Project Performance?

Since the first launch of the new engineering contract (NEC) in 1993, early warning of problems has been widely recognized as an important approach of proactive management during a construction or engineering project. Is early warning really effective for the improvement of problem solving and project performance? This is a research question that still lacks a good answer. For this reason, an empirical investigation was made in the United Kingdom (U.K.) to answer the question. This study adopts a combination of literature review, expert interview, and questionnaire survey. Nearly 100 questionnaire responses were collected from the U.K. construction industry, based on which the use of early warning under different forms of contract is compared in this paper. Problem solving and project performance are further compared between the projects using early warning and the projects not using early warning. The comparison provides clear evidence for the significant effect of early warning on problem solving and project performance in terms of time, cost, and quality. Subsequently, an input-process-output model is developed in this paper to explore the relationship among early warning, problem solving, and project
performance. All these help construction researchers and practitioners to better understand the role of early warning in ensuring project success.

Design methodology for low power and arametric robustness through output-quality modulation:Application to color-interpolation filtering

Power dissipation and robustness to process variation have conflicting design requirements. Scaling of voltage is associated with larger variations, while Vdd upscaling or transistor upsizing for parametric-delay variation tolerance can be detrimental for power dissipation. However, for a class of signal-processing systems, effective tradeoff can be achieved between Vdd scaling, variation tolerance, and output quality. In this paper, we develop a novel low-power variation-tolerant algorithm/architecture for color interpolation that allows a graceful degradation in the peak-signal-to-noise ratio (PSNR) under aggressive voltage scaling as well as extreme process variations. This feature is achieved by exploiting the fact that all computations used in interpolating the pixel values do not equally contribute to PSNR improvement. In the presence of Vdd scaling and process variations, the architecture ensures that only the less important computations are affected by delay failures. We also propose a different sliding-window size than the conventional one to improve interpolation performance by a factor of two with negligible overhead. Simulation results show that, even at a scaled voltage of 77% of nominal value, our design provides reasonable image PSNR with 40% power savings. © 2006 IEEE.

Design methodology to trade off power, output quality and error resiliency: Application to color interpolation filtering

Power dissipation and tolerance to process variations pose conflicting design requirements. Scaling of voltage is associated with larger variations, while Vdd upscaling or transistor up-sizing for process tolerance can be detrimental for power dissipation. However, for certain signal processing systems such as those used in color image processing, we noted that effective trade-offs can be achieved between Vdd scaling, process tolerance and "output quality". In this paper we demonstrate how these tradeoffs can be effectively utilized in the development of novel low-power variation tolerant architectures for color interpolation. The proposed architecture supports a graceful degradation in the PSNR (Peak Signal to Noise Ratio) under aggressive voltage scaling as well as extreme process variations in. sub-70nm technologies. This is achieved by exploiting the fact that some computations are more important and contribute more to the PSNR improvement compared to the others. The computations are mapped to the hardware in such a way that only the less important computations are affected by Vdd-scaling and process variations. Simulation results show that even at a scaled voltage of 60% of nominal Vdd value, our design provides reasonable image PSNR with 69% power savings.

Falls prevention and support:: translating research, integrating services and promoting the contribution of service users for quality and innovative programmes of care

Falls are a significant threat to the safety, health and independence of older citizens. Despite the substantial evidence that is available around effective falls prevention programmes and interventions, their translation into falls reduction programmes and policies has yet to be fully realised. While hip fracture rates are decreasing, the number and incidence of fall-related hospital admissions among older people continue to rise. Given the demographic trends that highlight increasing numbers of older people in the UK, which is broadly reflected internationally, there is a financial and social imperative to minimise the rate of falls and associated injuries. Falling is closely aligned to growing older (Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010). According to the World Health Organization, around 30% of older people aged over 65 and 50% of those over 80 will fall each year (Falls Fact Sheet Number 344, WHO, Geneva, 2010). Falls happen as a result of many reasons and can have harmful consequences, including loss of mobility and independence, confidence and in many cases even death (Cochrane Database Syst Rev 15, 2009, 146; Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010; Falling Standards, Broken Promises: Report of the National
Audit of Falls and Bone Health in Older People 2010, Health Care Quality
Improvement Partnership, London, 2011). What is neither fair nor correct is the
common belief by old and young alike that falls are just another inconvenience to put up with. The available evidence justifiably supports the view that well-organised services, based upon national standards and expert guidance, can prevent future falls among older people and reduce death and disability from fractures. This paper will draw from the UK, as an exemplar for policy and practice, to discuss the strategic direction of falls prevention programmes for older people and the partnerships that need to exist between researchers, service providers and users of services to translate evidence to the clinical setting. Second, it will propose some mechanisms for disseminating evidence to healthcare professionals and other stakeholders, to improve the quality and capacity of the clinical workforce.

Perception and Automatic Recognition of Laughter from Whole-Body Motion: Continuous and Categorical Perspectives

Despite its importance in social interactions, laughter remains little studied in affective computing. Intelligent virtual agents are often blind to users’ laughter and unable to produce convincing laughter themselves. Respiratory, auditory, and facial laughter signals have been investigated but laughter-related body movements have received less attention. The aim of this study is threefold. First, to probe human laughter perception by analyzing patterns of categorisations of natural laughter animated on a minimal avatar. Results reveal that a low dimensional space can describe perception of laughter “types”. Second, to investigate observers’ perception of laughter (hilarious, social, awkward, fake, and non-laughter) based on animated avatars generated from natural and acted motion-capture data. Significant differences in torso and limb movements are found between animations perceived as laughter and those perceived as non-laughter. Hilarious laughter also differs from social laughter. Different body movement features were indicative of laughter in sitting and standing avatar postures. Third, to investigate automatic recognition of laughter to the same level of certainty as observers’ perceptions. Results show recognition rates of the Random Forest model approach human rating levels. Classification comparisons and feature importance analyses indicate an improvement in recognition of social laughter when localized features and nonlinear models are used.

European Cystic Fibrosis Society Standards of Care: Quality Management in cystic fibrosis

Since the earliest days of cystic fibrosis (CF) treatment, patient data have been recorded and reviewed in order to identify the factors that lead to more favourable outcomes. Large data repositories, such as the US Cystic Fibrosis Registry, which was established in the 1960s, enabled successful treatments and patient outcomes to be recognized and improvement programmes to be implemented in specialist CF centres. Over the past decades, the greater volumes of data becoming available through Centre databases and patient registries led to the possibility of making comparisons between different therapies, approaches to care and indeed data recording. The quality of care for individuals with CF has become a focus at several levels: patient, centre, regional, national and international. This paper reviews the quality management and improvement issues at each of these levels with particular reference to indicators of health, the role of CF Centres, regional networks, national health policy, and international data registration and comparisons. 

QA and Enhancement Marketplace for HEIs – An Erasmus+ project

Improving European education and training system quality has been set as a key target in Europe’s strategy to become a smart, sustainable and inclusive economy by 2020 (European Commission, 2010). These objectives are more specifically defined in the so called Modernisation Agenda (European Commission, 2011). More specifically it sets a goal to improve the quality and relevance of higher education. In this process external evaluation and
Proceedings of the 11th International CDIO Conference, Chengdu University of Information Technology,
Chengdu, Sichuan, P.R. China, June 8-11, 2015.
self-assessment are seen in a key role! In the CDIO approach the 12 CDIO standards provide a framework for continuous improvement. Each institution/institutional department are encouraged to regularly do the self-evaluation using the CDIO Standards. Eight European universities identified a need for further enhancement of the self-evaluations and creation of processes with peers to reduce the inertia of heavy accreditations/evaluations in HEIs. In September 2014 these universities started an Erasmus+ project (QAEMarketPlace4HEI) aiming at
1. Developing a collaborative, comprehensive and accessible evaluation process model, methods and tools for HEIs to complement the accreditation systems.
2. Promoting, increasing and exploiting further the European collaboration in the evaluation processes and the exchange of best practices.
3. Disseminating the model, best practices and widen the cooperation to new HEIs in Europe through the partner networks.

Cataract extraction and patient vision-related quality of life: a cohort study

Aims: Cataract surgery is one of the most common surgeries performed, but its overuse has been reported. The threshold for cataract surgery has become increasingly lenient; therefore, the selection process and surgical need has been questioned. The aim of this study was to evaluate the changes associated with cataract surgery in patient-reported vision-related quality of life (VR-QoL).

Methods: A prospective cohort study was conducted. Consecutive patients referred to cataract clinics in an NHS unit in Scotland were identified. Those listed for surgery were invited to complete a validated questionnaire (TyPE) to measure VR-QoL pre- and post-operatively. TyPE has five different domains (near vision, distance vision, daytime driving, night-time driving, and glare) and a global score of vision. The influence of pre-operative visual acuity (VA) levels, vision, and lens status of the fellow eye on changes in VR-QoL were explored. 

Results: A total of 320 listed patients were approached, of whom 36 were excluded. Among the 284 enrolled patients, 229 (81%) returned the questionnaire after surgery. Results revealed that the mean overall vision improved, as reported by patients. Improvements were also seen in all sub-domains of the questionnaire.

Conclusion: The majority of patients appear to have improvement in patient-reported VR-QoL, including those with good pre-operative VA and previous surgery to the fellow eye. VA thresholds may not capture the effects of the quality of life on patients. This information can assist clinicians to make more informed decisions when debating over the benefits of listing a patient for cataract extraction.

Avaliação da Escola - Resultados Escolares e a procura da Qualidade

Trabalho de Projeto apresentado para a obtenção do grau de Mestre na especialidade em Administração Educacional. Orientador:Prof. Doutor João Sebastião

Microbiological quality of bivalves: relevance to food safety

Os moluscos bivalves constituem um recurso haliêutico de elevada importância na economia (inter)nacional pelas suas características organolépticas, valor nutritivo e relevância na gastronomia tradicional. Não obstante, representam um produto alimentar de elevado risco para a saúde pública. A contaminação microbiológica (autóctone e antropogénica), sendo crónica nos bancos de bivalves das zonas estuarino-lagunares, constitui uma das principais preocupações associadas à segurança alimentar. Aquando da filtração inerente aos processos de respiração e alimentação, os bivalves bioacumulam passivamente microrganismos incluindo os patogénicos. A sua colocação no mercado impõe pois, prévia salubrização para níveis microbiológicos compatíveis com a legislação em vigor, salvaguardando a saúde pública. Apesar da monitorização das áreas de apanha e produção, das medidas de prevenção e da depuração, a ocorrência de surtos associados ao consumo de bivalves tem aumentado. Tal deve-se à insuficiente monitorização da contaminação microbiológica dos bivalves, contribuindo para uma gestão ineficaz do produto e consequente sub-valorização. O presente trabalho pretendeu caracterizar o estado de desenvolvimento do sector de exploração de bivalves em Portugal do ponto de vista da segurança alimentar, e analisar os aspectos cruciais da monitorização e da depuração do produto apresentando alternativas abrangentes e aplicáveis ao sector. Assim, desenvolveu-se uma metodologia de base molecular passível de adaptação à monitorização dos bivalves das zonas conquícolas, como alternativa ao método de referência vigente do Número Mais Provável que é baseado apenas na quantificação de Escherichia coli. O mexilhão (Mytilus edulis) da Ria de Aveiro, bivalve de interesse comercial a nível (inter)nacional serviu de modelo para a comparação de protocolos de extração de DNA. Esta metodologia foi desenvolvida de modo a que os métodos de extração de DNA sejam passíveis de aplicação a outras matrizes biológicas ou ambientais. Para além da detecção e quantificação directa de bactérias patogénicas, esta metodologia poderá ser aplicada à monitorização da transferência vertical microbiana nos bancos de bivalves bem como à caracterização da dinâmica espacio-temporal das populações microbianas no ambiente e à monitorização dos processos de depuração. Foi ainda abordado o potencial da aplicação de bacteriófagos ou de enzimas líticas para a optimização dos processos de purificação. O trabalho realizado e as perspectivas futuras propostas pretendem contribuir para a dinamização e requalificação do sector de exploração de bivalves através da melhoria do nível de segurança alimentar dos moluscos bivalves comercializados para alimentação humana, valorizando este recurso.

Qualidade em saúde: que trajetos de formação dos enfermeiros?

ENQUADRAMENTO: A avaliação da qualidade dos serviços de saúde, a crescente melhoria do desempenho dos profissionais, e a monitorização sistemática das atividades desenvolvidas pelas instituições de saúde, potenciam a qualidade dos cuidados prestados. A intervenção dos enfermeiros e dos restantes profissionais de saúde é imprescindível na promoção desta qualidade conforme defendem os diversos modelos da sua gestão. Para a generalidade destes, considera-se que a supervisão clínica em enfermagem e a formação dos profissionais são ferramentas de eleição para a promoção da excelência clínica. OBJETIVO: Analisar as principais dimensões a considerar num processo de supervisão e formação para a avaliação e acreditação da qualidade duma instituição hospitalar, numa perspetiva ecológica. MÉTODO: Trata-se de um estudo de caso que abrange uma unidade de cuidados de um hospital. Para a colheita de dados recorreu-se a um conjunto de técnicas e instrumentos, entre as quais a observação participante, entrevistas semiestruturadas e um questionário, aplicados aos enfermeiros dessa unidade. A informação obtida foi submetida à análise qualitativa e quantitativa, com recurso aos programas NUD*IST QSR N6 e SPSS 17, respetivamente. RESULTADOS E DISCUSSÃO: Os resultados obtidos permitiram caracterizar quatro dimensões: i) Processos de qualidade; ii) Práticas supervisivas; iii) Formação em contexto de trabalho; e iv) Relações interpessoais. A partir destas compreendeu-se que a acreditação deve ser um processo contínuo e documentado da análise das atividades de enfermagem, visando a realização de mudanças nos processos de gestão, na orientação das atividades de aperfeiçoamento dos recursos humanos, na pesquisa de respostas às dificuldades no ato de cuidar enfrentadas e identificadas, e nas atividades administrativas ligadas às modificações de processos assistenciais e de gestão. O cruzamento dos dados com os referenciais teóricos veio corroborar a importância da implementação de um processo de gestão de qualidade para os cuidados de enfermagem, num hospital, onde são decisivos os processos supervisivos e formativos, assim como se tornou emergente atender-se às relações interpessoais nas equipas.

Manutenção produtiva total: implementação na Simoldes Plásticos, SA

O presente trabalho descreve um projeto de implementação da metodologia de Manutenção Produtiva Total (TPM) desenvolvido na Simoldes Plásticos, unidade industrial de injeção de plásticos que opera no setor automóvel. A metodologia TPM salienta o papel fundamental que o trabalho em equipa e, em particular, a participação do pessoal, podem desempenhar na identificação de oportunidades de melhoria e na sua implementação. A sua aplicação visa a diminuição dos desperdícios, acidentes, defeitos, paragens e falhas ao longo de um processo produtivo. De uma forma geral, a TPM utiliza uma ideia base elementar que passa pela sensibilização, formação e treino dos operadores para que estes consigam realizar a manutenção autónoma dos equipamentos e melhorar continuamente o seu desempenho. Este trabalho apresenta em primeiro lugar uma revisão dos conceitos de Gestão da Qualidade Total, particularmente da Melhoria Contínua e da Metodologia TPM. De seguida, é descrita a aplicação da TPM na empresa Simoldes Plásticos, que inclui uma descrição dos principais problemas encontrados e das medidas aplicadas para a sua correção. Finalmente é feita uma análise do impacto das melhorias implementadas, a partir da análise de um indicador de eficiência específico, desenvolvido na empresa - o RUTPM - Rendimento de Utilização TPM.

Combining sampling, profiling, remote sensing and modelling to efficiently monitoring estuarine and coastal water quality

Monitoring of coastal and estuarine water quality has been traditionally performed by sampling with subsequent laboratory analysis. This has the disadvantages of low spatial and temporal resolution and high cost. In the last decades two alternative techniques have emerged to overcome this drawback: profiling and remote sensing. Profiling using multi-parameter sensors is now in a commercial stage. It can be used, tied to a boat, to obtain a quick “picture” of the system. The spatial resolution thus increases from single points to a line coincident with the boat track. The temporal resolution however remains unchanged since campaigns and resources involved are basically the same. The need for laboratory analysis was reduced but not eliminated because parameters like nutrients, microbiology or metals are still difficult to obtain with sensors and validation measurements are still needed. In the last years the improvement in satellite resolution has enabled its use for coastal and estuarine water monitoring. Although spatial coverage and resolution of satellite images in the present is already suitable to coastal and estuarine monitoring, temporal resolution is naturally limited to satellite passages and cloud cover. With this panorama the best approach to water monitoring is to integrate and combine data from all these sources. The natural tools to perform this integration are numerical models. Models benefit from the different sources of data to obtain a better calibration. After calibration they can be used to extend spatially and temporally the methods resolution. In Algarve (South of Portugal) a monitoring effort using this approach is being undertaken. The monitoring effort comprises five different locations including coastal waters, estuaries and coastal lagoons. The objective is to establish the base line situation to evaluate the impact of Waste Water Treatment Plants design and retrofitting. The field campaigns include monthly synoptic profiling, using an YSI 6600 multi-parameter system, laboratory analysis and fixed stations. The remote sensing uses ENVISAT\MERIS Level 2 Full Resolution data. This data is combined and used with the MOHID modelling system to obtain an integrate description of the systems. The results show the limitations of each method and the ability of the modelling system to integrate the results and to produce a comprehensive picture of the system.