Developing the clinical components of a complex intervention for a glaucoma screening trial:a mixed methods study

BACKGROUND: Glaucoma is a leading cause of avoidable blindness worldwide. Open angle glaucoma is the most common type of glaucoma. No randomised controlled trials have been conducted evaluating the effectiveness of glaucoma screening for reducing sight loss. It is unclear what the most appropriate intervention to be evaluated in any glaucoma screening trial would be. The purpose of this study was to develop the clinical components of an intervention for evaluation in a glaucoma (open angle) screening trial that would be feasible and acceptable in a UK eye-care service.

METHODS: A mixed-methods study, based on the Medical Research Council (MRC) framework for complex interventions, integrating qualitative (semi-structured interviews with 46 UK eye-care providers, policy makers and health service commissioners), and quantitative (economic modelling) methods. Interview data were synthesised and used to revise the screening interventions compared within an existing economic model.

RESULTS: The qualitative data indicated broad based support for a glaucoma screening trial to take place in primary care, using ophthalmic trained technical assistants supported by optometry input. The precise location should be tailored to local circumstances. There was variability in opinion around the choice of screening test and target population. Integrating the interview findings with cost-effectiveness criteria reduced 189 potential components to a two test intervention including either optic nerve photography or screening mode perimetry (a measure of visual field sensitivity) with or without tonometry (a measure of intraocular pressure). It would be more cost-effective, and thus acceptable in a policy context, to target screening for open angle glaucoma to those at highest risk but for both practicality and equity arguments the optimal strategy was screening a general population cohort beginning at age forty.

CONCLUSIONS: Interventions for screening for open angle glaucoma that would be feasible from a service delivery perspective were identified. Integration within an economic modelling framework explicitly highlighted the trade-off between cost-effectiveness, feasibility and equity. This study exemplifies the MRC recommendation to integrate qualitative and quantitative methods in developing complex interventions. The next step in the development pathway should encompass the views of service users.

Establishing the validity of English GP Patient Survey items evaluating out-of-hours care

Background A 2014 national audit used the English General Practice Patient Survey (GPPS) to compare service users’ experience of out-of-hours general practitioner (GP) services, yet there is no published evidence on the validity of these GPPS items. Objectives Establish the construct and concurrent validity of GPPS items evaluating service users’ experience of GP out-of-hours care. Methods Cross-sectional postal survey of service users (n=1396) of six English out-of-hours providers. Participants reported on four GPPS items evaluating out-of-hours care (three items modified following cognitive interviews with service users), and 14 evaluative items from the Out-of-hours Patient Questionnaire (OPQ). Construct validity was assessed through correlations between any reliable (Cochran's α>0.7) scales, as suggested by a principal component analysis of the modified GPPS items, with the ‘entry access’ (four items) and ‘consultation satisfaction’ (10 items) OPQ subscales. Concurrent validity was determined by investigating whether each modified GPPS item was associated with thematically related items from the OPQ using linear regressions. Results The modified GPPS item-set formed a single scale (α=0.77), which summarised the two-component structure of the OPQ moderately well; explaining 39.7% of variation in the ‘entry access’ scores (r=0.63) and 44.0% of variation in the ‘consultation satisfaction’ scores (r=0.66), demonstrating acceptable construct validity. Concurrent validity was verified as each modified GPPS item was highly associated with a distinct set of related items from the OPQ. Conclusions Minor modifications are required for the English GPPS items evaluating out-of-hours care to improve comprehension by service users. A modified question set was demonstrated to comprise a valid measure of service users’ overall satisfaction with out-of-hours care received. This demonstrates the potential for the use of as few as four items in benchmarking providers and assisting services in identifying, implementing and assessing quality improvement initiatives.

Developing an information booklet to meet the needs of intensive care patients and relatives

Changes in the economic climate and the delivery of health care require that pre-operative information programmes are effective and efficiently implemented. In order to be effective the pre-operative programme must meet the information needs of intensive care unit (ICU) patients and their relatives. Efficiency can be achieved through a structured pre-operative programme which provides a framework for teaching. The need to develop an ICU information booklet in a large teaching hospital in Northern Ireland has become essential to provide relevant information and improve the quality of service for patients and relatives, as set out in the White Paper, ‘Working for Patients’, (DoH, 1989). The first step in establishing a patient education programme was to ascertain patients' and relatives' informational needs. A ‘needs assessment’ identified the pre-operative information needs of ICU patients and their relatives (McGaughey, 1994) and the findings were used to plan and publish an information booklet. The ICU booklet provides a structure for pre-operative visits to ensure that patients and relatives information needs are met.

Performance analysis of 4G wireless networks using system level simulator

In the last decade, mobile wireless communications have witnessed an explosive growth in the user’s penetration rate and their widespread deployment around the globe. In particular, a research topic of particular relevance in telecommunications nowadays is related to the design and implementation of mobile communication systems of 4th generation (4G). 4G networks will be characterized by the support of multiple radio access technologies in a core network fully compliant with the Internet Protocol (all IP paradigms). Such networks will sustain the stringent quality of service (QoS) requirements and the expected high data rates from the type of multimedia applications (i.e. YouTube and Skype) to be available in the near future. Therefore, 4G wireless communications system will be of paramount importance on the development of the information society in the near future. As 4G wireless services will continue to increase, this will put more and more pressure on the spectrum availability. There is a worldwide recognition that methods of spectrum managements have reached their limit and are no longer optimal, therefore new paradigms must be sought. Studies show that most of the assigned spectrum is under-utilized, thus the problem in most cases is inefficient spectrum management rather spectrum shortage. There are currently trends towards a more liberalized approach of spectrum management, which are tightly linked to what is commonly termed as Cognitive Radio (CR). Furthermore, conventional deployment of 4G wireless systems (one BS in cell and mobile deploy around it) are known to have problems in providing fairness (users closer to the BS are more benefited relatively to the cell edge users) and in covering some zones affected by shadowing, therefore the use of relays has been proposed as a solution. To evaluate and analyse the performances of 4G wireless systems software tools are normally used. Software tools have become more and more mature in recent years and their need to provide a high level evaluation of proposed algorithms and protocols is now more important. The system level simulation (SLS) tools provide a fundamental and flexible way to test all the envisioned algorithms and protocols under realistic conditions, without the need to deal with the problems of live networks or reduced scope prototypes. Furthermore, the tools allow network designers a rapid collection of a wide range of performance metrics that are useful for the analysis and optimization of different algorithms. This dissertation proposes the design and implementation of conventional system level simulator (SLS), which afterwards enhances for the 4G wireless technologies namely cognitive Radios (IEEE802.22) and Relays (IEEE802.16j). SLS is then used for the analysis of proposed algorithms and protocols.

Service composition for biomedical applications

A exigente inovação na área das aplicações biomédicas tem guiado a evolução das tecnologias de informação nas últimas décadas. Os desafios associados a uma gestão, integração, análise e interpretação eficientes dos dados provenientes das mais modernas tecnologias de hardware e software requerem um esforço concertado. Desde hardware para sequenciação de genes a registos electrónicos de paciente, passando por pesquisa de fármacos, a possibilidade de explorar com precisão os dados destes ambientes é vital para a compreensão da saúde humana. Esta tese engloba a discussão e o desenvolvimento de melhores estratégias informáticas para ultrapassar estes desafios, principalmente no contexto da composição de serviços, incluindo técnicas flexíveis de integração de dados, como warehousing ou federação, e técnicas avançadas de interoperabilidade, como serviços web ou LinkedData. A composição de serviços é apresentada como um ideal genérico, direcionado para a integração de dados e para a interoperabilidade de software. Relativamente a esta última, esta investigação debruçou-se sobre o campo da farmacovigilância, no contexto do projeto Europeu EU-ADR. As contribuições para este projeto, um novo standard de interoperabilidade e um motor de execução de workflows, sustentam a sucesso da EU-ADR Web Platform, uma plataforma para realizar estudos avançados de farmacovigilância. No contexto do projeto Europeu GEN2PHEN, esta investigação visou ultrapassar os desafios associados à integração de dados distribuídos e heterogéneos no campo do varíoma humano. Foi criada uma nova solução, WAVe - Web Analyses of the Variome, que fornece uma coleção rica de dados de variação genética através de uma interface Web inovadora e de uma API avançada. O desenvolvimento destas estratégias evidenciou duas oportunidades claras na área de software biomédico: melhorar o processo de implementação de software através do recurso a técnicas de desenvolvimento rápidas e aperfeiçoar a qualidade e disponibilidade dos dados através da adopção do paradigma de web semântica. A plataforma COEUS atravessa as fronteiras de integração e interoperabilidade, fornecendo metodologias para a aquisição e tradução flexíveis de dados, bem como uma camada de serviços interoperáveis para explorar semanticamente os dados agregados. Combinando as técnicas de desenvolvimento rápidas com a riqueza da perspectiva "Semantic Web in a box", a plataforma COEUS é uma aproximação pioneira, permitindo o desenvolvimento da próxima geração de aplicações biomédicas.

Service building in dense service provider environments

Genericamente falando, os serviços sobre redes têm vindo a afastar-se de um modelo monolítico para um modelo de criação de serviços que permite ou - como é mais frequente - requer a cooperação entre vários Provedores de Serviço. A Internet, que tem vindo a forçar a convergência de serviços, mostra que começa a ser virtualmente impossível a um único operador fornecer qualquer serviço com um mínimo de interesse para os utilizadores. Esta tese foca-se em serviços de transporte (e.g., connectividade) e discute o impacto das fronteira que as ofertas de serviços têm com o negócio. A questão central é a seguinte: o que muda quando o mesmo serviço é oferecido não apenas por um mas por mais do que um Provedor de Serviço. Por um lado, esta tese cobre, em abs tracto, a noção de Provedor se Serviço, como evoluiu e em que sentido está a evoluir, particularmente num contexto de muitos Provedores de Serviço. Os primeiros capítulos desta tese analizam e propõem arquitecturas para cooperação inter-Provedor-de-Serviço e para serviços comuns tais como multimédia. Por outro lado, oferece-se soluções práticas, com as respectivas avaliações, para alguns problemas, que ainda hoje se mantêm em aberto, tais como encaminhamento inter-domínio, Qualidade-de-Serviço, Mobilidade e distribuição de conteúdos, tais como as contribuições relacionadas com o impacto da noção administrativa de Sistemas Autónomos sobre encaminhamento inter-domínio, uma arquitectura de transporte inter-domínio e o problema que levanta da ineficiência que decorre do planeamento não- cooperativo de Redes de Entrega de Conteúdos.

Condition monitoring and diagnostics of power transformers

This paper addresses the subject of condition monitoring and diagnostics of power transformers. The main results of two reliability surveys, carried out under the auspices of CIGRE and IEEE in order to assemble objective data on the performance of transformers in service, are presented, providing useful information on the main causes of transformer failures, the most likely affected components and the related outages times. A survey of the most important methods, actually in use, for condition monitoring and diagnostics of power transformers is also given, which stresses the need for the development of new diagnostic methods, that can be applied without taking the transformers out of service, and that can also provide a fault severity criteria, in particular for determining transformers windings integrity. Preliminary results, concerning the on-going research activity on the development of a new approach for inter-turn winding fault diagnosis in three-phase transformers, are also reported in the paper.

Condition monitoring and diagnostics of power transformers

This paper addresses the subject of condition monitoring and diagnostics of power transformers. The main results of two reliability surveys, carried out under the auspices of CIGRE and IEEE in order to assemble objective data on the performance of transformers in service, are presented, providing useful information on the main causes of transformer failures, the most likely affected components and the related outages times. A survey of the most important methods, actually in use, for condition monitoring and diagnostics of power transformers is also given, which stresses the need for the development of new diagnostic methods, that can be applied without taking the transformers out of service, and that can also provide a fault severity criteria, in particular for determining transformers windings integrity. Preliminary results, concerning the on-going research activity on the development of a new approach for inter-turn winding fault diagnosis in three-phase transformers, are also reported in the paper.

Increasing the use of group interventions in a pediatric rehabilitation program: perceptions of administrators, therapists, and parents

Objectives. To explore perceptions related to increased utilization of group interventions as a part of the service reorganization within a pediatric rehabilitation program. Methods. Individual interviews with program administrators (n=13) and focus groups with therapists (n=19) and parents of children with disabilities (n=5) were conducted. Data were analyzed using a coding grid inspired by the organized action systems theory. Results. Administrators and therapists identified several issues including the need to improve the referral process for groups and the coordination across services. Groups considerably modified practice and required substantial efforts from therapists. Administrators felt groups contributed to increased service accessibility. Although therapists had some doubts about service quality in groups, especially in regard to the reduced attention to individual needs, they reported positive benefits on children’s social participation. Generally, parents were satisfied with group interventions. Conclusion. Groups appear to be a promising method of service delivery, but organizational-related issues should be considered.

Monitoring of urban transportation networks using wireless sensor networks

Dissertação de mestrado, Engenharia Informática, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Effects of Unionization on Graduate Student Employees: Faculty-Student Relations, Academic Freedom, and Pay

In cases involving unionization of graduate student research and teaching assistants at private U.S. universities, the National Labor Relations Board has, at times, denied collective bargaining rights on the presumption that unionization would harm faculty-student relations and academic freedom. Using survey data collected from PhD students in five academic disciplines across eight public U.S. universities, the authors compare represented and non-represented graduate student employees in terms of faculty-student relations, academic freedom, and pay. Unionization does not have the presumed negative effect on student outcomes, and in some cases has a positive effect. Union-represented graduate student employees report higher levels of personal and professional support, unionized graduate student employees fare better on pay, and unionized and nonunionized students report similar perceptions of academic freedom. These findings suggest that potential harm to faculty-student relationships and academic freedom should not continue to serve as bases for the denial of collective bargaining rights to graduate student employees.

Analysis and compensation of RF impairments for next generation multimode GNSS receivers

Global navigation satellite system (GNSS) receivers require solutions that are compact, cheap and low-power, in order to enable their widespread proliferation into consumer products. Furthermore, interoperability of GNSS with non-navigation systems, especially communication systems will gain importance in providing the value added services in a variety of sectors, providing seamless quality of service for users. An important step into the market for Galileo is the timely availability of these hybrid multi-mode terminals for consumer applications. However, receiver architectures that are amenable to high-levels of integration will inevitably suffer from RF impairments hindering their easy widespread use in commercial products. This paper studies and presents analytical evaluations of the performance degradation due to the RF impairments and develops algorithms that can compensate for them in the DSP domain at the base band with complexity-reduced hardware overheads, hence, paving the way for low-power, highly integrated multi-mode GNSS receivers.

The Interactions between clients and providers of services related to marketing activities

The purpose of this paper is to analyze the business interactions involved in the purchase of services related to marketing activities. We build on the literature about business services classifications and the interaction between clients and providers of business services. An empirical study is conducted by means of a survey questionnaire. Data were collected from a sample of 80 buying firms of services related to marketing activities who agreed to cooperate and represent medium and large Portuguese’s firms. The results show that the buying of services related to marketing activities involves both the client and the provider in the interaction process. This paper contributes to understanding the interaction process of buying services related to marketing activities in terms of the parties involved, product/service exchange, financial and information exchange. Providers of services related to marketing activities can expect stable and preferred relationships if they can offer a good price and quality of service, meet the agreed deadlines and respond quickly to client orders. On the client’s side, the relevance, the characteristics and the wide diversity of services related to marketing activities requires a good understanding and management of the interaction portfolio with providers.

Service offloading in adaptive real-time systems

Smartphones and other internet enabled devices are now common on our everyday life, thus unsurprisingly a current trend is to adapt desktop PC applications to execute on them. However, since most of these applications have quality of service (QoS) requirements, their execution on resource-constrained mobile devices presents several challenges. One solution to support more stringent applications is to offload some of the applications’ services to surrogate devices nearby. Therefore, in this paper, we propose an adaptable offloading mechanism which takes into account the QoS requirements of the application being executed (particularly its real-time requirements), whilst allowing offloading services to several surrogate nodes. We also present how the proposed computing model can be implemented in an Android environment

Energy and delay trade-off of the GTS allocation mechanism in IEEE 802.15.4 for wireless sensor networks

The IEEE 802.15.4 protocol proposes a flexible communication solution for Low-Rate Wireless Personal Area Networks (LR-WPAN) including wireless sensor networks (WSNs). It presents the advantage to fit different requirements of potential applications by adequately setting its parameters. When in beaconenabled mode, the protocol can provide timeliness guarantees by using its Guaranteed Time Slot (GTS) mechanism. However, power-efficiency and timeliness guarantees are often two antagonistic requirements in wireless sensor networks. The purpose of this paper is to analyze and propose a methodology for setting the relevant parameters of IEEE 802.15.4-compliant WSNs that takes into account a proper trade-off between power-efficiency and delay bound guarantees. First, we propose two accurate models of service curves for a GTS allocation as a function of the IEEE 802.15.4 parameters, using Network Calculus formalism. We then evaluate the delay bound guaranteed by a GTS allocation and express it as a function of the duty cycle. Based on the relation between the delay requirement and the duty cycle, we propose a power-efficient superframe selection method that simultaneously reduces power consumption and enables meeting the delay requirements of real-time flows allocating GTSs. The results of this work may pave the way for a powerefficient management of the GTS mechanism in an IEEE 802.15.4 cluster.