Innovation in healthcare services: a customer focused approach

Although the various tools and techniques of quality management are routinely deployed in order to improve healthcare quality, an integrated approach is lacking, which combines the customer focus to identify quality issues, analytical techniques for prioritising improvement measures and a project management approach to plan, implement and evaluate the improvement projects. This study develops an innovative framework using Quality Function Deployment (QFD) and a logical framework in order to address this issue, and demonstrates its effectiveness using a case study on the intensive care unit of a hospital.

Malmquist indexes using a geometric distance function (GDF):application to a sample of Portuguese bank branches

Traditional approaches to calculate total factor productivity (TFP) change through Malmquist indexes rely on distance functions. In this paper we show that the use of distance functions as a means to calculate TFP change may introduce some bias in the analysis, and therefore we propose a procedure that calculates TFP change through observed values only. Our total TFP change is then decomposed into efficiency change, technological change, and a residual effect. This decomposition makes use of a non-oriented measure in order to avoid problems associated with the traditional use of radial oriented measures, especially when variable returns to scale technologies are to be compared. The proposed approach is applied in this paper to a sample of Portuguese bank branches.

Bars and edges: what makes a feature for human vision?

There have been two main approaches to feature detection in human and computer vision - luminance-based and energy-based. Bars and edges might arise from peaks of luminance and luminance gradient respectively, or bars and edges might be found at peaks of local energy, where local phases are aligned across spatial frequency. This basic issue of definition is important because it guides more detailed models and interpretations of early vision. Which approach better describes the perceived positions of elements in a 3-element contour-alignment task? We used the class of 1-D images defined by Morrone and Burr in which the amplitude spectrum is that of a (partially blurred) square wave and Fourier components in a given image have a common phase. Observers judged whether the centre element (eg ±458 phase) was to the left or right of the flanking pair (eg 0º phase). Lateral offset of the centre element was varied to find the point of subjective alignment from the fitted psychometric function. This point shifted systematically to the left or right according to the sign of the centre phase, increasing with the degree of blur. These shifts were well predicted by the location of luminance peaks and other derivative-based features, but not by energy peaks which (by design) predicted no shift at all. These results on contour alignment agree well with earlier ones from a more explicit feature-marking task, and strongly suggest that human vision does not use local energy peaks to locate basic first-order features. [Supported by the Wellcome Trust (ref: 056093)]

Lichtspielkunstwerk und Sprachkunstwerk. Zur Funktion und Rolle des Films im oeuvre von Gerhard Roth:the function and role of film in the oeuvre of Gerhard Roth

This article examines the multi-layered interrelation between Gerhard Roth’s writing and film. It charts the corresponding relationship of his early books to their accompanying television documentaries. The main focus of this essay however is on the film adaptation of Stille Ozean (1980) and Landäufiger Tod (1984), the two major novels in his cycle Archive des Shweigens. Supplemented by a look at the two radically different adaptations of his volume of topographical essays on Vienna called Eine Reise in das Innere von Wien (1991), the article also provides a summary overview of the seven dramas written by Roth for Austrian television in the 1990s, some of which were directed by his son Thomas. Finally Roth's approach to the medium of film is being discussed by drawing on the 59 reviews he published between 1995 and 1997 as a film critic for the Austrian magazine NEWS.

Feminist Post-structuralist discourse analysis: a new theoretical and methodological approach?

This chapter serves three very important functions within this collection. First, it aims to make the existence of FPDA better known to both gender and language researchers and to the wider community of discourse analysts, by outlining FPDA’s own theoretical and methodological approaches. This involves locating and positioning FPDA in relation, yet in contradistinction to, the fields of discourse analysis to which it is most often compared: Critical Discourse Analysis (CDA) and, to a lesser extent, Conversation Analysis (CA). Secondly, the chapter serves a vital symbolic function. It aims to contest the authority of the more established theoretical and methodological approaches represented in this collection, which currently dominate the field of discourse analysis. FPDA considers that an established field like gender and language study will only thrive and develop if it is receptive to new ways of thinking, divergent methods of study, and approaches that question and contest received wisdoms or established methods. Thirdly, the chapter aims to introduce some new, experimental and ground-breaking FPDA work, including that by Harold Castañeda-Peña and Laurel Kamada (same volume). I indicate the different ways in which a number of young scholars are imaginatively developing the possibilities of an FPDA approach to their specific gender and language projects.

A three dimensional surface measurement and reconstruction system for respiratory function analysis

Respiration is a complex activity. If the relationship between all neurological and skeletomuscular interactions was perfectly understood, an accurate dynamic model of the respiratory system could be developed and the interaction between different inputs and outputs could be investigated in a straightforward fashion. Unfortunately, this is not the case and does not appear to be viable at this time. In addition, the provision of appropriate sensor signals for such a model would be a considerable invasive task. Useful quantitative information with respect to respiratory performance can be gained from non-invasive monitoring of chest and abdomen motion. Currently available devices are not well suited in application for spirometric measurement for ambulatory monitoring. A sensor matrix measurement technique is investigated to identify suitable sensing elements with which to base an upper body surface measurement device that monitors respiration. This thesis is divided into two main areas of investigation; model based and geometrical based surface plethysmography. In the first instance, chapter 2 deals with an array of tactile sensors that are used as progression of existing and previously investigated volumetric measurement schemes based on models of respiration. Chapter 3 details a non-model based geometrical approach to surface (and hence volumetric) profile measurement. Later sections of the thesis concentrate upon the development of a functioning prototype sensor array. To broaden the application area the study has been conducted as it would be fore a generically configured sensor array. In experimental form the system performance on group estimation compares favourably with existing system on volumetric performance. In addition provides continuous transient measurement of respiratory motion within an acceptable accuracy using approximately 20 sensing elements. Because of the potential size and complexity of the system it is possible to deploy it as a fully mobile ambulatory monitoring device, which may be used outside of the laboratory. It provides a means by which to isolate coupled physiological functions and thus allows individual contributions to be analysed separately. Thus facilitating greater understanding of respiratory physiology and diagnostic capabilities. The outcome of the study is the basis for a three-dimensional surface contour sensing system that is suitable for respiratory function monitoring and has the prospect with future development to be incorporated into a garment based clinical tool.

Surface wave techniques for the study of engineering structures and materials

A wire drive pulse echo method of measuring the spectrum of solid bodies described. Using an 's' plane representation, a general analysis of the transient response of such solids has been carried out. This was used for the study of the stepped amplitude transient of high order modes of disks and for the case where there are two adjacent resonant frequencies. The techniques developed have been applied to the measurenent of the elasticities of refractory materials at high temperatures. In the experimental study of the high order in-plane resonances of thin disks it was found that the energy travelled at the edge of the disk and this initiated the work on one dimensional Rayleigh waves.Their properties were established for the straight edge condition by following an analysis similar to that of the two dimensional case. Experiments were then carried out on the velocity dispersion of various circuits including the disk and a hole in a large plate - the negative curvature condition.Theoretical analysis established the phase and group velocities for these cases and experimental tests on aluminium and glass gave good agreement with theory. At high frequencies all velocities approach that of the one dimensional Rayleigh waves. When applied to crack detection it was observed that a signal burst travelling round a disk showed an anomalous amplitude effect. In certain cases the signal which travelled the greater distance had the greater amplitude.An experiment was designed to investigate the phenanenon and it was established that the energy travelled in two nodes with different velocities.It was found by analysis that as well as the Rayleigh surface wave on the edge, a seoond node travelling at about the shear velocity was excited and the calculated results gave reasonable agreement with the experiments.

Perception of concurrent sentences with harmonic or frequency-shifted voiced excitation:performance of human listeners and of computational models based on autocorrelation

Keyword identification in one of two simultaneous sentences is improved when the sentences differ in F0, particularly when they are almost continuously voiced. Sentences of this kind were recorded, monotonised using PSOLA, and re-synthesised to give a range of harmonic ?F0s (0, 1, 3, and 10 semitones). They were additionally re-synthesised by LPC with the LPC residual frequency shifted by 25% of F0, to give excitation with inharmonic but regularly spaced components. Perceptual identification of frequency-shifted sentences showed a similar large improvement with nominal ?F0 as seen for harmonic sentences, although overall performance was about 10% poorer. We compared performance with that of two autocorrelation-based computational models comprising four stages: (i) peripheral frequency selectivity and half-wave rectification; (ii) within-channel periodicity extraction; (iii) identification of the two major peaks in the summary autocorrelation function (SACF); (iv) a template-based approach to speech recognition using dynamic time warping. One model sampled the correlogram at the target-F0 period and performed spectral matching; the other deselected channels dominated by the interferer and performed matching on the short-lag portion of the residual SACF. Both models reproduced the monotonic increase observed in human performance with increasing ?F0 for the harmonic stimuli, but not for the frequency-shifted stimuli. A revised version of the spectral-matching model, which groups patterns of periodicity that lie on a curve in the frequency-delay plane, showed a closer match to the perceptual data for frequency-shifted sentences. The results extend the range of phenomena originally attributed to harmonic processing to grouping by common spectral pattern.

Estimating parameters in stochastic systems:a variational Bayesian approach

This work is concerned with approximate inference in dynamical systems, from a variational Bayesian perspective. When modelling real world dynamical systems, stochastic differential equations appear as a natural choice, mainly because of their ability to model the noise of the system by adding a variation of some stochastic process to the deterministic dynamics. Hence, inference in such processes has drawn much attention. Here a new extended framework is derived that is based on a local polynomial approximation of a recently proposed variational Bayesian algorithm. The paper begins by showing that the new extension of this variational algorithm can be used for state estimation (smoothing) and converges to the original algorithm. However, the main focus is on estimating the (hyper-) parameters of these systems (i.e. drift parameters and diffusion coefficients). The new approach is validated on a range of different systems which vary in dimensionality and non-linearity. These are the Ornstein–Uhlenbeck process, the exact likelihood of which can be computed analytically, the univariate and highly non-linear, stochastic double well and the multivariate chaotic stochastic Lorenz ’63 (3D model). As a special case the algorithm is also applied to the 40 dimensional stochastic Lorenz ’96 system. In our investigation we compare this new approach with a variety of other well known methods, such as the hybrid Monte Carlo, dual unscented Kalman filter, full weak-constraint 4D-Var algorithm and analyse empirically their asymptotic behaviour as a function of observation density or length of time window increases. In particular we show that we are able to estimate parameters in both the drift (deterministic) and the diffusion (stochastic) part of the model evolution equations using our new methods.

A new variational radial basis function approximation for inference in multivariate diffusions

In this paper we present a radial basis function based extension to a recently proposed variational algorithm for approximate inference for diffusion processes. Inference, for state and in particular (hyper-) parameters, in diffusion processes is a challenging and crucial task. We show that the new radial basis function approximation based algorithm converges to the original algorithm and has beneficial characteristics when estimating (hyper-)parameters. We validate our new approach on a nonlinear double well potential dynamical system.