Organisational and systems factors impacting on patient safety in acute care organisations: lessons from four multi-site research studies

Background Patient safety is concerned with preventable harm in healthcare, a subject that became a focus for study in the UK in the late 1990s. How to improve patient safety, presented both a practical and a research challenge in the early 2000s, leading to the eleven publications presented in this thesis. Research question The overarching research question was: What are the key organisational and systems factors that impact on patient safety, and how can these best be researched? Methods Research was conducted in over 40 acute care organisations in the UK and Europe between 2006 and 2013. The approaches included surveys, interviews, documentary analysis and non-participant observation. Two studies were longitudinal. Results The findings reveal the nature and extent of poor systems reliability and its effect on patient safety; the factors underpinning cases of patient harm; the cultural issues impacting on safety and quality; and the importance of a common language for quality and safety across an organisation. Across the publications, nine key organisational and systems factors emerged as important for patient safety improvement. These include leadership stability; data infrastructure; measurement capability; standardisation of clinical systems; and creating an open and fair collective culture where poor safety is challenged. Conclusions and contribution to knowledge The research presented in the publications has provided a more complete understanding of the organisation and systems factors underpinning safer healthcare. Lessons are drawn to inform methods for future research, including: how to define success in patient safety improvement studies; how to take into account external influences during longitudinal studies; and how to confirm meaning in multi-language research. Finally, recommendations for future research include assessing the support required to maintain a patient safety focus during periods of major change or austerity; the skills needed by healthcare leaders; and the implications of poor data infrastructure.

Preschoolers’ Executive Control and Diurnal Cortisol as Mediators of the Relations of Prenatal Stress to Child Adjustment

Thesis (Ph.D.)--University of Washington, 2016-08

Towards Proactive Context-aware Computing and Systems

A primary goal of context-aware systems is delivering the right information at the right place and right time to users in order to enable them to make effective decisions and improve their quality of life. There are three key requirements for achieving this goal: determining what information is relevant, personalizing it based on the users’ context (location, preferences, behavioral history etc.), and delivering it to them in a timely manner without an explicit request from them. These requirements create a paradigm that we term as “Proactive Context-aware Computing”. Most of the existing context-aware systems fulfill only a subset of these requirements. Many of these systems focus only on personalization of the requested information based on users’ current context. Moreover, they are often designed for specific domains. In addition, most of the existing systems are reactive - the users request for some information and the system delivers it to them. These systems are not proactive i.e. they cannot anticipate users’ intent and behavior and act proactively without an explicit request from them. In order to overcome these limitations, we need to conduct a deeper analysis and enhance our understanding of context-aware systems that are generic, universal, proactive and applicable to a wide variety of domains. To support this dissertation, we explore several directions. Clearly the most significant sources of information about users today are smartphones. A large amount of users’ context can be acquired through them and they can be used as an effective means to deliver information to users. In addition, social media such as Facebook, Flickr and Foursquare provide a rich and powerful platform to mine users’ interests, preferences and behavioral history. We employ the ubiquity of smartphones and the wealth of information available from social media to address the challenge of building proactive context-aware systems. We have implemented and evaluated a few approaches, including some as part of the Rover framework, to achieve the paradigm of Proactive Context-aware Computing. Rover is a context-aware research platform which has been evolving for the last 6 years. Since location is one of the most important context for users, we have developed ‘Locus’, an indoor localization, tracking and navigation system for multi-story buildings. Other important dimensions of users’ context include the activities that they are engaged in. To this end, we have developed ‘SenseMe’, a system that leverages the smartphone and its multiple sensors in order to perform multidimensional context and activity recognition for users. As part of the ‘SenseMe’ project, we also conducted an exploratory study of privacy, trust, risks and other concerns of users with smart phone based personal sensing systems and applications. To determine what information would be relevant to users’ situations, we have developed ‘TellMe’ - a system that employs a new, flexible and scalable approach based on Natural Language Processing techniques to perform bootstrapped discovery and ranking of relevant information in context-aware systems. In order to personalize the relevant information, we have also developed an algorithm and system for mining a broad range of users’ preferences from their social network profiles and activities. For recommending new information to the users based on their past behavior and context history (such as visited locations, activities and time), we have developed a recommender system and approach for performing multi-dimensional collaborative recommendations using tensor factorization. For timely delivery of personalized and relevant information, it is essential to anticipate and predict users’ behavior. To this end, we have developed a unified infrastructure, within the Rover framework, and implemented several novel approaches and algorithms that employ various contextual features and state of the art machine learning techniques for building diverse behavioral models of users. Examples of generated models include classifying users’ semantic places and mobility states, predicting their availability for accepting calls on smartphones and inferring their device charging behavior. Finally, to enable proactivity in context-aware systems, we have also developed a planning framework based on HTN planning. Together, these works provide a major push in the direction of proactive context-aware computing.

Milestones in Software Engineering and Knowledge Engineering History: A Comparative Review

We present a review of the historical evolution of software engineering, intertwining it with the history of knowledge engineering because “those who cannot remember the past are condemned to repeat it.” This retrospective represents a further step forward to understanding the current state of both types of engineerings; history has also positive experiences; some of them we would like to remember and to repeat. Two types of engineerings had parallel and divergent evolutions but following a similar pattern. We also define a set of milestones that represent a convergence or divergence of the software development methodologies. These milestones do not appear at the same time in software engineering and knowledge engineering, so lessons learned in one discipline can help in the evolution of the other one.

Fibre components and systems for mid-IR applications

Fibre-optic components and systems are used in a wide variety of industrial, medical and communication applications and can be found in use everywhere in the modern world, from the bottom of the ocean to satellites in orbit. The field of fibre optics has seen rapid growth in the past few decades to become an essential enabling technology. However, much more work is needed to develop components and systems that can work at wavelengths in the short-wavelength infrared (SWIR) / mid-IR part of the spectrum (defined in this work as 1.5 – 4.5.

Effect of different doses of post-emergence-applied iodosulfuron on weed control and grain yield of malt barley (Hordeum distichum L.), under Mediterranean conditions

A study was carried out over a two year period (2009/2010 and 2012/2013) on an experimental farm in the Alentejo region (Beja), in southern Portugal where rainfed malt barley (Hordeum distichum L.) is sown at the end of autumn or beginning of winter (November– December). The aim of this experiment was to study the efficiency of the herbicide iodosulfuron-methyl-sodium to control post-emergence broadleaved weeds in this cereal crop. The malt barley crop was established using no-till farming. This technology provides the necessary machine bearing capacity of the soil to assure the post-emergence application of herbicides at two diferente weed development stages. The herbicide iodosulfuron-methyl-sodium was applied at three doses (5.0, 7.5, and 10.0 g a. i. · ha–1) and at two different broadleaved weed development stages (3 to 4 and 6 to 7 pairs of leaves), that also corresponded to two diferente crop development stages (beginning of tillering and complete tillering). The results indicated that early herbicide application timing provided a significantly higher efficiency for all the applied herbicide doses, but this better weed control was not reflected in a higher crop grain yield. The lack of a higher crop grain yield was probably due to a crop phytotoxicity of the herbicide, when used at an early application timing.

MOSQUITO CONTROL AND ZIKA

This checklist is a tool to help local governments prepare for mosquito season and potential mosquito-borne disease outbreaks. It contains recommended items to be considered as part of a Zika readiness plan.

An ecosystem of products and systems for ambient intelligence – the AAL4ALL users perspective

Texto completo em atas de encontros científicos internacionais com arbitragem

The organization, form and function of intermediate care services and systems in England: results from a national survey

This paper reports the results of a postal survey of intermediate care co-ordinators (ICCs) on the organization and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, ‘tick-box’ and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). We discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, we highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate our findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care and the evidence for and aims of the policy as part of NHS modernization, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.

Survey of infection control and antimicrobial stewardship practices in Australian residential aged-care facilities

This study assessed infection prevention and antimicrobial stewardship (AMS) practices in Australian residential aged-care facilities (RACF). Two hundred and sixty-five surveys (15.6%) were completed with all states represented and the majority (177 (67.3%)) privately run. Only 30.6% RACF had infection control trained staff on site. Few facilities had AMS policies, only 14% had antimicrobial prescribing restrictions. Most facilities offered vaccination to residents (influenza vaccination rates >75% in 73% of facilities), but pneumococcal vaccination was poor.