NHS Wales e-library portal evaluation (For Informing Healthcare Strategy implementation programme)

Thomas, R. & Urquhart, C. NHS Wales e-library portal evaluation. (For Informing Healthcare Strategy implementation programme). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth Follow-on to NHS Wales User Needs study Sponsorship: Informing Healthcare, NHS Wales

Authenticated Index Structures for Outsourced Database Systems

In outsourced database (ODB) systems the database owner publishes its data through a number of remote servers, with the goal of enabling clients at the edge of the network to access and query the data more efficiently. As servers might be untrusted or can be compromised, query authentication becomes an essential component of ODB systems. Existing solutions for this problem concentrate mostly on static scenarios and are based on idealistic properties for certain cryptographic primitives. In this work, first we define a variety of essential and practical cost metrics associated with ODB systems. Then, we analytically evaluate a number of different approaches, in search for a solution that best leverages all metrics. Most importantly, we look at solutions that can handle dynamic scenarios, where owners periodically update the data residing at the servers. Finally, we discuss query freshness, a new dimension in data authentication that has not been explored before. A comprehensive experimental evaluation of the proposed and existing approaches is used to validate the analytical models and verify our claims. Our findings exhibit that the proposed solutions improve performance substantially over existing approaches, both for static and dynamic environments.

Cereal products for specific dietary requirements. Evaluation and improvement of technological and nutritional properties of gluten free raw materials and end products

Coeliac disease is one of the most common food intolerances worldwide and at present the gluten free diet remains the only suitable treatment. A market overview conducted as part of this thesis on nutritional and sensory quality of commercially available gluten free breads and pasta showed that improvements are necessary. Many products show strong off-flavors, poor mouthfeel and reduced shelf-life. Since the life-long avoidance of the cereal protein gluten means a major change to the diet, it is important to also consider the nutritional value of products intending to replace staple foods such as bread or pasta. This thesis addresses this issue by characterising available gluten free cereal and pseudocereal flours to facilitate a better raw material choice. It was observed that especially quinoa, buckwheat and teff are high in essential nutrients, such as protein, minerals and folate. In addition the potential of functional ingredients such as inulin, β-glucan, HPMC and xanthan to improve loaf quality were evaluated. Results show that these ingredients can increase loaf volume and reduce crumb hardness as well as rate of staling but that the effect diverges strongly depending on the bread formulation used. Furthermore, fresh egg pasta formulations based on teff and oat flour were developed. The resulting products were characterised regarding sensory and textural properties as well as in vitro digestibility. Scanning electron and confocal laser scanning microscopy was used throughout the thesis to visualise structural changes occurring during baking and pasta making

Development and psychometric evaluation of the spirituality instrument (SpI-27) in a sample of people with chronic illness

Background: Spirituality is fundamental to all human beings, existing within a person, and developing until death. This research sought to operationalise spirituality in a sample of individuals with chronic illness. A review of the conceptual literature identified three dimensions of spirituality: connectedness, transcendence, and meaning in life. A review of the empirical literature identified one instrument that measures the three dimensions together. Yet, recent appraisals of this instrument highlighted issues with item formulation and limited evidence of reliability and validity. Aim: The aim of this research was to develop a theoretically-grounded instrument to measure spirituality – the Spirituality Instrument-27 (SpI-27). A secondary aim was to psychometrically evaluate this instrument in a sample of individuals with chronic illness (n=249). Methods: A two-phase design was adopted. Phase one consisted of the development of the SpI-27 based on item generation from a concept analysis, a literature review, and an instrument appraisal. The second phase established the psychometric properties of the instrument and included: a qualitative descriptive design to establish content validity; a pilot study to evaluate the mode of administration; and a descriptive correlational design to assess the instrument’s reliability and validity. Data were analysed using SPSS (Version 18). Results: Results of exploratory factor analysis concluded a final five-factor solution with 27 items. These five factors were labelled: Connectedness with Others, Self-Transcendence, Self-Cognisance, Conservationism, and Connectedness with a Higher Power. Cronbach’s alpha coefficients ranged from 0.823 to 0.911 for the five factors, and 0.904 for the overall scale, indicating high internal consistency. Paired-sample t-tests, intra-class correlations, and weighted kappa values supported the temporal stability of the instrument over 2 weeks. A significant positive correlation was found between the SpI-27 and the Spirituality Index of Well-Being, providing evidence for convergent validity. Conclusion: This research addresses a call for a theoretically-grounded instrument to measure spirituality.

Evaluation of the new ESR network software for the retrieval of direct sun products from cimel ce318 and prede pom01 sun-sky radiometers.

The European Skynet Radiometers network (EuroSkyRad or ESR) has been recently established as a research network of European PREDE sun-sky radiometers. Moreover, ESR is federated with SKYNET, an international network of PREDE sun-sky radiometers mostly present in East Asia. In contrast to SKYNET, the European network also integrates users of the CIMEL CE318 sky–sun photometer. Keeping instrumental duality in mind, a set of open source algorithms has been developed consisting of two modules for (1) the retrieval of direct sun products (aerosol optical depth, wavelength exponent and water vapor) from the sun extinction measurements; and (2) the inversion of the sky radiance to derive other aerosol optical properties such as size distribution, single scattering albedo or refractive index. In this study we evaluate the ESR direct sun products in comparison with the AERosol RObotic NETwork (AERONET) products. Specifically, we have applied the ESR algorithm to a CIMEL CE318 and PREDE POM simultaneously for a 4-yr database measured at the Burjassot site (Valencia, Spain), and compared the resultant products with the AERONET direct sun measurements obtained with the same CIMEL CE318 sky–sun photometer. The comparison shows that aerosol optical depth differences are mostly within the nominal uncertainty of 0.003 for a standard calibration instrument, and fall within the nominal AERONET uncertainty of 0.01–0.02 for a field instrument in the spectral range 340 to 1020 nm. In the cases of the Ångström exponent and the columnar water vapor, the differences are lower than 0.02 and 0.15 cm, respectively. Therefore, we present an open source code program that can be used with both CIMEL and PREDE sky radiometers and whose results are equivalent to AERONET and SKYNET retrievals.

Project evaluation SOU-estuTUtor: mentors’ perception

The introduction of new degrees in the Faculty of Education and the relevance of educational guidance comes to them, as a compulsory subject in all four grades started from 2009-2010, gives the opportunity to return and boost the University Guidance Service (UGS) as a means of consistency with the profile of their education and professional development of its students. The aim of the paper focuses on the evaluation of the results after the first year of implementing a peer mentoring project, SOU-estuTUtor Project, developed from UGS with all degree students of the Faculty of Education for Students new entrants. Program has been evaluated through the perception and satisfaction of the mentors on the organization, training, skills developed and adapted to the needs of students. After one academic year of implementation, the results show, on the one hand, the satisfaction and commitment of those involved and the partial response to the needs of the students served, as well as the optimization of the personal resources of the university but also some limitations that make it necessary to review the mentoring program in terms of control and duration of the process.

Co-evaluation as a strategy to improve working group dynamics: an experience in Sport Sciences

The aim of this study was to analyze if the perceptions of students before and after carrying out the work, that is, their perception of different aspects of the functioning of the group, the working skills acquired as well as those they think that need to be improved, varied depending on whether the contribution of the different members of the group was being co-evaluated or not. 144 students of Physical Activity and Sport Sciences participated in this study. In order to analyze the students' perception of group work the adapted questionnaire by Bourne et al. (2001) was used. Results showed that groups which implemented co-evaluation assessed more negatively the experience in general than those which did not. However, co-evaluation groups perceived their competence to work as a team had improved to a greater extent than the groups without co-evaluation, evaluating more positively both the performance and the result of work and increasing their knowledge of the other team members. Using a co-evaluation system seems to generate both a better assessment of the running of the team and the result of its work.

Evaluation of Serpa cheese proteolysis by nitrogen content and capillary zone electrophoresis

Proteolysis of Serpa cheese produced traditionally (B) and semi-industrially (C) was evaluated for the first time by determination of nitrogen content and capillary zone electrophoresis (CZE). A citrate dispersion of cheese was fractionated to determine the nitrogen in pH 4.4, trichloroacetic and phosphotungstic acid soluble fractions (pH 4.4-SN, TCA-SN and PTA-SN, respectively). The pH 4.4-SN was significantly higher for B ( P <0.001), while TCA-SN was significantly higher for C ( P <0.001). PTA-SN was also higher for C but at 60 days ripening no significant difference was found between B and C. Degradation of alpha(s1) - and beta-caseins evaluated by CZE was in good agreement with the maturation index (pH 4.4-SN/TN).

Organisational Self-Evaluation and Teacher Education for Community Relations in a Transforming Society?

During 2004, the School of Education at the University of Ulster embarked on an innovative three-year project designed to embed community relations objectives within initial teacher education. With the advent of more peaceful times in Northern Ireland, this was a precipitous time for initial teacher educators to review the preparation given to beginner teachers for teaching in an increasingly pluralist society emerging from conflict. The present paper reports on one very specific and time-limited element of the broader project. That is, development work designed to investigate the possibilities of using processes of self-review and evaluation as a lever for improvements in initial teacher education for community relations. Following a brief contextualisation, the background to, and the development of, a set of materials designed to support rigorous and systematic self-review of all aspects of provision in a university-based initial teacher education department is described. The Community Relations Index for Initial Teacher Education (Cr-ITE) was envisaged as being of use to initial teacher education establishments in order to help teacher educators take responsibility for rigorous learning from their practice, whilst placing inclusive values at the centre of organisational development. The final section includes further critical reflection on the role of organisational self-review in transforming teacher education for inclusion in a society emerging from longstanding communal conflict.

Workspace evaluation of manipulators through finite-partition of SE(3)

Workspace analysis and optimization are important in a manipulator design. As the complete workspace of a 6-DOF manipulator is embedded into a 6-imensional space, it is difficult to quantify and qualify it. Most literatures only considered the 3-D sub workspaces of the complete 6-D workspace. In this paper, a finite-partition approach of the Special Euclidean group SE(3) is proposed based on the topology properties of SE(3), which is the product of Special Orthogonal group SO(3) and R^3. It is known that the SO(3) is homeomorphic to a solid ball D^3 with antipodal points identified while the geometry of R^3 can be regarded as a cuboid. The complete 6-D workspace SE(3) is at the first time parametrically and proportionally partitioned into a number of elements with uniform convergence based on its geometry. As a result, a basis volume element of SE(3) is formed by the product of a basis volume element of R^3 and a basis volume element of SO(3), which is the product of a basis volume element of D^3 and its associated integration measure. By this way, the integration of the complete 6-D workspace volume becomes the simple summation of the basis volume elements of SE(3). Two new global performance indices, i.e., workspace volume ratio Wr and global condition index GCI, are defined over the complete 6-D workspace. A newly proposed 3 RPPS parallel manipulator is optimized based on this finite-partition approach. As a result, the optimal dimensions for maximal workspace are obtained, and the optimal performance points in the workspace are identified.

Surveillance for ocular hypertension: An evidence synthesis and economic evaluation

OBJECTIVES: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways.

DESIGN: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model.

SETTING: Primary and secondary care.

PARTICIPANTS: Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences).

INTERVENTIONS: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community.

MAIN OUTCOME MEASURES: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs).

RESULTS: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence.

LIMITATIONS: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates.

CONCLUSIONS: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment.

FUNDING: The National Institute for Health Research Health Technology Assessment Programme.

The relationship between breastfeeding and postpartum weight change-a systematic review and critical evaluation

Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were 2 years postpartum and with a body mass index (BMI) >18.5 kg m(-2), with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.International Journal of Obesity advance online publication, 20 August 2013; doi:10.1038/ijo.2013.132.

Lung clearance index: Evidence for use in clinical trials in cystic fibrosis

The ECFS-CTN Standardisation Committee has undertaken this review of lung clearance index as part of the group's work on evaluation of clinical endpoints with regard to their use in multicentre clinical trials in CF. The aims were 1) to review the literature on reliability, validity and responsiveness of LCI in patients with CF, 2) to gain consensus of the group on feasibility of LCI and 3) to gain consensus on answers to key questions regarding the promotion of LCI to surrogate endpoint status. It was concluded that LCI has an attractive feasibility and clinimetric properties profile and is particularly indicated for multicentre trials in young children with CF and patients with early or mild CF lung disease. This is the first article to collate the literature in this manner and support the use of LCI in clinical trials in CF.

Evaluation of the effect of wheat aleurone-rich foods on markers of antioxidant status, inflammation and endothelial function in apparently healthy men and women

Observational data show an inverse association between the consumption of whole-grain foods, and inflammation and related diseases. Although the underlying mechanisms are unclear, whole grains, and in particular the aleurone layer, contain a wide range of components with putative antioxidant and anti-inflammatory effects. We evaluated the effects of a diet high in wheat aleurone on plasma antioxidants status, markers of inflammation and endothelial function. In this parallel, participant-blinded intervention, seventy-nine healthy, older, overweight participants (45-65 years, BMI>25 kg/m²) incorporated either aleurone-rich cereal products (27 g aleurone/d), or control products balanced for fibre and macronutrients, into their habitual diets for 4 weeks. Fasting blood samples were taken at baseline and on day 29. Results showed that, compared to control, consumption of aleurone-rich products provided substantial amounts of micronutrients and phytochemicals which may function as antioxidants. Additionally, incorporating these products into a habitual diet resulted in significantly lower plasma concentrations of the inflammatory marker, C-reactive protein (P = 0·035), which is an independent risk factor for CVD. However, no changes were observed in other markers of inflammation, antioxidant status or endothelial function. These results provide a possible mechanism underlying the beneficial effects of longer-term whole-grain intake. However, it is unclear whether this effect is owing to a specific component, or a combination of components in wheat aleurone.

A Tight Upper Bound on Bit Error Rate of Joint OFDM and Multi-Carrier Index Keying

This letter investigates performance enhancement by the concept of multi-carrier index keying in orthogonal frequency division multiplexing (OFDM) systems. For the performance evaluation, a tight closed-form approximation of the bit error rate (BER) is derived introducing the expression for the number of bit errors occurring in both the index domain and the complex domain, in the presence of both imperfect and perfect detection of active multi-carrier indices. The accuracy of the derived BER results for various cases are validated using simulations, which can provide accuracy within 1 dB at favorable channels.