Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

Gender and general practice: the single-handed woman General Practitioner

This research examines women GPs' careers, how they run their practices and how they reconcile professional and domestic lives. It looks at the particular experiences of women GPs who practise alone, and at the pressures in past practice experience which have led them to do so. It is argued that many of the problems of group practice which can be identified are attributable to gender. For example, one reason given for entering general practice is a desire to be able to provide the full range of medical care and not to specialise. Women GPs, however, may find themselves seeing more women patients for "women's problems" and children than they would freely choose. Women have not entered general practice in order to specialise in these areas of medicine. Indeed, if they had wanted to specialise in obstetrics, gynaecology or paediatrics they would have had difficulty advancing very far in these male-dominated areas of hospital hierarchy. Other gender related problems exist for women in general practice and practising single-handedly is one strategy that women GPs have used to counter the problems of working in male-dominated practices and partnerships. However, the twenty-four hour commitment of single-handed practice may bring further pressures in reconciling this with responsibility for home life. Out-of-hours cover, which can be viewed as the link between professional and domestic life, where the one intrudes into the other, is also examined in terms of the gender issues it raises. The interaction of gender and ethnicity is also considered for the 11 Asian women GPs in the study. Interviews were conducted with 29 single-handed women GPs in the Midlands. In addition, some cases were studied in greater depth by being observed in their surgeries and on home visits for a day each. A qualitative/feminist approach to analysis has been employed.

Self-regulatory behaviours and flow dispositions in musical practice: a survey with advanced performers

Flow experience, a holistic sensation of total involvement in an activity, seems to have positive influences on musical performance activities. Although its main requirements (balance between challenges and skills, clear goals and unequivocal feedback) are inherent elements of musical practice, there is a lack of research about flow occurrences in the context of musical practice and on how specific practice behaviours affect the experience of flow and its particular dimensions. The aims of this thesis were to investigate advanced performersʼ dispositions to flow in musical practice, and to investigate whether the frequency of these experiences of holistic engagement with practice are associated with self-regulatory practice behaviours. 168 advanced classicallytrained performers (male = 50.0%; female = 50.0%), ranging in age from 18 to 74 years (m = 34.41, SD = 12.39), answered a survey that included two measures: the Dispositional Short Flow Scale, assessing performersʼ flow dispositions, and the Self-Regulated Practice Behaviours Questionnaire, developed specifically for the present research. The overall results of the survey suggested that advanced musicians have high dispositions to flow in musical practice, but not associated with the participantsʼ demographic characteristics. Three of the individual flow indicators were less experienced, suggesting that the most intense flow experiences are rare in musical practice. However, the results point to the existence of another relevant experience, named optimal practice experience. Practice engagement levels were positively associated with knowledge of oneʼs own personal resources and a capacity for practice organization, but not with inclusion/use of external resources. A capacity for setting optimal practice goals was related to self-regulation and to immersion aspects of flow. Current findings offer new clues about the assessment of flow dispositions in performers, helping to clarify how daily practice can heighten positive affective responses in musicians who are vulnerable to the requirements and difficulties of deliberate practice, as well as to other negative practice outcomes. The current research questions issues pertaining to the optimization and sustaining of flow in daily practice, suggesting future directions in the study of the affective subjective functioning of engagement with deliberate practice.

Applying semantics to grid middleware

Scheduling parallel and distributed applications efficiently onto grid environments is a difficult task and a great variety of scheduling heuristics has been developed aiming to address this issue. A successful grid resource allocation depends, among other things, on the quality of the available information about software artifacts and grid resources. In this article, we propose a semantic approach to integrate selection of equivalent resources and selection of equivalent software artifacts to improve the scheduling of resources suitable for a given set of application execution requirements. We also describe a prototype implementation of our approach based on the Integrade grid middleware and experimental results that illustrate its benefits. Copyright (C) 2009 John Wiley & Sons, Ltd.

Resource use pattern analysis for predicting resource availability in opportunistic grids

This work presents a method for predicting resource availability in opportunistic grids by means of use pattern analysis (UPA), a technique based on non-supervised learning methods. This prediction method is based on the assumption of the existence of several classes of computational resource use patterns, which can be used to predict the resource availability. Trace-driven simulations validate this basic assumptions, which also provide the parameter settings for the accurate learning of resource use patterns. Experiments made with an implementation of the UPA method show the feasibility of its use in the scheduling of grid tasks with very little overhead. The experiments also demonstrate the method`s superiority over other predictive and non-predictive methods. An adaptative prediction method is suggested to deal with the lack of training data at initialization. Further adaptative behaviour is motivated by experiments which show that, in some special environments, reliable resource use patterns may not always be detected. Copyright (C) 2009 John Wiley & Sons, Ltd.

A checkpointing-enabled and resource-aware Java Virtual Machine for efficient and robust e-Science applications in grid environments

Object-oriented programming languages presently are the dominant paradigm of application development (e. g., Java,. NET). Lately, increasingly more Java applications have long (or very long) execution times and manipulate large amounts of data/information, gaining relevance in fields related with e-Science (with Grid and Cloud computing). Significant examples include Chemistry, Computational Biology and Bio-informatics, with many available Java-based APIs (e. g., Neobio). Often, when the execution of such an application is terminated abruptly because of a failure (regardless of the cause being a hardware of software fault, lack of available resources, etc.), all of its work already performed is simply lost, and when the application is later re-initiated, it has to restart all its work from scratch, wasting resources and time, while also being prone to another failure and may delay its completion with no deadline guarantees. Our proposed solution to address these issues is through incorporating mechanisms for checkpointing and migration in a JVM. These make applications more robust and flexible by being able to move to other nodes, without any intervention from the programmer. This article provides a solution to Java applications with long execution times, by extending a JVM (Jikes research virtual machine) with such mechanisms. Copyright (C) 2011 John Wiley & Sons, Ltd.

Desocultando questões de género pelo/no teatro

Relatório de Estágio apresentado à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Ensino no 1º e no 2º Ciclos do Ensino Básico

Informe final creación y evaluación de campo de un instrumento para la medición de las competencias clínicas en Fisioterapia

La evaluación de los procesos formativos en el área clínica, basados en competencias, es fundamental para la Fisioterapia. Este proceso articula la teoría con la práctica, orienta la organización de los procesos académicos, promueve la formación integral y establece mecanismos de retroalimentación permanentes y rigurosos, basados en la evaluación del desempeño del profesional en formación ante situaciones del día a día que dan cuenta de su toma de decisiones profesional. Se espera que los estudiantes se formen y puedan actuar como profesionales competitivos a nivel nacional e internacional, de manera integral, con sólidos compromisos éticos y sociales para responder a las necesidades del entorno social en el que se desenvuelven (PEP, Universidad del Rosario). Los esfuerzos actuales en investigación de la evaluación educativa se encuentran orientados a la integración de la adquisición del conocimiento y al desarrollo de estrategias de medición y cuantificación de capacidades técnico-científicas dentro de cada disciplina. En este sentido, hasta el momento, en Colombia no se encuentra evidencia alrededor de la validación de instrumentos de medición de las competencias clínicas, ni se cuenta con estándares para la evaluación en práctica clínica en el proceso de formación del recurso humano en Fisioterapia. En el proyecto se desarrolló y fueron evaluadas las propiedades psicométricas de un instrumento que mide las competencias clínicas del estudiante de fisioterapia en la práctica clínica. Este proceso involucró a Fisioterapeutas que con experiencia en el área de docencia y clínica, contribuyen con la formación de fisioterapeutas en Colombia.

PRISM and ENES: a European approach to Earth system modelling

Europe's widely distributed climate modelling expertise, now organized in the European Network for Earth System Modelling (ENES), is both a strength and a challenge. Recognizing this, the European Union's Program for Integrated Earth System Modelling (PRISM) infrastructure project aims at designing a flexible and friendly user environment to assemble, run and post-process Earth System models. PRISM was started in December 2001 with a duration of three years. This paper presents the major stages of PRISM, including: (1) the definition and promotion of scientific and technical standards to increase component modularity; (2) the development of an end-to-end software environment (graphical user interface, coupling and I/O system, diagnostics, visualization) to launch, monitor and analyse complex Earth system models built around state-of-art community component models (atmosphere, ocean, atmospheric chemistry, ocean bio-chemistry, sea-ice, land-surface); and (3) testing and quality standards to ensure high-performance computing performance on a variety of platforms. PRISM is emerging as a core strategic software infrastructure for building the European research area in Earth system sciences. Copyright (c) 2005 John Wiley & Sons, Ltd.

Eye gaze in virtual environments: evaluating the need and initial work on implementation

For efficient collaboration between participants, eye gaze is seen as being critical for interaction. Video conferencing either does not attempt to support eye gaze (e.g. AcessGrid) or only approximates it in round table conditions (e.g. life size telepresence). Immersive collaborative virtual environments represent remote participants through avatars that follow their tracked movements. By additionally tracking people's eyes and representing their movement on their avatars, the line of gaze can be faithfully reproduced, as opposed to approximated. This paper presents the results of initial work that tested if the focus of gaze could be more accurately gauged if tracked eye movement was added to that of the head of an avatar observed in an immersive VE. An experiment was conducted to assess the difference between user's abilities to judge what objects an avatar is looking at with only head movements being displayed, while the eyes remained static, and with eye gaze and head movement information being displayed. The results from the experiment show that eye gaze is of vital importance to the subjects correctly identifying what a person is looking at in an immersive virtual environment. This is followed by a description of the work that is now being undertaken following the positive results from the experiment. We discuss the integration of an eye tracker more suitable for immersive mobile use and the software and techniques that were developed to integrate the user's real-world eye movements into calibrated eye gaze in an immersive virtual world. This is to be used in the creation of an immersive collaborative virtual environment supporting eye gaze and its ongoing experiments. Copyright (C) 2009 John Wiley & Sons, Ltd.

Seamlessly integrating similarity queries in SQL

Modern database applications are increasingly employing database management systems (DBMS) to store multimedia and other complex data. To adequately support the queries required to retrieve these kinds of data, the DBMS need to answer similarity queries. However, the standard structured query language (SQL) does not provide effective support for such queries. This paper proposes an extension to SQL that seamlessly integrates syntactical constructions to express similarity predicates to the existing SQL syntax and describes the implementation of a similarity retrieval engine that allows posing similarity queries using the language extension in a relational DBM. The engine allows the evaluation of every aspect of the proposed extension, including the data definition language and data manipulation language statements, and employs metric access methods to accelerate the queries. Copyright (c) 2008 John Wiley & Sons, Ltd.

Scalable model-based configuration management of security services in complex enterprise networks

Security administrators face the challenge of designing, deploying and maintaining a variety of configuration files related to security systems, especially in large-scale networks. These files have heterogeneous syntaxes and follow differing semantic concepts. Nevertheless, they are interdependent due to security services having to cooperate and their configuration to be consistent with each other, so that global security policies are completely and correctly enforced. To tackle this problem, our approach supports a comfortable definition of an abstract high-level security policy and provides an automated derivation of the desired configuration files. It is an extension of policy-based management and policy hierarchies, combining model-based management (MBM) with system modularization. MBM employs an object-oriented model of the managed system to obtain the details needed for automated policy refinement. The modularization into abstract subsystems (ASs) segment the system-and the model-into units which more closely encapsulate related system components and provide focused abstract views. As a result, scalability is achieved and even comprehensive IT systems can be modelled in a unified manner. The associated tool MoBaSeC (Model-Based-Service-Configuration) supports interactive graphical modelling, automated model analysis and policy refinement with the derivation of configuration files. We describe the MBM and AS approaches, outline the tool functions and exemplify their applications and results obtained. Copyright (C) 2010 John Wiley & Sons, Ltd.

Performance results of running parallel applications on the InteGrade

The InteGrade middleware intends to exploit the idle time of computing resources in computer laboratories. In this work we investigate the performance of running parallel applications with communication among processors on the InteGrade grid. As costly communication on a grid can be prohibitive, we explore the so-called systolic or wavefront paradigm to design the parallel algorithms in which no global communication is used. To evaluate the InteGrade middleware we considered three parallel algorithms that solve the matrix chain product problem, the 0-1 Knapsack Problem, and the local sequence alignment problem, respectively. We show that these three applications running under the InteGrade middleware and MPI take slightly more time than the same applications running on a cluster with only LAM-MPI support. The results can be considered promising and the time difference between the two is not substantial. The overhead of the InteGrade middleware is acceptable, in view of the benefits obtained to facilitate the use of grid computing by the user. These benefits include job submission, checkpointing, security, job migration, etc. Copyright (C) 2009 John Wiley & Sons, Ltd.