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Analysis of a Web-Based Dashboard to Support the Use of National Audit Data in Quality Improvement: Realist Evaluation
Get PDFYesDashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices needs further investigation.
This paper reports the findings of a realist evaluation of a web-based quality dashboard (QualDash) developed to support the use of national audit data in quality improvement.
QualDash was co-designed with data users and installed in 8 clinical services (3 pediatric intensive care units and 5 cardiology services) across 5 health care organizations (sites A-E) in England between July and December 2019. Champions were identified to support adoption. Data to evaluate QualDash were collected between July 2019 and August 2021 and consisted of 148.5 hours of observations including hospital wards and clinical governance meetings, log files that captured the extent of use of QualDash over 12 months, and a questionnaire designed to assess the dashboard's perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analyzed to understand how, why, and in what circumstances QualDash supported the use of national audit data in quality improvement.
The observations revealed that variation across sites in the amount and type of resources available to support data use, alongside staff interactions with QualDash, shaped its use and impact. Sites resourced with skilled audit support staff and established reporting systems (sites A and C) continued to use existing processes to report data. A number of constraints influenced use of QualDash in these sites including that some dashboard metrics were not configured in line with user expectations and staff were not fully aware how QualDash could be used to facilitate their work. In less well-resourced services, QualDash automated parts of their reporting process, streamlining the work of audit support staff (site B), and, in some cases, highlighted issues with data completeness that the service worked to address (site E). Questionnaire responses received from 23 participants indicated that QualDash was perceived as useful and easy to use despite its variable use in practice.
Web-based dashboards have the potential to support data-driven improvement, providing access to visualizations that can help users address key questions about care quality. Findings from this study point to ways in which dashboard design might be improved to optimize use and impact in different contexts; this includes using data meaningful to stakeholders in the co-design process and actively engaging staff knowledgeable about current data use and routines in the scrutiny of the dashboard metrics and functions. In addition, consideration should be given to the processes of data collection and upload that underpin the quality of the data visualized and consequently its potential to stimulate quality improvement.National Institute for Health Research Health Services and Delivery Research Program (project #16/04/06)
Addressing Semantic Interoperability and Text Annotations. Concerns in Electronic Health Records using Word Embedding, Ontology and Analogy
Get PDFElectronic Health Record (EHR) creates a huge number of databases which are
being updated dynamically. Major goal of interoperability in healthcare is to
facilitate the seamless exchange of healthcare related data and an environment
to supports interoperability and secure transfer of data. The health care
organisations face difficulties in exchanging patient’s health care information
and laboratory reports etc. due to a lack of semantic interoperability. Hence,
there is a need of semantic web technologies for addressing healthcare
interoperability problems by enabling various healthcare standards from various
healthcare entities (doctors, clinics, hospitals etc.) to exchange data and its
semantics which can be understood by both machines and humans. Thus, a
framework with a similarity analyser has been proposed in the thesis that dealt
with semantic interoperability. While dealing with semantic interoperability,
another consideration was the use of word embedding and ontology for
knowledge discovery. In medical domain, the main challenge for medical
information extraction system is to find the required information by considering
explicit and implicit clinical context with high degree of precision and accuracy.
For semantic similarity of medical text at different levels (conceptual, sentence
and document level), different methods and techniques have been widely
presented, but I made sure that the semantic content of a text that is presented
includes the correct meaning of words and sentences. A comparative analysis
of approaches included ontology followed by word embedding or vice-versa
have been applied to explore the methodology to define which approach gives
better results for gaining higher semantic similarity. Selecting the Kidney Cancer
dataset as a use case, I concluded that both approaches work better in different circumstances. However, the approach in which ontology is followed by word
embedding to enrich data first has shown better results. Apart from enriching
the EHR, extracting relevant information is also challenging. To solve this
challenge, the concept of analogy has been applied to explain similarities
between two different contents as analogies play a significant role in
understanding new concepts. The concept of analogy helps healthcare
professionals to communicate with patients effectively and help them
understand their disease and treatment. So, I utilised analogies in this thesis to
support the extraction of relevant information from the medical text. Since
accessing EHR has been challenging, tweets text is used as an alternative for
EHR as social media has appeared as a relevant data source in recent years.
An algorithm has been proposed to analyse medical tweets based on analogous
words. The results have been used to validate the proposed methods. Two
experts from medical domain have given their views on the proposed methods
in comparison with the similar method named as SemDeep. The quantitative
and qualitative results have shown that the proposed analogy-based method
bring diversity and are helpful in analysing the specific disease or in text
classification
The role of CCR7 axis in facilitating chemoresistance, radioresistance and induction of cell proliferation in cancer
Get PDFChemokines are a family of chemotactic cytokines that play a multifaceted role in
human biology. Chemokine receptor CCR7, activated by its ligands CCL19 &
CCL21, is known to play a significant role in cancer metastasis. In view of the wider
roles that chemokines play in the biology of the cell, we hypothesised that CCR7
could influence cancer progression through other mechanisms in particular
increased proliferation and/or increased chemo- and radioresistance, and whether
these effects may have a physiological/clinical relevance. Interestingly, CXCR4
involvement in cancer recurrence, metastasis and proliferation is already well
established. Thus, it was used as a point of reference to compare whether CCR7
axis effect on cancer proliferation and chemoresistance is similar to that observed
in CXCR4 axis.
It is proven that hypoxia is a driving factor in increased CCR7 expression. This
study shows that CCR7 expression is upregulated as a response to a number of
other stress factors, in particular that caused by different chemotherapeutic
treatments. In addition, we showed that CCL21, one of the two endogenous
ligands for CCR7 is similarly produced under these conditions
We used several techniques to establish the expression and functionality of CCR7 and CXCR4 in different cancer cell lines. We then showed that activation of the
CCR7 axis by physiologically relevant concentrations of CCL21 induces cancer
cell proliferation and chemo- and radio-resistance. Furthermore, these effects are
abrogated by small molecule antagonists (ICT13069), neutralizing monoclonal
antibody, or CCR7 knockdown.
Our findings support the hypothesis that antagonising CCR7 receptor will not only
inhibit cancer metastasis, as it is well-illustrated in the literature, but it would also
lead to alternative therapeutic approaches as well as potential clinical endpoints.University of Tobruk, and the Ministry of Higher Education of Liby
Talking Trains, Planes and Automobiles: Machine Anthropomorphism in Children’s Fiction
Get PDFMachine anthropomorphism is the reification of technology in representation, giving machines human features, qualities, and motivations. This study aims to investigate the origins and functions of machine anthropomorphism and the impact that it has on readers in a technic society as part of an ideological apparatus. It looks at how machine anthropomorphism creates a social imaginaire for technology and how animist representations of machines have shifted from adult culture to children’s fiction. Working from the premise that children identify with childlike machines such as Thomas the Tank Engine this study examines how the relationships between machines and humans are used to model relationships between children and adults. These fall into three modes of representation: the promethean machine, the fraternal machine, and the dominant machine. Each mode functions as an ideological apparatus to either support the promethean ideology, provide a counter discourse, or turn it on its head completely.
The case studies focus on promethean representations in The Railway Series/Thomas and Friends and Bob the Builder; on fraternal representations in Ivor the Engine and WALL·E; and on reverse promethean representations in The Transformers franchise and Pixar’s Cars films.
Machine anthropomorphism is an important mode of representation not only in children’s entertainment but increasingly in adult culture as well, functioning as part of an ideological apparatus to reproduce consumer power in a post-technic society. As technology becomes more human-like machine anthropomorphism functions to create a new social imaginaire, preparing society for the technical disruption of increased automation, robotics, cybernetics, and artificial intelligence
Patient experience and physiological response to two commercially available daily disposable myopia control contact lenses
Get PDFYesBackground: A range of myopia management (MM) contact lenses are becoming available to practitioners. These lenses are designed to slow myopia progression and axial elongation. This study explored the initial experience of participants wearing daily disposable MM contact lenses to investigate established factors previously associated with successful lens wear.
Methods: This was a prospective, double-masked, crossover study. Twenty participants aged 18–30 years old were assigned to wear two daily disposable MM lenses in a randomised order. Visual acuity, contrast sensitivity, and amplitude/lag of accommodation were assessed at baseline, post-insertion, and after 2 and 6 h of lens wear. Self-reported lens comfort and vision quality were recorded at the same timepoints, and at 10 h post-insertion. Pairwise comparisons were performed between the two lenses at each timepoint, as well as assessing changes throughout wear. The relationship of the measured parameters to overall lens satisfaction was also assessed.
Results: There were no significant differences between the two MM lenses at any timepoint for any of the participant-reported parameters, including overall satisfaction. A small difference in visual acuity was noted at 6 h post-insertion, although this is unlikely to be clinically significant. Comfort decreased throughout the day, most notably at 10 h post-insertion. A moderate positive correlation was observed between participant-reported visual quality and overall satisfaction. A similar pattern was seen for comfort and overall satisfaction. Self-reported vision quality and measured visual acuity were poorly correlated, highlighting the benefit of subjectively assessing the quality of vision with these lenses.
Conclusions: The participants demonstrated comparable measures across a range of measures between the two MM lenses. Notably, half of the participants demonstrated a clear lens preference, although the preferred lens varied between individuals. Candidates for MM may benefit from trialling more than one MM lens design, to maximise initial wearing satisfaction.This project was supported by the British Contact Lens Association Summer Research Scholarship
Adipose tissue-derived mesenchymal stem cells for breast tissue regeneration
Get PDFYesWith an escalating incidence of breast cancer cases all over the world and the deleterious psychological impact that mastectomy has on patients along with several limitations of the currently applied modalities, it's plausible to seek unconventional approaches to encounter such a burgeoning issue. Breast tissue engineering may allow that chance via providing more personalized solutions which are able to regenerate, mimicking natural tissues also facing the witnessed limitations. This review is dedicated to explore the utilization of adipose tissue-derived mesenchymal stem cells for breast tissue regeneration among postmastectomy cases focusing on biomaterials and cellular aspects in terms of harvesting, isolation, differentiation and new tissue formation as well as scaffolds types, properties, material-host interaction and an in vitro breast tissue modeling
Obtaining archaeointensity data from British Neolithic pottery: A feasibility study
Get PDFYesThere is a significant lack of geomagnetic field strength (archaeointensity) measurements for many archaeological time periods in the United Kingdom (UK). This not only makes past geomagnetic secular variation difficult to model but also limits the development of archaeointensity dating. This paper presents the first archaeointensity study on UK Neolithic material. In this study, twenty-five sherds of Neolithic Grooved Ware pottery from the Ness of Brodgar, Orkney, UK, some with direct radiocarbon dates, were subjected to a full archaeomagnetic investigation with the aim of increasing the amount of archaeointensity data for the UK. Both thermal Thellier and microwave palaeointensity experiments were used to determine which technique would be most suitable for British Neolithic pottery. Three successful archaeointensity results between 35 and 40μT were obtained using thermal Thellier method, which is consistent with the limited data available within a 15° radius and geomagnetic field model predictions from the same time. We separated the results into four different types with an intention of explaining the behaviours that determine the likelihood of achieving an acceptable archaeointensity estimate. The feasibility of obtaining geomagnetic field strength information during the UK Neolithic from ceramics has been demonstrated and the results provide a solid basis for improving our knowledge of geomagnetic secular variation during archaeological time in Britain.The Andy Jagger Fund, University of Bradford, for supporting the stay at the University of Liverpool and Crafoord Grant, Sweden, No. 20160763. The radiocarbon dates were funded by AHRC NF/2017/2/7
Living with dementia during the COVID-19 pandemic: coping and support needs of community-dwelling people with dementia and their family carers. Research findings from the IDEAL COVID-19 Dementia Initiative (IDEAL-CDI)
Get PDFYesWe interviewed people with dementia and carers from the IDEAL cohort to find out how the COVID-19 lockdown and continuing restrictions affected those living with dementia. Some people with dementia coped well, while others coped with difficulty or were only just coping. The additional stress of COVID-19 exacerbated pre-existing coping difficulties. For many, social isolation increased anxiety. Some felt that lack of activity or lack of social contact caused a decline in their abilities to manage everyday tasks. Confusion about COVID-19 rules or difficulty remembering what to do led to anxiety when leaving the house. People felt that members of the public might not understand their particular needs. While some carers felt they were coping well, others experienced stress when having to leave the home because the person with dementia might not be safe if left alone. Some experienced increased strain in the caring relationship compounded by an uncertainty about future availability of respite. Some were concerned about the complex health needs of the person with dementia alongside COVID-19 risk and lack of personalised information. Both people with dementia and carers talked about the importance of access to safe outdoor space. People were anxious about how others would react or behave towards them regarding keeping a distance if they went out. Being connected to friends, family and wider community or support groups was important to help combat the effects of isolation. People from BAME communities worried about their increased vulnerability to the virus. A lack of trust in Government guidance and in health care services added to their anxiety. However, some benefitted from strong community and faith group involvement. What might be helpful for people with dementia? • Reablement to help regain or maintain skills • Personalised health advice regarding managing COVID-19 risk and the opportunity to ask questions. • Identification of people with dementia who live alone and an assessment of their needs. What might be helpful for carers? • Needs assessment in regard to respite. • Novel forms of respite care that incorporate social distancing. What might be helpful for both carers and people with dementia? • Access to COVID-safe outdoor spaces. • Continuation and expansion of ‘just checking’ services. • Support to get online and use the internet. • Communication and information through non-digital means. • Community COVID-19 ‘dementia awareness’ initiatives. What might be helpful for people from Black and minority ethnic groups? • Addressing concerns about their increased risk of COVID-19. • Directing information and support through existing community and faith groups.This report presents independent research funded by the National Institute for Health Research Policy Research Unit in Older People and Frailty
Spiking neural P systems: matrix representation and formal verification
Get PDFYesStructural and behavioural properties of models are very important in development of complex systems and applications. In this paper, we investigate such properties for some classes of SN P systems. First, a class of SN P systems associated to a set of routing problems are investigated through their matrix representation. This allows to make certain connections amongst some of these problems. Secondly, the behavioural properties of these SN P systems are formally verified through a natural and direct mapping of these models into kP systems which are equipped with adequate formal verification methods and tools. Some examples are used to prove the effectiveness of the verification approach.EPSRC research grant EP/R043787/1; DOST-ERDT research grants; Semirara Mining Corp; UPD-OVCRD
An exploration of migrant women's perceptions of public health messages to reduce stillbirth in the UK: a qualitative study
Get PDFYesStillbirth is a global public health priority. Within the United Kingdom, perinatal mortality disproportionately impacts Black, Asian and minority ethnic women, and in particular migrant women. Although the explanation for this remains unclear, it is thought to be multidimensional. Improving perinatal mortality is reliant upon raising awareness of stillbirth and its associated risk factors, as well as improving maternity services. The aim of this study was to explore migrant women’s awareness of health messages to reduce stillbirth risk, and how key public health messages can be made more accessible.
Method: Two semi-structured focus groups and 13 one to one interviews were completed with a purposive sample of 30 migrant women from 18 countries and across 4 NHS Trusts.
Results: Participants provided an account of their general awareness of stillbirth and recollection of the advice they had been given to reduce the risk of stillbirth both before and during pregnancy. They also suggested approaches to how key messages might be more effectively communicated to migrant women.
Conclusions: Our study highlights the complexity of discussing stillbirth during pregnancy. The women in this study were found to receive a wide range of advice from family and friends as well as health professionals about how to keep their baby safe in pregnancy, they recommended the development of a range of resources to provide clear and consistent messages. Health professionals, in particular midwives who have developed a trusting relationship with the women will be key to ensuring that public health messages relating to stillbirth reduction are accessible to culturally and linguistically diverse communities.Funding was received from the University of Huddersfield internal funding scheme