Learning Rich Geographical Representations: Predicting Colorectal Cancer Survival in the State of Iowa

Neural networks are capable of learning rich, nonlinear feature representations shown to be beneficial in many predictive tasks. In this work, we use these models to explore the use of geographical features in predicting colorectal cancer survival curves for patients in the state of Iowa, spanning the years 1989 to 2012. Specifically, we compare model performance using a newly defined metric -- area between the curves (ABC) -- to assess (a) whether survival curves can be reasonably predicted for colorectal cancer patients in the state of Iowa, (b) whether geographical features improve predictive performance, and (c) whether a simple binary representation or richer, spectral clustering-based representation perform better. Our findings suggest that survival curves can be reasonably estimated on average, with predictive performance deviating at the five-year survival mark. We also find that geographical features improve predictive performance, and that the best performance is obtained using richer, spectral analysis-elicited features.Comment: 8 page

The role of individual and group level variables in healthcare profissionals' hand hygiene compliance: a multi-level perspective

Literature shows that non-compliance with hand hygiene increases hospital-acquired infections and research in this area is far from synthesized. This work aims to conciliate the contributions of the Theory of Planned Behavior (TPB), the Precede-Proceed model and the safety climate approach to analyse (1) this problematic during the education of future healthcare professionals; (2) hand hygiene as arising from micro-systems (e.g. care-delivery teams); (3) the specificities of compliance between different categories of professionals; and (4) the importance of work experience in constraining intention to comply. We also intend to analyse the impact of the moral norm and the vulnerability perception. The former as a behavioural intention predictor will be tested as an inhibitor of compliance; the latter, will be used as a multi-level moderator to explore its role in the relationship between team safety climate and compliance. Furthermore, we will also analyse self-reported and observed compliance. We present five studies whose results indicate that (1) TPB behavioural intention predictors function as significant mediators in transferring the impact of team safety climate to intention; (2) social influence is an important predictor enhancing the relevance of role models; (3) professionals present multi-faceted moral prerogatives that inhibit compliance, particularly physicians and medical students; 4) reported compliance appears to be an adequate way to measure hand hygiene due to its consistency with observed compliance. In the end, predisposing, enabling and reinforcing variables are presented to link the empirical evidence of this work with its practical dimension by defining measures to design future interventions.A literatura demonstra que a não adesão à higiene das mãos aumenta as infecções hospitalares, contudo a investigação nesta área permanece dispersa. Este trabalho pretende conciliar os contributos da Teoria da Acção Planeada (TAP), modelo Precede-Proceed e abordagem de clima de segurança para analisar esta problemática (1) durante a formação de futuros profissionais de saúde; (2) a higiene das mãos como um comportamento que emerge de micro-sistemas (e.g. equipas de trabalho); (3) as especificidades entre diferentes categorias de profissionais; e (4) o impacto da experiência de trabalho na intenção de aderir. Pretende-se ainda aferir o papel da norma moral enquanto preditora da intenção, sendo testada como inibidora da adesão; e da percepção de vulnerabilidade como moderadora numa relação multinível para explorar o seu papel entre o clima de segurança de equipa e a adesão. Para além disso, iremos também avaliar a adesão reportada e observada. Serão apresentados cinco estudos cujos resultados indicam que (1) os preditores da intenção da TAP funcionam como mediadores transferindo o impacto do clima de segurança de equipa para a intenção; (2) a influência social é um preditor importante reforçando o papel dos “role models”; (3) os profissionais apresentam prerrogativas morais multi-facetadas que inibem a adesão, particularmente os médicos e estudantes de medicina; (4) a adesão reportada parece ser uma medida adequada para avaliar este comportamento devido à sua consistência com a adesão observada. No final, as variáveis que predispõem, facilitam e reforçam a adesão serão apresentadas relacionando a evidência empírica deste trabalho com a sua dimensão prática pela apresentação de medidas de intervenção

A Mixed Methods Approach to Context Specific Curriculum Design for Very Small and Small Strawberry Growers in the Southeastern United States

Outbreaks of foodborne illness due to fresh produce are a continued threat to both the publichealth and the economy in the United States. Though there are many factors which influence the perpetuation of foodborne pathogens, the inability of the food industry to curtail this issue indicates systemic failure of interventions aimed at improving food safety practices. In this dissertation, we detail the efforts made over the past few decades to provide training to food producers and food handlers as well as recommendations that have been made for improvement based on these studies. By borrowing from more advanced fields of study such as implementation science, we will outline and evaluate a novel method for approaching context and commodity specific education for the food industry

Healthcare professionals' hand hygiene : predicting and improving practice

This programme of research consists of eight studies which sought to determine how healthcare professionals' hand hygiene practice might be improved. The Theory of Planned Behaviour was used to isolate perceived cognitive and physical factors that may explain the variance in their hand hygiene behaviour. Practice was observed and healthcare professionals' understanding of the hand hygiene policy to which they were expected to adhere was assessed. Messages on hand hygiene posters were analysed. The effect of two educational interventions on students' attitudes was tested. Achieving change will be challenging for several reasons. Healthcare professionals hold false perceptions about their hand hygiene behaviour; they think it is better than it is but their practice is unrelated to their intentions and self-reports of behaviour. Adherence to the national guideline was poor and practice was neither rational nor informed by risk assessment, even when caring for patients colonised with methicillin-resistant Staphylococcus aureus. Student nurses' attitudes towards the importance of hand hygiene showed progressively downward trends between three cohorts in their first, second and third years of training. The difference was particularly pronounced between first and second years. Their attitudes also showed optimistic bias and false consensus beliefs. For all but one of the 11 clinical procedures measured, they said that they value hand hygiene practice significantly more than other nurses and doctors they work alongside. A microbiology laboratory practical and a demonstration using a fluorescent cream and an ultraviolet light hand inspection cabinet were equally effective at enhancing students' attitudes towards hand hygiene, but the improvement was quickly eroded by their first experience of clinical practice. Various factors in the clinical setting impact negatively on healthcare professionals' attitudes and practice and undermine the principles taught in the pre-clinical phase of training. These include poor role models, ambiguous hand hygiene policies and inappropriately framed messages on hand hygiene posters which lead to confusion in the minds of healthcare professionals about when hands should be washed. In order to improve healthcare professionals' hand hygiene behaviour, it is necessary to disambiguate their understanding about when hands should be washed. There needs to be more emphasis on infection prevention. An active process called the Dynamic Assessment Strategy for Hand Hygiene (DASHH) offers one way of changing poor practice. It does this by teaching healthcare professionals to consider hand hygiene before and after care as separate activities requiring separate risk assessment. Such a strategy provides them with a simple mind map to make the quick informed decisions that are required on a busy ward. The effectiveness of the strategy needs to be evaluated. Observation should form part of the assessment to ensure that there is a beneficial outcome and that good practice is becoming a habit

Modelling Hospital Acquired Clostridium difficile Infections And Its Transmission In Acute Hospital Settings

The thesis explored a number of fundamental issues regarding the development of predictive models for hospital acquired Clostridium difficile infection (HA CDI) and its outbreaks. As predictive modeling for hospital acquired infection is still an emerging field and the ability to analyse HA CDI and potential outbreaks are in a developmental stage, the research documented in this thesis is exploratory and preliminary. Predictive modeling for the outbreak of hospital acquired infections can be considered at two levels: population and individual. We provide a comprehensive review regarding modeling methodology in this field at both population level and individual level. The transmission of HA CDI is not well understood. An agent based simulation model was built to evaluate the relative importance of the potential sources of Clostridium difficile (C. difficile) infection in a non-outbreak ward setting in an acute care hospital. The model was calibrated through a two stage procedure which utilized Latin Hypercube Sampling methodology and Genetic Algorithm optimization to capture five different patterns reported in the literature. A number of aspects of the model including housekeeping, hand hygiene compliance, patient turnover, and antibiotic pressure were explored. Based on the modeling results, several prevention policies are recommended. One widely used tool to better understand the dynamics of infectious disease outbreaks is network epidemiology. We explored the potential of using network statistics for the prediction of the transmission of HA CDIs in the hospital. Two types of dynamic networks were studied: ward level contacts and hospital transfers. An innovative method that combines time series data mining and predictive classification models was introduced for the analysis of these dynamic networks and for the prediction of HA CDI transmission. The results suggest that the network statistics extracted from the dynamic networks are potential predictors for the transmission of HA CDIs. We explored the potential of using the “multiple modeling methods approach” to predict HA CDI patient at risk by using the data from the information systems in the hospital. A range of machine learning predictive models were utilized to analyse collected data from a hospital. Our results suggest that the multiple modeling methods approach is able to improve prediction performance and to reveal new insights in the data set. We recommend that this approach might be considered for future studies on the predictive model construction and risk factor analysis

A Quantitative Comparative Study of Employee Engagement Among Full-Time Seventh-day Adventist Pastors in the North American Division of Seventh-day Adventists and Its Relationship to Level of Participation in Annual Pastoral Continuing Education (CE)

Problem Research was needed to determine the relationship between pastoral CE and employee engagement to guide policy implementation as well as future efforts for pastoral professional development within the Adventist organization. Method This study presents a new theoretical Adventist pastor development model integrating several theories and concepts including: the call, the Seven Core Qualities of an NAD pastor framework, andragogy, CE, SDT, and employee engagement. Employee engagement was measured using Herzberg\u27s hygiene-motivation factor employee engagement theory. Comparisons were conducted on six groups of pastors related to selfreported participation in annual CE. Results Major research findings indicate that pastors, perhaps inevitably as humans, are complex, and several factors seem to work synergistically to result in positive hygiene and motivation (employee engagement) scores including: The call, age, having adult children, ethnicity, a combination of CE and age, and a combination of children and CE. Of key importance, increased knowledge and specific life experiences work together to create a more engaged pastor. CE as a stand-alone factor did not have a statistically significant positive impact on hygiene or motivation employee engagement scores based on this data. Factors that have a negative impact on hygiene and motivation scores are family suffering, feeling like leaving ministry, doubting God’s call, ethnicity, and children at home or no children at all, and. The most popular CE activity of Adventist pastors was conventions, the least favorite was creating CE content for peers. Conclusions Recommendations for pastoral professional practice are related to five areas of focus: education, CE policy, coaching and mentoring, work environments, and pastoral family supports. Recommendations for future research are specific to four areas: pastoral CE, pastoral development factors, work environments, and family support. More scholarly research on pastors is urgently needed utilizing a factorial approach