Continuous Improvement Through Knowledge-Guided Analysis in Experience Feedback

Continuous improvement in industrial processes is increasingly a key element of competitiveness for industrial systems. The management of experience feedback in this framework is designed to build, analyze and facilitate the knowledge sharing among problem solving practitioners of an organization in order to improve processes and products achievement. During Problem Solving Processes, the intellectual investment of experts is often considerable and the opportunities for expert knowledge exploitation are numerous: decision making, problem solving under uncertainty, and expert configuration. In this paper, our contribution relates to the structuring of a cognitive experience feedback framework, which allows a flexible exploitation of expert knowledge during Problem Solving Processes and a reuse such collected experience. To that purpose, the proposed approach uses the general principles of root cause analysis for identifying the root causes of problems or events, the conceptual graphs formalism for the semantic conceptualization of the domain vocabulary and the Transferable Belief Model for the fusion of information from different sources. The underlying formal reasoning mechanisms (logic-based semantics) in conceptual graphs enable intelligent information retrieval for the effective exploitation of lessons learned from past projects. An example will illustrate the application of the proposed approach of experience feedback processes formalization in the transport industry sector

Improved dynamic object detection within evidential grids framework

International audienceThe deployment of autonomous robots/vehicles is increasing in several domains. To perform tasks properly, a robot must have a good perception about its environment while detecting dynamic obstacles. Recently, evidential grids have attracted more interest for environment perception since they permit more effective uncertainty handling. The latest studies on evidential grids relied on the use of thresholds for information management e.g. the use of a threshold, for the conflict characterized by the mass of empty set, in order to detect dynamic objects. Nevertheless, the mass of empty set alone is not consistent in some cases. Also, the thresholds used were chosen either arbitrary or tuned manually without any computational method. In this paper, first the conflict is composed of two parameters instead of mass of empty set alone, and dynamic objects detection is performed using a threshold on the evolution of this conflict pair. Secondly, the paper introduces a general threshold along with a mathematical demonstration to compute it which can be used in different dynamic object detection cases. A real-time experiment is performed using the RB1-BASE robot equipped with a RGB-D camera and a laser scanner

Why do women not use antenatal services in low and middle income countries? A metasynthesis of qualitative studies

Background: Almost 50% of women in low & middle income countries (LMIC’s) don’t receive adequate antenatal care. Women’s views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies. Methods and Findings: Using a pre-determined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMIC’s who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line of argument synthesis. We derived policy relevant hypotheses from the findings. We included 21 papers representing the views of more than 1230 women from 15 countries. Three key themes were identified: ‘Pregnancy as socially risky and physiologically healthy’; ‘Resource use and survival in conditions of extreme poverty’and ‘Not getting it right first time’. The line of argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralized, risk-focused antenatal care programmes may be at odds with the resources, beliefs and experiences of pregnant women who underuse antenatal services. Conclusions: Our findings suggest that there may be a mis-alignment between current antenatal provision and the social and cultural context of some women in LMIC’s. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences are likely to be underused, especially when attendance generates increased personal risks of lost family resource or physical danger during travel; when the promised care is not delivered due to resource constraints; and when women experience covert or overt abuse in care settings

National evaluation of Partnerships for Older People Projects

Executive Summary The Partnership for Older People Projects (POPP) were funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and preventing or delaying their need for higher intensity or institutional care. The evaluation found that a wide range of projects resulted in improved quality of life for participants and considerable savings, as well as better local working relationships. • Twenty-nine local authorities were involved as pilot sites, working with health and voluntary sector partners to develop services, with funding of £60m • Those projects developed ranged from low level services, such as lunch-clubs, to more formal preventive initiatives, such as hospital discharge and rapid response services • Over a quarter of a million people (264,637) used one or more of these services • The reduction in hospital emergency bed days resulted in considerable savings, to the extent that for every extra £1 spent on the POPP services, there has been approximately a £1.20 additional benefit in savings on emergency bed days. This is the headline estimate drawn from a statistically valid range of £0.80 to £1.60 saving on emergency bed days for every extra £1 spent on the projects. • Overnight hospital stays were seemingly reduced by 47% and use of Accident & Emergency departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and clinic or outpatient appointments with a total cost reduction of £2,166 per person • A practical example of what works is pro-active case coordination services, where visits to A&E departments fell by 60%, hospital overnight stays were reduced by 48%, phone calls to GPs fell by 28%, visits to practice nurses reduced by 25% and GP appointments reduced by 10% • Efficiency gains in health service use appear to have been achieved without any adverse impact on the use of social care resources • The overwhelming majority of the POPP projects have been sustained, with only 3% being closed – either because they did not deliver the intended outcomes or because local strategic priorities had changed • PCTs have contributed to the sustainability of the POPP projects within all 29 pilot sites. Moreover, within almost half of the sites, one or more of the projects are being entirely sustained through PCT funding – a total of 20% of POPP projects. There are a further 14% of projects for which PCTs are providing at least half of the necessary ongoing funding • POPP services appear to have improved users’ quality of life, varying with the nature of individual projects; those providing services to individuals with complex needs were particularly successful, but low-level preventive projects also had an impact • All local projects involved older people in their design and management, although to varying degrees, including as members of steering or programme boards, in staff recruitment panels, as volunteers or in the evaluation • Improved relationships with health agencies and the voluntary sector in the locality were generally reported as a result of partnership working, although there were some difficulties securing the involvement of GP

Fünf evidenzbasierte Heuristiken für den Einsatz von Video in der universitären Lehrerausbildung

This article provides a research synthesis on the use of video in pre-service teacher education. Common ideas and evidences concerning the use of video in pre-service teacher education are reviewed. Based on the state-of-the-art in using video, five research-based heuristics are derived. Research findings of a number of studies are further used to illustrate the specification of heuristics. Specifically, a set of rules of thumb about when, how, and why to use video is presented to clarify the strengths and limitations of video as a medium to support pre-service teacher learning. (DIPF/Orig.)Der Beitrag liefert eine Forschungssynthese zur Nutzung von Video in der universitären Lehrerausbildung. Die Forschung wird dahingehend zusammengefasst, welche Ideen derzeit verfolgt werden und welche Evidenzen zur Nutzung von Video vorliegen. Basierend auf dem Forschungsstand leiten die Autoren fünf forschungsbasierte Heuristiken zum Einsatz von Video ab. Die Forschungsergebnisse einer Reihe ausgewählter Studien werden genutzt, um die Heuristiken weiter zu spezifizieren. Es werden Erfahrungsregeln vorgestellt, wann, wie und warum Video in der universitären Lehrerbildung eingesetzt werden kann. Die Erfahrungsregeln sollen helfen, Stärken und Schwächen von Video als ein Medium zur Unterstützung des Lernens von Lehramtsstudierenden zu klären. (DIPF/Orig.

Reframing: A Grounded Theory Study of Postmenopausal Women Following Osteoporotic Fracture

BACKGROUND: Osteoporosis is a chronic disease resulting in low bone mass and increased bone fragility. Most often seen in women age 65 and older, osteoporosis is usually diagnosed following osteoporotic fracture. Despite numerous treatment options many women continue to remain untreated for osteoporosis and are at increased risk for subsequent fractures and complications. PURPOSE: The initial purpose of this classic grounded theory study was to explore the decision-making process women aged 65 and older experience when considering osteoporosis treatment following osteoporotic fracture. Following the tenth participant interview the researcher discovered a new main concern that emerged from participant interviews. Participants reported longing to return to a time prior to osteoporosis and fracture during which they reported higher levels of independence and freedom. Based on the emerging information the initial purpose of the study and spill question were altered to reflect the main concern of the participants: to develop a theory of reframing following osteoporotic fracture. METHODS: This classic grounded theory study utilized purposive sampling to recruit 12 women aged 65 and older with a recent osteoporotic fracture. Data from open-ended interviews were collected and analyzed. RESULTS: The grounded theory of reframing: a grounded theory study of postmenopausal women following osteoporotic fracture. The theory consists of three stages and a critical juncture. The first stage of the theory is resting in contentment. This stage occurs prior to osteoporotic fracture during which participants have varying degrees of pre-existing osteoporotic knowledge. The stage includes the properties of unsuspecting danger, underestimating risk, and looking the other way. Stage one is followed by the critical juncture, facing the threat, during which osteoporotic fracture occurs. The stage of adjustment follows the critical juncture. During this stage participants are either letting go of a previous life for one with osteoporosis or are blame shifting and diminishing the significance of osteoporosis and its relation to their current fracture. During the final stage, reframing, participants undergo an embodied revelation toward a new life with osteoporosis. Participants unable to view life through a new lens continue to long for a pre-fracture life which may no longer be attainable. CONCLUSIONS: Reframing: A grounded theory study of postmenopausal women following osteoporotic fracture explains from the participant perspective what is going on following osteoporotic fracture. This new grounded theory has profound implications for research, education, and clinical practice

Being serious about games:Whether, how, why, and when computer- and game-based interventions could facilitate in reducing burdens of chronic somatic symptoms

Computertoepassingen hebben de potentie om patiënten met een chronische aandoening op een toegankelijke of kosteneffectieve wijze te ondersteunen. ‘Serious games’ zijn computergames die bedoeld zijn om spelers van de games te vermaken, maar ook hun kennis, gedrag, of (mentale) gezondheid te beïnvloeden. Voor patiënten met chronische klachten van pijn of vermoeidheid werd de game LAKA ontwikkeld om hen te motiveren tot oefening in zelfbewustzijn in de omgang met dagelijkse onzekere sociaal-emotionele situaties. Naar schatting heeft één op de vijf Europeanen langer dan zes maanden pijn. Chronische pijn eist aandacht op en daagt uit om daarmee om te gaan. In veel gevallen ontstaan daarbij psychosociale problemen, zoals depressie en verzuim, met sterke maatschappelijke gevolgen. Veel is nog onduidelijk over de haalbaarheid en effectiviteit van computerinterventies, zoals serious games, ter vermindering van individuele lasten van chronische lichamelijke symptomen. In dit onderzoek is met diverse methoden geprobeerd antwoord te geven op de vragen: In hoeverre werken computerinterventies en serious games bij welke mensen met langdurige pijn, hoe werken ze en onder welke omstandigheden? Allereerst werd een literatuurstudie uitgevoerd naar eerder gepubliceerde experimenten over de effectiviteit van computerinterventies voor patiënten met chronische pijn of onverklaarde chronische lichamelijke klachten. Voor onderzoek naar de haalbaarheid van ‘LAKA’, oftewel de acceptatie en het gebruik van de game door patiënten tijdens een multidisciplinair revalidatieprogramma, werden gegevens uit patiëntendossiers, aanvullende vragenlijsten, automatische gebruiksregistraties en patiëntinterviews gebruikt. In een daaropvolgend experiment werden veranderingen in ervaren pijnintensiteit, vermoeidheid, toekenning van negatieve betekenissen aan pijn en psychische lasten vergeleken tussen 2 groepen patiënten: (1) een groep die een door zorgverleners ondersteunde interventie met LAKA volgde tijdens multidisciplinaire revalidatie en (2) een groep die hetzelfde revalidatieprogramma volgde zonder serious gaming. Ook werden patiënten en zorgpersoneel bevraagd naar hun ervaringen met de game. Er werden geen eerdere experimenten met serious games gevonden. De overgrote meerderheid van de geïdentificeerde studies onderzochten het effect van online cognitieve gedragstherapie. Hiervoor werden positieve en blijvende effecten gevonden op patiëntuitkomsten van fysiek en emotioneel functioneren. Echter, de geschatte effecten waren dermate klein en wisselend dat ze voor veel patiënten niet of nauwelijks merkbaar zijn. In het eigen experiment met serious gaming tijdens multidisciplinaire revalidatie werd een ‘zeer klein’ effect gevonden. De inzet van LAKA is haalbaar gebleken tijdens multidisciplinaire revalidatie voor mensen met langdurige pijn. Acceptatie en gebruik varieerden met gewoonten, percepties over plezier en gemak, een coping stijl van actief aanpakken van patiënten en adequate implementatieprocessen. Eerdere experimenten en het experiment met LAKA suggereerden dat leer- en gezondheidseffecten ontstaan door aandachtig gebruik van strategieën voor gedragsverandering. De verklaring hiervoor is dat mensen het piekeren of het toekennen van een negatieve betekenis aan pijn tegengaan. Daarnaast leren zij acceptatie en zelfbewustzijn te bevorderen. Hiervan is sprake bij patiënten die symptomen van depressie tonen of weinig controle over stress of pijn ervaren. Deskundige begeleiding en leren uit blootstelling aan sociale omgevingen, in het echt of in een serious game, zijn daarbij belangrijke voorwaarden. Dit onderzoek kan als basis worden gezien voor meer theoriegerichte en contextgevoelige evaluaties van serious games voor mensen die chronische pijn ervaren. Meer informatie is nodig voor patiënten, zorgverleners en andere besluitvormers, zodat zij beter weten wat ze in persoonlijke en lokale omstandigheden kunnen verwachten van serious games als onderdeel van de behandeling

Exploring Men who have sex with men’s HIV Pre-exposure Prophylaxis Initiation Decision-making Processes in the Southern United States

In 2012, the first pharmacological HIV preventative agent, pre-exposure prophylaxis (PrEP) was approved in the U.S. for individuals at high-risk of contracting HIV. Men who have sex with men (MSM) are at increased HIV risk, due to their engagement in anal intercourse (AI), which is the most common mode of HIV transmission and the riskiest type of sex. Although evidence indicates that most PrEP paients are MSM, a paucity of evidence exists on MSM’s PrEP initation decision-making process. The purpose of this study was to explore how HIV-negative MSM engaging in protected or unprotected AI decide to initiate PrEP based on the evaluation and perceptions pertaining to their: (a) PrEP knowledge and HIV risk(s)/concern(s); (b) personal and social motivations to initiate PrEP; and (c) behavioral skills and abilities to adhere to PrEP. Guided by the Information-Motivation Behavioral (IMB) skills model, a six-item questionnaire was constructed and used to conduct one-on-one semi-structured interviews. Fourteen MSM (71% African-American) living in the Southern U.S. consented to an interview between March and August of 2018. Several themes emerged from the inductive content analysis, and these themes were categorized into five broader concepts: (1) acknowledged HIV-risks, (2) HIV concerns, (3) PrEP understanding, (4) PrEP accessibility, and (5) PrEP consideration. On further analysis, the data revealed the PrEP Initiation Decision-making (PID) model, a conceptualization of this sample’s non-linear thoughtful process of weighing and evaluating their perceptions and attitudes surrounding these five factors in deriving at their decision to initiate PrEP. The findings give insight into the PrEP initiation decision-making process of an HIV-vulnerable population. Knowledge of patients’ rationale and decision-making process for initiating PrEP allows nursing professionals to provide in-depth PrEP patient education, ensuring that patients receive accurate and complete PrEP information including the (1) relationship between adherence and efficacy; (2) utilization of traditional risk-reduction behaviors in conjunction with PrEP; and (3) the availability of financial assistance programs. This study’s evidence is foundational, establishing a knowledge base for PrEP initiation inquiries in the MSM and other PrEP patient populations in the U.S

Using a Pediatric Early Warning Score Algorithm for Activating a Rapid Response Team

The nursing culture of an inpatient pediatric unit was resistant to activating pediatric rapid response team (PRRT) alerts despite guidelines for activation. Nurses routinely assessed patients and assigned a pediatric early warning score (PEWS); however, the level of illness severity was not interpreted consistently among nurses and a PEWS action algorithm did not exist to guide nurses\u27 minimal actions based on the PEWS score. Guided by 3 adult learning theories (Knowles, Kolb, and Bandura) and 1 evaluation model (Kirkpatrick), this staff education project sought to educate pediatric nurses on a PEWS action algorithm and determine whether this project improved nurses\u27 knowledge, situational awareness, and attitude toward activating PRRT alerts. A convenience sample of 30 pediatric nurses completed a preeducation knowledge survey (EKS), attended an interactive PEWS education class, and completed a postEKS. After participating in the class, correct responses on the EKS increased from 43% to 82% and, using the Wilcoxon-signed rank test, a significant increase was noted in nurses\u27 responses to questions related to self-efficacy, factual knowledge, and application. The overall increase in the nurses\u27 self-efficacy and knowledge about the PEWS might enhance critical-thinking skills, foster identification of patients at risk for clinical deterioration, and empower nurses to follow the PEWS action algorithm including activation of PRRT alerts when indicated. This project has the potential to effect positive social change by supporting nurses\u27 actions designed to improve pediatric patient outcomes