Pediatric Nurse Practitioner Home Visitation is Associated with a Decrease in Home Care and Healthcare Utilization Errors in High Risk Infants

The Santa Clara Valley Health and Hospital System’s (SCVHHS) Babies Reaching Improved Development and Growth in their Environment (BRIDGE) program was developed in 2011 to optimize high risk infants\u27 care transition from Neonatal Intensive Care Unit (NICU) to home. In addition to hospital discharge teaching and public health nursing efforts, NICU infants need further in home support given their medical vulnerability after discharge. The objectives of the SCVHHS BRIDGE program are to provide caregiver interventions to minimize home care errors after NICU discharge and to optimize health care access and utilization across the transition of care. SCVHHS NICU infants at risk for developmental delay, who met Department of Health and Human Services (DHHS) California Children’s Services (CCS) High Risk Infant Follow-up (HRIF) criteria, qualified for SCVHHS BRIDGE visits. From April of 2011 to January of 2015 Pediatric Nurse Practitioners (PNPs) met caregivers in the NICU, visited homes a minimum of two times after discharge, identified errors, educated caregivers, coordinated care, and facilitated in the resolution of the errors. Errors were defined as a deviation from prescribed plan of care upon discharge from the NICU or after an ambulatory care visit. Data were collected prospectively and Institutional Review Board (IRB) approved. Chi Square with Yates correction was used to assess for significance. Wilcoxon Rank Sum test was used to assess association between gestational age, length of stay, and birth weight in infants with and without errors. Wilcoxon Signed Rank test was used to assess for significance of error reduction across visits. PNPs monitored, educated and attenuated home care errors between home visits and caregivers over time. Collaborating with caregivers and health care providers in the inpatient, home, and outpatient environments, PNPs have the potential to decrease errors, improve health, reduce health care costs, and optimize growth and development for high risk infants

Business Case and Technology Analysis for 5G Low Latency Applications

A large number of new consumer and industrial applications are likely to change the classic operator's business models and provide a wide range of new markets to enter. This article analyses the most relevant 5G use cases that require ultra-low latency, from both technical and business perspectives. Low latency services pose challenging requirements to the network, and to fulfill them operators need to invest in costly changes in their network. In this sense, it is not clear whether such investments are going to be amortized with these new business models. In light of this, specific applications and requirements are described and the potential market benefits for operators are analysed. Conclusions show that operators have clear opportunities to add value and position themselves strongly with the increasing number of services to be provided by 5G.Comment: 18 pages, 5 figure

Adoption of vehicular ad hoc networking protocols by networked robots

This paper focuses on the utilization of wireless networking in the robotics domain. Many researchers have already equipped their robots with wireless communication capabilities, stimulated by the observation that multi-robot systems tend to have several advantages over their single-robot counterparts. Typically, this integration of wireless communication is tackled in a quite pragmatic manner, only a few authors presented novel Robotic Ad Hoc Network (RANET) protocols that were designed specifically with robotic use cases in mind. This is in sharp contrast with the domain of vehicular ad hoc networks (VANET). This observation is the starting point of this paper. If the results of previous efforts focusing on VANET protocols could be reused in the RANET domain, this could lead to rapid progress in the field of networked robots. To investigate this possibility, this paper provides a thorough overview of the related work in the domain of robotic and vehicular ad hoc networks. Based on this information, an exhaustive list of requirements is defined for both types. It is concluded that the most significant difference lies in the fact that VANET protocols are oriented towards low throughput messaging, while RANET protocols have to support high throughput media streaming as well. Although not always with equal importance, all other defined requirements are valid for both protocols. This leads to the conclusion that cross-fertilization between them is an appealing approach for future RANET research. To support such developments, this paper concludes with the definition of an appropriate working plan

Enhanced Value Stream Mapping for Improving Turnaround Process Efficiency in Oil and Gas Industry

Turnaround maintenance (TAM) is one of the most important maintenance strategies to minimise the risk of production losses. Managing these TAM projects is challenging as for its complexity due to the involvement of massive man powers and financial resources. The aim of this research is to develop an enhanced-Value Stream Mapping (enhanced-VSM) framework to effectively improve TAM efficiency. Four theoretical enhancements are made to the conventional VSM method and validation results show the successful implementation

A Process Modelling Framework Based on Point Interval Temporal Logic with an Application to Modelling Patient Flows

This thesis considers an application of a temporal theory to describe and model the patient journey in the hospital accident and emergency (A&E) department. The aim is to introduce a generic but dynamic method applied to any setting, including healthcare. Constructing a consistent process model can be instrumental in streamlining healthcare issues. Current process modelling techniques used in healthcare such as flowcharts, unified modelling language activity diagram (UML AD), and business process modelling notation (BPMN) are intuitive and imprecise. They cannot fully capture the complexities of the types of activities and the full extent of temporal constraints to an extent where one could reason about the flows. Formal approaches such as Petri have also been reviewed to investigate their applicability to the healthcare domain to model processes. Additionally, to schedule patient flows, current modelling standards do not offer any formal mechanism, so healthcare relies on critical path method (CPM) and program evaluation review technique (PERT), that also have limitations, i.e. finish-start barrier. It is imperative to specify the temporal constraints between the start and/or end of a process, e.g., the beginning of a process A precedes the start (or end) of a process B. However, these approaches failed to provide us with a mechanism for handling these temporal situations. If provided, a formal representation can assist in effective knowledge representation and quality enhancement concerning a process. Also, it would help in uncovering complexities of a system and assist in modelling it in a consistent way which is not possible with the existing modelling techniques. The above issues are addressed in this thesis by proposing a framework that would provide a knowledge base to model patient flows for accurate representation based on point interval temporal logic (PITL) that treats point and interval as primitives. These objects would constitute the knowledge base for the formal description of a system. With the aid of the inference mechanism of the temporal theory presented here, exhaustive temporal constraints derived from the proposed axiomatic system’ components serves as a knowledge base. The proposed methodological framework would adopt a model-theoretic approach in which a theory is developed and considered as a model while the corresponding instance is considered as its application. Using this approach would assist in identifying core components of the system and their precise operation representing a real-life domain deemed suitable to the process modelling issues specified in this thesis. Thus, I have evaluated the modelling standards for their most-used terminologies and constructs to identify their key components. It will also assist in the generalisation of the critical terms (of process modelling standards) based on their ontology. A set of generalised terms proposed would serve as an enumeration of the theory and subsume the core modelling elements of the process modelling standards. The catalogue presents a knowledge base for the business and healthcare domains, and its components are formally defined (semantics). Furthermore, a resolution theorem-proof is used to show the structural features of the theory (model) to establish it is sound and complete. After establishing that the theory is sound and complete, the next step is to provide the instantiation of the theory. This is achieved by mapping the core components of the theory to their corresponding instances. Additionally, a formal graphical tool termed as point graph (PG) is used to visualise the cases of the proposed axiomatic system. PG facilitates in modelling, and scheduling patient flows and enables analysing existing models for possible inaccuracies and inconsistencies supported by a reasoning mechanism based on PITL. Following that, a transformation is developed to map the core modelling components of the standards into the extended PG (PG*) based on the semantics presented by the axiomatic system. A real-life case (from the King’s College hospital accident and emergency (A&E) department’s trauma patient pathway) is considered to validate the framework. It is divided into three patient flows to depict the journey of a patient with significant trauma, arriving at A&E, undergoing a procedure and subsequently discharged. Their staff relied upon the UML-AD and BPMN to model the patient flows. An evaluation of their representation is presented to show the shortfalls of the modelling standards to model patient flows. The last step is to model these patient flows using the developed approach, which is supported by enhanced reasoning and scheduling

Combined flow cytometry and high-throughput image analysis for the study of essential genes in Caenorhabditis elegans

Background: Advances in automated image-based microscopy platforms coupled with high-throughput liquid workflows have facilitated the design of large-scale screens utilising multicellular model organisms such as Caenorhabditis elegans to identify genetic interactions, therapeutic drugs or disease modifiers. However, the analysis of essential genes has lagged behind because lethal or sterile mutations pose a bottleneck for high-throughput approaches, and a systematic way to analyse genetic interactions of essential genes in multicellular organisms has been lacking. Results: In C. elegans, non-conditional lethal mutations can be maintained in heterozygosity using chromosome balancers, commonly expressing green fluorescent protein (GFP) in the pharynx. However, gene expression or function is typically monitored by the use of fluorescent reporters marked with the same fluorophore, presenting a challenge to sort worm populations of interest, particularly at early larval stages. Here, we develop a sorting strategy capable of selecting homozygous mutants carrying a GFP stress reporter from GFP-balanced animals at the second larval stage. Because sorting is not completely error-free, we develop an automated high-throughput image analysis protocol that identifies and discards animals carrying the chromosome balancer. We demonstrate the experimental usefulness of combining sorting of homozygous lethal mutants and automated image analysis in a functional genomic RNA interference (RNAi) screen for genes that genetically interact with mitochondrial prohibitin (PHB). Lack of PHB results in embryonic lethality, while homozygous PHB deletion mutants develop into sterile adults due to maternal contribution and strongly induce the mitochondrial unfolded protein response (UPR mt ). In a chromosome-wide RNAi screen for C. elegans genes having human orthologues, we uncover both known and new PHB genetic interactors affecting the UPR mt and growth. Conclusions: The method presented here allows the study of balanced lethal mutations in a high-throughput manner. It can be easily adapted depending on the user's requirements and should serve as a useful resource for the C. elegans community for probing new biological aspects of essential nematode genes as well as the generation of more comprehensive genetic networks.European Research Council ERC-2011-StG-281691Ministerio de Economía y Competitividad BFU2012–3550

The road to reducing dementia onset and prevalence: are diet and physical activity interventions worth investing in?

In Australia, deaths as a result of dementia have now taken over cerebrovascular disease as the second leading cause of death. At present, over a quarter million Australians suffer from dementia and projected estimates indicate that the figure can reach a high of nearly one million by 2050. Diet and physical activity have been shown to promote brain health and offer some protection against cognitive decline. Moreover, they have also been recognised as risk factors for developing other conditions such as cardiovascular disease, diabetes, hypertensive diseases and certain cancers all of which are leading causes of death in Australia. Research shows that higher ratios of saturated fat to monounsaturated fats are predictive of negative mental function. In addition, high mid-life serum cholesterol levels and excessive caloric intake have been found to be associated with impaired cognitive function. Increased intakes of fish, vegetables and legumes, antioxidant rich foods and adequate amounts of certain B-vitamins have been reported to have a protective brain effect. Increased levels of physical activity have been found to promote neuro-protective changes in the hippocampus of the brain – a region central to learning and memory. This brain region is one of the first areas affected by dementia. Most studies have demonstrated that a high level of physical activity in adults with no dementia is associated with a 30% to 50% reduction in the risk of cognitive decline and dementia. Some studies have also theorised that poor physical function may precede the onset of dementia and Alzheimer’s disease and higher levels of physical function may be associated with delayed onset. Results from the Australian Bureau of Statistics National Health Survey (2011 – 2013) show that many Australian adults do not meet the National Physical Activity Guidelines (to do at least 30 minutes of moderate intensity physical activity on most days) as more than half the population is inactive. Further, two-thirds of Australians are now overweight/obese and a large proportion of total energy consumed comes from foods considered to be of little nutritional value. An intervention that focuses on improving diet and physical activity habits therefore has the ability to produce inestimable benefits. There are many factors that must be considered when developing a successful diet and physical activity intervention. These span a gamut of issues from carefully defining the target audience, utilising a multidisciplinary approach, tailoring content and materials, determining forms of delivery and identifying specific behaviour change techniques to determining financial costs in relation to health benefits and training staff. The success of any intervention also relies on the setting and method that will be employed in its implementation. Policy-makers must be cognizant of the fact that no singular government intervention/policy, operating on its own, can have the effect of directly reducing dementia onset/prevalence and changing lifestyle habits. Six actions for policy-makers are identified in this issues brief which have the potential to have immeasurable benefits: i) development of a comprehensive dementia prevention strategy, ii) establishment of a body whose aim is to keep track of scientific research (central to this will be the establishment of a national digital dementia research repository), iii) ensuring a multisectoral approach is adopted in the fight against dementia that includes both ‘traditional’ and ‘incidental’ health agencies, iv) continued investment into research and innovation, v) identifying incentives beyond the health domain and vi) development of longevity literacy programs. These actions all have as their foundation the Health in all Policies Initiative and social determinants of health approach

How 5G wireless (and concomitant technologies) will revolutionize healthcare?

The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution