1,754 research outputs found

    The role of nursing in multimorbidity care

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    Background Multimorbidity (the co-occurrence of two or more chronic conditions in the same person) affects around one in three persons, and it is strongly associated with a range of negative outcomes including worsening physical function, increased health care use, and premature death. Due to the way healthcare is provided to people with multimorbidity, treatment can become burdensome, fragmented and inefficient. In people with palliative conditions, multimorbidity is increasingly common. Better models of care are needed. Methods A mixed-methods programme of research designed to inform the development of a nurse-led intervention for people with multimorbidity and palliative conditions. A mixed-methods systematic review explored nurse-led interventions for multimorbidity and their effects on outcomes. A cross-sectional study of 63,328 emergency department attenders explored the association between multimorbidity, complex multimorbidity (≥3 conditions affecting ≥3 body systems), and disease-burden on healthcare use and inpatient mortality. A focussed ethnographic study of people with multimorbidity and life-limiting conditions and their carers (n=12) explored the concept of treatment burden. Findings Nurse-led interventions for people with multimorbidity generally focus on care coordination (i.e., case management or transitional care); patients view them positively, but they do not reliably reduce health care use or costs. Multimorbidity and complex multimorbidity were significantly associated with admission from the emergency department and reattendance within 30 and 90 days. The association was greater in those with more conditions. There was no association with inpatient mortality. People with multimorbidity and palliative conditions experienced treatment burden in a manner consistent with existing theoretical models. This thesis also noted the effect of uncertainty on the balance between capacity and workload and proposes a model of how these concepts relate to one another. Discussion This thesis addresses a gap in what is known about the role of nurses in providing care to the growing number of people with multimorbidity. A theory-based nurse-led intervention is proposed which prioritises managing treatment burden and uncertainty. Conclusions Nursing in an age of multimorbidity necessitates a perspective shift which conceptualises chronic conditions as multiple overlapping phenomena situated within an individual. The role of the nurse should be to help patients navigate the complexity of living with multiple chronic conditions

    On the real world practice of Behaviour Driven Development

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    Surveys of industry practice over the last decade suggest that Behaviour Driven Development is a popular Agile practice. For example, 19% of respondents to the 14th State of Agile annual survey reported using BDD, placing it in the top 13 practices reported. As well as potential benefits, the adoption of BDD necessarily involves an additional cost of writing and maintaining Gherkin features and scenarios, and (if used for acceptance testing,) the associated step functions. Yet there is a lack of published literature exploring how BDD is used in practice and the challenges experienced by real world software development efforts. This gap is significant because without understanding current real world practice, it is hard to identify opportunities to address and mitigate challenges. In order to address this research gap concerning the challenges of using BDD, this thesis reports on a research project which explored: (a) the challenges of applying agile and undertaking requirements engineering in a real world context; (b) the challenges of applying BDD specifically and (c) the application of BDD in open-source projects to understand challenges in this different context. For this purpose, we progressively conducted two case studies, two series of interviews, four iterations of action research, and an empirical study. The first case study was conducted in an avionics company to discover the challenges of using an agile process in a large scale safety critical project environment. Since requirements management was found to be one of the biggest challenges during the case study, we decided to investigate BDD because of its reputation for requirements management. The second case study was conducted in the company with an aim to discover the challenges of using BDD in real life. The case study was complemented with an empirical study of the practice of BDD in open source projects, taking a study sample from the GitHub open source collaboration site. As a result of this Ph.D research, we were able to discover: (i) challenges of using an agile process in a large scale safety-critical organisation, (ii) current state of BDD in practice, (iii) technical limitations of Gherkin (i.e., the language for writing requirements in BDD), (iv) challenges of using BDD in a real project, (v) bad smells in the Gherkin specifications of open source projects on GitHub. We also presented a brief comparison between the theoretical description of BDD and BDD in practice. This research, therefore, presents the results of lessons learned from BDD in practice, and serves as a guide for software practitioners planning on using BDD in their projects

    UMSL Bulletin 2023-2024

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    The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp

    LIPIcs, Volume 251, ITCS 2023, Complete Volume

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    LIPIcs, Volume 251, ITCS 2023, Complete Volum

    UMSL Bulletin 2022-2023

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    The 2022-2023 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1087/thumbnail.jp

    Image-based Decision Support Systems: Technical Concepts, Design Knowledge, and Applications for Sustainability

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    Unstructured data accounts for 80-90% of all data generated, with image data contributing its largest portion. In recent years, the field of computer vision, fueled by deep learning techniques, has made significant advances in exploiting this data to generate value. However, often computer vision models are not sufficient for value creation. In these cases, image-based decision support systems (IB-DSSs), i.e., decision support systems that rely on images and computer vision, can be used to create value by combining human and artificial intelligence. Despite its potential, there is only little work on IB-DSSs so far. In this thesis, we develop technical foundations and design knowledge for IBDSSs and demonstrate the possible positive effect of IB-DSSs on environmental sustainability. The theoretical contributions of this work are based on and evaluated in a series of artifacts in practical use cases: First, we use technical experiments to demonstrate the feasibility of innovative approaches to exploit images for IBDSSs. We show the feasibility of deep-learning-based computer vision and identify future research opportunities based on one of our practical use cases. Building on this, we develop and evaluate a novel approach for combining human and artificial intelligence for value creation from image data. Second, we develop design knowledge that can serve as a blueprint for future IB-DSSs. We perform two design science research studies to formulate generalizable principles for purposeful design — one for IB-DSSs and one for the subclass of image-mining-based decision support systems (IM-DSSs). While IB-DSSs can provide decision support based on single images, IM-DSSs are suitable when large amounts of image data are available and required for decision-making. Third, we demonstrate the viability of applying IBDSSs to enhance environmental sustainability by performing life cycle assessments for two practical use cases — one in which the IB-DSS enables a prolonged product lifetime and one in which the IB-DSS facilitates an improvement of manufacturing processes. We hope this thesis will contribute to expand the use and effectiveness of imagebased decision support systems in practice and will provide directions for future research

    Tradition and Innovation in Construction Project Management

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    This book is a reprint of the Special Issue 'Tradition and Innovation in Construction Project Management' that was published in the journal Buildings

    Modern meat: the next generation of meat from cells

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    Modern Meat is the first textbook on cultivated meat, with contributions from over 100 experts within the cultivated meat community. The Sections of Modern Meat comprise 5 broad categories of cultivated meat: Context, Impact, Science, Society, and World. The 19 chapters of Modern Meat, spread across these 5 sections, provide detailed entries on cultivated meat. They extensively tour a range of topics including the impact of cultivated meat on humans and animals, the bioprocess of cultivated meat production, how cultivated meat may become a food option in Space and on Mars, and how cultivated meat may impact the economy, culture, and tradition of Asia

    A Changing Landscape:On Safety & Open Source in Automated and Connected Driving

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    Discovering Causal Relations and Equations from Data

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    Physics is a field of science that has traditionally used the scientific method to answer questions about why natural phenomena occur and to make testable models that explain the phenomena. Discovering equations, laws and principles that are invariant, robust and causal explanations of the world has been fundamental in physical sciences throughout the centuries. Discoveries emerge from observing the world and, when possible, performing interventional studies in the system under study. With the advent of big data and the use of data-driven methods, causal and equation discovery fields have grown and made progress in computer science, physics, statistics, philosophy, and many applied fields. All these domains are intertwined and can be used to discover causal relations, physical laws, and equations from observational data. This paper reviews the concepts, methods, and relevant works on causal and equation discovery in the broad field of Physics and outlines the most important challenges and promising future lines of research. We also provide a taxonomy for observational causal and equation discovery, point out connections, and showcase a complete set of case studies in Earth and climate sciences, fluid dynamics and mechanics, and the neurosciences. This review demonstrates that discovering fundamental laws and causal relations by observing natural phenomena is being revolutionised with the efficient exploitation of observational data, modern machine learning algorithms and the interaction with domain knowledge. Exciting times are ahead with many challenges and opportunities to improve our understanding of complex systems.Comment: 137 page
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