Spanning Trees and bootstrap reliability estimation in correlation based networks

We introduce a new technique to associate a spanning tree to the average linkage cluster analysis. We term this tree as the Average Linkage Minimum Spanning Tree. We also introduce a technique to associate a value of reliability to links of correlation based graphs by using bootstrap replicas of data. Both techniques are applied to the portfolio of the 300 most capitalized stocks traded at New York Stock Exchange during the time period 2001-2003. We show that the Average Linkage Minimum Spanning Tree recognizes economic sectors and sub-sectors as communities in the network slightly better than the Minimum Spanning Tree does. We also show that the average reliability of links in the Minimum Spanning Tree is slightly greater than the average reliability of links in the Average Linkage Minimum Spanning Tree.Comment: 17 pages, 3 figure

A lean way of design and production for healthcare construction projects

As a consequence of the lack of solid conceptual foundation, the project management concepts and techniques usually applied within the construction sector are fragmented and have proved to be incapable of solving the complex problems of design management. As a result, healthcare providers have become frustrated with the outcomes such as cost and schedule overruns, accidents, less than expected quality and inadequate functionality. However, an investigation of successful healthcare projects reveals that new approaches have been developed to tackle such problems. This study uses recent data based on six construction projects. The idea is demonstrate how successful projects are dealing with the integration between design, production, and operations, through an appropriate approach to the management of production systems. The paper aims to assist the different parties of the AEC industry to better understand how practices applied into design phase could support the efficiency in the management of production systems

The development and testing of a contextual model for healthcare quality improvement using Lean and the Model for Understanding Success in Quality (MUSIQ) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Quality Systems at Massey University, Palmerston North, New Zealand

This study developed a new theoretical model of quality improvement (QI) contextual factors, for QI activity undertaken at the healthcare microsystem level. The Model for Understanding Success in Quality (MUSIQ) (Kaplan, Provost, Froehle, & Margolis, 2012), was aligned with Lean improvement activity using the Toyota Way framework. The aim of the research was to improve the effectiveness of healthcare quality improvement initiatives by providing more understanding of the associations, relative importance and precise functioning of critical contextual factors. A new survey instrument, based on the literature, was developed to collect data and the hypothesised theoretical relationships were tested using the partial least squares path modelling (PLSPM) technique. QI practitioners at a large New Zealand District Health Board were surveyed on a range of contextual factors hypothesised to influence improvement outcomes. All survey participants had recently completed a small-scale improvement project using Lean, or were participants in training programmes that introduced them to Lean thinking and methods. Some participants worked autonomously on improvements of their own selection; others were part of a wider training programme derived from the National Health Service’s (UK) ‘productive ward’ programme. In the healthcare organisational context, the majority of these improvement initiatives were carried out at the microsystem level – initiated and delivered by the teams responsible for the work processes being modified. Survey responses were first analysed via principal components analysis (to examine the dimensionality of the scales) and then PLSPM. The defined contextual factors for ‘Teamwork’, ‘Respect for People’, ‘Lean Actions’ and the influence of negatively motivating factors all reached significance. Defined contextual factors for ‘Previous Experience’ and the influence of positive motivating factors did not reach significance at 5% level. The final model showed a statistically significant, moderate predictive strength, with an overall adjusted R2 of 0.58. This result was an encouraging validation of the microsystem-level layer of the MUSIQ model using Lean as the QI method (context). The relative influence of ‘Teamwork’, ‘Respect for People’, ‘Motivation’, and a mediating mechanism for making process changes (in this instance, Lean) were measured and found to be consistent with the MUSIQ model. Identifying more detailed causal mechanisms (the present model was intentionally parsimonious due to the time frame allowed and the resources available for the research), refining the operational definitions, and developing and testing predictive models for the defined contextual factors are the proposed next steps in the research

Evaluation of a digital consultation and self-care advice tool in primary care: a multi-methods study

Digital services are often regarded as a solution to the growing demands on primary care services. Provision of a tool offering advice to support self-management as well as the ability to digitally consult with a General Practitioner (GP) has the potential to alleviate some of the pressure on primary care. This paper reports on a Phase II, 6-month evaluation of eConsult, a web-based triage and consultation system that was piloted across 11 GP practices across Scotland. Through a multi-method approach the evaluation explored eConsult use across practices, exposing both barriers and facilitators to its adoption. Findings suggest that expectations that eConsult would offer an additional and alternative method of accessing GP services were largely met. However, there is less certainty that it has fulfilled expectations of promoting self-help. In addition, low uptake meant that evaluation of current effectiveness was difficult for practices to quantify. The presence of an eConsult champion(s) within the practice was seen to be a significant factor in ensuring successful integration of the tool. A lack of patient and staff engagement, insufficient support and lack of protocols around processes were seen as barriers to its success

A lean way of design and production for healthcare construction projects

As a consequence of the lack of solid conceptual foundation, the project management concepts and techniques usually applied within the construction sector are fragmented and have proved to be incapable of solving the complex problems of design management. As a result, healthcare providers have become frustrated with the outcomes such as cost and schedule overruns, accidents, less than expected quality and inadequate functionality. However, an investigation of successful healthcare projects reveals that new approaches have been developed to tackle such problems. This study uses recent data based on six construction projects. The idea is demonstrate how successful projects are dealing with the integration between design, production, and operations, through an appropriate approach to the management of production systems. The paper aims to assist the different parties of the AEC industry to better understand how practices applied into design phase could support the efficiency in the management of production systems

How competent are healthcare professionals in working according to a bio-psycho-social model in healthcare? : the current status and validation of a scale

Background : Over the past decades, there has been a paradigm shift from a purely biomedical towards a bio-psycho-social (BPS) conception of disability and illness, which has led to a change in contemporary healthcare. However, there seems to be a gap between the rhetoric and reality of working within a BPS model. It is not clear whether healthcare professionals show the necessary skills and competencies to act according to the BPS model. Objective : The aim of this study was (1) to develop a scale to monitor the BPS competencies of healthcare professionals, (2) to define its factor-structure, (3) to check internal consistency, (4) test-retest reliability and (5) feasibility. Design and Setting : Item derivation for the BPS scale was based on qualitative research with seven multidisciplinary focus groups (n = 58) of both patients and professionals. In a cross-sectional study design, 368 healthcare professionals completed the BPS scale through a digital platform. An exploratory factor analysis was performed to determine underlying dimensions. Statistical coherence was expressed in item-total correlations and in Cronbach's alpha coefficient. An intra-class-correlation coefficient was used to rate the test-retest reliability. Results : The qualitative study revealed 45 items. The exploratory factor analysis showed five underlying dimensions labelled as: (1) networking, (2) using the expertise of the client, (3) assessment and reporting, (4) professional knowledge and skills and (5) using the environment. The results show a good to strong homogeneity (item-total ranged from 0.59 to 0.79) and a strong internal consistency (Cronbach's alpha ranged from 0.75 to 0.82). ICC ranged between 0.82 and 0.93. Conclusion : The BPS scale appeared to be a valid and reliable measure to rate the BPS competencies of the healthcare professionals and offers opportunities for an improvement in the healthcare delivery. Further research is necessary to test the construct validity and to detect whether the scale is responsive and able to detect changes over time

Measures of Health-Related Quality of Life Outcomes in Pediatric Neurosurgery: Literature Review

Background Improving value in healthcare means optimizing outcomes and minimizing costs. The emerging pay-for-performance era requires understanding of the effect of healthcare services on health-related quality of life (HRQoL). Pediatric and surgical subspecialties have yet to fully integrate HRQoL measures into practice. The present study reviewed and characterized the HRQoL outcome measures across various pediatric neurosurgical diagnoses. Methods A literature review was performed by searching PubMed and Google Scholar with search terms such as “health-related quality of life” and “pediatric neurosurgery” and then including the specific pathologies for which a HRQoL instrument was found (e.g., “health-related quality of life” plus “epilepsy”). Each measurement was evaluated by content and purpose, relative strengths and weaknesses, and validity. Results We reviewed 68 reports. Epilepsy, brain tumor, cerebral palsy, spina bifida, hydrocephalus, and scoliosis were diagnoses found in reported studies that had used disease-specific HRQoL instruments. Information using general HRQoL instruments was also reported. Internal, test–retest, and/or interrater reliability varied across the instruments, as did face, content, concurrent, and/or construct validity. Few instruments were tested enough for robust reliability and validity. Significant variability was found in the usage of these instruments in clinical studies within pediatric neurosurgery. Conclusions The HRQoL instruments used in pediatric neurosurgery are currently without standardized guidelines and thus exhibit high variability in use. Clinicians should support the development and application of these methods to optimize these instruments, promote standardization of research, improve performance measures to reflect clinically modifiable and meaningful outcomes, and, ultimately, lead the national discussion in healthcare quality and patient-centered care

Health Figures: An Open Source JavaScript Library for Health Data Visualization

The way we look at data has a great impact on how we can understand it, particularly when the data is related to health and wellness. Due to the increased use of self-tracking devices and the ongoing shift towards preventive medicine, better understanding of our health data is an important part of improving the general welfare of the citizens. Electronic Health Records, self-tracking devices and mobile applications provide a rich variety of data but it often becomes difficult to understand. We implemented the hFigures library inspired on the hGraph visualization with additional improvements. The purpose of the library is to provide a visual representation of the evolution of health measurements in a complete and useful manner. We researched the usefulness and usability of the library by building an application for health data visualization in a health coaching program. We performed a user evaluation with Heuristic Evaluation, Controlled User Testing and Usability Questionnaires. In the Heuristics Evaluation the average response was 6.3 out of 7 points and the Cognitive Walkthrough done by usability experts indicated no design or mismatch errors. In the CSUQ usability test the system obtained an average score of 6.13 out of 7, and in the ASQ usability test the overall satisfaction score was 6.64 out of 7. We developed hFigures, an open source library for visualizing a complete, accurate and normalized graphical representation of health data. The idea is based on the concept of the hGraph but it provides additional key features, including a comparison of multiple health measurements over time. We conducted a usability evaluation of the library as a key component of an application for health and wellness monitoring. The results indicate that the data visualization library was helpful in assisting users in understanding health data and its evolution over time.Comment: BMC Medical Informatics and Decision Making 16.1 (2016