Protocol for a mixed-methods exploratory investigation of care following intensive care discharge: the REFLECT study

© Author(s) 2019. Re-use permitted under CC BY. Published by BMJ.INTRODUCTION: A substantial number of patients discharged from intensive care units (ICUs) subsequently die without leaving hospital. It is unclear how many of these deaths are preventable. Ward-based management following discharge from ICU is an area that patients and healthcare staff are concerned about. The primary aim of REFLECT (Recovery Following Intensive Care Treatment) is to develop an intervention plan to reduce in-hospital mortality rates in patients who have been discharged from ICU. METHODS AND ANALYSIS: REFLECT is a multicentre mixed-methods exploratory study examining ward care delivery to adult patients discharged from ICU. The study will be made up of four substudies. Medical notes of patients who were discharged from ICU and subsequently died will be examined using a retrospective case records review (RCRR) technique. Patients and their relatives will be interviewed about their post-ICU care, including relatives of patients who died in hospital following ICU discharge. Staff involved in the care of patients post-ICU discharge will be interviewed about the care of this patient group. The medical records of patients who survived their post-ICU stay will also be reviewed using the RCRR technique. The analyses of the substudies will be both descriptive and use a modified grounded theory approach to identify emerging themes. The evidence generated in these four substudies will form the basis of the intervention development, which will take place through stakeholder and clinical expert meetings. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Wales Research and Ethics Committee 4 (17/WA/0107). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER: ISRCTN14658054.Peer reviewedFinal Published versio

Linked health data for pharmacovigilance in children : Perceived legal and ethical issues for stakeholders and data guardians

Peer reviewedPublisher PD

Multimedia delivery in the future internet

The term “Networked Media” implies that all kinds of media including text, image, 3D graphics, audio and video are produced, distributed, shared, managed and consumed on-line through various networks, like the Internet, Fiber, WiFi, WiMAX, GPRS, 3G and so on, in a convergent manner [1]. This white paper is the contribution of the Media Delivery Platform (MDP) cluster and aims to cover the Networked challenges of the Networked Media in the transition to the Future of the Internet. Internet has evolved and changed the way we work and live. End users of the Internet have been confronted with a bewildering range of media, services and applications and of technological innovations concerning media formats, wireless networks, terminal types and capabilities. And there is little evidence that the pace of this innovation is slowing. Today, over one billion of users access the Internet on regular basis, more than 100 million users have downloaded at least one (multi)media file and over 47 millions of them do so regularly, searching in more than 160 Exabytes1 of content. In the near future these numbers are expected to exponentially rise. It is expected that the Internet content will be increased by at least a factor of 6, rising to more than 990 Exabytes before 2012, fuelled mainly by the users themselves. Moreover, it is envisaged that in a near- to mid-term future, the Internet will provide the means to share and distribute (new) multimedia content and services with superior quality and striking flexibility, in a trusted and personalized way, improving citizens’ quality of life, working conditions, edutainment and safety. In this evolving environment, new transport protocols, new multimedia encoding schemes, cross-layer inthe network adaptation, machine-to-machine communication (including RFIDs), rich 3D content as well as community networks and the use of peer-to-peer (P2P) overlays are expected to generate new models of interaction and cooperation, and be able to support enhanced perceived quality-of-experience (PQoE) and innovative applications “on the move”, like virtual collaboration environments, personalised services/ media, virtual sport groups, on-line gaming, edutainment. In this context, the interaction with content combined with interactive/multimedia search capabilities across distributed repositories, opportunistic P2P networks and the dynamic adaptation to the characteristics of diverse mobile terminals are expected to contribute towards such a vision. Based on work that has taken place in a number of EC co-funded projects, in Framework Program 6 (FP6) and Framework Program 7 (FP7), a group of experts and technology visionaries have voluntarily contributed in this white paper aiming to describe the status, the state-of-the art, the challenges and the way ahead in the area of Content Aware media delivery platforms

Exploring spatiotemporal dynamics of urban fires: A case of Nanjing, China

Urban fire occurs within the built environment, usually involving casualties and economic losses, and affects individuals and socioeconomic activities in the surrounding neighborhoods. A good understanding of the spatiotemporal dynamics of fire incidents can offer insights into potential determinants of various fire events, therefore enabling better fire risk estimation which can assist with future allocation of prevention resources and strategic planning of mitigation programs. Using a twelve-year (2002–2013) dataset containing the urban fire events in Nanjing, China, this research explores the spatiotemporal dynamics of urban fires using a range of exploratory spatial data analysis (ESDA) approaches. Of particular interest here are the fire incidents involving residential properties and local facilities due to their relatively higher occurrence frequencies. The results indicate that the overall amount of urban fires has greatly increased in the last decade and the spatiotemporal distribution of fire events varies among different incident types. The identified spatiotemporal patterns of urban fires in Nanjing can be linked to the urban development strategies and how they have been reflected in reality in recent years

Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations

BACKGROUND: A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Our objectives were to describe the rationale for having multiple EP systems within a single hospital, and to explore perceptions of stakeholders about the advantages and disadvantages of multiple systems including any impact on patient safety. METHODS: Hospitals were selected from previous census respondents. A decision matrix was developed to achieve a maximum variation sample, and snowball sampling used to recruit stakeholders of different professional backgrounds. We then used an a priori framework to guide and analyse semi-structured interviews. RESULTS: Ten participants, comprising pharmacists and doctors and a nurse, were interviewed from four hospitals. The findings suggest that use of multiple EP systems was not strategically planned. Three co-existing models of EP systems adoption in hospitals were identified: organisation-led, clinician-led and clinical network-led, which may have contributed to multiple systems use. Although there were some perceived benefits of multiple EP systems, particularly in niche specialities, many disadvantages were described. These included issues related to access, staff training, workflow, work duplication, and system interfacing. Fragmentation of documentation of the patient's journey was a major safety concern. DISCUSSION: The complexity of EP systems' adoption and deficiencies in IT strategic planning may have contributed to multiple EP systems use in the NHS. In the near to mid-term, multiple EP systems may remain in place in many English hospitals, which may create challenges to quality and patient safety.Peer reviewe

Sustained data access and tools as key ingredients to strengthening EO capacities : examples from land application perspective + powerpoint

Sustainably managing agriculture and forests is key for development, in particular in Africa, and for facing global challenges such as climate change or food security, but requires reliable information. As Earth Observation (EO) satellite data can contribute to these information needs, more and more institutes integrate this technology into their daily work. Facing ever-growing and evolving EO data sources (e.g. new satellites and sensors) and access technology (both online and via EUMETCast satellite broadcast), their applications require software tools to particularly facilitate (i) the exchange of data between the analysis tools, so users can take advantage of each tool’s strengths, and (ii) the processing and analysis of time series. A first example is the Land Surface Analysis Satellite Application Facility (LSA-SAF), that entered the second part of the Continuous Development and Operations Phase (CDOP-2), under the lead of the Portuguese Institute for Sea and Atmosphere (IPMA), in 2011. VITO, joining the LSA-SAF network for the first time and building on previous experiences (e.g. http://www.metops10.vito.be), aims to contribute by producing and delivering operational, 10-daily vegetation indicators based on MetOp-AVHRR. Furthermore, a software tool is developed to aid exploitation of LSA-SAF products, provisionally called “MSG Toolbox”. A second example is the AGRICAB project, that receives funding from the European Union’s 7th Framework Programme for Research (FP7) and aims to build a comprehensive framework for strengthening capacities in the use of EO for agriculture and forestry management in Africa. This framework starts from sustained access to relevant satellite data (e.g. CBERS-3, DEIMOS) and derived products, such as those from the European Copernicus Global Land service, the 15 year time series of SPOT-VEGETATION (and its transition to PROBA-V) and Meteosat Second Generation (e.g. rainfall estimates). It combines local and EO data with tools and training into applications on crop monitoring, area statistics and yield forecasting, livestock insurance and modelling, forest and fire management, all fitted to the needs of stakeholders in the African focus countries

Prevention of occupational diseases in Turkey : deriving lessons from journey of surveillance

Introduction: To prevent and manage the societal and economic burden of occupational diseases (ODs), countries should develop strong prevention policies, health surveillance and registry systems. This study aims to contribute to the improvement of OD surveillance at national level as well as to identify priority actions in Turkey. Methods: The history and current status of occupational health studies were considered from the perspective of OD surveillance. Interpretative research was done through literature review on occupational health at national, regional and international level. Analyses were focused on countries' experiences in policy development and practice, roles and responsibilities of institutions, multidisciplinary and intersectoral collaboration. OD surveillance models of Turkey, Belgium and the Netherlands were examined through exchange visits. Face-to-face interviews were conducted to explore the peculiarities of legislative and institutional structures, the best and worst practices, and approach principles. Results: Some countries are more focused on exploring OD trends through effective and cost-efficient researches, with particular attention to new and emerging ODs. Other countries try to reach every single case of OD for compensation and rehabilitation. Each practice has advantages and shortcomings, but they are not mutually exclusive, and thus an effective combination is possible. Conclusion: Effective surveillance and registry approaches play a key role in the prevention of ODs. A well-designed system enables monitoring and assessment of OD prevalence and trends, and adoption of preventive measures while improving the effectiveness of redressing and compensation. A robust surveillance does not only provide protection of workers' health but also advances prevention of economic losses

Training Competences in Industrial Risk Prevention with Lego® Serious Play®: A Case Study

This paper proposes the use of the Lego® Serious Play® (LSP) methodology as a facilitating tool for the introduction of competences for Industrial Risk Prevention by engineering students from the industrial branch (electrical, electronic, mechanical and technological engineering), presenting the results obtained in the Universities of Cadiz and Seville in the academic years 2017–2019. Current Spanish legislation does not reserve any special legal attribution, nor does it require specific competence in occupational risk prevention for the regulated profession of a technical industrial engineer (Order CIN 351:2009), and only does so in a generic way for that of an industrial engineer (Order CIN 311:2009). However, these universities consider the training in occupational health and safety for these future graduates as an essential objective in order to develop them for their careers in the industry. The approach is based on a series of challenges proposed (risk assessments, safety inspections, accident investigations and fire protection measures, among others), thanks to the use of “gamification” dynamics with Lego® Serious Play®. In order to carry the training out, a set of specific variables (industrial sector, legal and regulatory framework, business organization and production system), and transversal ones (leadership, teamwork, critical thinking and communication), are incorporated. Through group models, it is possible to identify dangerous situations, establish causes, share and discuss alternative proposals and analyze the economic, environmental and organizational impact of the technical solutions studied, as well as take the appropriate decisions, in a creative, stimulating, inclusive and innovative context. In this way, the theoretical knowledge which is acquired is applied to improve safety and health at work and foster the prevention of occupational risks, promoting the commitment, effort, motivation and proactive participation of the student teams.Spanish Ministry of Science, Innovation and Universities / European Social Fund: Ramón y Cajal contract (RYC-2017-22222

An Action Research for Improving the Sustainability Assessment Framework Instruments

[Abstract] In the last years, software engineering researchers have defined sustainability as a quality requirement of software, but not enough effort has been devoted to develop new methods/techniques to support the analysis and assessment of software sustainability. In this study, we present the Sustainability Assessment Framework (SAF) that consists of two instruments: the software sustainability–quality model, and the architectural decision map. Then, we use participatory and technical action research in close collaboration with the software industry to validate the SAF regarding its applicability in specific cases. The unit of analysis of our study is a family of software products (Geographic Information System- and Mobile-based Workforce Management Systems) that aim to address sustainability goals (e.g., efficient collection of dead animals to mitigate social and environmental sustainability risks). The results show that the sustainability–quality model integrated with the architectural decision maps can be used to identify sustainability–quality requirements as design concerns because most of its quality attributes (QAs) have been either addressed in the software project or acknowledged as relevant (i.e., creating awareness on the relevance of the multidimensional sustainability nature of certain QAs). Moreover, the action–research method has been helpful to enrich the sustainability–quality model, by identifying missing QAs (e.g., regulation compliance, data privacy). Finally, the architectural decision maps have been found as useful to guide software architects/designers in their decision-making process.This work has received partial support by Xunta de Galicia/FEDER-UE CSI (ED431G/01, ED431C 2017/58); Xunta de Galicia/FEDER-UE, ConectaPeme, GEMA (IN852A 2018/14); MINECO-AEI/FEDER-UE with the projects: Datos 4.0 (TIN2016-78011-C4-1-R), BIZDEVOPS (RTI2018-098309-B-C32), FLATCITY (TIN2016-77158-C4-3-R.); and FONDECYT with the Kusisqa project (014-2019-FONDECYTBM-INC.INV)Xunta de Galicia; ED431G/01Xunta de Galicia; ED431C 2017/58Xunta de Galicia; IN852A 2018/14Gobierno de Chile; 014-2019-FONDECYTBM-INC.IN