NorthStar, a support tool for the design and evaluation of quality improvement interventions in healthcare

Background: The Research-Based Education and Quality Improvement (ReBEQI) European partnership aims to establish a framework and provide practical tools for the selection, implementation, and evaluation of quality improvement (QI) interventions. We describe the development and preliminary evaluation of the software tool NorthStar, a major product of the ReBEQI project. Methods: We focused the content of NorthStar on the design and evaluation of QI interventions. A lead individual from the ReBEQI group drafted each section, and at least two other group members reviewed it. The content is based on published literature, as well as material developed by the ReBEQI group. We developed the software in both a Microsoft Windows HTML help system version and a web-based version. In a preliminary evaluation, we surveyed 33 potential users about the acceptability and perceived utility of NorthStar. Results: NorthStar consists of 18 sections covering the design and evaluation of QI interventions. The major focus of the intervention design sections is on how to identify determinants of practice (factors affecting practice patterns), while the major focus of the intervention evaluation sections is on how to design a cluster randomised trial. The two versions of the software can be transferred by email or CD, and are available for download from the internet. The software offers easy navigation and various functions to access the content. Potential users (55% response rate) reported above-moderate levels of confidence in carrying out QI research related tasks if using NorthStar, particularly when developing a protocol for a cluster randomised trial Conclusion: NorthStar is an integrated, accessible, practical, and acceptable tool to assist developers and evaluators of QI interventions

Applicability of Three Alternative Instruments for Food Authenticity Analysis: GMO Identification

Ensuring foods are correctly labelled for ingredients derived from genetically modified organisms (GMOs) is an issue facing manufacturers, retailers, and enforcement agencies. DNA approaches for the determination of food authenticitys often use the polymerase chain reaction (PCR), and PCR products can be detected using capillary or gel electrophoresis. This study examines the fitness for purpose of the application of three laboratory electrophoresis instruments (Agilent Bioanalyzer 2100, Lab901 TapeStation, and Shimadzu MCE-202 MultiNA) for the detection of GMOs using PCR based on a previously validated protocol. Whilst minor differences in the performance characteristics of bias and precision were observed, all three instruments demonstrated their applicability in using this protocol for screening of GMO ingredients

Home Literacy Environment and Phonological Awareness in Preschool Children: Differential Effects for Rhyme and Phoneme Awareness

The literature to date suggests that the best predictor of early reading ability, phonological awareness, appears to be associated with the acquisition of letter-sound and vocabulary knowledge and with the development of well-defined phonological representations. It further suggests that at least some aspects of phonological awareness critically depend upon literacy exposure. In this study of 4- to 6-year-olds, we examine whether aspects of the home literacy environment are differentially associated with phonological awareness. Parental responses to a questionnaire about the home literacy environment are compared to children\u27s awareness of rhyme and phonemes, as well as to their vocabulary, letter knowledge, and performance on measures of phonological strength (nonword repetition, rapid naming skill, phonological distinctness, and auditory discrimination). The results showed that a teaching focus in the home literacy environment and exposure to reading-related media are directly associated with phoneme awareness and indirectly associated via letter knowledge and vocabulary. Exposure to reading-related media and parents\u27 active involvement in children\u27s literature were also directly and indirectly linked with rhyme awareness skills via their association with letter and vocabulary knowledge

Effects of Onset Density in Preschool Children: Implications for Development of Phonological Awareness and Phonological Representation

Neighborhood density influences adult performance on several worked processing tasks. Some studies show age-related effects of density on children\u27s performance, reflecting a developmental restructuring of the mental lexicon from holistic into segmental representations that may play a role in phonological awareness. To further investigate density effects and their implications for development of phonological awareness, we compared performance on dense and sparse onset words. We adapted these materials to three phonological awareness tests that were pretested on adults then administered to preschool children who were expected to vary in phonological awareness skills. For both the adults and the children who passed a phonological awareness screening task, dense onset neighborhoods were associated with slower reaction times and increased errors. A separate comparison of word repetition by the children who passed and who did not pass the phoneme awareness screening failed to provide evidence that lexical restructuring was a sufficient condition for the attainment of phonological awareness. Both groups of children more accurately repeated words from high onset density neighborhoods, regardless of the level of their phonological awareness. Thus, we find no evidence of either age or ability driven effects in children\u27s performance, contradictory to a view that the attainment of phoneme awareness relates to developmental changes in the segmental representation of words in dense neighborhoods

‘Our voice started off as a whisper and now it is a great big roar’ : The Salford Dementia Associate Panel as a model of involvement in research activities

This paper presents the work of the ‘Salford Dementia Associate Panel’, based at the Salford Institute for Dementia, Salford University (UK). We discuss the roles of the Dementia Associates, in particular around the areas of engagement and research. The panel is made up of people living with dementia, and current and former care partners. It highlights the development of this group over a four-year period and demonstrates over time how the role of a Dementia Associate member has evolved. The panel is involved in research, education and public engagement activities conducted by staff and students within the Institute. The motivations for becoming involved are clearly articulated and demonstrate how the personal backgrounds of individuals have driven the collective involvement and desire to bring about change. The benefits and challenges associated with working as part of a panel are discussed. We conclude by bringing together our experiences as a set of suggestions for others who may wish to create a similar forum to promote the involvement of people living with dementia and former and current care partners

Optimizing Medical Kits for Spaceflight

The Integrated Medical Model (IMM) is a probabilistic model that estimates medical event occurrences and mission outcomes for different mission profiles. IMM simulation outcomes describing the impact of medical events on the mission may be used to optimize the allocation of resources in medical kits. Efficient allocation of medical resources, subject to certain mass and volume constraints, is crucial to ensuring the best outcomes of in-flight medical events. We implement a new approach to this medical kit optimization problem. METHODS We frame medical kit optimization as a modified knapsack problem and implement an algorithm utilizing a dynamic programming technique. Using this algorithm, optimized medical kits were generated for 3 different mission scenarios with the goal of minimizing the probability of evacuation and maximizing the Crew Health Index (CHI) for each mission subject to mass and volume constraints. Simulation outcomes using these kits were also compared to outcomes using kits optimized..RESULTS The optimized medical kits generated by the algorithm described here resulted in predicted mission outcomes more closely approached the unlimited-resource scenario for Crew Health Index (CHI) than the implementation in under all optimization priorities. Furthermore, the approach described here improves upon in reducing evacuation when the optimization priority is minimizing the probability of evacuation. CONCLUSIONS This algorithm provides an efficient, effective means to objectively allocate medical resources for spaceflight missions using the Integrated Medical Model

The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Wavefront sensing with a brightest pixel selection algorithm

Astronomical adaptive optics systems with open-loop deformable mirror control have recently come on-line. In these systems, the deformable mirror surface is not included in the wavefront sensor paths, and so changes made to the deformable mirror are not fed back to the wavefront sensors. This gives rise to all sorts of linearity and control issues mainly centred on one question: Has the mirror taken the shape requested? Non-linearities in wavefront measurement and in the deformable mirror shape can lead to significant deviations in mirror shape from the requested shape. Here, wavefront sensor measurements made using a brightest pixel selection method are discussed along with the implications that this has for open-loop AO systems. Discussion includes elongated laser guide star spots and also computational efficiency.Comment: 10 pages, 12 figures, accepted by MNRA