Evaluating Evaluations of Clinical Decision Support Systems: Case Studies From NHS Clinical Settings

The NHS is under increasing pressure to cut costs while delivering high quality care. At the same time, the demand for healthcare services has grown, driven in part by the increasing number of older people in the population. NHS Trusts are adopting clinical decision support systems (CDSSs) to help decision making at the point of care. CDSSs are said to bring benefits such as improvements in guideline adherence, clinical processes and user performance but evidence of these benefits is not always available and their effectiveness in terms of improving patient outcomes is often open to question. This thesis presents research that was carried out in a large teaching NHS Trust looking at the evaluations of three CDSSs. Semi structured interviews were carried out with key informants who were involved in their adoption, use and evaluations. Documentary analysis and observations were also used to augment the interviews. Most evaluations were carried out informally by the developers and were primarily driven by external regulatory pressures rather than patient outcomes and organisational needs. Evaluation documentation was inadequate or missing, thus making it difficult to systematically assess these evaluations. This thesis contends that evaluations are important to provide decision makers in NHS Trusts with adequate information to make decisions about CDSSs and computerised healthcare information technologies in general. NHS Trusts need to build organisational capacity and readiness to enable them to effectively carry out evaluations that will provide meaningful information to gain better understanding of CDSSs and to inform their successful adoption, implementation, usage and to justify the resource allocation. This research shows that CDSS evaluations investigated took a predominantly narrow view. It thus provides evidence for the need for a more systemic approach to evaluation

Long-baseline neutrino oscillation physics potential of the DUNE experiment: DUNE Collaboration

The sensitivity of the Deep Underground Neutrino Experiment (DUNE) to neutrino oscillation is determined, based on a full simulation, reconstruction, and event selection of the far detector and a full simulation and parameterized analysis of the near detector. Detailed uncertainties due to the flux prediction, neutrino interaction model, and detector effects are included. DUNE will resolve the neutrino mass ordering to a precision of 5σ, for all δCP values, after 2 years of running with the nominal detector design and beam configuration. It has the potential to observe charge-parity violation in the neutrino sector to a precision of 3σ (5σ) after an exposure of 5 (10) years, for 50% of all δCP values. It will also make precise measurements of other parameters governing long-baseline neutrino oscillation, and after an exposure of 15 years will achieve a similar sensitivity to sin22θ13 to current reactor experiments

Mental Health Care Practitioners’ Construing about non-White people: Implications for Cultural Competence and the Therapeutic Alliance

Australia is a country known for its multicultural population. The country has a broad range of visa schemes and a rapidly increasing overall intake of migrants. Australia thus provides a particularly rich case study of a migrant-receiving country undergoing rapid transformation. This diversity results in the need for mental health care systems and practitioners to adapt to a range of health and wellbeing needs of individuals and groups across cultural, linguistic, and ethnic backgrounds. This goal is challenged by the prevailing and overarching sociopolitical and ethnocultural construct of Whiteness, which is present in Australia, other Western nations and much of the world. To both acknowledge and understand this construct, and its consequences, within the context of mental health and wellbeing, this thesis examined the ways in which mental health practitioners in Australia construe non-White people. The research also sought to ascertain the links between practitioners’ construals of Whiteness and their cultural competence as well as their therapeutic alliance with non-White clients. This research is important as it helps to expose the modes by which Whiteness may influence construing and may provide more clarity on how Whiteness, its invisibility and processes work in the context of mental health care

Making sense of sex with people with Cerebral Palsy

Constructions of sexuality and disability have been discussed widely by scholars across a number of fields. However, there has been relatively little research on how people with Cerebral Palsy construct their own sexuality and the salience of the socio-sexual schema which are involved in this process. As such this study aimed to address three questions; 1) the relative salience of public, interactional and private sexual schema in the construction of sexuality for people with Cerebral Palsy, 2) how people with Cerebral Palsy construct sexual participation, and particularly sexual spontaneity and, 3) how people with Cerebral Palsy describe their sexuality. This project utilized a hermeneutic phenomenological approach to explore these questions. In doing so, this study helps fill the gap between how sexuality and disability is constructed external to the individual and how the individual constructs their own sexuality. For this research, seven in-depth, semi-structured interviews were conducted with five men and two women with moderate to severe Cerebral Palsy. Participant data indicated that how people with Cerebral Palsy perceive sexual experiences with others (interactional) is the most influential factor in the construction of their sexuality. Public influences were cumulatively the second most important factor in the construction of sexuality by people with Cerebral Palsy. Finally, private influences were cumulatively the least influential factor in the construction of their sexuality. Sexual spontaneity primarily was a derivative of sexual exploration. Furthermore, participants defined sexual spontaneity as liberating and allowed them to experience their sexuality with others relatively independent of normative sexual scripts. Participants also described their sexuality primarily in terms of major transitions and experiences which involved others. Based on the findings sexual theory needs to be more cognizant of sexual agency as primary in the construction of sexuality with significant disability. In addition, healthcare providers and people with Cerebral Palsy are likely to be successful partners in sexual health when they promote positive and agentic constructions of sexuality with significant disability. The findings emphasize that people with Cerebral Palsy are cognizant and intelligent agents in the construction of their sexuality. Their articulations, understandings and descriptions of their sexuality demonstrate their interest and awareness in their sexuality and issues related to it. People with Cerebral Palsy are sexual agents and beings who empower themselves

Analogical Problem Solving: The Differential Impact of Type of Training, Amount of Practice, and Type of Analogy On Spontaneous Transfer

Research on analogical problem solving has delineated several factors that impact one\u27s ability to spontaneously generate a correct solution strategy to a target problem. These factors include, but are not limited to, type of analogy provided to subjects (i.e., partial versus complete), the level of analogical problem-solving expertise, and the absence of or type of analogical problem-solving training (i.e., teacher-generated or learner-generated) provided to learners. Recently, researchers have begun to focus on providing solvers with multiple practice opportunities and extending these opportunities over a systematically distributed period of time. When combined with analogical problem-solving training, these factors will augment the learner\u27s ability to spontaneously generate a correct solution strategy to both complete and partial target problems. Using an experimental design, the present study examined the differential effects of type of analogue (partial versus complete), type of training (teacher-generated, learner-generated, or no training), and length of training (condensed versus extended) on novice learners\u27 ability to spontaneously generate correct solution strategies to two target problems. Findings indicate that, on the complete target problem, regardless of training group membership, no effect over control group participants was found. Partial target problem results indicate a slight advantage for participating in the learner-generated extended training group over no training. Also on the partial target problem, a moderate advantage was found for participating in the learner-generated extended training group over the condensed training. Limitations of the study, implications for educators, and recommendations for future studies are provided

An evaluation of how the conceptualisation of waste influences separation at source behaviours and waste practices: a case study of Elizabeth Fry Village, Vorna Valley, Midrand South Africa

A research report submitted to the School of Geography, Archaeology and Environmental Studies in Partial Fulfillment for the Master‘s Degree in Science University of the Witwatersrand. Johannesburg, 5 June 2017.With consumer culture that encourages societies to buy more, waste production increases as well. A lack of site specific data regarding waste conceptualisations and practices inhibits sustainable waste initiatives such as separation at source programmes from being successful and results in poor participation levels. This research report investigates these issues through a case study of Elizabeth Fry Village (EFV) in Vorna Valley, Midrand, particularly focusing on a Separation at Source programme in Elizabeth Fry Village. This research was conducted over a 6 month period between September 2016 and March 2017. There are two approaches within the broad debate around waste that this research engages with. The first is the approach presented by Moore (2012), Gutberlet (2013), Oteng-Ababio (2014) and Parizeau (2015) who argue that the different ways that people understand and conceptualise waste influences their waste practices, including participation in recycling programmes. The second approach focuses on the practical factors that affect participation in recycling programmes (Tonglet et al., 2004 and Martin et al., 2006). Based on mixed methods including participant observation, interviews, desktop studies and a waste composition study conducted in Elizabeth Fry Village, this research report argues that it is necessary to combine both approaches to develop a comprehensive understanding of people‘s participation or lack thereof in recycling programmes such as separation at source (S@S). It is recommended that future research explores mechanisms for the better use of putrescible waste and that aspects such as convenience, time, space, knowledge and awareness are further investigated to increase participation rates in the area. Another major aspect identified for future research is exploring how to shift people‘s conceptualision of waste to recognise it as a positive material. Keywords: Recycling, waste, separation at source (S@S), conceptualisation, participation, Elizabeth Fry Village (EFV), MidrandLG201

Making sense of sex with people with Cerebral Palsy

Constructions of sexuality and disability have been discussed widely by scholars across a number of fields. However, there has been relatively little research on how people with Cerebral Palsy construct their own sexuality and the salience of the socio-sexual schema which are involved in this process. As such this study aimed to address three questions; 1) the relative salience of public, interactional and private sexual schema in the construction of sexuality for people with Cerebral Palsy, 2) how people with Cerebral Palsy construct sexual participation, and particularly sexual spontaneity and, 3) how people with Cerebral Palsy describe their sexuality. This project utilized a hermeneutic phenomenological approach to explore these questions. In doing so, this study helps fill the gap between how sexuality and disability is constructed external to the individual and how the individual constructs their own sexuality. For this research, seven in-depth, semi-structured interviews were conducted with five men and two women with moderate to severe Cerebral Palsy. Participant data indicated that how people with Cerebral Palsy perceive sexual experiences with others (interactional) is the most influential factor in the construction of their sexuality. Public influences were cumulatively the second most important factor in the construction of sexuality by people with Cerebral Palsy. Finally, private influences were cumulatively the least influential factor in the construction of their sexuality. Sexual spontaneity primarily was a derivative of sexual exploration. Furthermore, participants defined sexual spontaneity as liberating and allowed them to experience their sexuality with others relatively independent of normative sexual scripts. Participants also described their sexuality primarily in terms of major transitions and experiences which involved others. Based on the findings sexual theory needs to be more cognizant of sexual agency as primary in the construction of sexuality with significant disability. In addition, healthcare providers and people with Cerebral Palsy are likely to be successful partners in sexual health when they promote positive and agentic constructions of sexuality with significant disability. The findings emphasize that people with Cerebral Palsy are cognizant and intelligent agents in the construction of their sexuality. Their articulations, understandings and descriptions of their sexuality demonstrate their interest and awareness in their sexuality and issues related to it. People with Cerebral Palsy are sexual agents and beings who empower themselves

The focal plane instrumentation for the DUNE mission

DUNE (Dark Universe Explorer) is a proposed mission to measure parameters of dark energy using weak gravitational lensing The particular challenges of both optical and infrared focal planes and the DUNE baseline solution is discussed. The DUNE visible Focal Plane Array (VFP) consists of 36 large format red-sensitive CCDs, arranged in a 9x4 array together with the associated mechanical support structure and electronics processing chains. Four additional CCDs dedicated to attitude control measurements are located at the edge of the array. All CCDs are 4096 pixel red-enhanced e2v CCD203-82 devices with square 12 $\mu$m pixels, operating from 550-920nm. Combining four rows of CCDs provides a total exposure time of 1500s. The VFP will be used in a closed-loop system by the spacecraft, which operates in a drift scan mode, in order to synchronize the scan and readout rates. The Near Infrared (NIR) FPA consists of a 5 x 12 mosaic of 60 Hawaii 2RG detector arrays from Teledyne, NIR bandpass filters for the wavelength bands Y, J, and H, the mechanical support structure, and the detector readout and signal processing electronics. The FPA is operated at a maximum temperature of 140 K for low dark current of 0.02e$-$/s. Each sensor chip assembly has 2048 x 2048 square pixels of 18 $\mu$m size (0.15 arcsec), sensitive in the 0.8 to 1.7 $\mu$m wavelength range. As the spacecraft is scanning the sky, the image motion on the NIR FPA is stabilized by a de-scanning mirror during the integration time of 300 s per detector. The total integration time of 1500 seconds is split among the three NIR wavelengths bands. DUNE has been proposed to ESA's Cosmic Vision program and has been jointly selected with SPACE for an ESA Assessment Phase which has led to the joint Euclid mission concept.Comment: 9 pages; To appear in Proc. of SPIE Astronomical Telescopes and Instrumentation (23 - 28 June 2008, Marseille, France

Analogical Problem Solving: An Exploratory Analysis of the Facilitating Effects of Type of Training, Analog Type, and Level of Expertise on Spontaneous Transfer

Research on analogical problem solving has delineated several factors that impact one\u27s ability to spontaneously generate a correct solution strategy to a target problem. These factors include, but are not limited to, type of analogy provided to subjects (i.e., partial versus complete), the level of isomorphism between analogies and target problems, and the solver\u27s level of analogical problem-solving expertise Recently, researchers have begun to focus on providing solvers with direct instruction on analogical problem-solving processes and strategies in an effort to augment analogical problem-solving ability. The most common type of instruction (i.e., teacher-generated) involves providing direct instruction on problem-solving processes and strategies without input from the solver. A second type of instruction (i.e., learner-generated) that has gained some attention in the literature but has not yet been tested in the realm of analogical problem solving involves learners actively participating in developing analogical problem-solving strategies while being guided by the instructor. Using an experimental design. the present study examined the differential effects of type of analogue (i.e., partial versus complete), level of expertise (i.e., novice versus expert). and type of training (teacher-generated, learner-generated, or no training) on spontaneous generation of correct solution strategies to two target problems. Findings indicate that solvers. regardless of training group or ability level. were better able to solve the target problem to the complete analogies than the target problem to the partial analogies. x2 (1, N = 116) = 18, p \u3c .001; d = .85. Moreover, there was no advantage for expert solvers to participate in problem-solving training. However. when examining novice solvers. findings indicate that direct instruction on problem-solving processes and strategies resulted in better performance when solving the partial analogy than did no instruction (d = .61). Also, active participation in the learning process resulted in better performance when solving the partial analogy than did no instruction (d = .80). Limitations of the study, implications for educators, and recommendations for future studies are provided