How should we measure ambulance service quality and performance?

The problem Ambulance services in England treat 6.5 million people per year but get no information about what happens to patients after discharge. This has led to a reliance on measuring response times rather than outcomes to assess how well services perform, and little opportunity for identifying problems and good practice or evaluating service developments. Research aim There is a lack of consensus on which outcome measures are important for pre-hospital care so we set out to address this within the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) research programme. Methods We conducted a two round Delphi study to prioritise outcome measures identified from a systematic review and a multi-stakeholder consensus event. 20 participants scored 57 measures over two rounds. Participants included policy makers and commissioners, clinical ambulance service and ambulance service operational groups. Outcomes were scored in three categories: patient outcomes; whole service measures and clinical management. Results Highly ranked patient outcome measures related to pain, survival, recontacts and patient experience. High ranking outcomes in the Clinical Management group related to compliance with protocols and guidelines and appropriateness and accuracy of triage. In the Whole Service measures group highly ranked measures related to completeness of clinical records, staff training and time to definitive care. Conclusions The next steps are to identify which measures are suitable for measuring with routine data; use a linked dataset to build predictive models and determine what aspects of care can predict good or poor outcomes (mortality and non-mortality); measure the effectiveness and quality of ambulance service care, and; assess the practical use of the measures and the linked data as a way to support quality improvement in the NHS

Geometric registration of images by similarity transformation using two reference points

A method for registering a first image to a second image using a similarity transformation. The each image includes a plurality of pixels. The first image pixels are mapped to a set of first image coordinates and the second image pixels are mapped to a set of second image coordinates. The first image coordinates of two reference points in the first image are determined. The second image coordinates of these reference points in the second image are determined. A Cartesian translation of the set of second image coordinates is performed such that the second image coordinates of the first reference point match its first image coordinates. A similarity transformation of the translated set of second image coordinates is performed. This transformation scales and rotates the second image coordinates about the first reference point such that the second image coordinates of the second reference point match its first image coordinates

Permeability Enhancement in Porous‐Sintered Reaction‐Bonded Silicon Nitrides

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87172/1/j.1744-7402.2010.02511.x.pd

A New Method for Estimation of the Sensible Heat Flux Under Unstable Conditions Using Satellite Vector Winds

It has been difficult to estimate the sensible heat flux at the air - sea interface using satellite data because of the difficulty in remotely observing the sea level air temperature. In this study, a new method is developed for estimating the sensible heat flux using satellite observations under unstable conditions. The basic idea of the method is that the air - sea temperature difference is related to the atmospheric convergence. Employed data include the wind convergence, sea level humidity, and sea surface temperature. These parameters can be derived from the satellite wind vectors, Special Sensor Microwave Imager (SSM/I) precipitable water, and Advanced Very High Resolution Radiometer (AVHRR) observations, respectively. The authors selected a region east of Japan as the test area where the atmospheric convergence appears all year. Comparison between the heat fluxes derived from the satellite data and from the National Centers for Environmental Prediction (NCEP) data suggests that the rms difference between the two kinds of sensible heat fluxes has low values in the sea area east of Japan with a minimum of 10.0 W m(-2). The time series of the two kinds of sensible heat fluxes at 10 locations in the area are in agreement, with rms difference ranging between 10.0 and 14.1 W m(-2) and correlation coefficient being higher than 0.7. In addition, the National Aeronautics and Space Administration ( NASA) Goddard Satellite-Based Surface Turbulent Flux (GSSTF) was used for a further comparison. The low-rms region with high correlation coefficient (\u3e0.7) was also found in the region east of Japan with a minimum of 12.2 W m(-2). Considering the nonlinearity in calculation of the sensible monthly means, the authors believe that the comparison with GSSTF is consistent with that with NCEP data

How should we measure ambulance service quality and performance? Results from a Delphi study

Background and objectives The Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) research programme aims to develop better ways of measuring the quality of ambulance service care. Ambulance service care is often measured by the speed of the ambulance response rather than the quality of care provided or patient outcomes. Whilst response times are relevant to a small proportion of seriously ill patients, they are not clinically relevant for most people who contact the ambulance service. We identified existing and aspirational ambulance service quality and performance measures from reviews of the literature and interviews with service users and prioritised these as part of a Delphi study. Methods We conducted a Delphi study to prioritise ambulance service quality and performance measures. 42 people were invited to take part and 29 agreed. Of the 29 participants, 20 provided data for 2 Delphi rounds. For each round, 67 measures were scored on a 1 – 9 scale. Participants included policy makers and commissioners, clinical ambulance service and ambulance service operational groups. Outcomes were included from three categories: patient outcomes; whole service measures and clinical management. Measures with a median group score of 7 or above were classified as high scoring measures. Results There was little score change between the two Delphi rounds and over half of the measures scored 7 or above (13/25 patient outcomes, 9/10 clinical management measures and 18/32 whole system measures scored 7 and above). High scoring patient outcome measures related to pain, survival, patient experience and re-contacts with emergency medical services. The highest scoring patient outcomes were: proportion of ambulance service calls referred for telephone advice who re-contact the ambulance service within 24 hours and proportion of patients given analgesia who report having pain. Low scoring measures related to re-contacts with non-EMS services, intubation and wound infection. Nearly all of the clinical management measures scored highly. These measures related to correct categorisation of urgency, patient safety and compliance with protocols and guidelines. The highest ranking measure was: proportion of life-threatening category A calls correctly identified as category A. The only high scoring time measures were time to definitive care and ambulance response time within 30 minutes. Other high scoring whole system measures were compliance with training and completion of patient records, whereas over triage and other time measures, for example, average time spent on scene or other response times scored <7. Conclusion Participants thought time to definitive care was more important than speed of response. Other important measures related to pain management, patient safety, re-contacts with EMS services and correct identification of call urgency. The public acceptability of the Delphi results will be discussed during a patient and public involvement (PPI) event, where PPI participants will have an opportunity to vote on and discuss the measures. Following this, a final shortlist of measures will be used to inform a predictive model to identify what aspects of care can predict good or poor outcomes (mortality and non-mortality) and we will use this to measure the effectiveness and quality of ambulance service car

Moving on from response rates: linking patient level ambulance data to ED, hospital and survival data to assess quality and performance

The problem The ambulance service has no information about what happens beyond the prehospital phase of care. This leads to process measures, e.g. response rates, being used as a proxy for quality of care. Research aim To develop better ways of measuring the quality and performance of ambulance service care. Methods Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) is a five year National Institute for Health Research (NIHR) programme to develop better ways of measuring the performance, quality and impact of ambulance service care by: identifying and prioritising ambulance related outcome measures; creating a new information source by linking together routinely collected data; using the linked dataset to build predictive models to assess what aspects of care can predict good or poor outcomes (mortality and non-mortality) and measure the effectiveness and quality of ambulance service care; assessing the practical use of the measures and the linked data as a way to support quality improvement in the NHS; in order to provide better information about effectiveness and quality of care. We developed a data linking methodology that was acceptable to patients and complied with information legislation. Data from two participating ambulance services were processed and linked to other routinely collected data through the NHS Health and Social Care Information Centre’s Trusted Data Linkage Service, which is a designated safe haven for health information. Conclusions It is possible to link ambulance service data to subsequent care information. The new database can be used to support audit and research and to measure the impact of any new changes and innovations in how ambulance services provide care, to ensure continued improvements for patients. Allied to this we used consensus methods to develop a set of outcome measures for measuring the quality and performance of ambulance service care, which will be tested within the linked dataset using predictive models

Speleothems uncover Late Holocene environmental changes across the Nuragic period in Sardinia (Italy): A possible human influence on land use during bronze to post-Iron Age cultural shifts

During the Bronze and Iron Age, Sardinia was home of one of the most technologically advanced Mediterranean societies (the Nuragic culture). Given its key geographical location, the island was also the fulcrum of deep cultural exchanges. Toward the end of the Iron Age, Phoenicians, and especially Carthaginians and Romans, massively frequented Sardinia for different purposes. This marks an important cultural transition for the region, as the ancient Nuragic-related society terminated. At the same time, this impacted the subsistence and land use practices. Together with middle to late Holocene climate changes, the novel anthropic activities had a pivotal role in shaping the landscape around the island. However, high resolution climate and environmental records for these culturally important phases are still lacking in Sardinia. Thus, this paper explores palaeoenvironmental changes from the Bronze Age to post Iron Ages times by using carbonate speleothems from Suttaterra de Sarpis Cave (Urzulei, central east Sardinia), strategically located nearby the Or Murales Nuragic Village. U–Th ages (n = 20) indicate that five stalagmites comprehensively span the last ~7000 years. Peculiarly, they all show an evident stratigraphic discontinuity. Age models attest that hiatuses can be at times associated with the discontinuities, spanning periods of ~1200 to ~200 years. Importantly, the discontinuities occurred from the Late Iron Age to the Roman period. Based on fabric observations, trace elements and δ13C- δ18O analyses, the discontinuities are primarily attributed to a progressive change of land use above the cave. We suppose that deforestation aimed to clearance for agriculture and livestock practices probably was the most impacting factor for infiltration dynamics and soil state, thus affecting the studied speleothems, although archaeological and historical data are absent for the specific study area. Instead, this is in line with the cultural transition occurring in Sardinia toward the end of the Iron Age, with novel agricultural practices imported by the overseas populations. The anthropic disturbance to the millennial-long karst equilibrium possibly overprinted the response of speleothem proxies to climate oscillations, although future higher resolution analyses are necessary to better investigate the evolution of climate during the Holocene as well as its role in the development of ancient civilizations. Indeed, this is the first speleothem-based Holocene palaeoenvironmental reconstruction accomplished in Sardinia. Considering the paucity of natural lakes in this key location, speleothems here demonstrate their potential in exploring humandriven palaeoenvironmental changes during times of cultural transitions within the Mediterranean context