Adopting and Implementing a Software Development Methodology: An Organizational Perspective

Although much has been written about better aligning Information Systems (IS) with the business, too often organizations perceive software development as though it exists in its own little cocoon. Selection of a formal software development methodology (FSDM) is usually left to the IS area which focuses on the detail component levels and features of an FSDM. The authors instead approach an FSDM evaluation from an organizational perspective. An organizational systems level (OSL) model should first be used to examine the potential impacts of a new FSDM on human resource policies and practices, organizational culture, structure and design, and work design and technology. Critical success factors (CSF) for an organizational FSDM are also discussed

Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change

Defining adherence to therapeutic exercise for musculoskeletal pain : a systematic review

Objective To establish the meaning of the term ‘adherence’ (including conceptual and measurement definitions) in the context of therapeutic exercise (TE) for musculoskeletal (MSK) pain. Design Systematic review using a search strategy including terms for: adherence, TE and MSK pain. Identified studies were independently screened for inclusion by two researchers. Two independent researchers extracted data on: study type; MSK pain population; type of TE used; definitions, parameters, measurement methods and values of adherence. Data sources Seven electronic databases were searched from inception to December 2016. Eligibility criteria Any study type featuring TE for adults with MSK pain and containing a definition of adherence, or a description of how adherence was measured. Results 459 studies were identified and 86 were included in the review. Most were prospective cohort studies and featured back and/or neck pain. Strengthening and stretching were the most common types of TE. A clearly identifiable definition of adherence was provided in 40% of the studies, with 12% using the same definition. Exercise frequency was the most commonly measured parameter of adherence, with self-report logs the most common measurement method. The most common value range used to determine satisfactory adherence was 80%–99% of the recommended exercise dose. Conclusion No single definition of adherence to TE was apparent. We found no definition of adherence that specifically related to TE for MSK pain or described the dimensions of TE that should be measured. We recommend conceptualising adherence to TE for MSK pain from the perspective of all relevant stakeholders

SPICES II. Optical and Near-Infrared Identifications of Faint X-Ray Sources from Deep Chandra Observations of Lynx

We present our first results on field X-ray sources detected in a deep, 184.7 ks observation with the ACIS-I camera on Chandra. The observations target the Lynx field of SPICES, and contains three known X-ray-emitting clusters out to z=1.27. Not including the known clusters, in the 17'x17' ACIS-I field we detect 132 sources in the 0.5-2 keV (soft) X-ray band down to a limiting flux of \~1.7e-16 erg/cm2/s and 111 sources in the 2-10 keV (hard) X-ray band down to a limiting flux of ~1.3e-15 erg/cm2/s. The combined catalog contains a total of 153 sources, of which 42 are detected only in the soft band and 21 are detected only in the hard band. Confirming previous Chandra results, we find that the fainter sources have harder X-ray spectra, providing a consistent solution to the long-standing `spectral paradox'. From deep optical and near-infrared follow-up data, 77% of the X-ray sources have optical counterparts to I=24 and 71% of the X-ray sources have near-infrared counterparts to K=20. Four of the 24 sources in the near-IR field are associated with extremely red objects (EROs; I-K>4). We have obtained spectroscopic redshifts with the Keck telescopes of 18 of the Lynx Chandra sources. These sources comprise a mix of broad-lined active galaxies, apparently normal galaxies, and two late-type Galactic dwarfs. Intriguingly, one Galactic source is identified with an M7 dwarf exhibiting non-transient, hard X-ray emission. We review non-AGN mechanisms to produce X-ray emission and discuss properties of the Lynx Chandra sample in relation to other samples of X-ray and non-X-ray sources.Comment: 42 pages, 16 figures. Accepted for publication in the May 2002 Astronomical Journa

Health information management practices in informal caregiving: An artifacts analysis and implications for IT design

Introduction Unpaid informal caregivers of adult care recipients, including persons with dementia, experience multiple unmet information needs and information management challenges. Objectives To understand the current personal health information management (PHIM) practices in informal caregiving for adults with and without dementia. Methods Semi-structured interviews were performed with ten informal caregivers—half of whom were caring for persons with dementia—and four formal caregivers at an adult day service. Interviews centered on a paper-based tool distributed by the day service, the CARE Kit, permitting an artifacts analysis of the tools used by participants for PHIM. Qualitative thematic analysis was applied to interview data. Results Caregivers’ PHIM practices aimed to support daily care management and decision-making on behalf of care recipients, through: 1) information acquisition and integration across multiple sources and records; 2) information maintenance, updating, and use over time; and 3) information sharing and communication with healthcare professionals and other family caregivers. Participants reported advantages and challenges of their PHIM practices and tools, including fitting PHIM into their daily lives, managing PHIM-related cognitive workload, the functionality of PHIM tools, and the dynamic, longitudinal nature of PHIM. Conclusion The study produced a number of implications for caregiver health information management information technology (CHIM IT), based on findings about the nature of caregivers’ practices for managing information for adult care recipients. We present CHIM IT requirements related to privacy and security, customization and flexibility, ease of use, credibility and sensitivity, situation awareness, information integration, delegation and shared use, updating and maintenance, archiving and versioning, communication, agency and information access, and validation

First Results from the SPICES Survey

We present first results from SPICES, the Spectroscopic, Photometric, Infrared-Chosen Extragalactic Survey. SPICES is comprised of four ~30 square arcminute high Galactic latitude fields with deep BRIzJK imaging reaching depths of ~25th magnitude (AB) in the optical and ~23rd magnitude (AB) in the near-infrared. To date we have 626 spectroscopic redshifts for infrared-selected SPICES sources with K<20 (Vega). The project is poised to address galaxy formation and evolution to redshift z~2. We discuss initial results from the survey, including the surface density of extremely red objects and the fraction of infrared sources at z>1. One of the SPICES fields has been the target of a deep 190 ksec Chandra exposure; we discuss initial results from analysis of that data set. Finally, we briefly discuss a successful campaign to identify high-redshift sources in the SPICES fields.Comment: 5 pages, 2 figures; to appear in the proceedings of the ESO/ECF workshop on "Deep Fields", 9-12 Oktober 2000, Garchin

Chandra Detection of a TypeII Quasar at z=3.288

We report on observations of a TypeII quasar at redshift z=3.288, identified as a hard X-ray source in a 185 ks observation with the Chandra X-ray Observatory and as a high-redshift photometric candidate from deep, multiband optical imaging. CXOJ084837.9+445352 (hereinafter CXO52) shows an unusually hard X-ray spectrum from which we infer an absorbing column density N(H) = (4.8+/-2.1)e23 / cm2 (90% confidence) and an implied unabsorbed 2-10 keV rest-frame luminosity of L(2-10) = 3.3e44 ergs/s, well within the quasar regime. Hubble Space Telescope imaging shows CXO52 to be elongated with slight morphological differences between the WFPC2 F814W and NICMOS F160W bands. Optical and near-infrared spectroscopy of CXO52 show high-ionization emission lines with velocity widths ~1000 km/s and flux ratios similar to a Seyfert2 galaxy or radio galaxy. The latter are the only class of high-redshift TypeII luminous AGN which have been extensively studied to date. Unlike radio galaxies, however, CXO52 is radio quiet, remaining undetected at radio wavelengths to fairly deep limits, f(4.8GHz) < 40 microJy. High-redshift TypeII quasars, expected from unification models of active galaxies and long-thought necessary to explain the X-ray background, are poorly constrained observationally with few such systems known. We discuss recent observations of similar TypeII quasars and detail search techniques for such systems: namely (1) X-ray selection, (2) radio selection, (3) multi-color imaging selection, and (4) narrow-band imaging selection. Such studies are likely to begin identifying luminous, high-redshift TypeII systems in large numbers. We discuss the prospects for these studies and their implications to our understanding of the X-ray background.Comment: 28 pages, 5 figures; to appear in The Astrophysical Journa

Not all waits are equal: An investigation of emergency care patient pathway.

Abstract Background: Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals. Methods: VSM timing data were collected for patients accessing acute care at four hospitals in South West England. Data were categorised according to waits and activities, which were compared across sites to identify variations in practice from the patient viewpoint. We included Public and Patient Involvement (PPI) to fully interpret our findings; observations and initial findings were considered in a PPI workshop. Results: One hundred eight patients were recruited, comprising 25,432 min of patient time containing 4098 episodes of care or waiting. The median patient journey was 223 min (3 h, 43 min); just within the 4-h target. Although total patient journey times were similar between sites, the stage where the greatest proportion of waiting occurred varied. Reasons for waiting were dominated by waits for beds, investigations or results to be available. From our sample we observed that EDs without a discharge/clinical decision area exhibited a greater proportion of waiting time following an admission or discharge decision. PPI interpretation indicated that patients who experience waits at the beginning of their journey feel more anxious because they are ‘not in the system yet’. Conclusions: The novel application of VSM analysis across different hospitals, coupled with PPI interpretation, provides important insight into the impact of care provision on patient experience. Measures that could reduce patient waiting include automatic notification of test results, and the option of discharge/clinical decision areas for patients awaiting results or departure. To enhance patient experience, good communication with patients and relatives about reasons for waits is essential. Keywords: Health service research, Acute care, Emergency admissions, Patient care, Value stream mapping, Emergency department, Patient public involvemen

Schur functions and their realizations in the slice hyperholomorphic setting

we start the study of Schur analysis in the quaternionic setting using the theory of slice hyperholomorphic functions. The novelty of our approach is that slice hyperholomorphic functions allows to write realizations in terms of a suitable resolvent, the so called S-resolvent operator and to extend several results that hold in the complex case to the quaternionic case. We discuss reproducing kernels, positive definite functions in this setting and we show how they can be obtained in our setting using the extension operator and the slice regular product. We define Schur multipliers, and find their co-isometric realization in terms of the associated de Branges-Rovnyak space

Formin is associated with left-right asymmetry in the pond snail and the frog

While components of the pathway that establishes left-right asymmetry have been identified in diverse animals, from vertebrates to flies, it is striking that the genes involved in the first symmetry-breaking step remain wholly unknown in the most obviously chiral animals, the gastropod snails. Previously, research on snails was used to show that left-right signalling of Nodal, downstream of symmetry-breaking, may be an ancestral feature of the Bilateria. Here we report that a disabling mutation in one copy of a tandemly duplicated, diaphanous-related formin is perfectly associated with symmetry-breaking in the pond snail. This is supported by the observation that an anti-formin drug treatment converts dextral snail embryos to a sinistral phenocopy, and in frogs, drug inhibition or over-expression by microinjection of formin has a chirality-randomizing effect in early (pre-cilia) embryos. Contrary to expectations based on existing models, we discovered asymmetric gene expression in 2 and 4 cell snail embryos, preceding morphological asymmetry. As the formin-actin filament has been shown to be part of an asymmetry-breaking switch in vitro, together these results are consistent with the view that animals with diverse bodyplans may derive their asymmetries from the same intracellular chiral elements