An approach to safety analysis of clinical workflows

A clinical workflow considers the information and processes that are involved in providing a clinical service. They are safety critical since even minor faults have the potential to propagate and consequently cause harm to a patient, or even for a patient's life to be lost. Experiencing these kinds of failures has a destructive impact on all the involved parties. Due to the large number of processes and tasks included in the delivery of a clinical service, it can be difficult to determine the individuals or the processes that are responsible for adverse events, since such an analysis is typically complex and slow to do manually. Using automated tools to carry out an analysis can help in determining the root causes of potential adverse events and consequently help in avoiding preventable errors through either the alteration of existing workflows, or the design of a new workflow. This paper describes a technical approach to safety analysis of clinical workflows, utilising a safety analysis tool (Hierarchically-Performed Hazard Origin and Propagation Studies (HiP-HOPS)) that is already in use in the field of mechanical systems. The paper then demonstrates the applicability of the approach to clinical workflows by applying it to analyse the workflow in a radiology department. We conclude that the approach is applicable to this area of healthcare and provides a mechanism both for the systematic identification of adverse events and for the introduction of possible safeguards in clinical workflows

Factors affecting students’ attitude and performance when using a web-enhanced learning environment

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The purpose of this thesis is to investigate the use of a course management system in a University learning environment and the factors that affect students' attitude and performance in such environments and to study the relationship between these factors. The course management system that was used in the research studies in this thesis was WebCT. Three in-field studies were carried out to achieve the aim of this research thesis. A mixture of qualitative and quantitative approaches was used in the studies. Data from participants were collected via questionnaires, interviews, and numerical data from the WebCT tracking system. First the relationship between the students' attitude towards using WebCT and their module leaders' attitude towards using it was studied. Then, the relationship between students' cognitive styles and their satisfaction, their achievement, and their way of using WebCT was investigated. Finally, a model of the critical factors affecting students‟ attitudes to WebCT, use of WebCT and achievement was developed and tested. The model is divided into three main dimensions. The three dimensions are 1) The learner dimension: students' interaction with their classmates, students' capability of using the internet, students' capability of using WebCT. 2) The instructor dimension: Instructor's technical competence, instructor's way of presenting materials on WebCT, interaction between students and their instructor. 3) The technology dimension: usefulness, ease of use, flexibility, quality. The results suggested that students have a positive attitude towards using a course management system (WebCT) on their courses. Also, the results indicated that students' use of WebCT is a positive indicator of their academic achievement (in terms of performance on specific modules). It was also found that instructor attitude and way of using WebCT affects students' attitude and performance when using WebCT. The Technology dimension was found to be a positive indicator of students' attitude and use of WebCT. The Instructor dimension was also found to be a positive indicator of students' attitude and achievement in WebCT. Moreover, the Learner dimension was found to be a positive indicator of students' attitude, use of WebCT and achievement.Sponsored by AlBaath Universit

The Effect of Whole Body Horizontal Vibration in Position Sense and Dynamic Stability of the Spine

In many workplaces, workers are exposed to whole body vibration which involves multi-axis motion in fore-aft (x axis), lateral (y axis) and vertical (z axis) directions. In previous studies, our laboratory has found changes in biomechanical responses such as response time and position sense with exposure to vibration in single vertical direction. The objective of the current study was to investigate the effect of whole body, horizontal vibration on proprioception and sudden loading dynamics and to compare these results with the previously studied whole body vertical vibration experiment. Both position sense test and sudden loading test were performed in three conditions: a pre-exposure condition (pre), a post-washout condition (postw) and a post-vibration condition (postv). Subjects were exposed to the whole body horizontal vibration frequency of 5 Hz and constant acceleration of 0.284 RMS (m/s-2) for 30 minutes. Absolute reposition sense error increased slightly after vibration exposure (relative to after quiet sitting (postw)), although the results were not significant. Times to peak muscle response and flexion magnitude were also increased after horizontal vibration exposure, suggesting a decreased stability of the spine, but again these results were not significant. Compared to the previous study of vertical whole body vibration, the effects of horizontal vibration in this study were small and not significant. This may be due to differences in the transmissibility of vertical and horizontal vibrations at the 5 Hz frequency. These results would suggest that horizontal vibration may be less of a factor in whole-body vibration induced injuries. This work was supported by University of Kansas Transportation Research Institute Grant Program

The initiative of stem schools in Egypt: Issues of process, teachers\u27 compatibility and governance

This study discusses the Science, Technology, Engineering, and Mathematics (STEM) initiative as the latest policy move undertaken by the Egyptian government to improve the education system and prepare future generations of professionals in these fields. The findings of this study are based on a case study of two schools in Egypt. Data was collected using face-to-face and focus group interviewing along with a review of documents. This thesis discusses the role of the different stakeholders, the program structure, the student and teacher selection processes, teaching techniques, curricula, assessments, sustainability plan, and the views of STEM graduates. The study highlights the positive STEM learning environment but identifies a number of issues that could be threatening the quality and continuity of the STEM initiative in Egypt. These relate to: (1) the complex overarching bureaucratic legislation structure; (2) challenges in curricula design and assessment criteria; (3) teachers\u27 training and system compatibility challenges; and most importantly, (4) the shortfall in the availability of sustainable funding. Relying on the findings of the global STEM experience, the study discusses international best practices and recommendations

Assessing Impact of Food Structure on Oral Tribology and In-Vitro Digestion of Dairy Products

In this research, we focused on understanding the critical elements impacting consumer experience and the nutritional value of dairy products, specifically their texture, mouthfeel, and protein breakdown in the gastrointestinal tract. Our study aimed to accomplish two main goals. First, we performed analysis of the tribological attributes of various commercially dairy products. The second objective was to investigate the process of disintegration and protein release in selected dairy products. The study included an assessment of eight dairy products of varied consistencies: solid like cheddar, cheese curd, and parmesan; semi-solid such as cottage cheese, ricotta cheese, and yogurt; and liquid represented by milk and whey protein beverage. To achieve our objectives, we used variety of techniques like tribology, particle size examination, and SDS PAGE. We measured the samples\u27 mouthfeel via tribology. Furthermore, we examined the particle size distribution, a significant factor affecting mouthfeel. The findings indicate differences among the samples based on the Stribeck curve at various sliding speeds. Liquid dairy products displayed considerably higher friction (p \u3c 0.05) compared to semi-solid and solid dairy items, likely due to their unique food structures, protein levels, and moisture content. The second phase involved the in-vitro digestion of three structurally distinct dairy products using the INFOGEST protocol. The purpose was to understand the process of disintegration and protein release during the gastric and intestinal phases at specific time intervals. The outcomes highlighted the differences among liquid, semi-solid, and solid samples at different stages of the in-vitro digestion process (G0, G15, G30, G60, I5, I30, I60, I120, I180). For instance, liquid dairy items, such as milk, displayed a significantly quicker release of soluble protein compounds during the gastric phase when compared to solid dairy products like cheddar cheese. These varied protein degradation rates were primarily due to the differences in protein content and food structure. By examining the tribological properties and in-vitro digestibility of dairy products, this study offers valuable insights into the mechanics of texture, mouthfeel, and protein release. The findings of this research can help food industry professionals develop innovative dairy products, augment their nutritional worth, and boost consumer satisfaction

A Cognitive Approach to the Translation of Creative Metaphor in Othello and Macbeth from English into Arabic

ABSTRACT Despite the intriguing nature of metaphor and its acknowledged importance in the discipline of Translation Studies (TS), a relatively small number of studies have explored the translation of metaphor from the perspective of Conceptual Metaphor Theory, and very few of them adopted an experiential approach to the object of analysis. This research aims at exploring the translatability of creative metaphor in six Arabic translations of Shakespeare’s Othello and Macbeth based on a combined methodology that adopts the Conceptual Theory of Metaphor and the descriptive approach to text analysis in TS. The empirical study argues that metaphor translatability is an experiential process that is highly influenced by the diversity and richness of our conceptual system and the background knowledge shared by the metaphor producer and metaphor translator. Discussing metaphor translatability from the perspective of these factors involves dealing with different levels of variation in our metaphoric thinking including the cultural, contextual and pragmatic levels. The analyses and discussions of the empirical study mark a departure from text-linguistic approaches to the topic in that they deal with the Source Text’s and Target Text’s metaphoric content as physically embedded conceptual models rather than linguistic patterns with grammatically delineated features and structures. The arguments of the study answer several questions with regard to researching the translation of metaphor from the perspective of Conceptual Theory, providing a detailed description of what exactly influences the process and product of translation, and underlining the functionality of the variation factor in appreciating the conceptual nature of metaphor. The results of the empirical research reveal that, although our metaphoric thinking has a universally shared metaphoric structure, not all our metaphors are translatable or translated in a single way, which refutes the supremacy of the notion of metaphor universality, putting emphasis on the factors of experientialism, exposure and intentionality

Technological Advances in the Diagnosis and Management of Pigmented Fundus Tumours

Choroidal naevi are the most common intraocular tumour. They can be pigmented or non-pigmented and have a predilection for the posterior uvea. The majority remain undetected and cause no harm but are increasingly found on routine community optometry examinations. Rarely does a naevus demonstrate growth or the onset of suspicious features to fulfil the criteria for a malignant melanoma. Because of this very small risk, optometrists commonly refer these patients to hospital eye units for a second opinion, triggering specialist examination and investigation, causing significant anxiety to patients and stretching medical resources. This PhD thesis introduces the MOLES acronym and scoring system that has been devised to categorise the risk of malignancy in choroidal melanocytic tumours according to Mushroom tumour shape, Orange pigment, Large tumour size, Enlarging tumour and Subretinal fluid. This is a simplified system that can be used without sophisticated imaging, and hence its main utility lies in the screening of patients with choroidal pigmented lesions in the community and general ophthalmology clinics. Under this system, lesions were categorised by a scoring system as ‘common naevus’, ‘low-risk naevus’, ‘high-risk naevus’ and ‘probable melanoma.’ According to the sum total of the scores, the MOLES system correlates well with ocular oncologists’ final diagnosis. The PhD thesis also describes a model of managing such lesions in a virtual pathway, showing that images of choroidal naevi evaluated remotely using a decision-making algorithm by masked non-medical graders or masked ophthalmologists is safe. This work prospectively validates a virtual naevus clinic model focusing on patient safety as the primary consideration. The idea of a virtual naevus clinic as a fast, one-stop, streamlined and comprehensive service is attractive for patients and healthcare systems, including an optimised patient experience with reduced delays and inconvenience from repeated visits. A safe, standardised model ensures homogeneous management of cases, appropriate and prompt return of care closer to home to community-based optometrists. This research work and strategies, such as the MOLES scoring system for triage, could empower community-based providers to deliver management of benign choroidal naevi without referral to specialist units. Based on the positive outcome of this prospective study and the MOLES studies, a ‘Virtual Naevus Clinic’ has been designed and adapted at Moorfields Eye Hospital (MEH) to prove its feasibility as a response to the COVID-19 pandemic, and with the purpose of reducing in-hospital patient journey times and increasing the capacity of the naevus clinics, while providing safe and efficient clinical care for patients. This PhD chapter describes the design, pathways, and operating procedures for the digitally enabled naevus clinics in Moorfields Eye Hospital, including what this service provides and how it will be delivered and supported. The author will share the current experience and future plan. Finally, the PhD thesis will cover a chapter that discusses the potential role of artificial intelligence (AI) in differentiating benign choroidal naevus from choroidal melanoma. The published clinical and imaging risk factors for malignant transformation of choroidal naevus will be reviewed in the context of how AI applied to existing ophthalmic imaging systems might be able to determine features on medical images in an automated way. The thesis will include current knowledge to date and describe potential benefits, limitations and key issues that could arise with this technology in the ophthalmic field. Regulatory concerns will be addressed with possible solutions on how AI could be implemented in clinical practice and embedded into existing imaging technology with the potential to improve patient care and the diagnostic process. The PhD will also explore the feasibility of developed automated deep learning models and investigate the performance of these models in diagnosing choroidal naevomelanocytic lesions based on medical imaging, including colour fundus and autofluorescence fundus photographs. This research aimed to determine the sensitivity and specificity of an automated deep learning algorithm used for binary classification to differentiate choroidal melanomas from choroidal naevi and prove that a differentiation concept utilising a machine learning algorithm is feasible

PRARANCANGAN PABRIK NATRIUM KARBOKSIMETILSELULOSA (NA-CMC) DARI SELULOSA POWDER DENGAN KAPASITAS PRODUKSI 10.000 TON/TAHUN

Prarancangan pabrik Natrium Karboksimetil Selulosa (Na-CMC) dari Selulosa Powder ini bertujuan untuk memenuhi kebutuhan Na-CMC dalam negeri yang semakin meningkat. Pabrik Na-CMC ini menggunakan selulosa powder, NaOH 35% dan asam monokloro asetat sebagai bahan baku utama dengan kapasitas produksi 10.000 ton/tahun. Bentuk perusahaan yang direncanakan adalah Perseroan Terbatas (PT) dengan struktur organisasi garis dan staf dengan waktu kerja selama 330 hari/tahun. Kebutuhan tenaga kerja untuk menjalankan perusahaan ini berjumlah 160 orang. Lokasi pabrik direncanakan akan didirikan di Kawasan Industri Ngoro (NIP), Kabupaten Mojokerto, Provinsi Jawa Timur dengan luas lahan tanah 32.160 m2.Proses pembuatan Na-CMC dilakukan dengan proses kontinyu Wyandote melalui empat tahap, yaitu tahap alkalisasi, tahap karboksilasi, tahap aging, tahap pengeringan, dan tahap pengemasan produk. Bahan baku selulosa powder disuplai ke hopper melalui bucket elevator. Bongkahan-bongkahan kecil pada selulosa dihancurkan dengan ribbon mixer dan selanjutnya diangkut ke dalam reaktor menggunakan screw conveyor 101. Pada tahap alkalisasi, selulosa akan direaksikan dengan NaOH 35% pada zona 1 rotary reaktor. Pada tahap karboksilasi, Na-selulosa akan bereaksi dengan asam monokloro asetat membentuk Na-CMC. Suhu pada rotary reaktor berkisar 70oC. Tahap aging dilakukan untuk memantapkan ikatan yang terjadi pada Na-CMC. Suhu pada reaktor aging berkisar pada 58oC. Setelah tahap aging, Na-CMC akan dikeringkan dalam rotary dryer dan selanjutnya akan dikecilkan ukuran pada ball mill serta dikemas dalam kemasan berbentuk karung yang telah disediakan.Sumber air pabrik Na-CMC ini berasal dari sungai Brantas, Jawa Timur. Untuk memenuhi kebutuhan listrik diperoleh dari Perusahaan Listrik Negara (PLN) dan Generator dengan daya 2.942,73 kW.Kelayakan pabrik juga dievaluasi melalui perhitungan ekonomi. Hasil analisa ekonomi yang diperoleh adalah sebagai berikut:a.Fixed Capital Investment= Rp.210.513.407.546b.Working Capital Investment= Rp. 37.149.424.861c.Total Capital Investment= Rp. 247.662.832.407d.Total Biaya Produksi= Rp 667.967.443.350e.Hasil Penjualan= Rp. 776.843.381.639f.Laba bersih= Rp. 81.656.953.716g.Pay Out Time (POT) = 4 tahun 5 bulanh.Break Even Point (BEP)= 41,24%i.Internal Rate of Return (IRR)= 62,36%Keywords:Na-CMC, kontinyu Wyandote, alkalisasi, karboksilasi, agin