430 research outputs found
Usage Based Materials by Simulating Layered Imperfections
Maintaining the ability to make quick iterations is very important to any artist in Computer Graphics, which is not always easy for simulating realistic materials based on how they are used. This thesis will examine imperfections in materials and the way different imperfections interact with each other based on how they are used. A new system will be created to save artist time by simulating how imperfections are layered and positioned
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Supporting Clinical Decision Making in Cancer Care Delivery
Background: Cancer treatment and management require complicated clinical decision making to provide the highest quality of care for an individual patient. This is facilitated in part with ever-increasing availability of medications and treatments but hindered due to barriers such as access to care, cost of medications, clinician knowledge, and patient preferences or clinical factors. Although guidelines for cancer treatment and many symptoms have been developed to inform clinical practice, implementation of these guidelines into practice is often delayed or does not occur. Informatics-based approaches, such as clinical decision support, may be an effective tool to improve guideline implementation by delivering patient-specific and evidence-based knowledge to the clinician at the point of care to allow shared decision making with a patient and their family. The large amount of data in the electronic health record can be utilized to develop, evaluate, and implement automated approaches; however, the quality of the data must first be examined and evaluated.
Methods: This dissertation addresses gaps the literature about clinical decision making for cancer care delivery. Specifically, following an introduction and review of the literature for relevant topics to this dissertation, the researcher presents three studies. In Study One, the researcher explores the use of clinical decision support in cancer therapeutic decision making by conducting a systematic review of the literature. In Study Two, the researcher conducts a quantitative study to describe the rate of guideline concordant care provided for prevention of acute chemotherapy-induced nausea and vomiting (CINV) and to identify predictors of receiving guideline concordant care. In Study Three, the researcher conducts a mixed-methods study to evaluate the completeness, concordance, and heterogeneity of clinician documentation of CINV. The final chapter of this dissertation is comprised of key findings of each study, the strengths and limitations, clinical and research implications, and future research.
Results: In Study One, the systematic review, the researcher identified ten studies that prospectively studied clinical decision support systems or tools in a cancer setting to guide therapeutic decision making. There was variability in these studies, including study design, outcomes measured, and results. There was a trend toward benefit, both in process and patient-specific outcomes. Importantly, few studies were integrated into the electronic health record.
In Study Two, of 180 patients age 26 years or less, 36% received guideline concordant care as defined by pediatric or adult guidelines, as appropriate. Factors associated with receiving guideline concordant care included receiving a cisplatin-based regimen, being treated in adult oncology compared to pediatric oncology, and solid tumor diagnosis.
In Study Three, of the 127 patient records reviewed for the documentation of chemotherapy-induced nausea and vomiting, 75% had prescriber assessment documented and 58% had nursing assessment documented. Of those who had documented assessments by both prescriber and nurse, 72% were in agreement of the presence/absence of chemotherapy-induced nausea and vomiting. After mapping the concept through the United Medical Language System and developing a post-coordinated expression to identify chemotherapy-induced nausea and vomiting in the text, 85% of prescriber documentation and 100% of nurse documentation could be correctly categorized as present/absent. Further descriptors of the symptoms, such as severity or temporality, however, were infrequently reported.
Conclusion: In summary, this dissertation provides new knowledge about decision making in cancer care delivery. Specifically, in Study One the researcher describes that clinical decision support, one potential implementation strategy to improve guideline concordant care, is understudied or under published but a promising potential intervention. In Study Two, I identified factors that were associated with receipt of guideline concordant care for CINV, and these should be further explored to develop interventions. Finally, in Study Three, I report on the limitations of the data quality of CINV documentation in the electronic health record. Future work should focus on validating these results on a multi-institutional level
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Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors
Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions
Foreword
I write this foreword from the traditional lands of the Ainawan people. It is a complex region of environmental, social and cultural change that has experienced a series of recent and historical natural disasters. It is a region that inspires the multiple ways in which we can co-produce knowledge that protects, transforms, stewards and sustains
Mitochondria and apoptosis: a quick take on a long view
Fifteen years of apoptosis research have led to the widely accepted idea that the major form of programmed cell death in mammals proceeds via the mitochondria, and that mitochondrial control of apoptosis is regulated by a specialized family of proteins known as the Bcl-2 family. Here we will consider some very recent data that has shed new insight into the regulation of these proteins and the impact of mitochondrial dynamics on mitochondrial outer membrane permeabilization (MOMP) and apoptosis
Usage Based Materials by Simulating Layered Imperfections
Maintaining the ability to make quick iterations is very important to any artist in Computer Graphics, which is not always easy for simulating realistic materials based on how they are used. This thesis will examine imperfections in materials and the way different imperfections interact with each other based on how they are used. A new system will be created to save artist time by simulating how imperfections are layered and positioned
Evaluating events data for cultural analytics : a case study on the economic and social effects of Covid-19 on the Edinburgh Festivals
Funding: This work was supported by the Arts and Humanities Research Council under Grant AH/W007533/1.The effects of the Covid-19 pandemic on the Creative and Cultural Industries can be difficult to quantify. Metadata about events (theatre productions, music and comedy gigs, sporting fixtures, days out, and more) are an untapped resource for cultural analytics that can be used as a proxy metric for financial and social impact. This article uses a sample of large-scale cultural events data from UK industry providers Data Thistle to ask: how can events data at scale be used to quantify the financial and social effects of the Covid-19 pandemic on the cultural events sector in a particular region? We analysed the changes in event provision in Edinburgh in August 2018, 2019, 2020 and 2021, revealing an estimated 97.3% fall in ticketing revenue between 2019 and 2020. Additionally, the effects that pandemic restrictions had on different categories of event reveal a disparity in how different audience sectors were affected, with ‘Visual Art’ and ‘Days Out’ showing most resilience and ‘Theatre’, ‘Comedy’ and ‘LGBT’ events being most reduced. Our findings indicate that events data are a rich but heterogenous source of information regarding the cultural and creative economy, which is not yet routinely used by researchers.Peer reviewe
Employers' perception of the costs and the benefits of hiring individuals with autism spectrum disorder in open employment in Australia
Research has examined the benefits and costs of employing adults with autism spectrum disorder (ASD) from the perspective of the employee, taxpayer and society, but few studies have considered the employer perspective. This study examines the benefits and costs of employing adults with ASD, from the perspective of employers. Fifty-nine employers employing adults with ASD in open employment were asked to complete an online survey comparing employees with and without ASD on the basis of job similarity. The findings suggest that employing an adult with ASD provides benefits to employers and their organisations without incurring additional costs
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