How to identify when a performance indicator has run its course

The official published version can be found at the link below.Increasing numbers of countries are using indicators to evaluate the quality of clinical care, with some linking payment to achievement. For performance frameworks to remain effective the indicators need to be regularly reviewed. The frameworks cannot cover all clinical areas, and achievement on chosen indicators will eventually reach a ceiling beyond which further improvement is not feasible. However, there has been little work on how to select indictors for replacement. The Department of Health decided in 2008 that it would regularly replace indicators in the national primary care pay for performance scheme, the Quality and Outcomes Framework, making a rigorous approach to removal a priority. We draw on our previous work on pay for performance and our current work advising the National Institute for Health and Clinical Excellence (NICE) on the Quality and Outcomes Framework to suggest what should be considered when planning to remove indicators from a clinical performance framework

Electronic Quality of Life Assessment using computer-adaptive testing

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Quality of life (QoL) questionnaires are desirable for clinical practice but can be time-consuming to administer and interpret, making their widespread adoption difficult. OBJECTIVE: Our aim was to assess the performance of the World Health Organization Quality of Life (WHOQOL)-100 questionnaire as four item banks to facilitate adaptive testing using simulated computer adaptive tests (CATs) for physical, psychological, social, and environmental QoL. METHODS: We used data from the UK WHOQOL-100 questionnaire (N=320) to calibrate item banks using item response theory, which included psychometric assessments of differential item functioning, local dependency, unidimensionality, and reliability. We simulated CATs to assess the number of items administered before prespecified levels of reliability was met. RESULTS: The item banks (40 items) all displayed good model fit (P>.01) and were unidimensional (fewer than 5% of t tests significant), reliable (Person Separation Index>.70), and free from differential item functioning (no significant analysis of variance interaction) or local dependency (residual correlations .90) could be gained with a median of 9 items. CONCLUSIONS: Using CAT, simulated assessments were as reliable as paper-based forms of the WHOQOL with a fraction of the number of items. These properties suggest that these item banks are suitable for computerized adaptive assessment. These item banks have the potential for international development using existing alternative language versions of the WHOQOL items.This work was funded by a National Institute for Health Research Postdoctoral Fellowship grant (NIHR-PDF-2014-07-028) for the lead author, CG

Human emotion characterization by heart rate variability analysis guided by respiration

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting /republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other worksDeveloping a tool which identifies emotions based on their effect on cardiac activity may have a potential impact on clinical practice, since it may help in the diagnosing of psycho-neural illnesses. In this study, a method based on the analysis of heart rate variability (HRV) guided by respiration is proposed. The method was based on redefining the high frequency (HF) band, not only to be centered at the respiratory frequency, but also to have a bandwidth dependent on the respiratory spectrum. The method was first tested using simulated HRV signals, yielding the minimum estimation errors as compared to classical and respiratory frequency centered at HF band based definitions, independently of the values of the sympathovagal ratio. Then, the proposed method was applied to discriminate emotions in a database of video-induced elicitation. Five emotional states, relax, joy, fear, sadness and anger, were considered. The maximum correlation between HRV and respiration spectra discriminated joy vs. relax, joy vs. each negative valence emotion, and fear vs. sadness with p-value = 0.05 and AUC = 0.70. Based on these results, human emotion characterization may be improved by adding respiratory information to HRV analysis.Peer ReviewedPostprint (author's final draft

Evaluation of the Suitability of NEON SIMD Microprocessor Extensions Under Proton Irradiation

This paper analyzes the suitability of single-instruction multiple data (SIMD) extensions of current microprocessors under radiation environments. SIMD extensions are intended for software acceleration, focusing mostly in applications that require high computational effort, which are common in many fields such as computer vision. SIMD extensions use a dedicated coprocessor that makes possible packing several instructions in one single extended instruction. Applications that require high performance could benefit from the use of SIMD coprocessors, but their reliability needs to be studied. In this paper, NEON, the SIMD coprocessor of ARM microprocessors, has been selected as a case study to explore the behavior of SIMD extensions under radiation. Radiation experiments of ARM CORTEX-A9 microprocessors have been accomplished with the objective of determining how the use of this kind of coprocessor can affect the system reliability

Towards the Composition of Services by End-Users: A Mobile-Based Solution

[EN] Nowadays, we live surrounded by heterogeneous and distributed services that are available to people anytime and anywhere. Even though these services can be used individually, it is through their synchronized and combined usage that end-users are provided with added value. However, existing solutions to service composition are not targeted at ordinary end-users. In fact, these solutions require technical knowledge to deal with the technological heterogeneity in which they are offered to the market. To this end, the paper presents a tool-supported platform that is aided by: (1) EUCalipTool, an end-user mobile tool that implements a Domain Specific Visual Language, which has been specifically designed to compose services on mobile devices; (2) a Faceted Service Registry, which plays the role of gateway between service implementations and end-users, hiding technological issues from the latter when including services in a composition; and (3) a Generation Module, which transforms end-user descriptions into BPMN specification that are interpreted by an execution infrastructure developed for that purpose.This work has been developed with the financial support of the Spanish State Research Agency under the project TIN2017-84094-R and co-financed with ERDF.Valderas, P.; Torres Bosch, MV.; Pelechano Ferragud, V. (2020). Towards the Composition of Services by End-Users: A Mobile-Based Solution. 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A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

This is the final version of the article. Available from Taylor & Francis via the DOI in this record.BACKGROUND: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. OBJECTIVE: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. METHODS: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. RESULTS: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. CONCLUSION: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement.The research leading to these results has received funding from the European Community’s Seventh Framework Programme FP7/2008–2012 under grant agreement no. 223424

Online error detection through trace infrastructure in ARM microprocessors

This paper presents a solution for error detection in ARM microprocessors based on the use of the trace infrastructure. This approach uses the Program and Instrumentation Trace Macrocells that are part of ARM's CoreSight architecture to detect control-flow and data-flow errors, respectively. The proposed approach has been tested with low-energy protons. Experimental results demonstrate high accuracy with up to 95% of observed errors detected in a commercial microprocessor with no hardware modification. In addition, it is shown how the proposed approach can be useful for further analysis and diagnosis of the cause of errors

Clinical Performance of a New Hybrid Contact Lens for Keratoconus

OBJECTIVES: To compare the clinical performance of the Clearkone hybrid contact lens for the treatment of keratoconus against the habitual contact lens of the patients. METHODS: A total of 33 eyes from 18 patients were fitted with the Clearkone. High- and low-contrast visual acuity (HCVA and LCVA), central corneal thickness (CCT), and contrast sensitivity acuity (CSF) were recorded with habitual lenses (prestudy visit) and after 1 week, 15 days, and 1 month of wear of prescribed Clearkone. Subjective vision and comfort were rated using visual analogue scales (VAS). RESULTS: Three patients discontinued the study, one because of diffuse corneal staining after 1 day of use and the other two because of extreme discomfort. The rest of the patients completed the 1-month study. High contrast visual acuity and LCVA (logMAR) improved significantly from 0.16 ± 0.12 and 0.44 ± 0.22, respectively, with the patient's habitual contact lenses to -0.006 ± 0.058 and 0.23 ± 0.13 after 1 day wearing Clearkone, remaining significant during all follow-up visits (P<0.001; repeated measures analysis of variance [RM-ANOVA]). There were no statistically significant differences in the mean CCT. The improvement of CSF was statistically significant with hybrid contact lenses prescribed compared with the patient's habitual contact lenses (P<0.001; RM-ANOVA test). Improvement in VAS score, with prescribed Clearkone, was statistically significant for comfort (P=0.043; RM-ANOVA test), but not for the subjective vision (P=0.759; RM-ANOVA test). CONCLUSIONS: Clearkone provides an improvement in visual acuity, contrast sensitivity, and subjective comfort in patients with keratoconus when compared with other contact lens options. However, clinicians must get specific training to fit the lens and be aware of potential adverse events

Ortoqueratología en hipermetropía: una revisión sistemática

La ortoqueratología (orto-k) nocturna es un tratamiento corneal refractivo que permite compensar la refracción de forma reversible al modificar la curvatura corneal durante la noche. En relación a la hipermetropía existe la necesidad de conocer aún más cómo funciona esta técnica y conocer la evidencia científica al respecto. Esta revisión sistemática muestra el escaso número de artículos publicados hasta la fecha sobre orto-k en hipermetropía, así como la dificultad de poder extrapolar sus resultados a la práctica clínica diaria debido a su corta duración en el tiempo y a los sesgos de selección en la muestra. Aún se debe seguir estudiando sobre el funcionamiento y la eficacia de esta técnica en hipermetropía, así como llevar a cabo estudios con un mayor seguimiento en el tiempo y con un mejor diseño metodológico