Using a knowledge-based approach: the way healthy communities make decisions

The planning for Knowledge Cities faces significant challenges due to the lack of effective information tools. These challenges are magnified while planning healthy communities. The Australian Health Information Council (AHIC) concluded in its last report that health information needs to be shared more effectively (AHIC, 2008). Some research justifies the use of Decision Support Systems (DSS) as an E-planning tool, particularly in the context of healthy communities. However, very limited research has been conducted in this area to date, especially in terms of evaluating the impact of these tools on decision-makers within the health planning practice. The paper presents the methodological instruments which were developed to measure the impact of the E-planning tool (i.e., Health Decision Support System [HDSS])) on a group of health planners, namely, the Logan Beaudesert Health Coalition (LBHC). The paper is focused on the culture in which decisions were made before and after the intervention of the HDSS. Subsequently, the paper presents the observed impact of the HDSS tool, to facilitate a knowledge-based decision-making approach. This study is an attempt to make some contribution to the Knowledge Cities literature in the context of planning healthy communities by adopting E-planning tools

Operating theatre time, where does it all go? A prospective observational study

Objective To assess the accuracy of surgeons and anaesthetists in predicting the time it will take them to complete an operation or procedure and therefore explain some of the difficulties encountered in operating theatre scheduling. Design Single centre, prospective observational study. Setting Plastic, orthopaedic, and general surgical operating theatres at a level 1 trauma centre serving a population of about 370 000. Participants 92 operating theatre staff including surgical consultants, surgical registrars, anaesthetic consultants, and anaesthetic registrars. Intervention Participants were asked how long they thought their procedure would take. These data were compared with actual time data recorded at the end of the case. Primary outcome measure Absolute difference between predicted and actual time. Results General surgeons underestimated the time required for the procedure by 31 minutes (95% confidence interval 7.6 to 54.4), meaning that procedures took, on average, 28.7% longer than predicted. Plastic surgeons underestimated by 5 minutes (−12.4 to 22.4), with procedures taking an average of 4.5% longer than predicted. Orthopaedic surgeons overestimated by 1 minute (−16.4 to 14.0), with procedures taking an average of 1.1% less time than predicted. Anaesthetists underestimated by 35 minutes (21.7 to 48.7), meaning that, on average, procedures took 167.5% longer than they predicted. The four specialty mean time overestimations or underestimations are significantly different from each other (P=0.01). The observed time differences between anaesthetists and both orthopaedic and plastic surgeons are significantly different (P<0.05), but the time difference between anaesthetists and general surgeons is not significantly different. Conclusion The inability of clinicians to predict the necessary time for a procedure is a significant cause of delay in the operating theatre. This study suggests that anaesthetists are the most inaccurate and highlights the potential differences between specialties in what is considered part of the “anaesthesia time.

Peroxisome Proliferator Activated Receptor Ligands as Regulators of Airway Inflammation and Remodelling in Chronic Lung Disease

Inflammation is a major component in the pathology of chronic lung diseases, including asthma. Anti-inflammatory treatment with corticosteroids is not effective in all patients. Thus, new therapeutic options are required to control diverse cellular functions that are currently not optimally targeted by these drugs in order to inhibit inflammation and its sequelae in lung disease. Peroxisome proliferator activated receptors (PPARs), originally characterised as regulators of lipid and glucose metabolism, offer marked potential in this respect. PPARs are expressed in both lung infiltrating and resident immune and inflammatory cells, as well as in resident and structural cells in the lungs, and play critical roles in the regulation of airway inflammation. In vitro, endogenous and synthetic ligands for PPARs regulate expression and release of proinflammatory cytokines and chemoattractants, and cell proliferation and survival. In murine models of allergen-induced inflammation, PPARα and PPARγ ligands reduce the influx of inflammatory cells, cytokine and mucus production, collagen deposition, and airways hyperresponsiveness. The activity profiles of PPAR ligands differ to corticosteroids, supporting the hypothesis that PPARs comprise additional therapeutic targets to mimimise the contribution of inflammation to airway remodelling and dysfunction

Development of cytomegalovirus (CMV) immune recovery uveitis is associated with Th17 cell depletion and poor systemic CMV-specific T cell responses.

Backgroundthe immune reconstitution inflammatory syndromes (IRIS) are a spectrum of inflammatory conditions associated with opportunistic infections and occurring in approximately16% of human immunodeficiency type 1 (HIV-1)-infected patients given antiretroviral therapy. It has been proposed that these conditions are linked by a dysregulated immune system that is prone to exaggerated responses. However, immunologic studies have been limited by the availability of longitudinal samples from patients with IRIS and appropriate matched control subjects. Cytomegalovirus (CMV) immune recovery uveitis (IRU) is an IRIS occurring in up to 38% of patients with CMV retinitis. Although the pathologic immune responses occur in the eye, immune dysregulation that allows for development of pathologic responses is presumably caused by faulty systemic immune cell reconstitution.Methodswe examined CMV-specific T cell responses, regulatory T (T(reg)) cell function and polyclonal T cell responses, including IL-17 production, in 25 patients with CMV IRU and 49 immunorestored control subjects with CMV retinitis who did not develop IRU.Resultspatients with CMV IRU had poor CMV-specific CD4(+) T cell responses, as compared with control subjects, whereas CD8(+) T cell responses were comparable. Patients with CMV IRU were characterized by smaller numbers of circulating Th17 cells. Deficiency in anti-CMV responses was not associated with differences in T(reg) cell function.Conclusionsthe T(reg) cell compartment is intact in patients with CMV IRU, and these patients do not develop exaggerated systemic CMV-specific or polyclonal immune responses. Cases are instead characterized by more profound depletion of Th17 cells and poor antiviral immune responses. CMV IRU may be most likely to develop in persons experiencing the greatest degree of immune dysfunction before initiating highly active antiretroviral therapy

ANALISIS SISTEM DAN PROSEDUR PENGADAAN KEBUTUHAN FARMASI PADA RSUD SULTAN SYARIF MOHAMAD ALKADRIE PONTIANAK

This research aimed to gauge effectiveness of the procurement system and procedures which implemented by Sultan Syarif Mohamad Alkadrie Pontianak Hospital. The applied research method was qualitative method with descriptive research form. Then, the data analysis technic was conducted with Internal Control Questionaires (ICQ) analysis, flowchartand Organizational Structure. The research outcome showed that Sultan Syarif Mohamad Alkadrie Pontianak Hospital entire system and pharmaceutical need procurement procedures were quite effective and implemented well. This could be traced back from Internal Control Questionaires (ICQ) results that indicated 76,77% for answers “Yes” and 22,26% untuk answers “No”. Based on previous analysis, strictly functional responsibility separation was not implemented which caused employee double function. This research showed there were weaknesses in the procurement planning system causing accumulation of medicine in the warehouse. Implementation of online purchasing system (Epurchasing) caused the incomplete document used in procurement procedures due to perceived government institution perception about effectiveness of the system and procedures. Keywords : systems and procedures, analysis, internal control questionnaire

Razor: Mining distance-constrained embedded subtrees

Our work is focused on the task of mining frequent subtrees from a database of rooted ordered labelled subtrees. Previously we have developed an efficient algorithm, MB3 [12], for mining frequent embedded subtrees from a database of rooted labeled and ordered subtrees. The efficiency comes from the utilization of a novel Embedding List representation for Tree Model Guided (TMG) candidate generation. As an extension the IMB3 [13] algorithm introduces the Level of Embedding constraint. In this study we extend our past work by developing an algorithm, Razor, for mining embedded subtrees where the distance of nodes relative to the root of the subtree needs to be considered. This notion of distance constrained embedded tree mining will have important applications in web information systems, conceptual model analysis and more sophisticated ontology matching. Domains representing their knowledge in a tree structured form may require this additional distance information as it commonly indicates the amount of specific knowledge stored about a particular concept within the hierarchy. The structure based approaches for schema matching commonly take the distance among the concept nodes within a sub-structure into account when evaluating the concept similarity across different schemas. We present an encoding strategy to efficiently enumerate candidate subtrees taking the distance of nodes relative to the root of the subtree into account. The algorithm is applied to both synthetic and real-world datasets, and the experimental results demonstrate the correctness and effectiveness of the proposed technique

The Effects of Diegetic and Nondiegetic Music on Viewers’ Interpretations of a Film Scene

Previous studies have shown that pairing a film excerpt with different musical soundtracks can change the audience’s interpretation of the scene. This study examined the effects of mixing the same piece of music at different levels of loudness in a film soundtrack to suggest diegetic music (“source music,” presented as if arising from within the fictional world of the film characters) or to suggest nondiegetic music (a “dramatic score” accompanying the scene but not originating from within the fictional world). Adjusting the level of loudness significantly altered viewers’ perceptions of many elements that are fundamental to the storyline, including inferences about the relationship, intentions, and emotions of the film characters, their romantic interest toward each other, and the overall perceived tension of the scene. Surprisingly, varying the loudness (and resulting timbre) of the same piece of music produced greater differences in viewers’ interpretations of the film scene and characters than switching to a different music track. This finding is of theoretical and practical interest as changes in loudness and timbre are among the primary post-production modifications sound editors make to differentiate “source music” from “dramatic score” in motion pictures, and the effects on viewers have rarely been empirically investigated