The Long Road to Software Process Improvement: A Chronology of One Company\u27s Efforts

In late November 1996, AA Company (AAC) formed a \u27methodology team\u27 that began looking at ways to improve the company\u27s development environment. Currently (circa February 2000), AAC is following a plan for improvement based on the Capability Maturity Model (CMM). AAC\u27s initial effort to use CMM as a software process improvement (SPI) framework was somewhat flawed and, as a result, AAC has invested more than three years on the process; they still have a long way to go. This paper chronicles the route taken by AAC in their quest to improve software development and highlights some of the triumphs and traps along the way

Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study

© 2016 Wade et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal. Methods Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model. Results 19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of practice. Conclusions The implementation of home telehealth services is still in an early stage. Change agents and a community of practice can contribute by marketing telehealth, demonstrating policy alignment and providing potential solutions for difficult health services problems. This should assist health leaders to move from trials to large-scale services

Building an Architectural Component Model for a Telehealth Service

Copyright © 2015 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY).Models of services, processes and technology are useful tools for conceptualizing complex systems such as healthcare. The application of a component architecture helps illustrate the processes and technologies that are important to the operation of a health service and conceptualize the relationships between each component. Telehealth services are relatively recent and have characteristics that do not fit neatly into established models of health services. This paper analyzes the components used to build a telehealth in the home service in South Australia and the design choices that were taken. The service used commodity-based devices and systems to deliver simple to use, low-cost in the home care. Building on this analysis, the components required in an architectural component model of a telehealth service are identified enabling a provisional architecture for telehealth services to be derived from an existing internationally recognized architectural model for eHealth systems. Situated within the broad family of eHealth architectures, a Telehealth Architectural Model of telehealth processes, software, devices, common systems and ICT infrastructure is proposed that represents the components required to support telehealth and allows for customization of services according to clinical models of care

Can Video Conferencing Be as Easy as Telephoning?-A Home Healthcare Case Study

Copyright © 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY).In comparison with almost universal adoption of telephony and mobile technologies in modern day healthcare, video conferencing has yet to become a ubiquitous clinical tool. Currently telehealth services are faced with a bewildering range of video conferencing software and hardware choices. This paper provides a case study in the selection of video conferencing services by the Flinders University Telehealth in the Home trial (FTH Trial) to support healthcare in the home. Using pragmatic methods, video conferencing solutions available on the market were assessed for usability, reliability, cost, compatibility, interoperability, performance and privacy considerations. The process of elimination through which the eventual solution was chosen, the selection criteria used for each requirement and the corresponding results are described. The resulting product set, although functional, had restricted ability to directly connect with systems used by healthcare providers elsewhere in the system. This outcome illustrates the impact on one small telehealth provider of the broader struggles between competing video conferencing vendors. At stake is the ability to communicate between healthcare organizations and provide public access to healthcare. Comparison of the current state of the video conferencing market place with the evolution of the telephony system reveals that video conferencing still has a long way to go before it can be considered as easy to use as the telephone. Health organizations that are concerned to improve access and quality of care should seek to influence greater standardization and interoperability though cooperation with one another, the private sector, international organizations and by encouraging governments to play a more active role in this sphere

Epistemic vice and motivation

This article argues that intellectual character vices involve non-instrumental motives to oppose, antagonise, or avoid things that are epistemically good in themselves. This view has been the recent target of criticism based on alleged counterexamples presenting epistemically vicious individuals who are virtuously motivated or at least lack suitable epistemically bad motivations. The paper first presents these examples and shows that they do not undermine the motivational approach. Finally, having distinguished motivating from explanatory reasons for belief and action, it argues that our epistemic practice of vice attribution supplies evidence in favour of motivational accounts of vice

Death receptor 3 regulates distinct pathological attributes of acute versus chronic murine allergic lung inflammation

The Death Receptor 3 (DR3)/Tumour Necrosis Factor-like cytokine 1A (TL1A) axis stimulates effector T cells and type 2 innate lymphocytes (ILC2) that trigger cytokine release and drive disease pathology in several inflammatory and autoimmune diseases, including murine models of acute allergic lung inflammation (ALI). The aim of this study was to elucidate the role of DR3 in chronic ALI compared to acute ALI, using mice genetically deficient in the DR3 gene (DR3ko). Results showed DR3 expression in the lungs of wild-type mice was up-regulated following induction of acute ALI and this increased expression was maintained in chronic disease. DR3ko mice were resistant to cellular accumulation within the alveolar passages in acute, but not chronic ALI. However, DR3ko mice displayed reduced immuno-histopathology and goblet cell hyperplasia; hallmarks of the asthmatic phenotype; in chronic, but not acute ALI. These data suggest DR3 is a potential therapeutic target, involved in temporally distinct aspects of ALI progression and pathogenesis

ATM Mutations and Phenotypes in Ataxia-Telangiectasia Families in the British Isles: Expression of Mutant ATM and the Risk of Leukemia, Lymphoma, and Breast Cancer

SummaryWe report the spectrum of 59 ATM mutations observed in ataxia-telangiectasia (A-T) patients in the British Isles. Of 51 ATM mutations identified in families native to the British Isles, 11 were founder mutations, and 2 of these 11 conferred a milder clinical phenotype with respect to both cerebellar degeneration and cellular features. We report, in two A-T families, an ATM mutation (7271T→G) that may be associated with an increased risk of breast cancer in both homozygotes and heterozygotes (relative risk 12.7; P=.0025), although there is a less severe A-T phenotype in terms of the degree of cerebellar degeneration. This mutation (7271T→G) also allows expression of full-length ATM protein at a level comparable with that in unaffected individuals. In addition, we have studied 18 A-T patients, in 15 families, who developed leukemia, lymphoma, preleukemic T-cell proliferation, or Hodgkin lymphoma, mostly in childhood. A wide variety of ATM mutation types, including missense mutations and in-frame deletions, were seen in these patients. We also show that 25% of all A-T patients carried in-frame deletions or missense mutations, many of which were also associated with expression of mutant ATM protein