Partnering with physicians to achieve quality improvement

BACKGROUND: The Maine Medical Assessment Foundation (MMAF) has successfully involved hundreds of Maine physicians in study groups to analyze data on small-area variation and assess physician decision-making patterns. In 1991 the MMAF model was replicated across a tri-state area (Maine, New Hampshire, Vermont) in an effort called the Outcomes Dissemination Project, which is funded by a five-year grant from the U.S. Agency for Health Care Policy and Research. THE OUTCOMES DISSEMINATION PROJECT: Five specialty study groups, each meeting three times a year, examine local and national utilization data, examine guidelines and research findings, participate in outcomes studies and patient education, and disseminate their findings through specialty society presentations and other feedback efforts. The MMAF study group process is based on the beliefs that medicine is a subculture with a complex set of professional values, beliefs, socialization processes, and norms, and that quality improvement efforts work best when they are nonpunitive and educational. ISSUES IN OBTAINING PHYSICIAN INVOLVEMENT: (1) Physicians are willing to change their practices if they are brought into a culturally appropriate improvement program. (2) Related specialties (for example, internists and family practitioners) can often work together effectively on issues of common interest. (3) Involving respected clinical leaders has helped establish the legitimacy of MMAF methods among physicians. (4) Area- and physician-specific data are not made public, so as to build a sense of confidentiality among participants. CONCLUSIONS: The project continues to function as a powerful education process and serves as a model for replication elsewhere.     

Mobile Network Evolution – “The Return of the Pipe”

The mobile network evolution from second generation to third generation systems has opened possibilities for inclusion of new technologies both in the network infrastructure as well as on the radio access. Within this paper, we concentrate on the evolution of the network infrastructure towards a future mobile network that balances the demand for increased flexibility with the necessity of limiting system complexity. Based on existing architectures, to lower complexity such as layered architecture for the core network and mobile packet backbone, we describe one possible evolution path for the control layer. Our approach is a step towards a control space that includes packetpipe control functions for a multitude of packetpipes. Such control function needs to be supported in the heterogeneous networks of today and the future.     

Modelling biological processes under anaerobic conditions through integrating titrimetric and off-gas measurements-applied to EBPR systems.

An innovative method for modelling biological processes under anaerobic conditions is presented and discussed. The method is based on titrimetric and off-gas measurements. Titrimetric data is recorded as the addition rate of hydroxyl ions or protons that is required to maintain pH in a bioreactor at a constant level. An off-gas analysis arrangement measures, among other things, the transfer rate of carbon dioxide. The integration of these signals results in a continuous signal which is solely related to the biological reactions. When coupled with a mathematical model of the biological reactions, the signal allows a detailed characterisation of these reactions, which would otherwise be difficult to achieve. Two applications of the method to the enhanced biological phosphorus removal processes are presented and discussed to demonstrate the principle and effectiveness of the method.     

Pathogen removal efficiency from UASB + BF effluent using conventional and UV post-treatment systems.

The aim of this study was to verify the efficiency of removal of microorganisms in effluents of a Wastewater Treatment Plant (WWTP) comprising an association of a UASB reactor followed by three submerged aerated biofilters (BAF) and one tertiary filter. The WWTP designed to treat domestic wastewater from a population of 1,000 inhabitants showed high removal efficiency for organic matter and suspended solids. Helminth eggs were also efficiently removed from the tertiary effluent and were found in the sludge from the UASB reactor; however, removal of bacteria in this system was very low. To enhance the efficiency of the system, the effluent from tertiary filters was submitted to UV disinfection in a real scale reactor. Our results showed that UV irradiation was very effective at lowering the concentrations of E. coli, thermotolerant coliforms and coliphages to acceptable levels for agricultural reuse. Salmonella spp. and helminth eggs were seeded into the tertiary effluent before passing through the UV reactor. Salmonella was not found in the final effluent, but helminth eggs were not completely inactivated by UV irradiation and viable eggs were detected after 28 d of incubation.     

The Wetting of Calcite Surfaces

Three established methods for deriving the surface energetic parameters for calcite were studied. These are based on the contact angle in air using various wetting liquids, and submerged systems in water and in alkanes. Two variations of these methods that require less elaborate experimental procedures were also explored. Although the results of these methods were not entirely in agreement, several interesting observations emerged. The contact angles of water on the heated and alkylketene-dimer-(AKD)-treated calcite samples were higher than the untreated sample, and were observed to decrease with time. These results strongly suggest that these treatments alter the calcite surface to reduce its stability toward water. The work of adhesion determined in alkanes and water suggests that water interacts so strongly with calcite that it cannot be displaced by alkanes. This conclusion is reinforced by the results obtained using the more recent theory of adhesion of van Oss and Good which emphasizes the acid-base contribution of the surface and interacting liquid adhesion. These energy parameters were also determined for the calcite-water system.     

Textures on Rank‐1 Lattices

Storing textures on orthogonal tensor product lattices is predominant in computer graphics, although it is known that their sampling efficiency is not optimal. In two dimensions, the hexagonal lattice provides the maximum sampling efficiency. However, handling these lattices is difficult, because they are not able to tile an arbitrary rectangular region and have an irrational basis. By storing textures on rank‐1 lattices, we resolve both problems: Rank‐1 lattices can closely approximate hexagonal lattices, while all coordinates of the lattice points remain integer. At identical memory footprint texture quality is improved as compared to traditional orthogonal tensor product lattices due to the higher sampling efficiency. We introduce the basic theory of rank‐1 lattice textures and present an algorithmic framework which easily can be integrated into existing off‐line and real‐time rendering systems.     

Efficient high order matching

We present a computational approach to high-order matching of data sets in IR(d). Those are matchings based on data affinity measures that score the matching of more than two pairs of points at a time. High-order affinities are represented by tensors and the matching is then given by a rank-one approximation of the affinity tensor and a corresponding discretization. Our approach is rigorously justified by extending Zass and Shashua's hypergraph matching to high-order spectral matching. This paves the way for a computationally efficient dual-marginalization spectral matching scheme. We also show that, based on the spectral properties of random matrices, affinity tensors can be randomly sparsified while retaining the matching accuracy. Our contributions are experimentally validated by applying them to synthetic as well as real data sets.     

Relational mountain (density) clustering method and web log analysis

The mountain clustering method and the subtractive clustering method are useful methods for finding cluster centers based on local density in object data. These methods have been extended to shell clustering. In this article, we propose a relational mountain clustering method (RMCM), which produces a set of (proto) typical objects as well as a crisp partition of the objects generating the relation, using a new concept that we call relational density. We exemplify RMCM by clustering several relational data sets that come from object data. Finally, RMCM is applied to web log analysis, where it produces useful user profiles from web log data. © 2005 Wiley Periodicals, Inc. Int J Int Syst 20: 375–392, 2005.     

Noise peaks influence communication in the operating room. An observational study

Noise peaks are powerful distractors. This study focuses on the impact of noise peaks on surgical teams’ communication during 109 long abdominal surgeries. We related measured noise peaks during 5-min intervals to the amount of observed communication during the same interval. Results show that noise peaks are associated with less case-relevant communication; this effect is moderated by the level of surgical experience; case-relevant communications decrease under high noise peak conditions among junior, but not among senior surgeons. However, case-irrelevant communication did not decrease under high noise level conditions, rather there was a trend to more case-irrelevant communication under high noise peaks. The results support the hypothesis that noise peaks impair communication because they draw on attentional resources rather than impairing understanding of communication. As case-relevant communication is important for surgical performance, exposure to high noise peaks in the OR should be minimised especially for less experienced surgeons.

Practitioner Summary: This study investigated whether noise during surgeries influenced the communication within surgical teams. During abdominal surgeries, noise levels were measured and communication was observed. Results showed that high noise peaks reduced the frequency of patient-related communication, but did not reduce patient-irrelevant communication. Noise may negatively affect team coordination in surgeries.