Practical Guidelines For Implementation Research Articles

Home telehealth—Current state and future trends

The purpose of this paper is to give an overview about the state of the art in research on home telehealth in an international perspective. The study is based on a review of the scientific literature published between 1990 and 2003 and retrieved via Medline in January/February 2004. All together, the abstracts of 578 publications have been analyzed. The majority of publications (44%) comes from the United States, followed by UK and Japan. Most publications deal with vital sign parameter (VSP) measurement and audio/video consultations ("virtual visits"). Publications about IT tools for improved information access and communication as well as decision support for staff, patients and relatives are relatively sparse. Clinical application domains are mainly chronic diseases, the elderly population and paediatrics. Internationally, we observe a trend towards tools and services not only for professionals but also for patients and citizens. However, their impact on the patient-provider relationship and their design for special user groups, such as elderly and/or disabled needs to be further explored. In general, evaluation studies are rare and further research is critical to determine the impacts and benefits, and limitations, of potential solutions and to overcome a number of hinders and restrictions, such as - the lack of standards to combine incompatible information systems; - the lack of an evaluation framework considering legal, ethical, organisational, clinical, usability and technical aspects; - the lack of proper guidelines for practical implementation of home telehealth solutions.

Calibrated interpolated confidence intervals for population quantiles

Beran & Hall's (1993) simple linear interpolation provides a very convenient approach for constructing nonparametric confidence intervals for population quantiles based on a random sample of size n. We show that the coverage error of the interpolated interval, which is of order O(n -1 ), can be improved upon by calibrating the nominal coverage level. Three distinct methods of calibration are considered. The analytical and Monte Carlo methods succeed in reducing the order of coverage error to O(n -3/2 ), while the smoothed bootstrap method reduces it further to O(n -25/14 ). We provide guidelines for practical implementation of the calibration methods. Their performance is compared with the simple linear interpolated interval in a simulation study which confirms superiority of the calibrated intervals.

The W5, how and what next of BMS specimen dissection

Following a period of debate and successful pilot study the Royal College of Pathologists and Institute of Biomedical Science have formally approved the participation of Biomedical Scientists (BMSs) in histopathological specimen dissection. Practical guidelines for implementation and recommendations for audit and assessment have been given. Such extended roles highlight changing job boundaries within the National Health Service and the progressive move towards multi-professional team working in pathology services. This paper summarizes the journey, current status and future challenges of BMS specimen dissection.

Women's health education initiatives: why have they stalled?

Since the U.S. Congress first requested an assessment of women's health content in medical school curricula ten years ago, surveys indicate at least a two-fold increase in the number of schools with a women's health curriculum and no change in the number that offer a women's health clinical elective or rotation. Despite a marked increase in the number of schools with an office or program responsible for integration of women's health and gender-specific content into curricula, change has been modest. Reasons for this slow progress include uncertainty about the domain of women's health and what should be included in a curriculum, a lack of practical guidelines for implementation, and institutional resistance to change. The dominant factors that will influence future curriculum development are the increasing scientific knowledge base on sex and gender differences and the emerging scientific field of sex-based biology, both of which have potential to benefit the health of women. Evidence-based data on significant sex and gender differences will provide compelling reasons for schools to integrate this information into curricula, and new educational initiatives must further develop educational models to help implement change. As women's health becomes synonymous with the term "sex and gender differences," the challenge to schools is to address equally in their curricula those unique aspects of women's health that were part of the original intent of the congressional mandate.

Experiences from Implementation and Evaluation of Event Processing and Distribution of Notifications in an Object Monitoring Service

Organization of events processing and distribution of notifications is a key issue for performance of software monitoring and management systems, particularly for reducing the execution-time overheads they incur. This paper provides practical guidelines for design and implementation of event report generation and dissemination frameworks, based on experiences from implementation, configuration and evaluation of Melita On-line Object Monitoring Service (MOOMS): an on-line monitoring service for distributed object-oriented applications. As MOOMS is in many aspects similar to the Java Management Extensions (JMX) framework, the presented evaluation may shed some light on how this class of object services may be developed and used with efficiency in mind.

Four-quadrant and zero-speed sensorless control of a switched reluctance motor

A four-quadrant sensorless controller for switched reluctance motor (SRM) drives is presented in this paper. The drive system with appropriate turn-on and turn-off angles for each operating quadrant delivers excellent dynamic performance over a wide speed range including zero speed. The problems associated with practical implementation especially at low and zero speeds have been addressed and overcome with engineering solutions. Experimental results for a 1-kW SRM obtained on a dSPACE-based system are presented along with useful guidelines for practical implementation.

Prescreening, In‐Depth Exploration, and Choice: From Decision Theory to Career Counseling Practice

The authors present a 3‐stage model—Prescreening, In‐depth exploration, and Choice (PIC)—aimed at increasing the quality of the career decision‐making process and its outcome. PIC provides a framework for a dynamic and interactive process that emphasizes the role of career counselors as decision counselors, whose aim is to facilitate an active decision‐making process. The proposed model offers the advantages of systematic, analytical processing, while remaining compatible with individuals' natural way of thinking. The authors outline the implementation of PIC, discuss the role of intuition in decision making, and compare the PIC with the person‐environment fit approach.

Intensive diabetes management in pediatric patients.

Intensive diabetes management requires frequent home glucose monitoring, multiple daily insulin injections or chronic subcutaneous insulin infusion, and adjustments of insulin doses in response to changes in blood glucose levels, food intake, and exercise. It also requires a periodic review of previous glucose results to recognize patterns of hyper- or hypoglycemia. The goals of intensive management are age dependent. In young children, avoidance of severe hypoglycemia is the major goal. In older children and adolescents, lowering hemoglobin A(1c) becomes an increasingly important goal. In children of all ages, the ability to have a flexible lifestyle and meal plan is often a priority. This article provides a brief overview of the rationale for implementing intensive diabetes management in pediatric patients, and practical guidelines for implementation.

Issues in quality engineering research

The field of quality has undergone significant changes as reflected by changes in its definition, paradigms, approaches, techniques, and scope of application. This paper reviews emerging trends and issues focusing on quality engineering. Changes in customer expectation have driven the changes in the technology of design and manufacturing, which is becoming more important in satisfying individual customer expectations. This also calls for special attention to the engineering aspects of quality. Brief reviews on recent advances in the prominent quality tools such as statistical process control, quality function deployment, and design of experiment are reported. General trends in quality engineering research show the tools are being enhanced, integrated, computerized and broaden their application bases, where possible opportunities for further investigation are indicated. Among others these include contributions in multiple‐response optimization, intelligent quality systems, multivariate SPC, and practical and simple guidelines for actual implementation of various tools.

Convergent and divergent technological and market strategies for global leadership

This paper analyses the technological and market strategies of eight technology-intensive companies (5 American, 2 Japanese, I European) that have achieved global leadership through strategic focus. Both technological and market strategies are divided into two broad categories: (1) convergent; (2) divergent. Therefore, four strategy clusters could occur. A convergent technology strategy is defined as the development and synergistic integration of all technologies necessary to achieve worldwide leadership for a new product. A typical example is the first laptop computer by Toshiba. A divergent technological strategy is defined as the development of alternative technologies, related or unrelated, that will assure leadership in a given market. A typical example is General Electric Medical Systems. A convergent market strategy is defined as the utilisation of all marketing efforts to gain worldwide leadership in a specific market segment, as for example General Electric Medical Systems. Finally, a divergent market strategy is defined as targeting a broad spectrum of customers across many industries, with a great variety of diverse applications. A typical example is the Toray Company of Japan which has achieved worldwide leadership in the application of carbon fibres. The paper discusses the characteristics of the four strategy clusters, their applicability on a contingency basis, and their impact on corporate strategy and organisation. Guidelines for practical implementation are offered, which appear to be applicable within the triad of North America, Western Europe and Japan.

Recent developments in finite element methods for structural acoustics

The study of structural acoustics involves modeling acoustic radiation and scattering, primarily in exterior regions, coupled with elastic and structural wave propagation. This paper reviews recent progress in finite element analysis that renders computation a practical tool for solving problems of structural acoustics. The cost-effectiveness of finite element methods is composed of several ingredients. Boundary-value problems in unbounded domains are inappropriate for direct discretization. Employing DtN methodology yields an equivalent problem that is suitable for finite element analysis by posing impedance relations at an artificial exterior boundary. Vell-posedness of the resulting continuous formulations is discussed, leading to simple guidelines for practical implementation and verifying that DtN boundary conditions provide a suitable basis for computation. Approximation by Galerkin finite element methods results in spurious dispersion, degrading with reduced wave resolution. Accuracy is improved by Galerkin/least-squares and related technologies on the basis of detailed examinations of discrete errors in simplified settings, relaxing wave-resolution requirements. This methodology is applied to time-harmonic problems of acoustics and coupled problems of structural acoustics. Space-time finite methods based on time-discontinuous Galerkin/least-squares are derived for transient problems of structural acoustics. Numerical results validate the superior performance of Galerkin/least-squares finite elements for problems of structural acoustics. A comparative study of the cost of computation demonstrates that Galerkon/least-squares finite element methods are economically competitive with boundary element methods, the prevailing numerical approach to exterior problems of acoustics. Efficient iterative methods are derived for solving the large-scale matrix problems that arise in structural acoustics computation of realistics configuration at high wavenumbers. An a posteriori error estimator and adaptive strategy are developed for time-harmonic acoustic problems and the role of adaptivity in reducing the cost of computation is addressed.

A K-step look-ahead analysis of value iteration algorithms for Markov decision processes

We introduce and analyze a general look-ahead approach for Value Iteration Algorithms used in solving both discounted and undiscounted Markov decision processes. This approach, based on the value-oriented concept interwoven with multiple adaptive relaxation factors, leads to accelerating procedures which perform better than the separate use of either the concept of value oriented or of relaxation. Evaluation and computational considerations of this method are discussed, practical guidelines for implementation are suggested and the suitability of enhancing the method by incorporating Phase 0, Action Elimination procedures and Parallel Processing is indicated. The method was successfully applied to several real problems. We present some numerical results which support the superiority of the developed approach, particularly for undiscounted cases, over other Value Iteration variants.

Friction-Term Response to Boundary-Condition Type in Flow Models

The friction-slope term in the unsteady open-channel flow equations is examined using two numerical models based on different formulations of the governing equations and employing different solution methods. The purposes of the study are to analyze, evaluate, and demonstrate the behavior of the term in a set of controlled numerical experiments using varied types and combinations of boundary conditions. Results of numerical experiments illustrate that a given model can respond inconsistently for the identical resistance-coefficient value under different types and combinations of boundary conditions. Findings also demonstrate that two models employing different dependent variables and solution methods can respond similarly for the identical resistance-coefficient value under similar types and combinations of boundary conditions. Discussion of qualitative considerations and quantitative experimental results provides insight into the proper treatment, evaluation, and significance of the friction-slope term, thereby offering practical guidelines for model implementation and calibration.

The Challenges of Management Development in Sub‐Saharan Africa

The management development specialist, local or international, must understand Africa′s historical background in order to contribute effectively to the continent′s current management development needs. Important elements of management development in pre‐colonial Africa, from which lessons can be learned for present and future management development programmes, are outlined. The impact of the colonial period on institutional and management development, and the need to draw on local resources and indigenous knowledge systems for designing and implementing these programmes, is discussed. The institutional infrastructure commonly used for management development in Africa is outlined and the objectives, challenges and opportunities of national and regional institutes are discussed. Finally, practical guidelines for solicitation, design, implementation, and evaluation of management development programmes in Africa are provided.

Digital Synthesis of Self-Modifying Waveforms by Means of Linear Automata

Linear Automata Synthesis (LASy) is a new sound synthesis technique that uses cellular automata as models for the evolution of the synthesized sound. The technique has two positive characteristics: simplicity of the computational algorithm (realtime synthesis is possible using a common microprocessor); and the wealth of musical results that can be achieved. The LASy technique allows the creation of a large range of timbres, from simple tones (e.g., the Karplus-Strong plucked string algorithm may be simulated by some automata) to very complex ones. Due to the computational properties of the algorithm, the generation of a large family of sounds presents a unique character not found in classical synthesis techniques. This article gives some guidelines for practical implementation and musical applications of the LASy algorithm. The drawbacks of the LASy technique are examined too, along with some methods to avoid them. Elements for the analysis of the synthesis algorithm are given in Appendix 1.