Read Back Research Articles

Accelerating Health System Change and Transformation with the Health System Transformation Playbook: A Work Shop for Practitioners

Introduction: Health systems are complex adaptive systems (CAS) operating within larger socioeconomic contexts. Health system transformation (HST) is a complex endeavour that often results in unintended consequences. Existing methods to drive health system transformation is slow, have intrinsic limitations, and may impede successful implementation in local contexts.
 Yishun Health is a small regional population health system of 320,000 people. In our HST experience, services redesign and transformation projects were initiated continuously through time with transformation actions interacting across all health system sub-systems e.g. governance, manpower, financing, informatics systems, etc. Ensuring synergistic and coherent transformation into a more people-centred, integrated and value-driven health system at scale was extremely challenging.
 We designed a Health System Transformation Playbook (HSTP) as a design-, systems-, and complexity-thinking enabled methodology to systematically design, prioritize and test health system and services transformation actions, anchored on a three-step (1) iterative story-telling, (2) model building and (3) pathfinding process that tackles the scale of socially and technologically complex adaptive systems through time.
 It is hypothesized that the use of HSTP enables stewards of health systems to gain a more systematic and coherent understanding of health systems services planning and organization development, so as to accelerate transformation towards people-centred, integrated and value-driven health systems.
 Workshop: Our experience suggested that any HST method with the hope of accelerating whole system change must address the need to train and gather numerous stakeholders as co-designers, it must enable a continual series of innovations that remain synergistic despite their introduction at different time points and into different sub-systems of a CAS, and it must guard against incremental-only innovations, premature convergence and lock-in into HST paths that are less transformative or with potential negative effects.
 We hope to engage with health system leaders, designers, organization development and change management practitioners across the world through a facilitated workshop that encourages participant sharing and group discussion on how we lead and accelerate HST in our own organizational and cultural contexts. The session aims to co-create new knowledge on HST methodologies that can accelerate whole health systems change and transformation.
 
 Outline of Workshop (90 minutes) 
 
 Introduction to Health System Transformation (5min)
 Presentation on Health System Transformation Playbook (15min)
 Table Discussions (25min):
 
 - Group Story Telling: Each participant to share own experiences in leading and facilitating large scale or whole health systems change and transformation. Highlight valuable lessons, especially what didn’t work, counter-intuitive results and reasons.
 - Pathfinding: Generate questions or recommendations for accelerating HST. 
 
 Table Read Back & Facilitated Q&A (25min)
 Invitation to Share Personal Takeaways (15min)
 Closing (5min)
 
 Facilitators: A/Prof Ng Yeuk Fan & Dr Teo Ken Wah

Thinking with the Nation: "National" Literatures at the Cusp

Thinking with the Nation"National" Literatures at the Cusp Sukanya Banerjee (bio) Critical discussions of the nineteenth-century nation tend to be anachronistic inasmuch as we retrofit contemporary notions of the nation into nineteenth-century politico-cultural formations. One can be forgiven for this anachronistic move because nineteenth-century literary and cultural history bears ample evidence of the singularity with which the spirit of nationalism imbued itself in and through aesthetic and cultural practices, be it in Romantic imaginings or the literary artifact of the Victorian novel. However, it is worth noting that the object of nationalism—the nation—remained considerably opaque throughout the century. Incidentally, while the French Revolution is widely understood to mark the point at which state power begins to affix itself to national sentiment, the sovereign nation-state was hardly a ubiquitous phenomenon until about the mid-twentieth century.1 But it is also the case that the nation itself was quite amorphous over the course of the nineteenth century. Even as Walter Bagehot authored a definitive treatise on what is a key instrument of nationhood, the constitution (in this case, the English constitution), he also mused: "But what are nations?"2 The opacity of the nation arose not so much from its mutability (changing borders) but from the uncertainty regarding its organizing logic. What was the coherent element around which a community imagined itself? Was it language? Was it race? How much could one put store in territoriality, which, after all, could shift? As twenty-first century readers and scholars, we are all too familiar with the artifice of the nation, the fact of its constructedness. But so were thinkers in the nineteenth [End Page 84] century. What does it mean, then, to read this contingency back into the nineteenth century, when nations were are at various stages of making, nonmaking, and unmaking? How does such a chronologically apposite view impinge upon our otherwise unitary understanding of "national literature" or "national tradition" that a post–Second World War critical and political legacy has bequeathed us? How might revisiting the nation in the late nineteenth century, at the cusp, in fact, between the nineteenth and twentieth centuries, reorient our thinking about the nation and the critical frameworks that it might generate? In addressing these questions, I want to consider analytical frameworks that might be apropos to the late nineteenth and early twentieth centuries given that this was a period that came in the wake of the Italian Risorgimento and German unification but also witnessed an upsurge in anticolonial agitation as well as colonial nationalisms that understood sovereignty and affiliation as nested, layered, and dispersed.3 The idea of the nation was very much in the air in Britain, too, where national sovereignty had been continually negotiated through franchise reform (the latest installment in 1882) and national identity found expression in patriotic jingoism attending the Boer wars. But the British nation was also inextricable from its empire, and if, as Hedinger and Hee point out, the tendency of "transnational history" is to "nationalize empires," such that "imperial history is read as the history of a nation-state beyond its borders,"4 then it is worth noting the inadequacy of the transnational as an analytical template in this context, not least because of the impossibility of reading the British nation as a discrete formation. In trying to read the late nineteenth- and early twentieth-century nation and the literatures and traditions that gathered under its rubric, it might be productive, instead, to consider theories of nation extant in the nineteenth century, which is to say, to read through the nineteenth century and with the Victorians—widely understood—rather than retrospectively superimpose our late twentieth- and twenty-first-century critical frameworks upon them. At one level, then, I am making a temporal argument about our reading of the nation, suggesting that while we tend to read back into the nineteenth- and early twentieth-century nation and its literatures and cultures, we should focus instead on the nineteenth century and use that as a basis for reading [End Page 85] forward. Evidently, the famed temporal paradoxes of the nation inflect our reading habits, as well. But why focus on the...

Is It Too Late? A Theology of Ecology

Is It Too Late? A Theology of Ecology

Topology optimization of a heat-assisted magnetic recording write head to reduce transition curvature using a binary optimization algorithm utilizing the adjoint method

In this work, the possibility to reduce transition curvature in heat-assisted magnetic recording, using a conventional write head design, by shaping the recording field to counteract the circular profile of the heat pulse is investigated. Topology optimization of the head tip is performed in order to create the desired cross-track field profile for increasing distances from the write head tip. For the topology optimization, the adjoint method is utilized to calculate the necessary gradients and a binary optimization scheme is proposed. The optimizations are performed considering linearized material parameters reducing the computational complexity and the results are compared to optimizations incorporating the full non-linear material behavior. The optimized field profiles are evaluated for their influence on the read-back process. To do so, switching probability phase diagrams are calculated and the curvature parameter, the signal to noise ratio and the channel bit density are extracted. The presented results show that while transition curvature can be reduced by shaping the cross-track profile of the write field, this alone does not consequently lead to an improvement of the read back process. Therefore, completely new head designs, considering additional parameters have to be investigated.

The neurodevelopmental basis of schizophrenia: clinical clues from craniofacial dysmorphology in northwest Ethiopia, 2020

BackgroundThe neurodevelopmental speculation of schizophrenia states that the pathogenesis of schizophrenia starts with early fetal or neonatal neurocraniofacial development rather than youthful adulthood when manic signs and symptoms are evident. However, there is no direct evidence of a pre-or peri-natal lesion associated with schizophrenia, rather indirect evidence of impaired development can be seen in macroscopic anatomical variations as well as microscopic immunohistochemical anomalies. One approach to studying neurodevelopmental disturbances among schizophrenic patients is somatic physical evidence or neurodevelopmental markers. Thus Our study aimed to assess the neurodevelopmental basis of schizophrenia clinical clues from anthropometric assessment of craniofacial dysmorphology among schizophrenic patients in North West Ethiopia 2019–2020.MethodInstitutional-based comparative cross-sectional study design was conducted in Debre Markos comprehensive specialized hospitals in 190 schizophrenic patients, 190 1st-degree relatives, and 190 healthy controls. Data were collected using standard methods, entered into EpiData version 3.1, and exports to SPSS version 24 for analysis. Descriptive data were analyzed using descriptive statistics. Welch ANOVA and post hoc comparison, a Games-Howell test, were conducted. Significance was set at a p-value of α = 0.05. Read back analysis was also conducted for the conclusion.ResultsFive hundred seventy study samples, male 375(65.8%), and female 195 (34.2%), were included in this study. The Games-Howell test revealed that the coronal arc length and sagittal arc length among schizophrenic patients were statistically significantly longer than the healthy controls (p < 0.006; p < 0.001, respectively). However, the difference between schizophrenic and healthy control regarding head circumference was marginally significant (p = 0.056). Schizophrenic patients had a significantly shorter total facial height (p < 0.001) and upper facial height (p < 0.001) than healthy controls. Regarding facial depth, schizophrenic patients had significantly shallow upper facial depth (p < 0.001), middle facial depth (p = 0.046), and lower facial depth (p < 0.001).Conclusionour finding indicated indirect evidence for disturbed craniofacial development in schizophrenia patients, and close and read back analysis of the result supported the neurodevelopmental basis of disease.

The Effect of Survey, Connection, Read, Outline and Look Back (SCROL) Strategy to Increase Students’ Reading Comprehension of Descriptive Text in Tenth Grade of MAN 1 Takengon

The purpose of this research is: “To know whether Survey, Connection, Read, Outline and Look Back (SCROL) strategy significantly affect to increase students’ reading comprehension of descriptive at tenth grade of MAN 1 Takengon”. The method used in this research is quantitative research with an experiment approach. For collecting data are using observation and test. The population in this research is the tenth grade students of MAN 1 Takengon with total number 221 students. Sample used in this research is X Scince2 class as the experimental class and the control class X Science1. Both of the class consist of 20 students. The result of this research based on calculation of t-test, where the value of tscore 3,8 is higher than ttable 1,9 at the level significance 0,05. It shows that the hypothesis (Ha) is accepted and the research hypothesis (Ho) is rejected. Based on the results, for suggestion teacher can apply this method in teaching reading and using appropriate technique in teaching and the learning process.

Liability for embryo mix-ups in fertility practices in the USA.

To study recent legal cases involving the transfer of the incorrect embryo into patients and learn how fertility clinics can better serve clients, protect themselves financially, and safeguard their physicians' personal assets. The Nexis Uni database was used to review legal cases, news, and business publications of previous cases of embryo mix-ups. County and district courthouse dockets were also queried for filings and court documents related to lawsuits involving embryo mix-ups using Public Access to Court Electronic Records (PACER). Emphasis was placed on court decisions, awarded damages, and legal and media coverage related to embryo mix-up events. A case law review of US legal databases and courthouse dockets was conducted for cases between 2000 and 2020, focusing on lawsuits against reproductive endocrinologists and in vitro fertilization (IVF) facilities offering embryo transfer (ET). Improper labeling and ineffective communication led to errors in the cases reviewed. It is prudent for clinics to protect themselves from embryo mix-ups, which can subsequently lead to undesirable clinical outcomes, as well as lawsuits stemming from these errors. This article emphasizes following labeling guidelines when storing embryos, employing a two-step read back method prior to ET, and offering genetic testing when a discrepancy is found in the record. In the case an embryo mix-up does occur, it is recommended to protect personal assets through business organizing procedures and consider settlement offers for policy limits.

The Power of Lists: IDPs and Disaster Governmentality after the Attabad Landslide in Northern Pakistan

ABSTRACT This article analyses the political consequences of a large-scale landslide that hit Gojal in the high-mountain region of northern Pakistan in 2010. It destroyed parts of several villages and impeded access to the area for years. The article follows a list of internally displaced persons (IDPs) that was created as part of disaster governance. The list separates some affected persons from others, allocating them particular resources. Drawing on James Scott and Veena Das’ concepts of legibility, I argue that while these lists make some people legible for the state as disaster victims, people ‘read back’, developing their own strategies of appropriating such lists for their own purposes. While the concept of legibility rests on the distinction of state and society, it is argued in consonance with the recent ethnography of the state that instead we find a fragmented assemblage of criss-crossing relationships in disaster governmentality that produce enduring social friction.

Despite Technology, Verbal Orders Persist, Read Back Is Not Widespread, and Errors Continue.

Despite Technology, Verbal Orders Persist, Read Back Is Not Widespread, and Errors Continue.

HUBUNGAN MEDIA PEMBELAJARAN KOMIK DENGAN MOTIVASI BELAJAR SISWA KELAS VII PADA MATERI SISTEM ORGANISASI KEHIDUPAN

This study aims to find out the correlation of comic learning media with the students' learning motivation VII class in organizational life system materials. This research type is quantitative and research method of pre-experiment. Sampling technique is with cluster random sampling. Data collection was done by observation and using questionnaire. The results showed there was a positive and significant correlation between comic learning media with student learning motivation on organizational life system in VII class with correlation value 0,876. This value is categorized into a strong relationship with a significant value of 10,099. The result of coefficient of determination is 76,7% and the rest 23,3% influenced by other factor outside research variable. Based on this, it can be seen that the comic learning media can foster student learning motivation during the learning process in the classroom. Students interested in comic media are influenced by the visual factors of the comic media itself both in terms of design, appearance, material and images that support each other so that students are interested and happy to read back or review materials that have been taught in the classroom. Interesting learning process can foster students' learning motivation in the classroom where the learning media is a tool that can help the learning process more interesting.

Handover Structure and Quality in the Acute Medical Assessment Unit: A Prospective Observational Study.

Inadequate patient handovers are associated with the occurrence of medical errors. The objective of the present study was to explore the structure and quality of handovers in the acute medical assessment unit. A prospective observational study was conducted in an academic hospital in the Netherlands. Handover structure was observed by ordering handover information according to the elements of the Situation, Background, Assessment, Recommendation, and Read back (SBAR-R) handover tool. Handover quality was measured by means of a questionnaire, i.e., the rating tool for handover quality, and by assessing situation awareness of the degree to which professionals after a handover agreed on the complexity of the patient's care needs. A total of 71 handovers were observed. In most handovers, different elements of the SBAR-R were used frequently (median, 7.5 elements; range, 2.0-15.0). On the quality of handovers, 109 respondents (44.1%) completed the questionnaire. On a 0-to-100 scale, median scores on information transfer were 67.9 (interquartile range [IQR],17.9), 75.0 (IQR, 25.0) on shared understanding, and 75.0 (IQR, 16.7) on working atmosphere. Agreement in situation awareness was 70.0%. Handovers in the acute medical assessment unit were poorly structured; however, the perceived quality of handovers was substantial. Implementing the SBAR-R may be an effective strategy to improve handover practice and situation awareness, although further study to its applicability in acute medical assessment units is necessary.

AVALIAÇÃO DE DESEMPENHO DA SUSTENTABILIDADE FINANCEIRA DA UNIVERSIDADE DO MINDELO (CABO VERDE): UM MODELO MULTICRITÉRIO CONSTRUTIVISTA

Este artigo, de natureza exploratória-descritiva, tem por objetivo construir um modelo multicritério de avaliação de desempenho construtivista para apoiar a gestão da sustentabilidade financeira da Universidade do Mindelo (UM), sediada em Cabo Verde, na África. Para tal, selecionou-se a metodologia Multicritério de Apoio à Decisão-Construtivista (MCDA-C). Nas entrevistas com o pró-reitor, identificaram-se 51 conceitos agrupados nas áreas de preocupação: Planos e Orçamentos; Negociações com Entidade Financiadoras; Execução Financeira e Controladoria. O modelo construído permitiu: (i) a avaliação global do desempenho da UM, a qual indicou 50 pontos, em uma escala de 0 a 100; (ii) a proposta de ações de melhoria, para os indicadores que se encontravam com um desempenho no nível comprometedor, que, se implementadas, alavancariam o desempenho da UM; e, (iii) o cotejamento dos indicadores com os propostos pela literatura onde percebeu-se que a maioria não foi incorporada pelo modelo ah doc desenvolvido ao viés construtivista da pesquisa.

Dual track Wallace fly height measurement method to monitor slider motion in 2 dimension at near contact regime

Head media spacing of hard disk drive (HDD) is expected to continue its reduction in order to support areal density growth. At sub-nm clearance between the head and the disk, the intermittent head disk contact and interactions may happen. This does not only cause the fly height modulation but also induces the off-track motions as well. It is desirable to understand the characteristics of the 2D motions in the near contact regime, so as to enable further reduction of the clearance and to improve the reliability of HDD. This paper presents a method to measure instantaneous fly height (FH) motion and cross track motion concurrently by using read back signal from the dual data tracks written at different frequencies. The method is able to separate the FH motion and cross track motion of the head.

Embodiment, Time, and the Life Review in Jeff Lemire’s Ghost Stories

Embodiment, Time, and the Life Review in Jeff Lemire’s Ghost Stories Katie Mullins (bio) Jeff lemire’s graphic novel trilogy, Essex County (2009), has received much critical attention: the trilogy won the Joe Shuster Award and awards from the American Library Association and was also one of Canada Reads’ top five selections in 2010. It has also been nominated for two Eisner Awards, an Ignatz, and a Harvey Award. Perhaps surprisingly, however, little to nothing has been written about the trilogy in the way of scholarly study. Divided into three interconnected books, the trilogy explores the history, personal hardships, and intergenerational family ties that bind a collection of characters in a small rural community in Essex County, Ontario. Although I address aspects of the trilogy as a complete work, I focus on Book Two, Ghost Stories, and its representation of the aging body in connection with memory. Ghost Stories focuses on Lou Lebeuf, a once successful hockey player, who finds himself alone in old age and estranged from his younger brother Vince, with whom he once shared a close relationship. Elderly, deaf, and suffering from alcoholism and dementia, Lou attempts to tell his story as he recalls his earlier life in fragments of memory that emerge sometimes from triggers (photographs or places, for example) and sometimes spontaneously. The visual juxtaposition of youthful and aging bodies highlights [End Page 29] the effects of time on the body and foregrounds Lou’s struggle to maintain a sense of his identity in old age. In addressing Lou’s process of remembering, I explore how the narrative’s visual rhetoric and complex spatial configuration of time work to express Lou’s recourse to memory and his relationship to the past, as well as the vital role of the body within the process of remembering and storytelling. Ghost Stories presents Lou’s experience of isolation and alienation as a central issue in the narrative. Yet, while the narrative depicts the traumas of aging, it also shows how Lou’s body enables him to remember and tell his story; how, for instance, physically being in a certain place or adopting a particular posture aids his memory of a past event. Lou’s body also allows him to experience fleeting but positive moments of engagement with his present embodied experience and the external world. In other words, Lou’s embodied, sensory experiences (sight, vision, smell, and touch) often pull him out of his solitary reflections on the past and into an appreciation of his experiences in the present time. I argue that Essex County presents a model of aging that ascribes significance to the aging body by suggesting the ways in which embodied experiences are inseparable from processes of remembering. I also argue that, although Lou frequently dissociates from his aging body, his embodied experiences in the narrative’s present time allow him to experience fleeting, but life-affirming, moments of connectedness to others and to the external world, which counter his sense of isolation. My reasons for examining these issues with reference to a graphic novel are twofold. I am interested in probing the ways that experiences of the body and remembering are visually recorded but also in the medium’s ability to convey moments of time—past, present, and future—on the same page and the recursive effects that result from such (almost) concurrent temporality.1 In an interview with comics scholar Hilary Chute, comics artist and theorist Scott McCloud states that “comics is the only form in which past, present, and future are visible simultaneously” (“Scott McCloud”). In her own work on trauma and autobiographical comics, [End Page 30] Chute suggests that the effect of this simultaneity is to cause the reader to “look, and then look again” and thus the work “builds a productive recursivity into its narrative scaffolding” (Graphic Women 8). The interaction between text and image, which requires the reader to read back and forth between both, also works to this effect. Such recursivity becomes crucial to the work of confronting issues of subjectivity and selfhood and thus to my focus on the body in relation to time and remembering/storytelling, as it avoids reducing embodied experience to a...

On the Need for Precise, Concise Communication during Resuscitation: A Proposed Solution

On the Need for Precise, Concise Communication during Resuscitation: A Proposed Solution

Students’ Ability to Communicate a Critical Situation After Implementation of ISBARR in an Undergraduate Nursing Curriculum

Effective communication has been identified as a key factor in maintaining patient safety, promoting a professional attitude, and facilitating collaboration between health care professionals. This study evaluated whether the implementation of ISBARR (I=Identify Self, S=Situation, B=Background, R=Recommendations, R=Read Back Orders) into the curriculum improved nursing students’ ability to give a critical situation report. A sample of senior level students watched a videotaped critical situation and then gave an audiotaped ISBARR report. There were no significant differences in students’ ability to give an ISBARR report following implementation of ISBARR into the curriculum. There was a moderate correlation of ISBARR scores with grade point average (GPA). Students with higher GPAs did better in communicating a critical situation. As with any change, implementation of ISBARR into the curriculum will take time to be fully integrated. The true impact on student outcomes and performance may not be apparent for a number of years.

Re-tracing the Haole female teacher–traveler in Hawaii

Within this article I draw on the use of stories and interpretative reading practices: my own personal story and the literature of Asian American writer, Lois Yamanaka, to explore the racialization of social groups in Hawaii within a critical postcolonial perspective. I ask how we might learn to ‘read back’ to the colonial story of Hawaii without surrendering to a reification of the very structures of racial oppression and supremacy that drove the Imperial project, and I would argue, still influences the racial and social injuries of contemporary American life in Hawaii. I set Yamanaka’s fictional account of various white teachers in Hawaii against my own startling experiences of being a haole or foreign female teacher in Hawaii over the last four years as a way to consider a more ethical framework for human relations within education.

Read Back of Stored Data in Non Volatile Memory Devices by Scanning Capacitance Microscopy

ABSTRACTThis report outlines a methodology for reading back different electrical charges, from Non Volatile Memory (NVM) based Flash devices. The charge is stored in the floating gates (FGs) of the transistors. Reading back these charges in the form of logic levels of “1 bit (1b)” and “0 bit (0b)” without deleting the information from the device was the goal. Scanning Capacitance Microscopy (SCM) with ∼50-100 nm spatial resolution was used, to directly probe the charge on Floating Gate Transistor (FGT) channels. Transistor charge values (ON/OFF or “1b/0b”) are measured. Both the sample preparation and SCM probing methods are discussed. The application has been demonstrated with SanDisk based 64 MB NAND Flash memory device.

Performance of U-Pole Writers With Straighter Field Contours

Curvature of transitions recorded onto a magnetic disc has become more pronounced as tracks narrow. Curvature creates interference between adjacent transitions recorded at high bit density, and broadens the read back signal pulse. Curved transitions have a shape similar to that of the field contours that write them. A concave write pole trailing surface, or “U-pole”, pushes the field contours near the pole edges farther down track. This straightens the contours by partially compensating for transition curvature. We used a track trimming technique to compare transition curvature of flat poles and U-poles, and verified that the U-pole reduced curvature by more than 30%. We also demonstrated that the more curved transitions written by flat poles generate ~ 1 nm more pulse broadening at the track edge relative to those written by U-poles. However, modeling predicts a ~ 10% loss in down track field gradient near the center of a U-pole. Measurements of bit error rate across the track confirm the corresponding loss in U-pole performance relative to a flat pole over all but the outer portions of a track.

Testing validation of the confirmation method to correct receipt of job instructions (1): The effect of read back

Testing validation of the confirmation method to correct receipt of job instructions (1): The effect of read back