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Patient journey mapping is an emerging field of research that uses various methods to map and report evidence relating to patient experiences and interactions with healthcare providers, services, and systems. This research often involves the development of visual, narrative, and descriptive maps or tables, which describe patient journeys and transitions into, through, and out of health services. This methods corner paper presents an overview of how patient journey mapping has been conducted within the health sector, providing cardiovascular examples. It introduces six key steps for conducting patient journey mapping and describes the opportunities and benefits of using patient journey mapping and future implications of using this approach. [ABSTRACT FROM AUTHOR]

Wavelet decompositions of integral operators have proven their efficiency in reducing computing times for many problems, ranging from the simulation of waves or fluids to the resolution of inverse problems in imaging. Unfortunately, computing the decomposition is itself a hard problem which is oftentimes out of reach for large-scale problems. The objective of this work is to design fast decomposition algorithms based on another representation called product-convolution expansion. This decomposition can be evaluated efficiently, assuming that a few impulse responses of the operator are available, but it is usually less efficient than the wavelet decomposition when incorporated in iterative methods. The proposed decomposition algorithms, run in quasi-linear time and we provide some numerical experiments to assess its performance for an imaging problem involving space-varying blurs. [ABSTRACT FROM AUTHOR]

This article suggests that the illuminated initials and borderwork added to ten early printed books in England are attributable to a single illuminator, the 'Incunables Limner', an individual for whom there is circumstantial evidence that he specialized in the illumination of printed books. Five of these books are copies of William Caxton's Golden Legend (Westminster, 1483–84), while the other five are Continental imprints (two from Strasbourg, and one from each of Basel, Verona, and Parma) printed between 1476 and 1484. In addition, a second illuminator can be identified in a sixth copy of Caxton's Golden Legend , working to the same design as that employed within the five copies decorated by the Incunables Limner. The possibility is considered that books illuminated by the Incunables Limner were products of Caxton's overseas trade, and that it was through acting in this capacity that the artist's specialization was viable. The Continental books are explored for what they might imply about Caxton's wider book-selling strategies, and three with evidence for early English ownership are selected for particular attention. [ABSTRACT FROM AUTHOR]

The quality and shelf-life of NCS (non-centrifugal sugar) mainly depend on the moisture content present in it. NCS formed by the current practice of open sun drying contains moisture substantially greater than the acceptable level of 3%. This paper presents the work undertaken to design a tunnel dryer to achieve the required moisture content of granular NCS for various load conditions. An experimental investigation was conducted on a laboratory-scale dryer to achieve the required moisture content for various loads. This experimental data was compared with the output of two drying models and a validated one that could be used to design an industrial-scale dryer. For various load conditions on each tray and dryer exit temperature, nine different cases were determined. The number of trucks, drying time, and energy requirements were computed using the validated theoretical model. A tunnel dryer with a length, height and width of 18, 1.2 and 1 m respectively and 18 trucks with 24 trays on each truck is shown to be dry 1 tone of NCS based on the minimum energy requirement of 176.49 MJ, and a drying time of 68 min. [ABSTRACT FROM AUTHOR]

This commentary describes the creation of a microbiology-themed Monopoly™ gameboard assignment for studying microbial diversity. Students worked in groups to redesign the standard Monopoly™ playing tokens, currency, action cards, properties, and special spaces for any microbial-themed topic using a provided template. A postassignment anonymous survey found that the students enjoyed this assignment and the opportunity to share their knowledge in a unique and creative format. While this assignment is especially amenable to microbiology due the large diversity seen in the microbial world, it could easily be adapted to other topics such as genetics, chemistry, or even math, where categorical associations or patterns are prevalent. [ABSTRACT FROM AUTHOR]

Reversible data hiding (RDH) with contrast enhancement (RDH-CE) is a special type of RDH in improving the subjective visual perception by enhancing the image contrast during the process of data embedding. In RDH-CE, data hiding is achieved via pairwise histogram expansion, and the embedding rate can be increased by performing multiple cycles of histogram expansions. However, when embedding rate gets high, human visible image degradation is observed. Previous work designed an upper bound of the embedding level for RDH-CE, which effectively avoids image over-sharping but offers limited embedding capacity. In this paper, a better tunable bound is designed to enhance the embedding capacity of RDH-CE by exploiting the characteristics of histogram distribution. Furthermore, the objective distortion introduced by histogram pre-shifting is minimized when the embedding level is no more than the upper bound, and the human visible degradation is minimized when the embedding level exceeds the limitation of the proposed upper bound. Experimental results validate that the proposed method provides appropriate upper bound of the embedding level, increases the effective embedding capacity and offers better image contrast. [ABSTRACT FROM AUTHOR]

Background Few data exist to guide the physical design of biocontainment units, particularly the doffing area. This can impact the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment (PPE). Methods In phase I of our study, we analyzed simulations of a standard patient care task with 56 trained HCWs focusing on doffing of high-level PPE. In phase II, using a rapid cycle improvement approach, we tested different balance aids and redesigned doffing area layouts with 38 students. In phase III, we tested 1 redesigned layout with an additional 10 trained HCWs. We assessed the effectiveness of design changes on improving the HCW performance (measured by occurrence and number of risky behaviors) and reducing the physical and cognitive load by comparing the results from phase I and phase III. Results The physical load was highest when participants were removing their shoe covers without any balance aid; the use of a chair required the lowest physical effort, followed by horizontal and vertical grab bars. In the revised design (phase III), the overall performance of participants improved. There was a significant decrease in the number of HCW risky behaviors (P =.004); 5 risky behaviors were eliminated and 2 others increased. There was a significant decrease in physical load when removing disposable shoe covers (P =.04), and participants reported a similar workload in the redesigned doffing layout (P =.43). Conclusions Through optimizing the design and layout of the doffing space, we reduced risky behaviors of HCWs during doffing of high-level PPE. [ABSTRACT FROM AUTHOR]

Background: Few data exist to guide the physical design of biocontainment units, particularly the doffing area. This can impact the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment (PPE). Methods: In phase I of our study, we analyzed simulations of a standard patient care task with 56 trained HCWs focusing on doffing of high-level PPE. In phase II, using a rapid cycle improvement approach, we tested different balance aids and redesigned doffing area layouts with 38 students. In phase III, we tested 1 redesigned layout with an additional 10 trained HCWs. We assessed the effectiveness of design changes on improving the HCW performance (measured by occurrence and number of risky behaviors) and reducing the physical and cognitive load by comparing the results from phase I and phase III. Results: The physical load was highest when participants were removing their shoe covers without any balance aid; the use of a chair required the lowest physical effort, followed by horizontal and vertical grab bars. In the revised design (phase III), the overall performance of participants improved. There was a significant decrease in the number of HCW risky behaviors (P =.004); 5 risky behaviors were eliminated and 2 others increased. There was a significant decrease in physical load when removing disposable shoe covers (P =.04), and participants reported a similar workload in the redesigned doffing layout (P =.43). Conclusions: Through optimizing the design and layout of the doffing space, we reduced risky behaviors of HCWs during doffing of high-level PPE. The physical design of biocontainment units impacts the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment. Through optimizing the design and layout of the doffing space, HCWs perform fewer risky behaviors and are safer. [ABSTRACT FROM AUTHOR]

Motivation Accurate and wide-ranging prediction of thermodynamic parameters for biochemical reactions can facilitate deeper insights into the workings and the design of metabolic systems. Results Here, we introduce a machine learning method with chemical fingerprint-based features for the prediction of the Gibbs free energy of biochemical reactions. From a large pool of 2D fingerprint-based features, this method systematically selects a small number of relevant ones and uses them to construct a regularized linear model. Since a manual selection of 2D structure-based features can be a tedious and time-consuming task, requiring expert knowledge about the structure-activity relationship of chemical compounds, the systematic feature selection step in our method offers a convenient means to identify relevant 2D fingerprint-based features. By comparing our method with state-of-the-art linear regression-based methods for the standard Gibbs free energy prediction, we demonstrated that its prediction accuracy and prediction coverage are most favorable. Our results show direct evidence that a number of 2D fingerprints collectively provide useful information about the Gibbs free energy of biochemical reactions and that our systematic feature selection procedure provides a convenient way to identify them. Availability and implementation Our software is freely available for download at http://sfb.kaust.edu.sa/Pages/Software.aspx. Supplementary information Supplementary data are available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

Background Falling retention in UK general practice is a well-described problem but there has been little previous research into its underlying causes. Poor psychosocial work conditions may help explain falling workforce morale and early retirement from the profession. Aims To explore the impact upon morale and retirement decisions of changes in psychosocial aspects of UK general practice over the course of a career. Methods Biographical narrative interviewing method (BNIM) was used to obtain and analyse career narratives of 12 London general practitioners (GPs), aged 55–65, half of whom had retired. Findings were theorized using the Job Demands-Control-Support (JDCS) model. Results A spontaneous, consistent theme was evident across all 12 interviews: changes in the psychosocial work environment had contributed to a steady decline in morale. Sequential, multilayered reductions in autonomy were the most commonly cited causes for reduced enthusiasm. Increasing demands in the form of both a rising workload as well as a complaints culture drained energy and morale. The GPs described increasingly fragmented teams and therefore reduced social support for the role. Nonetheless, retirement decisions were not straightforward, provoking complex emotions. Conclusions The combination of increasing demands with reduced autonomy puts practitioners under intense strain, diminishing the satisfaction they derive from their work and affecting retirement decisions. The Job Demands-Control-Support (JDCS) model is an empirically tested model that could be used to inform improved work design in general practice. [ABSTRACT FROM AUTHOR]

The optical design of the Multi Conjugate Adaptive Optics RelaY for the Extremely Large Telescope experienced many modifications since Phase A conclusion in late 2009. These modifications were due to the evolution of the telescope design, the more and more accurate results of the performance simulations and the variations of the opto-mechanical interfaces with both the telescope and client instruments. Besides, in light of the optics manufacturing assessment feedbacks, the optical design underwent to a global simplification respect to the former versions. Integration, alignment, accessibility and maintenance issues took also a crucial role in the design tuning during the last phases of its evolution. This paper intends to describe the most important steps in the evolution of the optical design, whose rationale has always been to have a feasible and robust instrument, fulfilling all the requirements and interfaces. Among the wide exploration of possible solutions, all the presented designs are compliant with the high-level scientific requirements, concerning the maximum residual wavefront error and the geometrical distortion at the exit ports. The outcome of this decennial work is the design chosen as baseline at the kick-off of the Phase B in 2016 and subsequently slightly modified, after requests and inputs from alignment and maintenance side. [ABSTRACT FROM AUTHOR]

Motivation High-Throughput Sequencing technologies produce huge amounts of data in the form of short genomic reads, associated quality values and read identifiers. Because of the significant structure present in these FASTQ datasets, general-purpose compressors are unable to completely exploit much of the inherent redundancy. Although there has been a lot of work on designing FASTQ compressors, most of them lack in support of one or more crucial properties, such as support for variable length reads, scalability to high coverage datasets, pairing-preserving compression and lossless compression. Results In this work, we propose SPRING, a reference-free compressor for FASTQ files. SPRING supports a wide variety of compression modes and features, including lossless compression, pairing-preserving compression, lossy compression of quality values, long read compression and random access. SPRING achieves substantially better compression than existing tools, for example, SPRING compresses 195 GB of 25× whole genome human FASTQ from Illumina's NovaSeq sequencer to less than 7 GB, around 1.6× smaller than previous state-of-the-art FASTQ compressors. SPRING achieves this improvement while using comparable computational resources. Availability and implementation SPRING can be downloaded from https://github.com/shubhamchandak94/SPRING. Supplementary information Supplementary data are available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

Objectives: In a clinical laboratory, the design of the workspace directs the workflow and significantly affects the productivity of clinical laboratory scientists (CLS). With the chronic shortage of CLS, a well-designed workspace is essential to take full advantage of available staff, especially in high-volume laboratories.Methods: Through the use of quality improvement tools, a manual body fluid testing workspace was redesigned to address weaknesses in the layout that led to excessive physical steps taken by staff.Results: System engineering tools such as a fishbone diagram, spaghetti diagrams, Plan-Do-Study-Act cycles, and a counterbalance measure were all used in a CLS-led quality improvement initiative to redesign a workspace in the manual body fluid processing area of a clinical laboratory at Mayo Clinic.Conclusions: After the redesign, physical steps taken and time to process body fluids were reduced by an average of 40% and 32%, respectively, demonstrating the utility of quality improvement tools in clinical laboratory settings. [ABSTRACT FROM AUTHOR]

The article discusses the steps of implementation of the direct oral anticoagulant (DOAC) therapy. Topics covered include the establishment of an interprofessional work group, the identification of access options for DOAC therapy and the creation of patient education materials. Also mentioned is the creation of the acute venous thromboembolism (VTE) program order set in the electronic medical record (EMR).

Background: Although automation has become widely utilized in certain areas of diagnostic testing, its adoption in diagnostic microbiology has proceeded much more slowly. Objective: To describe our real-world experience of integrating an automated instrument for diagnostic microbiology (Walk-Away Specimen Processor, WASPLab) within a model of total laboratory automation (TLA). Methods: The implementation process was divided into 2 phases. The former period, lasting approximately 6 weeks, entailed the installation of the WASPLab processor to operate as a standalone instrumentation, whereas the latter, lasting approximately 2 weeks, involved physical connection of the WASPLab with the automation. Results: Using the WASPLab instrument in conjunction with the TLA model, we obtained a time savings equivalent to the work of 1.2 full-time laboratory technicians for diagnostic microbiology. The connection of WASPLab to TLA allowed its management by a generalist or clinical chemistry technician, with no need for microbiology skills on the part of either worker. Hence, diagnostic microbiology could be performed by the staff that is already using the TLA, extending their activities to include processing urgent clinical chemistry and hematology specimens. The time to result was also substantially improved. Conclusions: According to our experience, using the WASPLab instrument as part of a TLA in diagnostic microbiology holds great promise for optimizing laboratory workflow and improving the quality of testing. [ABSTRACT FROM AUTHOR]

Background: Research findings on the relationship between the psychosocial work environment and leisure-time physical activity (LTPA) are equivocal. This might partly be due to studies having focused on a restricted set of psychosocial dimensions, thereby failing to capture all relevant domains. Aims: To examine cross-sectional associations between seven psychosocial work environment domains and LTPA in a large sample of UK civil servants and to profile LTPA and consider this in relation to UK government recommendations on physical activity. Methods: In 2012 Northern Ireland Civil Service employees completed a questionnaire including measures of psychosocial working conditions (Management Standards Indicator Tool) and LTPA. We applied bivariate correlations and linear regression analyses to examine relations between psychosocial working conditions and LTPA. Results: Of 26 000 civil servants contacted, 5235 (20%) completed the questionnaire. 24% of men and 17% of women reported having undertaken 30 min or more of physical activity on five or more days in the past week. In men, job control (-0.08) and peer support (-0.05) were weakly but significantly negatively correlated with LTPA, indicating that higher levels of exposure to these psychosocial hazards was associated with lower levels of LTPA. Job role (-0.05) was weakly but significantly negatively correlated with LTPA in women. These psychosocial work characteristics accounted for 1% or less of the variance in LTPA. Conclusions: Longitudinal research to examine cause-effect relations between psychosocial work characteristics and LTPA might identify opportunities for psychosocial job redesign to increase employees' physical activity during leisure time. [ABSTRACT FROM AUTHOR]

Focus of Presentation People with disability experience inequality in relation to social determinants of health such as employment, education and housing. Under the UN Convention on the Rights of Persons with Disabilities, Australia must collect data to assess fulfilment of its Convention obligations and to identify and address barriers faced by people with disability in exercising their rights. The objective of our research was to determine the extent to which such data are currently available. Findings With input from people with disability, we developed a monitoring framework and indicators to measure inequalities between Australians with and without disability in relation to social determinants of health. National data sources that included a disability identifier were available to report on 73% of the 128 indicators. For example, in the domain 'Employment', national data were available for indicators of labour force status, long-term unemployment, leave entitlements, and employment in high-skill jobs. Data were not available for the following indicators: under-employment, access to job design modifications, and disability-related discrimination in the workplace. Conclusions/Implications It is currently not possible to quantify inequalities between Australians with and without disability, track change over time, or identify factors that can inform effective policy responses for indicators where we lack national data that include a disability identifier. Key messages Addressing data gaps, including by facilitating disability identification in existing data collections, is essential for tackling disability-related inequalities on social determinants of health and meeting our obligations under the UN Convention on the Rights of Persons with Disabilities. [ABSTRACT FROM AUTHOR]