Patterns of admission in forensic units during the COVID-19 pandemic: a process analysis

Introduction

The impact of COVID-19 pandemic on forensic service practice remains matter of debate. Increased rates of anxiety, depression, and exacerbation of psychotic symptoms were reported in the early phases of the pandemic among detained persons. However, longitudinal analyses in medium-security hospitals taking into account the whole pandemic period led to mitigated results.

Methods

This report examines the evolution of the type (voluntary versus involuntary) and reason of admissions, length of stay, history of outpatient care, short-term seclusion hours for aggressive behaviors, and clinical diagnoses for detainees needing acute psychiatric care during the COVID-19 pandemic in the sole secure ward located in the central prison of Geneva, Switzerland. To determine the general trend of the processes over time we applied a combination of process analysis with run chart plotting, and fractional polynomial regression.

Results

Run tests showed that the proportion of cases with personality disorders, substance use disorders (SUD), and previous outpatient care tended to increase during the COVID pandemic with subsequent decrease to reach the pre-COVID values. This was also the case for depressive symptoms as reason for admission. The proportion of involuntary admission showed a steady increase both during the COVID and post-COVID time periods. In contrast, short-term seclusion hours decreased during the COVID pandemic followed by a return to their pre-COVID values. Regression models revealed that the COVID pandemic was associated with a significant increase in the rates of inmates with personality disorders and SUD admitted for forensic care explaining 36 and 41% of their variance.

Discussion

These data support the idea that, in terms of acute care needs, the COVID-19 pandemic was associated with increased needs for acute forensic care that concerned detainees with personality disorders characterized by increased levels of impulsiveness, decreased tolerance to frustrations, loss of control, increased extraversion and frequent SUD comorbidity.

Analysis of the Machine-Specific Behavior of Injection Molding Machines

The performance of an injection molding machine (IMM) influences the process and the quality of the parts manufactured. Despite increasing data collection capabilities, their machine-specific behavior has not been extensively studied. To close corresponding research gaps, the machine-specific behavior of two hydraulic IMMs of different sizes and one electric IMM were compared with each other as part of the investigations. Both the start-up behavior from the cold state and the behavior of the machine at different operating points were considered. To complement this, the influence of various material properties on the machine-specific behavior was investigated by processing an unreinforced and glass-fiber-reinforced polyamide. The results obtained provide crucial insights into machine-specific behavior, which may, for instance, account for disparities between computer fluid dynamic (CFD) simulations and experimental results. Furthermore, it is expected that the description of the machine-specific behavior can contribute to transfer knowledge when applying transfer learning algorithms. Looking ahead to future research, it is advised to create what is referred to as a "machine fingerprint", and this proposal is accompanied by some preliminary recommendations for its development.

Study of the Single-Screw Extrusion Process Using Polylactide

This study presents the extrusion process while using a single-screw extruder and polylactide (PLA). This material belongs to the so-called biodegradable plastics, and is characterized by a higher density compared to typical polymeric materials used to manufacture products in this technology. Various polyethylenes and polypropylenes and their derivatives are commonly used. An evaluation of the extrusion process was carried out for various extruder operating parameters. The rotational speed of the screw and the process temperature were changed. For each rotational speed of the screw, the following readings were made: changes in temperature, active power, current intensity, pressure, and mass of extruded plastics each time.

The Process Analysis Method of SAR Target Recognition in Pre-Trained CNN Models

Recently, attention has been paid to the convolutional neural network (CNN) based synthetic aperture radar (SAR) target recognition method. Because of its advantages of automatic feature extraction and the preservation of translation invariance, the recognition accuracies are stronger than traditional methods. However, similar to other deep learning models, CNN is a "black-box" model, whose working process is vague. It is difficult to locate the decision reasons. Because of this, we focus on the process analysis of a pre-trained CNN model. The role of the processing to feature extraction and final recognition decision is discussed. The discussed components of CNN models are convolution, activation function, and full connection. Here, the convolution processing can be deemed as image filtering. The activation function provides a nonlinear element of processing. Moreover, the fully connected layers can also further extract features. In the experiment, four classical CNN models, i.e., AlexNet, VGG16, GoogLeNet, and ResNet-50, are trained by public MSTAR data, which can realize ten-category SAR target recognition. These pre-trained CNN models are processing objects of the proposed process analysis method. After the analysis, the content of the SAR image target features concerned by these pre-trained CNN models is further clarified. In summary, we provide a paradigm to process the analysis of pre-trained CNN models used for SAR target recognition in this paper. To some degree, the adaptability of these models to SAR images is verified.

[Analysis of Causes and Sources of Summer Ozone Pollution in Rizhao Based on CMAQ and HYSPLIT Models]

As a typical coastal city, O₃ pollution in Rizhao has become increasingly serious in recent years. In order to explore the causes and sources of O₃ pollution, IPR process analysis and ISAM source tracking tools based on the CMAQ model were used, respectively, to quantify the contributions of different physicochemical processes and different source tracking areas to O₃ in Rizhao. Additionally, by comparing the differences between O₃-exceeding days and non-exceeding days, combined with the HYSPLIT model, the regional transportation path of O₃ in Rizhao was explored. The results showed that the concentrations of O₃, NO_x, and VOCs near the coastal areas of Rizhao and Lianyungang were significantly increased on O₃ exceedance days compared with those on non-exceedance days. This was mainly because Rizhao was the convergence zone of western, southwestern, and eastern winds on exceedance days, which facilitated the transport and accumulation of pollutants. Process analysis showed that the transport process (TRAN) contribution to the near-surface O₃ near the coastal areas of Rizhao and Lianyungang increased significantly on the exceedance days, whereas the contribution to most areas to the west of Linyi decreased. Photochemical reaction (CHEM) had a positive contribution to the O₃ concentration in Rizhao during the daytime at all heights, and TRAN had a positive contribution at 0-60 m above the ground, and mainly had a negative contribution above 60 m. The contributions of CHEM and TRAN at 0-60 m above the ground would increase significantly on exceedance days, which was approximately twice that on the non-exceedance days. Source analysis showed that the local sources in Rizhao were the main contribution sources of NO_x and VOCs, with the contribution rates of 47.5% and 58.0%, respectively. O₃ mainly came from the contribution outside the simulation area (67.5%). The O₃ and precursor contributions of the western cities of Rizhao (Weifang, Linyi, etc.) and the southern cities (Lianyungang, etc.) would increase significantly on the days of exceeding the standard. The transportation path analysis showed that the number of exceedances accounted for the largest proportion (11.8%) in the path from the west of Rizhao, which was the main transportation channel of O₃ and precursors in Rizhao. This was verified through process analysis and source tracking results, and such trajectories accounted for 13.0% of the total number of trajectories, and their main routes were in the Shaanxi, Shanxi, Hebei, and Shandong regions.

In-Line Near-Infrared Spectroscopy Gives Rapid and Precise Assessment of Product Quality and Reveals Unknown Sources of Variation-A Case Study from Commercial Cheese Production

Quality testing in the food industry is usually performed by manual sampling and at/off-line laboratory analysis, which is labor intensive, time consuming, and may suffer from sampling bias. For many quality attributes such as fat, water and protein, in-line near-infrared spectroscopy (NIRS) is a viable alternative to grab sampling. The aim of this paper is to document some of the benefits of in-line measurements at the industrial scale, including higher precision of batch estimates and improved process understanding. Specifically, we show how the decomposition of continuous measurements in the frequency domain, using power spectral density (PSD), may give a useful view of the process and serve as a diagnostic tool. The results are based on a case regarding the large-scale production of Gouda-type cheese, where in-line NIRS was implemented to replace traditional laboratory measurements. In conclusion, the PSD of in-line NIR predictions revealed unknown sources of variation in the process that could not have been discovered using grab sampling. PSD also gave the dairy more reliable data on key quality attributes, and laid the foundation for future improvements.

Mediating Effect of Heat Waves between Ecosystem Services and Heat-Related Mortality of Characteristic Populations: Evidence from Jiangsu Province, China

In the context of climate change, heat waves are a serious hazard having significant impacts on human health, especially vulnerable populations. Many studies have researched the association between extreme heat and mortality. In the context of urban planning, many studies have explored the cooling effect of green roofs, parks, urban forests and urban gardens. Nevertheless, few studies have analyzed the effect mechanism of specific ecosystem services (Ess) as mitigation measures to heat waves. This study aimed to determine the relationship among Ess, heat waves and the heat-related mortality risk of different groups by diseases, age and sex. The research was conducted in three cities in Jiangsu Province, including Nanjing, Suzhou and Yancheng. We quantified five ecosystem services, i.e., water supply service, carbon sequestration service, cooling service, biodiversity and cultural service. Based on the previous studies, we took the frequency of heat waves into account, extending the concept of the Heat Wave Magnitude Index (HWMI). A distributed lag nonlinear model (DLNM) was applied to estimate the effect of extreme heat on mortality. Then, the study used the process analysis method to explore the relationship among Ess, heat waves and heat-related mortality risks. The results indicated that (i) water supply service, carbon sequestration service, cooling service and biodiversity can reduce heat-related mortality while cultural service increases; (ii) the effects of carbon sequestration service and cultural service are stronger than other Ess; (iii) the effects of Ess on cardiorespiratory disease, stroke and chronic obstructive pulmonary disease (COPD) mortality risks are higher than others; and (iv) women and elderly heat-related mortality risks are more affected by the Ess. This study can provide a theoretical support for policy makers to mitigate heatwave events, thus limiting heat-related mortality.

Why scapegoating can ruin an apology: The mediated-moderation model of appropriate crisis response messages in the context of South Korea

Introduction

As South Korean companies frequently use apologies for various crisis situations and pair them with other types of crisis response strategies (i.e., scapegoating), theory-driven recommendations for crisis response messages may fall short in practice. This study empirically examines the effectiveness of two crisis response messages (i.e., apology + compensation vs. apology + scapegoating) by integrating the theory of communicative responsibility and situational crisis communication theory.

Methods

South Korean participants (n = 392) read one of two vignettes: the vignettes described an automobile company's apology for malfunctioning seat belts which included either compensation or scapegoating. The participant's perceived communicative responsibility, appropriateness of the apology, and reputation of the company were measured. Process analysis was conducted to examine the mediated-moderation effect of the crisis response messages.

Results and Discussion

The findings indicate that an apology that is provided with compensation is more appropriate than those with scapegoating. The appropriateness is moderated by the perceived symmetry in communicative responsibility, and fully mediates the relationship between apology type and reputation. This study integrates two theoretical models to examine the mechanism behind the crisis response strategies from the perspective of the message receivers, while considering the cultural and normative context of South Korea.

Rapid Determination of Geniposide and Baicalin in Lanqin Oral Solution by Near-Infrared Spectroscopy with Chemometric Algorithms during Alcohol Precipitation

The selection of key variables is an important step that improves the prediction performance of a near-infrared (NIR) real-time monitoring system. Combined with chemometrics, NIR spectroscopy was employed to construct high predictive accuracy, interpretable models for the rapid detection of the alcohol precipitation process of Lanqin oral solution (LOS). The variable combination population analysis-iteratively retaining informative variables (VCPA-IRIV) was innovatively introduced into the variable screening process of the model of geniposide and baicalin. Compared with the commonly used synergy interval partial least squares regression, competitive adaptive reweighted sampling, and random frog, VCPA-IRIV achieved the maximum compression of variable space. VCPA-IRIV-partial least squares regression (PLSR) only needs to use about 1% of the number of variables of the original data set to construct models with Rp values greater than 0.95 and RMSEP values less than 10%. With the advantages of simplicity and strong interpretability, the prediction ability of the PLSR models had been significantly improved simultaneously. The VCPA-IRIV-PLSR models met the requirements of rapid quality detection. The real-time detection system can help researchers to understand the quality rules of geniposide and baicalin in the alcohol precipitation process of LOS and provide a reference for the optimization of a LOS quality control system.

Assessment of Urban Flood Vulnerability Using the Integrated Framework and Process Analysis: A Case from Nanjing, China

Flooding is a serious challenge that increasingly affects residents as well as policymakers. Many studies have noted that decreasing the urban flood vulnerability (UFV) is an indispensable strategy for reducing flood risks; however, some studies have several pertinent assessment limitations. The objective of this study is to assess the UFV of the Xuanwu-Qinhuai-Jianye-Gulou-Yuhua (XQJGY) region from 2012 to 2018 by integrating various indicators into a composite index. This study uses the environment for visualizing images (ENVI) and the geographic information system (GIS) to extract indicators that have geographic attributes for the assessment of UFV and the process analysis method is then used to explore the relationship between these indicators. The results indicated that: (1) The UFV of Xuanwu, Qinhuai, and Gulou decreased from 2012 to 2018 and the UFV of Jianye and Gulou increased from 2012 to 2015 and decreased from 2015 to 2018. (2) The vegetation coverage, precipitation during the flood season, population density, and highway density significantly contributed to the UFV. (3) There also exist transformation pathways between the indicators that led to vulnerability in five districts. This study provides a theoretical basis for the government to manage floods.

Advancement of door-to-needle times in acute stroke treatment after repetitive process analysis: never give up!

Background:

In acute ischemic stroke, timely treatment is of utmost relevance. Identification of delaying factors and knowledge about challenges concerning hospital structures are crucial for continuous improvement of process times in stroke care.

Objective:

In this study, we report on our experience in optimizing the door-to-needle time (DNT) at our tertiary care center by continuous quality improvement.

Methods:

Five hundred forty patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) at Hannover Medical School were consecutively analyzed in two phases. In study phase I, including 292 patients, process times and delaying factors were collected prospectively from May 2015 until September 2017. In study phase II, process times of 248 patients were obtained from January 2019 until February 2021. In each study phase, a new clinical standard operation procedure (SOP) was implemented, considering previously identified delaying factors. Pre- and post-SOP treatment times and delaying factors were analyzed to evaluate the new protocols.

Results:

In study phase I, SOP I reduced the median DNT by 15 min. The probability to receive treatment within 30 min after admission increased by factor 5.35 [95% confidence interval (CI): 2.46–11.66]. Further development of the SOP with implementation of a mobile thrombolysis kit led to a further decrease of DNT by 5 min in median in study phase II. The median DNT was 29 (25th–75th percentiles: 18–44) min, and the probability to undergo IVT within 15 min after admission increased by factor 4.2 (95% CI: 1.63–10.83) compared with study phase I.

Conclusion:

Continuous process analysis and subsequent development of targeted workflow adjustments led to a substantial improvement of DNT. These results illustrate that with appropriate vigilance, there is constantly an opportunity for improvement in stroke care.

Joining Processes for Fibre-Reinforced Thermoplastics: Phenomena and Characterisation

Thermoplastic composites (TPCs) are predestined for use in lightweight structures, especially for high-volume applications. In many cases, joining is a key factor for the successful application of TPCs in multi-material systems. Many joining processes for this material group are based on warm forming the joining zone. This results in a change of the local material structure characterised by modified fibre paths, as well as varying fibre contents, which significantly influences the load-bearing behaviour. During the forming process, many different phenomena occur simultaneously at different scales. In this paper, the deformation modes and flow mechanisms of TPCs during forming described in the literature are first analysed. Based on this, three different joining processes are investigated: embedding of inserts, moulding of contour joints, and hotclinching. In order to identify the phenomena occurring in each process and to describe the characteristic resulting material structure in the joining zones, micrographs as well as computed tomography (CT) analyses are performed for both individual process stages and final joining zones.

Improved Polypropylene Thermoformability through Polyethylene Layering

Due to its low cost, stiffness, and recyclability, isotactic polypropylene (iPP) is an excellent candidate for packaging applications. However, iPP is notoriously difficult to thermoform due to its low melt strength. The addition of just 10 thin layers of high-molecular-weight, linear low-density polyethylene (LLDPE) into iPP sheets by coextrusion significantly increased extensional viscosity and reduced sag. Both LLDPE and iPP were metallocene-catalyzed with excellent adhesion as measured in our previous work. We performed a series of hot tensile tests and sheet sag measurements to determine the properties of the iPP sheet and the multilayer sheet between 130 and 180 °C. To evaluate the thermoformability of these multilayer sheets, truncated conical cups were positive vacuum formed at different temperatures and heating times, and the crush strength was measured. Cups that released easily from the mold with good shape retention and a crush strength within 80% of the maximum value were used to define a temperature-time thermoformability window. We estimated the maximum stress that occurred during the thermoforming process to be 5 MPa. Layer thicknesses before and after thermoforming were used to estimate an average strain of 0.78. The thin LLDPE layers decreased the yield stress below 5 MPa. This enabled thermoforming at sheet temperatures as low as 150 °C. The immiscible LLDPE interfaces increased extensional viscosity, which decreased sag in the multilayer sheets compared to iPP. This broadened the thermoforming range to temperatures as high as 180 °C and allowed longer heating times. These highly thermoformable, layered sheets may be recycled as iPP since they contain only 8% of LLDPE.

Cohort difference in job environments: the mediating effect of organizational identification on the relationships between mindful leadership and self-spirituality

This paper aims to examine the effect of mindful leadership on employees' self-spirituality, and the mediating effect of organizational identification, and the moderating effect of cohort differences in machinery companies. This study collected data from three different periods. The result demonstrated that organizational identification mediated between mindful leadership and employees' self-spirituality, which boosted to deliver the peculiarity and attractiveness of their hardworking regarding personal capability. Besides, larger cohort differences negatively moderated between mindful leadership and employees' self-spirituality, and vice versa. The main dedication is the application of critical surveys depending on important supportive elements in the associated territory.

A differential process mining analysis of COVID-19 management for cancer patients

During the acute phase of the COVID-19 pandemic, hospitals faced a challenge to manage patients, especially those with other comorbidities and medical needs, such as cancer patients. Here, we use Process Mining to analyze real-world therapeutic pathways in a cohort of 1182 cancer patients of the Lausanne University Hospital following COVID-19 infection. The algorithm builds trees representing sequences of coarse-grained events such as Home, Hospitalization, Intensive Care and Death. The same trees can also show probability of death or time-to-event statistics in each node. We introduce a new tool, called Differential Process Mining, which enables comparison of two patient strata in each node of the tree, in terms of hits and death rate, together with a statistical significance test. We thus compare management of COVID-19 patients with an active cancer in the first vs. second COVID-19 waves to quantify hospital adaptation to the pandemic. We also compare patients having undergone systemic therapy within 1 year to the rest of the cohort to understand the impact of an active cancer and/or its treatment on COVID-19 outcome. This study demonstrates the value of Process Mining to analyze complex event-based real-world data and generate hypotheses on hospital resource management or on clinical patient care.

Analysis of a dream series by the Dream Coding System developed by Ulrich Moser

This paper serves psychotherapeutic process research and shows the process of change in a psychodynamic, individual psychological psychotherapy by means of a theory-based content analysis of the dreams reported in this therapy. The analysis of the patient's dreams is carried out according to the dream coding method by Ulrich Moser and Vera Hortig (2019). The guiding question is about changes in positioning and interactions of the dream elements, how can they be determined and how (within the framework of the underlying dream generation theory) the influence of these changes on the patient's ability to regulate affect can be assessed. Dream coding according to Moser and Hortig uses only the manifest dream and can be regarded as a research tool that rests, among other things, on psychoanalytic concepts, while at the same time taking into account more recent findings in dream and affect research. Its focus is on the coding of the present dream experience and the transformation of dream elements both within individual dreams and in the course of an entire dream series. It allows, without knowledge of the biographical anamnesis and without using psychoanalytic interpretation methods, to recognize changes in the dream structure and the affect regulation produced by it. The coding system thus also offers the possibility of making comparisons regarding the therapeutic changes achieved and thus (at least potentially) the effectiveness of different treatment methods (cf. Leuzinger-Bohleber, 2008, p. 7 f.). The coding of several dreams, i.e. the manifest dream content as a dream series highlighted the patient's inner psychic change process: while the safety principle dominated the beginning, involvement increased and the use of the elements was more flexible and the interactions more mixed, to approach the initial dream again towards the end of the dream series. The coding indicates that the patient was able to increase her self-efficacy due to better containment of the emergent (dysfunctional) affects. This coding procedure serves as a promising empirical process assessment for carrying out single case studies.

Patient-therapist congruent exchanges engaged with the potential-to-experience is associated with better outcome of psychotherapy

BACKGROUND

The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. However, as this assumption has never been empirically tested, the relationship between such interventions and treatment outcome is unclear. The aim of this pilot study is to explore the relationship between patient-therapist congruence of potential-to-experience engaged statements and the outcome of psychodynamic treatments.

METHODS

Transcripts of 90 sessions from good- and poor-outcome treatments (N = 18) were encoded using the MATRIX - a novel content analysis tool of psychodynamic psychotherapy. Based on fixed algorithms, this observer-coding system is designed to identify different types of clinical interventions, including those which focus on the potential-to-experience. Total number of MATRIX codes analysed was 11,125. We compared the total congruence/incongruence ratio of such statements in good and poor treatments. The importance of the congruence/incongruence ratio of the potential-to-experience statements was measured by applying general linear models to classify treatment outcome.

RESULTS

The congruence/incongruence ratio of the potential-to-experience engaged statements was significantly higher in good treatments. In the best model for classifying treatment outcome based on the congruence/incongruence ratios of several parameters, the congruence/incongruence ratio of the potential-to-experience engaged statements was the single most important predictor.

DISCUSSION

Maintaining the congruence of potential-to-experience engaged statements within the therapeutic session is associated with better clinical outcome. This provides an initial empirical indication to the importance of the potential-to-experience discourse in psychotherapy praxis.

PRACTITIONER POINTS

The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. The current results suggest that the ability of both patient and therapist to maintain the congruence of potential-to-experience statements within the session may improve clinical outcomes. These findings suggest a practical approach for a better management of the therapeutic process. Mainly, it recommends therapists to implement a very careful, active listening to potential-to-experience-related content throughout the session, while highlighting the patient's associations for their potential to become new modus operandi. Moreover, the current study presents an integrative, micro-level tool that enables the translation of complex theoretical concepts in psychotherapy into measurable constructs, aiming at the creation of a bridge between clinical theory and evidence-based practice.

[Heavy Pollution Episode in Tianjin Based on UAV Meteorological Sounding and Numerical Model]

Pollution occurs in the boundary layer, and the thermal and dynamic vertical structure of the boundary layer has a significant influence on the formation of heavy pollution episodes. Based on unmanned aerial vehicle (UAV) sounding, ground-based remote sensing and numerical modeling, this paper analyzes the vertical structure of the boundary layer and the causes of pollution during the heavy pollution episode in Tianjin from January 10 to 15, 2019, with a view to strengthening the understanding of the influence law of boundary layer processes on heavy pollution in northern coastal cities and improving the accuracy of weather forecasts and heavy pollution warnings. The results show that atmospheric temperature stratification had a significant influence on the formation, persistence, and dissipation of heavy pollution episodes. During an episode, accompanied by the development and dissipation of the inversion layer, a high PM_2.5 concentration area developed to the upper atmosphere with a height of over 300 m in the daytime and compressed to the ground at night with a height about 100 m. When fog appeared and continued in the daytime, the vertical structure characteristics of the boundary layer changed. A temperature inversion above the fog restrained the diffusion of pollutants to the upper air and made the contribution of turbulence vertical mixing process decrease significantly in the daytime, leading to the persistence and development of heavy pollution near the surface. Regional pollution transport accounted for 66.6% during the episode, which was closely related to regional pollution transport. Regional pollution transport mainly appeared at the top of the boundary layer and above the fog inversion layer where high wind speeds occurred. Pollutants were transported to the ground by a sinking motion as the boundary layer and fog height changed. This is how regional pollution transport occurred when Tianjin was controlled by a weak high pressure field in the north. The vertical structure of the boundary layer also affected the improvement of air quality by cold air. The strong temperature inversion at the top of the fog resulted in the failure of the cold air to transmit to the ground through turbulent shear stress in the S3 stage. There was an obvious difference in wind speed between the upper and lower air. The influence of cold air on the ground was delayed, and the effect of it was weakened. Thus, the heavy pollution episode could not be alleviated completely.

Quality of concept maps is affected by map building strategies

Concept-maps are widely used to assess students' conceptual understanding in different subject areas. Conventionally, it is mostly built maps which are assessed. In this study, we explore if "concept-mapping" could be used as a case for constructive alignment of both the process and the outcome of learning. Specifically, we have studied how a simple measure of looking at the order in which concept map elements-concepts (cards, C), links (arrows, A), and linking phrases (phrases, P)- are placed on the working space reveals information about the quality of the final generated map. We report findings from analysis of the concept-mapping process in two separate groups of university students (N = 38 (18 + 20)) who were asked, individually, to build concept maps related to two separate concepts in biology and chemistry respectively. We found that, across both groups, students consistently followed the same order of element placement that they began with and found significant differences in the quality of eventual maps resulting from students' map building strategies. Our results suggest that the quality of students' concept maps depends considerably on the strategy used to build it, and point to the supplementary role that the physical working space of the concept-mapping exercise offers to students' own working memory as a possible explanation for these quality differences.

Quality Markers for Astragali Radix and Its Products Based on Process Analysis

Due to the complex nature of traditional medicines, quality control methods need to cover two aspects: compliance of raw materials with quality standards and process control. Astragali radix (AR), the roots of Astragalus mongholicus Bunge, was selected in this study as an example of a widely used traditional medicine in various formulations. Astragaloside IV (AG IV) and calycosin 7-O-β-D-glucoside (CG) are used as the markers for the quality control of AR and its products in the Chinese Pharmacopoeia. However, in the raw materials, malic acid esters of the CG and acetate esters of the astragaloside are easily decomposed into CG and AG IV during storage and processing of AR to make extracts for various preparations. The thermal stability of the isoflavonoids and astragalosides in decoction was studied. The level of CG and astragalosides (AG I/AG II/AG IV) was strongly affected by prolonged heat during processing, while calycosin was stable in the conditions. Also the major astragalosides in AR could fully converted into AG IV which eventually reaches a stable level under certain conditions. With calycosin and AG IV as marker components, practical, reproducible, and precise methods were established and applied to the quality analysis of AR from its raw materials to its intermediates and products. This study demonstrates that a full chemical profiles analysis of the whole manufacturing process (from “raw materials—intermediates/extracts—final product”) is important to identify quality markers (Q-markers) and even to establish proper analysis methods for traditional Chinese medicine products.

Analysing synthesis of evidence in a systematic review in health professions education: observations on struggling beyond Kirkpatrick

Background: Systematic reviews in health professions education may well under-report struggles to synthesize disparate evidence that defies standard quantitative approaches. This paper reports further process analysis in a previously reported systematic review about mobile devices on clinical placements.Objective: For a troublesome systematic review: (1) Analyse further the distribution and reliability of classifying the evidence to Maxwell quality dimensions (beyond 'Does it work?') and their overlap with Kirkpatrick K-levels. (2) Analyse how the abstracts represented those dimensions of the evidence-base. (3) Reflect on difficulties in synthesis and merits of Maxwell dimensions.Design: Following integrative synthesis of 45 K2-K4 primary studies (by combined content-thematic analysis in the pragmatism paradigm): (1) Hierarchical cluster analysis explored overlap between Maxwell dimensions and K-levels. Independent and consensus-coding to Maxwell dimensions compared (using: percentages; kappa; McNemar hypothesis-testing) pre- vs post-discussion and (2) article abstract vs main body. (3) Narrative summary captured process difficulties and merits.Results: (1) The largest cluster (five-cluster dendrogram) was acceptability-accessibility-K1-appropriateness-K3, with K1 and K4 widely separated. For article main bodies, independent coding agreed most for appropriateness (good; adjusted kappa = 0.78). Evidence increased significantly pre-post-discussion about acceptability (p = 0.008; 31/45→39/45), accessibility, and equity-ethics-professionalism. (2) Abstracts suggested efficiency significantly less than main bodies evidenced: 31.1% vs 44.4%, p = 0.031. 3) Challenges and merits emerged for before, during, and after the review.Conclusions: There should be more systematic reporting of process analysis about difficulties synthesizing suboptimal evidence-bases. In this example, Maxwell dimensions were a useful framework beyond K-levels for classifying and synthesizing the evidence-base.

IT-Assisted Process Management in Healthcare

Clinical processes need to be well understood before a new health IT tool can be introduced. Observations, interviews, surveys, or documentation analysis are carried out to systematically collect information to better understand a clinical process. To aggregate and visualize the collected information about a clinical process, use case diagrams can build a basis. Formal process models such as process chain diagrams or BPMN diagrams are well suited to model the process in detail. The objective of this chapter is to discuss these methods for analyzing and modeling clinical processes, as this is an important precondition for systematic process management in health care.

Hot-Melt Extrusion Process Fluctuations and their Impact on Critical Quality Attributes of Filaments and 3D-printed Dosage Forms

Fused deposition modeling (FDM^TM) is a 3D-printing technology of rising interest for the manufacturing of customizable solid dosage forms. The coupling of hot-melt extrusion with FDM^TM is favored to allow the production of pharma-grade filaments for the printing of medicines. Filament diameter consistency is a quality of great importance to ensure printability and content uniformity of 3D-printed drug delivery systems. A systematical process analysis referring to filament diameter variations has not been described in the literature. The presented study aimed at a process setup optimization and rational process analysis for filament fabrication related to influencing parameters on diameter inhomogeneity. In addition, the impact of diameter variation on the critical quality attributes of filaments (mechanical properties) and uniformity of mass of printed drug-free dosage forms was investigated. Process optimization by implementing a winder with a special haul-off unit was necessary to obtain reliable filament diameters. Subsequently, the optimized setup was used for conduction of rational extrusion analysis. The results revealed that an increased screw speed led to diameter fluctuations with a decisive influence on the mechanical resilience of filaments and mass uniformity of printed dosage forms. The specific feed load was identified as a key parameter for filament diameter consistency.

[Pollution Characteristics and Enhanced Removal of Organic Phosphorus in Effluent from a Wastewater Treatment Plant]

Given the presence of organic phosphorus (OP) pollution in wastewater treatment plant (WWTP) effluents, contaminant properties and enhanced removal approaches were investigated. The experimental results showed that the respective levels of effluent total phosphorus (TP), PO₄^3--P, Poly-P, and OP were 0.62, 0.22, 0.03, and 0.37 mg·L^-1, respectively, for which the ratio of OP reached up to 59.7%. Based on the flow analysis, the proportions of influent PO₄^3--P, Poly-P, and OP changed from 54.4%, 6.3%, and 39.3% to 16.9%, 14.5%, and 68.6% within the effluent. The OP content was positively correlated with the DOC content (R²=0.65), and the average contents of hydrophilic and hydrophobic OP were 0.12 mg·L^-1 and 0.31 mg·L^-1, respectively. C/P in hydrophobic OP was relatively lower than that in hydrophilic OP, which indicated that the bioavailability of hydrophobic OP was higher. However, the bioavailability of hydrophobic OP was only 20%, which implied that the effluent OP basically consisted of refractory components. A total of 32.6% of OP within the effluent was removed through bioadsorption reactions with activated coke, while the removal of OP was up to 79.1% when 30 mg·L^-1 of O₃ was applied, which suggested that advanced oxidation was more beneficial for the enhancement of OP removal.

Mirror meetings with frail older people and multidisciplinary primary care teams: Process and impact analysis

OBJECTIVES

To analyse the process and impact of confronting multidisciplinary teams (MTs) in primary care with the experiences of frail older patients through mirror meetings (MMs), with the aim of supporting teams to organize care in a more patient-oriented way.

METHODS

Process and impact analyses were performed using a mixed-method approach. MMs were held with 14 frail older patients and four MTs comprising 23 health-care professionals (HCPs) in primary care in the Netherlands.

RESULTS

Mirror meetings were feasible for frail older people living at home, although their recruitment was time-consuming. Interaction between the patients was scarce, but they valued the opportunity to share their stories. HCPs preferred MMs overwritten reports about patient experiences. An impact analysis revealed four dominant professional areas for improvement: improve alignment with patient goals, improved communication with patients both orally and in writing, developing new pathways to connect with informal caregivers and an increased understanding that most HCPs are relative strangers to their patients.

CONCLUSIONS

Mirror meetings are a relatively simple and promising method for exploring the ways in which frail older patients experience care.

PRACTICE IMPLICATIONS

Given the right conditions, MMs could result in valuable processes to enable MTs to improve their working methods.

Healthcare practitioners' experiences of an intervention to detect and treat patients with liver disease (the LOCATE intervention): a qualitative process evaluation

OBJECTIVES

The local care and treatment of liver disease (LOCATE) intervention embedded specialist liver nurses in general practitioner (GP) practices to improve the identification of progressive liver disease, enabling earlier intervention. This current process evaluation examines GP practice staffs' perceptions of the LOCATE intervention, in order to understand any potential barriers to successful implementation in clinical practice.

STUDY DESIGN AND SETTING

A qualitative process evaluation nested within the LOCATE feasibility trial, using semistructured interviews with practice staff from five GP surgeries in the UK.

PARTICIPANTS

A purposive sample of 29 interviews with practice staff (GPs, nurses, practice managers).

DATA COLLECTION

Interview transcripts were subjected to thematic analysis.

FINDINGS

The intervention was found to be acceptable to practice staff and a number of barriers and facilitators to the success of the intervention were identified. However, interviews suggested that the intervention did not provide sufficient guidance for clinicians to be able to help patients make the behavioural changes needed to reduce risk factors associated with liver disease. The intervention did appear to improve clinician awareness and knowledge about liver disease, enabling GPs to feel more confident interpreting and managing liver function blood tests in order to identify the early signs of liver disease.

CONCLUSIONS

This study enabled identification of potential barriers to implementation of specialist nurses in primary care to identify progressive liver disease and enable earlier intervention. The next steps are to improve the intervention to make it more feasible to implement in practice and more likely to help patients to make the behavioural changes required to prevent a major liver event.

TRIAL REGISTRATION NUMBER

13/SC/0012; Post-results.

ETHICS

This study was reviewed and approved by NRES Committee South Central-Hampshire A, Bristol Research Ethics Committee Centre, level 3, block B, Whitefriars, Lewins Mead Bristol BS1 2NT.

Processes in Psychotherapy and the MATRIX: The Case of Projective Identification

The MATRIX is a tool designed to analyze psychoanalytic sessions. It is composed of two axes: focus (patient, therapist, and dyad) and dimension (space, content, and order). The MATRIX was found to be a reliable tool, and valid for identifying the therapist's theoretical inclinations in psychoanalytic-oriented psychotherapy sessions. In the present study, we suggest that the MATRIX can identify different (Kleinian, Bionian, and relational) approaches to projective identification, thus providing therapists and supervisors an easy-to-use tool for monitoring, and better managing, projective identifications during psychoanalytically oriented psychotherapy.

A Piecewise Local Partial Least Squares (PLS) Method for the Quantitative Analysis of Plutonium Nitrate Solutions

We have developed a piecewise local (PL) partial least squares (PLS) analysis method for total plutonium measurements by absorption spectroscopy in nitric acid-based nuclear material processing streams. Instead of using a single PLS model that covers all expected solution conditions, the method selects one of several local models based on an assessment of solution absorbance, acidity, and Pu oxidation state distribution. The local models match the global model for accuracy against the calibration set, but were observed in several instances to be more robust to variations associated with measurements in the process. The improvements are attributed to the relative parsimony of the local models. Not all of the sources of spectral variation are uniformly present at each part of the calibration range. Thus, the global model is locally overfitting and susceptible to increased variance when presented with new samples. A second set of models quantifies the relative concentrations of Pu(III), (IV), and (VI). Standards containing a mixture of these species were not at equilibrium due to a disproportionation reaction. Therefore, a separate principal component analysis is used to estimate of the concentrations of the individual oxidation states in these standards in the absence of independent confirmatory analysis. The PL analysis approach is generalizable to other systems where the analysis of chemically complicated systems can be aided by rational division of the overall range of solution conditions into simpler sub-regions.

[Research on optimal modeling strategy for licorice extraction process based on near-infrared spectroscopy technology]

The manufacture of traditional Chinese medicine (TCM) products is always accompanied by processing complex raw materials and real-time monitoring of the manufacturing process. In this study, we investigated different modeling strategies for the extraction process of licorice. Near-infrared spectra associate with the extraction time was used to detemine the states of the extraction processes. Three modeling approaches, i.e., principal component analysis (PCA), partial least squares regression (PLSR) and parallel factor analysis-PLSR (PARAFAC-PLSR), were adopted for the prediction of the real-time status of the process. The overall results indicated that PCA, PLSR and PARAFAC-PLSR can effectively detect the errors in the extraction procedure and predict the process trajectories, which has important significance for the monitoring and controlling of the extraction processes.

Statistical process control and verifying positional accuracy of a cobra motion couch using step-wedge quality assurance tool

This study utilizes process control techniques to identify action limits for TomoTherapy couch positioning quality assurance tests. A test was introduced to monitor accuracy of the applied couch offset detection in the TomoTherapy Hi‐Art treatment system using the TQA “Step‐Wedge Helical” module and MVCT detector. Individual X‐charts, process capability (cp), probability (P), and acceptability (cpk) indices were used to monitor a 4‐year couch IEC offset data to detect systematic and random errors in the couch positional accuracy for different action levels. Process capability tests were also performed on the retrospective data to define tolerances based on user‐specified levels. A second study was carried out whereby physical couch offsets were applied using the TQA module and the MVCT detector was used to detect the observed variations.

Random and systematic variations were observed for the SPC‐based upper and lower control limits, and investigations were carried out to maintain the ongoing stability of the process for a 4‐year and a three‐monthly period. Local trend analysis showed mean variations up to ±0.5 mm in the three‐monthly analysis period for all IEC offset measurements. Variations were also observed in the detected versus applied offsets using the MVCT detector in the second study largely in the vertical direction, and actions were taken to remediate this error. Based on the results, it was recommended that imaging shifts in each coordinate direction be only applied after assessing the machine for applied versus detected test results using the step helical module. User‐specified tolerance levels of at least ±2 mm were recommended for a test frequency of once every 3 months to improve couch positional accuracy. SPC enables detection of systematic variations prior to reaching machine tolerance levels. Couch encoding system recalibrations reduced variations to user‐specified levels and a monitoring period of 3 months using SPC facilitated in detecting systematic and random variations. SPC analysis for couch positional accuracy enabled greater control in the identification of errors, thereby increasing confidence levels in daily treatment setups.

Effects of Sequences of Cognitions on Group Performance Over Time

Extending past research showing that sequences of low cognitions (low-level processing of information) and high cognitions (high-level processing of information through questions and elaborations) influence the likelihoods of subsequent high and low cognitions, this study examines whether sequences of cognitions are related to group performance over time; 54 primary school students (18 triads) discussed and wrote an essay about living in another country (32,375 turns of talk). Content analysis and statistical discourse analysis showed that within each lesson, groups with more low cognitions or more sequences of low cognition followed by high cognition added more essay words. Groups with more high cognitions, sequences of low cognition followed by low cognition, or sequences of high cognition followed by an action followed by low cognition, showed different words and sequences, suggestive of new ideas. The links between cognition sequences and group performance over time can inform facilitation and assessment of student discussions.

Not re-inventing the wheel: the adaptive implementation of the meeting centres support programme in four European countries

OBJECTIVES

The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands.

METHOD

A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase.

RESULTS

Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious.

CONCLUSION

These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe.

Tracing and inhibiting growth of Staphylococcus aureus in barbecue cheese production after product recall

Staphylococcal food poisoning is one of the most prevalent causes of foodborne intoxication worldwide. It is caused by ingestion of enterotoxins formed by Staphylococcus aureus during growth in the food matrix. Following a recall of barbecue cheese due to the detection of staphylococcal enterotoxins in Switzerland in July 2015, we analyzed the production process of the respective dairy. Although most cheese-making processes involve acidification to inhibit the growth of pathogenic bacteria, barbecue cheese has to maintain a pH >6.0 to prevent undesired melting of the cheese. In addition, the dairy decided to retain the traditional manual production process of the barbecue cheese. In this study, therefore, we aimed to (1) trace Staph. aureus along the barbecue cheese production process, and (2) develop a sustainable strategy to inhibit growth of Staph. aureus and decrease the risk of staphylococcal food poisoning without changing the traditional production process. To this end, we traced Staph. aureus in a step-wise blinded process analysis on 4 different production days using spa (Staphylococcus protein A gene) typing, DNA microarray profiling, and pulsed-field gel electrophoresis analysis. We subsequently selected a new starter culture and used a model cheese production including a challenge test assay to assess its antagonistic effect on Staph. aureus growth, as well as its sensory and technological implications. We detected Staph. aureus in 30% (37/124) of the collected samples taken from the barbecue cheese production at the dairy. This included detection of Staph. aureus in the final product on all 4 production days, either after enrichment or using quantitative detection. We traced 2 enterotoxigenic Staph. aureus strains (t073/CC45 and t282/CC45) colonizing the nasal cavity and the forearms of the cheesemakers to the final product. In the challenge test assay, we were able to show that the new starter culture inhibited growth of Staph. aureus while meeting the sensory and technological requirements of barbecue cheese production.

Teaching workflow analysis and lean thinking via simulation: a formative evaluation

This article presents the rationale for the design and development of a video simulation used to teach lean thinking and workflow analysis to health services and health information management students enrolled in a course on the management of health information. The discussion includes a description of the design process, a brief history of the use of simulation in healthcare, and an explanation of how video simulation can be used to generate experiential learning environments. Based on the results of a survey given to 75 students as part of a formative evaluation, the video simulation was judged effective because it allowed students to visualize a real-world process (concrete experience), contemplate the scenes depicted in the video along with the concepts presented in class in a risk-free environment (reflection), develop hypotheses about why problems occurred in the workflow process (abstract conceptualization), and develop solutions to redesign a selected process (active experimentation).