Yes / The implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice. Objectives: To (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS. Design: Realist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was conducted across four trusts to test the theories. Data were collected using observation, video recording, interviews and questionnaires. Phase 3 – interviews were conducted in other surgical disciplines to assess the generalisability of the findings. Findings: The introduction of RAS is surgeon led but dependent on support at multiple levels. There is significant variation in the training provided to theatre teams. Contextual factors supporting the integration of RAS include the provision of whole-team training, the presence of handpicked dedicated teams and the availability of suitably sized operating theatres. RAS introduces challenges for teamwork that can impact operation duration, but, over time, teams develop strategies to overcome these challenges. Working with an experienced assistant supports teamwork, but experience of the procedure is insufficient for competence in RAS and experienced scrub practitioners are important in supporting inexperienced assistants. RAS can result in reduced distraction and increased concentration for the surgeon when he or she is supported by an experienced assistant or scrub practitioner. Conclusions: Our research suggests a need to pay greater attention to the training and skill mix of the team. To support effective teamwork, our research suggests that it is beneficial for surgeons to (1) encourage the team to communicate actions and concerns; (2) alert the attention of the assistant before issuing a request; and (3) acknowledge the scrub practitioner’s role in supporting inexperienced assistants. It is beneficial for the team to provide oral responses to the surgeon’s requests. Limitations: This study started after the trial, limiting impact on analysis of the trial. The small number of operations observed may mean that less frequent impacts of RAS were missed. Future work: Future research should include (1) exploring the transferability of guidance for effective teamwork to other surgical domains in which technology leads to the physical or perceptual separation of surgeon and team; (2) exploring the benefits and challenges of including realist methods in feasibility and pilot studies; (3) assessing the feasibility of using routine data to understand the impact of RAS on rare end points associated with patient safety; (4) developing and evaluating methods for whole-team training; and (5) evaluating the impact of different physical configurations of the robotic console and team members on teamwork. / National Inst for Health Research (NIHR)

Yes / Introduction This process evaluation was conducted in parallel to the randomised controlled feasibility trial of NIDUS-Professional, a manualised remote dementia training intervention for homecare workers (HCWs), delivered alongside an individualised intervention for clients living with dementia and their family carers (NIDUS-Family). The process evaluation reports on: (i) intervention reach, dose and fidelity; (ii) contexts influencing agency engagement and (iii) alignment of findings with theoretical assumptions about how the intervention might produce change. Methods We report proportions of eligible HCWs receiving any intervention (reach), number of sessions attended (dose; attending ≥4/6 main sessions was predefined as adhering), intervention fidelity and adherence of clients and carers to NIDUS-Family (attending all 6–8 planned sessions). We interviewed HCWs, managers, family carers and facilitators. We integrated and thematically analysed, at the homecare agency level, qualitative interview and intervention recording data. Results 32/141 (23%) of eligible HCWs and 7/42 (17%) of family carers received any intervention; most who did adhered to the intervention (89% and 71%). Intervention fidelity was high. We analysed interviews with 20/44 HCWs, 3/4 managers and 3/7 family carers, as well as intervention recordings involving 32/44 HCWs. All agencies reported structural challenges in supporting intervention delivery. Agencies with greater management buy-in had higher dose and reach. HCWs valued NIDUS-Professional for enabling group reflection and peer support, providing practical, actionable care strategies and increasing their confidence as practitioners. Conclusion NIDUS-Professional was valued by HCWs. Agency management, culture and priorities were key barriers to implementation; we discuss how to address these in a future trial. / Alzheimer's Society (Centre of Excellence grant 330), Dementia and Neurodegenerative Disease Policy Research Unit - Queen Mary (NIHR206110 and NIHR206110), NIHR Senior Investigator Award (NIHR205009)

A. Marudinaite. The evaluation of metadone maintenance treatment program process in Lithuania: Master Thesis // supervisor prof. Žilvinas Padaiga; Department of Social Medicine, Kaunas University of Medicine. – Kaunas, 2005 – 59 p. Objective: To evaluate methadone maintenance treatment program process in Lithuania. Methods: The analysis was based on instruments developed or adapted by the World Health Organization (WHO): Treatment services review, Checklist for Service Description, Checklist on service quality, Staff attitude and Satisfaction Questionnaire, Schedules for the Assessment of Standards of Care, and Treatment Perception Questionnaire. 50 patients from Vilnius, 20 from Kaunas and 30 from Klaipeda Centers for Addictive Disorders have been questioned, as well as focus groups, comprised of program personnel, patients, external experts, and community representatives. Results: the literature review revealed the factors influencing the process of methadone maintenance treatment (MMT) program: quantity and quality of services; consultations of psychologists to both patients, their relatives and social workers, as well as medical help; adequate methadone dose (it is usually 60 – 100 mg/day); take home privileges, which improve patients motivation; control urine tests, which deter patients from drug usage. The MMT in Lithuania review indicates that treatment accessibility for drug users is very limited geographically. MMT is run only in five largest Lithuanian cities:... [to full text]

iv Sheet metal forming technologies are challenged especially by the improvements in the automotive industry in the last decades. To fulfill the customer expectations, safety requirements and market competitions, new production technologies have been implemented. This study focuses on the assessment of conventional and new sheet metal forming technologies by performing a systematic analysis. A geometry spectrum consisting of six different circular, elliptic, quad cross-sections are selected for the assessment of conventional deep drawing, hydro-mechanical deep drawing and high-pressure sheet metal forming. Within each cross-section, three different equivalent drawing ratios are used as a variant. More than 200 numerical experiments are performed to predict the forming limits of three competing processes. St14 stainless steel is used as the material throughout the assessment study. The deformation behavior is described by an elasto-plastic material model and all numerical simulations are carried out by using dynamic-explicit commercial The process validation is done by interpreting the strain results of numerical experiment. Therefore, the reliability of predictions in the assessment study highly depends on the quality of simulations. The precision of numerical experiments are verified by comparing to NUMISHEET benchmarks, analytical formulation, and experiments to increase the assets of the assessment study. The analyses revealed that depending on the workpiece geometry and dimensional properties certain processes are more preferable for obtaining satisfactory products. The process limits for each process are established based on the analyzed crosssections of the spectrum. This data is expected to be useful for predicting the formability limits and for selecting the appropriate production process according to a given workpiece geometry.Dynamic-explicit FEM, Deep drawing, Hydroforming, Forming limits, Process evaluation

This study investigates software development process improvement approaches. In particular, the static process evaluation methodology proposed by S. G&uuml / ceglioglu is applied on the requirements analysis and validation process applied in Project X in MYCOMPANY and an improved process is proposed. That methodology is an extension of the ISO/IEC 9126 approach for software quality assessment, and is based on evaluating a set of well-defined metrics on the static model of software development processes. The improved process proposed for Project X is evaluated using G&uuml / ceglioglu&rsquo / s methodology. The applied and improved process measurement results compared to determine if the improved process is successful or not.

This report discusses the importance of test process evaluation in order to improve a test model and to provide developer- and management feedback. The report results in a test evaluation framework, developed in cooperation with a department at Ericsson Software Technology in Karlsrona. The framework is a result of discussions with the developers regarding performed testing, studying defect types from past projects and by analyzing the result from a small survey answered by some of the developers at Ericsson. The overall project aim was to evaluate performed testing in order to improve the test model. This requires a good insight of the test process, which is provided by the developed test evaluation framework. The test process is visualized by extracting test process data, making it possible to achieve the project aim. The project aim can be divided into the three following areas: Firstly to evaluate if the current test model is followed as expected, for example are all test techniques used according to the test model? Secondly to evaluate how well the test model fulfills predefined expectations, i.e. is a defect detected with the expected test technique and in the expected test phase? Finally to evaluate if there are any problematic defects that should receive extra attention during a project such as if one or several defect types occurs more frequently than others? The framework is based on another framework, Orthogonal Defect Classification [Chillarege92], combined with the research area Test Technique Effectiveness. The aim of this combination was to support the developed framework. Further a specific part of the framework is focusing on developer- and management feedback. / Dan Bengtsson Västra Stationstorget 7 222 37 Lund

At the water treatment plant in Dunedin, Florida, reverse osmosis membranes remove the hardness from groundwater sources. Reverse osmosis membranes remove salts, pathogens, and organics from the feed water but can create an aggressive permeate. The membranes strip most ions in the process and the resulting permeate, if not subjected to blending on post treatment, has a tendency to leach metals from lead and copper pipes in the distribution networks. To prevent such problems, the permeate needs to be blended with partially treated raw water or to be chemically treated to re-mineralize and add alkalinity back into the water. In the last decade nanofiltration treatment has gained an increasing foothold in the water treatment industry especially as a water softener. Although nanofiltration membranes also have a high removal rate for organics and pathogens, the separation process is more selective towards multivalent ions (e.g., Ca²+, and Mg²+) than monovalent (e.g., Na+) ions. Most membrane softening plants blend minimally treated raw water with the membrane permeate as a means to reduce the aggressiveness of the water. However, blending can cause issues with disinfection byproducts and pathogen re-introduction. With nanofiltration membranes, fewer mono-valent ions are rejected which creates a more stable permeate and can reduce the blended water ratio. Since it is unlikely that most plants that use membrane filtration for water softening will be able to stop blending entirely, any improvement or sustainability of water quality at a reduced blend ratio should be viewed favorably within the water treatment industry. The study evaluates three nanofiltration membranes: TFC-SR, NF-90, and ESNA1-LF in relation to the reverse osmosis TFC-S RO membrane currently in use at Dunedin. Water flux and salt rejection of the permeate water were compared using solutions of NaCl, MgSO4 and CaCl2. Since the Langelier Saturation Index (LSI) is one of the main tests of the blended finished water and is used to judge water quality prior to its release into the distribution system, this study created a 0%, 10%, 15%, 20%, 30%, and 100% blend ratio for each membrane to compare and contrast the change in the LSI. The TFC-SR membrane showed the most promise in lowering the blend ratio while improving the aggressiveness of the finished water by showing a lower rejection for divalent ions. The TFC-SR membrane also showed an improvement in the LSI relative to the other membranes over the total range of blend ratios.

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Recent literature has suggested the importance of physical activity in early childhood such as during the toddler years (12 months - 3 years.) Despite this, most toddlers are not physically active. There is a need to determine the types of physical activity programs that would interest toddlers within the settings they spend a significant amount of time in (e.g., childcare center). Currently, data on the feasibility, implementation, and process evaluation of physical activity interventions in toddler age children attending childcare centers is lacking within the literature. Therefore, the purpose of the Toddler Activity Pilot (TAP-A-LONG) study was to examine the feasibility and acceptability of a four day per week, 10-week physical activity program in toddler aged children during the childcare day. Process evaluation data was collected daily during the entire 10-week study using a semi-structured questionnaire. Once per week on a randomly selected day, toddlers’ physical activity was assessed with accelerometers during the 10-minute intervention session or gross-motor playtime for the treatment and control group, respectively. Accelerometers were also worn for the duration of the full day during baseline, midpoint, and post. Participants were male (58%), white (46%), and lived in a household with married parents (58%). Toddlers’ average age was 25.0 ± 4.2 months. A total of 69.4% of the toddler population was recruited to participate in the study amongst the three participating centers (TAP = 37; CON = 13). During the 10-minute intervention session, toddlers in the treatment group spent 60.4 ± 22.0%, 28.7 ± 15.7%, and 10.9 ± 10.6% of time in sedentary (SED), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA), respectively. While control center spent 55.7 ± 18.8%, 35.9 ± 15.1, and 8.4 ± 8.0% in SED, LPA, and MVPA, respectively. For program quality, 76.7% and 62.0% of researcher and provider led intervention sessions were delivered clearly (i.e., directions were understandable to toddlers), respectively. The majority of intervention sessions held toddlers’ attention (60% of toddlers participated in at least half of the intervention). Overall, the high acceptability of our TAP-A-LONG intervention highlights the usefulness of physical activity interventions within the childcare setting.