Yes / Background: In English hospitals, the patient’s vital signs are monitored and summarised into a National Early Warning Score (NEWS). NEWS is more accurate than the quick sepsis related organ failure assessment (qSOFA) score at identifying patients with sepsis. We investigate the extent to which the accuracy of the NEWS is enhanced by developing computer-aided NEWS (cNEWS) models. We compared three cNEWS models (M0=NEWS alone; M1=M0 + age + sex; M2=M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis. Methods: All adult emergency medical admissions discharged over 24-months from two acute hospitals (YH–York Hospital for model development; NH–Northern Lincolnshire and Goole Hospital for external model validation). We used a validated Canadian method for defining sepsis from administrative hospital data. Findings: The prevalence of sepsis was lower in YH (4.5%=1596/35807) than NH (8.5%=2983/35161). The c-statistic increased across models (YH: M0: 0.705, M1:0.763, M2:0.777; NH:M0: 0.708, M1:0.777, M2:0.791). At NEWS 5+, sensitivity increased (YH: 47.24% vs 50.56% vs 52.69%; NH: 37.91% vs 43.35% vs 48.07%)., the positive likelihood ratio increased (YH: 2.77 vs 2.99 vs 3.06; NH: 3.18 vs 3.32 vs 3.45) and the positive predictive value increased (YH: 11.44% vs 12.24% vs 12.49%; NH: 22.75% vs 23.55% vs 24.21%). Interpretation: From the three cNEWS models, Model M2 is the most accurate. Since it places no additional data collection burden on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure. / The Health Foundation, National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre / Research Development Fund Publication Prize Award winner, April 2019.

Published Article / Early indication of possible drought can help in developing suitable drought mitigation strategies and measures in advance. Therefore, drought forecasting plays an important role in the planning and management of water resource in such circumstances. In this study, a non-linear streamflow forecasting model was developed using Artificial Neural Network (ANN) modeling technique at the Melka Sedi stream gauging station, Ethiopia, with adequate lead times. The available data was divided into two independent sets using a split sampling tool of the neural network software. The first data set was used for training and the second data set, which is normally about one fourth of the total available data, was used for testing the model. A one year data was set aside for validating the ANN model. The streamflow predicted using the model on weekly time step compared favorably with the measured streamflow data (R2 = 75%) during the validation period. Application of the model in assessing appropriate agricultural water management strategies for a large-scale irrigation scheme in the Awash River Basin, Ethiopia, has already been considered for publication in a referred journal.

This work deals with two main fields: a) The design, built, installation, test, evaluation, deployment and maintenance of Seismological Network of Crete (SNC) of the Laboratory of Geophysics and Seismology (LGS) at Technological Educational Institute (TEI) at Chania. b) The use of Wavelet Transform (WT) in several applications during the operation of the aforementioned network. SNC began its operation in 2003. It is designed and built in order to provide denser network coverage, real time data transmission to CRC, real time telemetry, use of wired ADSL lines and dedicated private satellite links, real time data processing and estimation of source parameters as well as rapid dissemination of results. All the above are implemented using commercial hardware and software which is modified and where is necessary, author designs and deploy additional software modules. Up to now (July 2008) SNC has recorded 5500 identified events (around 970 more than those reported by national bulletin the same period) and its seismic catalogue is complete for magnitudes over 3.2, instead national catalogue which was complete for magnitudes over 3.7 before the operation of SNC. During its operation, several applications at SNC used WT as a signal processing tool. These applications benefited from the adaptation of WT to non-stationary signals such as the seismic signals. These applications are: HVSR method. WT used to reveal undetectable non-stationarities in order to eliminate errors in site’s fundamental frequency estimation. Denoising. Several wavelet denoising schemes compared with the widely used in seismology band-pass filtering in order to prove the superiority of wavelet denoising and to choose the most appropriate scheme for different signal to noise ratios of seismograms. EEWS. WT used for producing magnitude prediction equations and epicentral estimations from the first 5 secs of P wave arrival. As an alternative analysis tool for detection of significant indicators in temporal patterns of seismicity. Multiresolution wavelet analysis of seismicity used to estimate (in a several years time period) the time where the maximum emitted earthquake energy was observed.

School districts constantly struggle to find solutions to address the high school dropout problem. Literature supports the need to identify and intervene with these students earlier and in more systemic ways. The purpose of this study was to conduct a longitudinal examination of the relationship between sustained afterschool participation and the host district’s early warning index (EWI) associated with school dropout. Data included 65,341 students participating in an urban school district’s after school program from school years 2000-2001 through 2011-2012. The district serves more than 80,000 students annually. Data represented students in Pre-Kindergarten through Grade 12, and length of participation ranged from 1 through 12 years. Results indicated that student risk increased over time and that persistent participation in afterschool programming had a significant relationship with student individual growth trajectories. Slower growth rates, as evidenced through successive models, supported students being positively impacted by program participation. Additionally, participation was more meaningful if students persisted, as noted in the lower EWI rates, as compared to students who attended less consistently.

Early warning of slope instability will enable evacuation of vulnerable people and timely repair and maintenance of critical infrastructure. However, currently available warning systems are too expensive for wide-scale use or have technical limitations. The acoustic emission (AE) monitoring approach using active waveguides (i.e. a steel tube with granular backfill surround installed in a borehole through a slope), in conjunction with the Slope ALARMS AE measurement system, has the potential to be an affordable early warning system for slope instability. However, the challenge has been to develop strategies to interpret and quantify deformation behaviour from measured AE. The development of an approach to quantify slope deformation behaviour from measured AE will enable the AE monitoring system to provide early warning of slope instability through detecting, quantifying and communicating accelerations in slope movement. Field monitoring and full-scale physical modelling have been conducted to characterise the AE response from the system to both reactivated slope movements and first-time slope failure. Definitive field evidence has been obtained showing AE monitoring can measure slope movements and generated AE rates are proportional to slope displacement rates, which was confirmed through comparisons with both conventional inclinometer and continuous ShapeAccelArray deformation measurements. A field monitoring case study demonstrated that the AE approach can detect very slow slope movements of 0.075 mm/day. In addition, the concept of retrofitting inclinometer casings with active waveguides to convert the manually read instrument to a real-time monitoring system has been demonstrated using a field trial. Dynamic strain-controlled shear tests on active waveguide physical models demonstrated that AE monitoring can be used to quantify slope displacement rates, continuously and in real-time, with accuracy to within an order of magnitude. Large-scale first-time slope failure experiments allowed the AE response to slope failure to be characterised. AE was detected after shear deformations of less than a millimetre in previously un-sheared material, and AE rates increased proportionally with displacement rates as failure occurred. The AE rate-displacement rate relationship can be approximated as linear up to 100 mm/hour and shear surface deformations less than 10-20 mm. At greater velocities and larger deformations the gradient of the relationship progressively increases and is best represented using a polynomial. This is because complex pressure distributions develop along the active waveguide analogous to a laterally loaded pile, and the confining pressures increase. Variables that influence the AE rate-displacement rate relationship have been quantified using physical model experiments and empirical relationships. A framework has been developed to allow AE rate-displacement rate calibration relationships to be determined for any AE system installation. This provides a universal method that can be used by practitioners when installing AE systems, to calibrate them to deliver alarm statuses/warning levels that are related to slope displacement rates. Use of this framework has been demonstrated using a case study example, and decision making protocols have been suggested that use trends in alarms with time to trigger decisions, which could be to send an engineer to inspect the slope, manage traffic, or evacuate people.

Philosophiae Doctor - PhD / Critical Care Outreach Services (CCOSs) recognize early sign of deterioration in medical units, regarding the condition of the patient, by using elements of vital sign tracking namely modified early warning score (MEWS). Nurses as leaders should be proactive by using influence to obtain a desired outcome. It is unclear how nurses experience self-leadership in this outreach service in a private hospital in Pretoria. The purpose of this research was to understand nurses’ experience of their self-leadership in the current CCOS at a private hospital in Pretoria, in order to develop self-leadership strategies that could contributes to the implementation of a CCOS (for the broader population of nurses) in a private hospital group in Gauteng. In this research the steps as outlined in the self-leadership strategic framework of Neck and Milliman (1994) were adapted for this research. The theoretical assumptions furthermore informed the methodological steps followed in the research process. The theoretical assumptions of the Practice Orientated Theory of Dickoff, James and Wiedenbach (1968) were adapted and the survey lists of this theory served as a reasoning map in this research. The central statement of this research was that, nurses need to lead themselves in implementing a CCOS in general wards in a private hospital group in Gauteng.

Freqüentemente, a população das áreas metropolitanas é surpreendida pela ocorrência de inundações muito rápidas que causam danos diversos. O sistema de alerta antecipado contra inundações é uma ferramenta que visa minimizar tais impactos. O componente de previsão do sistema será abordado neste trabalho. Tal previsão é feita através de um modelo conceitual de previsão hidrometeorológica de precipitação baseado em equações termodinâmicas e modelo simplificado de física das nuvens seguido de um modelo chuva-vazão. A antecedência proporcionada pelo modelo hidrometeorológico aplicado é de 30 minutos para variáveis de entrada observadas. Este tempo pode ser estendido com a inclusão de estimativas futuras das variáveis de entrada. A calibração do modelo foi feita manualmente com o uso de duas medidas de desempenho, esta etapa pode ser aprimorada em pesquisas futuras. Apesar da simplicidade do modelo hidrometeorológico apresentou-se satisfatório em algumas simulações, conseguindo prever o início das precipitações. / Urban population are often surprised by flash floods which cause several kinds of damages. An early warning system is a tool which aims to minimize such impacts. This work will approach the forecast component of this system. A conceptual hydrometeorological precipitation forecasting model, based on thermodynamics equations and simplified cloud physics, will be used to perform the forecast. Model lead time is 30 minutes for measured inputs, this time can be extended by the use of estimated inputs instead of the measured ones. Calibration was performed manually based on conservation of precipitation volume and its distribution in time. This step can be improved on future researches. In spite of model’s simplicity, some simulations presented satisfactory results, being able to forecast precipitation’s beginning.

Cette thèse a permis la mise en place d’un système d’alerte précoce des épidémies de paludisme basé sur le système de surveillance sentinelle proposant différents seuils épidémiques et un modèle de prédiction. Les données collectées quotidiennement par SMS sont automatiquement stockées sur un serveur dédié. Concomitamment, le système acquiert systématiquement et de manière automatique des données satellitaires météorologiques sur chaque site sentinelle en lien avec les changements de prévalence du paludisme, tels que la température, les précipitations et l'indice de végétation (eng. NDVI). Une base de données des interventions contre le paludisme a également été créée. Ce système a déjà démontré sa capacité à détecter une épidémie de paludisme dans le sud-est du pays en 2014. Deuxièmement, nous avons réalisé une étude pour évaluer la relation entre la durée de l'efficacité de la campagne de masse des moustiquaires imprégnées d'insecticide à effet longue durée (MILD) et les épidémies de paludisme identifiées à Madagascar de 2009 à 2015 par le système de surveillance sentinelle. Cette étude a montré que la différence entre l'efficacité théorique et l’efficacité réelle peut entraîner des lacunes dans la couverture des services pendant les années suivantes, contribuant au rebond du paludisme et souligne la nécessité de mise en place de mécanisme de distribution continue de moustiquaires. Ce travail vise à maximiser l'utilité d'un système de surveillance sentinelle dans des milieux à ressources limitées, guider les changements dans l'orientation des programmes de lutte et fournir des exemples pratiques pour son utilisation dans d'autres systèmes ou contextes. / We describe a Malaria Early Warning System (MEWS) using various epidemic thresholds and a forecasting component with the support of recent technologies to improve the performance of a sentinel MEWS. Malaria-related data from sentinel sites collected by Short Message Service are automatically stored in a database hosted on a server at Institut Pasteur de Madagascar. Concomitantly our system routinely and automatically acquires site specific satellite weather data related to changes in malaria prevalence such as temperature, rainfall and Normalized Difference Vegetation Index (NDVI). A Malaria Control Intervention data base has also been. This system has already demonstrated its ability to detect a malaria outbreak in southeastern part of Madagascar in 2014. In a second time, we conducted a study to assess the relationship between the effectiveness of mass campaign of long-lasting insecticidal nets (LLIN) over time and malaria outbreaks identified in Madagascar from 2009 to 2015 through the Sentinel surveillance system. This study showed that the difference between efficacy and effectiveness may result in gaps in service coverage during the subsequent years contributing to malaria rebound well before the replacement of the LLINs and highlights the need of continuous distribution mechanism of LLINs.This work aims to maximize the usefulness of a sentinel surveillance system to predict and detect epidemics in limited-resource environments, to guide any changes in the orientation of malaria control programs and to provide practical examples and suggestions for use in other systems or settings.

The study aims to empirically study the Early warning system and how national parliaments in the EU vary regarding the issuing of reasoned opinions. In recent years the subject of subsidiarity within the EU has become an increasingly debated and controversial topic. The Early warning system aims to alleviate the democratic deficiency of the EU, but the scientific community is divided on how efficient it is. Using data from the European parliament this study examines reasoned opinions and factors that influences why national parliaments issue them and why there is such a variation amongst the national parliaments issuing them. The study finds that being a member of the Eurozone and the EU15 has important implications for parliaments issuing reasoned opinions.

Vi har undersökt hur Scandinavian Airlines Systems (SAS) årsredovisningar kanstuderas utifrån ord respektive siffror och vilket av de två som ger bäst informationför en extern intressent. Vidare har vi studerat hur väl redovisningen överrensstämmermed företagets situation. I studien har nyckeltal och analysmetoden Content analysisanvänts för att studera siffror i årsredovisningen, medans stycket ”VD har ordet” stårtill grund för analysen av text. Vårt syfte med uppsatsen är att bidra med kunskap omhur årsredovisningar kan användas av externa intressenter, det vill säga hurårsredovisningar kan belysa ett företags situation utifrån olika perspektiv.Studien bygger på både en kvalitativ och en kvantitativ metod på grund av uppsatsensuppdelning mellan att studera siffror samt tolka text. Vidare har en abduktiv processanvänts, det vill säga att teori och empiri har skapats i växelverkan. Endastsekundärdata har använts då vi har studerat SAS årsredovisningar mellan år 1992 tillår 2008.Vi har i studien kommit fram till att det bästa sättet för en extern intressent att förståett företags situation är att utföra en analys som kombinerar flera olika metoder, därnyckeltal och nyckelord fungerar som indikatorer medans tolkning av text ger endjupare förståelse för företaget. Vi har även funnit att redovisningen inte alltidstämmer överrens med företagets situation. Detta beror på att siffror endast gerindikationer på problem men inte visar orsakerna till dessa. Ytterligare är en text oftasubjektiv och beror även på läsarens tolkningsförmåga av den, vilket gör det svårareatt få en korrekt bild av företagets situation.