Acute decompensation of chronic heart failure is common and results in many patients being re-hospitalized every year (Jancin 2008). One of four voluntary core measures deployed by the Joint Commission for evaluation of quality of heart failure care in hospitals is heart failure discharge instructions, also called core measure HF1. Although the core measure is a widely disseminated standardized measure related to discharge education, there is little evidence about its impact on patient or readmission outcomes. The purpose of this study was to determine the relationship between the completion of heart failure discharge instructions as defined by the Joint Commission core measure HF1 in a single site, 500 bed tertiary hospital population in the Upper Midwest and the primary endpoint of subsequent readmission to the hospital 30, 90, 180 and 365 days following an index discharge for primary diagnosis of heart failure. Secondary endpoints included hospital readmission charges and total hospital readmission days per year. Patient characteristics, clinical characteristics, unit factors and index visit utilization variables were controlled. This study also described the relationship between nursing unit factors and completion of HF1. A retrospective, descriptive design, and analyses using primarily generalized linear models, were used to study the relationship of HF1 to utilization outcomes (readmission, hospital days and cost) and unit context (discharge unit and number of inter-unit transfers). Individual level retrospective demographic, clinical, administrative and performance improvement data were used (n = 1034). Results suggested a weak and non-significant association of completion of the core measure HF1 bundle and readmission within 30 days for all cause readmissions (p = .22; OR 1.32), and no association with HF to HF readmissions at 30 days. There was an inverse association 2 after 6 months for all cause readmission, and after 90 days for HF to HF readmission. There was a non-significant trend toward a relationship to total hospital days, but no relationship of HF1 to total annual charges. The study did find a significant relationship between type of discharge nursing unit and HF1 completion, and type of discharge unit and readmission. The discharge nursing unit was quite consistently and strongly related to all cause readmissions in binary (p = .029: OR 1.58) and counts analyses (p = .001; OR 1.52), but was not related to the subset of HF to HF readmissions. The study concludes that there is limited relationship between HF1 and 30 day all cause hospital readmission and total readmission days, but a stronger relationship between HF1 and discharge from a cardiology specialty unit. There was also a relationship between cardiology discharge unit and reduction in all cause readmissions.

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As the Internet becomes more pervasive, the content and services are increasing in quantity as well as improving in quality. This trend is fostered by the advancement of technologies, such as RESTful services, Web 2.0, and Mashups. Service composition integrates services to fulfill specific tasks using a set of tools. The existing service composition techniques and tools are mainly designed for the Service Oriented Architecture (SOA) professionals. The business processes used in the service composition systems are primarily designed by business analysts who have extensive process knowledge. Due to the lack of process knowledge, novice business analysts and end users face challenge to identify and orchestrate service into a well-defined business process. Even for the experienced users, it is challenging to select appropriate services from a set of functionally similar services as the quality information of services may not be available. In this thesis, we propose a framework that allows a non-technical user to combine web services to achieve a goal. Our approach helps users to find the process knowledge from the web. We index web services based on the semantic concepts available in the service description documents and help users to formulate a web service search query. We use online reviews to choose a web service from a set of functionally similar web services. Our approach automatically finds the data flow between web services and generates a user interface to execute a composite service. The effectiveness of our proposed approaches is demonstrated through a series of case studies. The results of our case studies show that our approaches for process knowledge extraction, service discovery, and service selection make it easier for people with less technical knowledge to compose services. / Thesis (Ph.D, Electrical & Computer Engineering) -- Queen's University, 2014-06-30 15:18:28.155

Thesis (Ph. D.)--University of Texas at Dallas, 2007. / Includes vita. Includes bibliographical references (leaves 165-170)

In this study, the aim is to find out how teachers and students perceive the computer as a writing tool in the teachingof the Swedish language. The research questions of the survey, seeksto find answers to what teachers look for opportunities and obstacles with the computer as a writing tool, and for what purpose they use the computer. I also want to find outstudentsthoughtsabout the computer as awriting tool and how they believethe computer can help them in their writing. The study is based on a qualitative approach with qualitative semi-structured interviews. Inthe student interviews, I have used 11 pupils from Year 1-5. In the interviews, I have used the same interview guide in order to produce comparable data. In the teacher interviews, I have used the idea map as interview method. My selection of teachers resulted in three active, workingteachers from primary school to secondary school.Broadly, the inquiry resulted in that the computer is very important for the students' text development as it is believed to increase the motivation of students. According to the result that there are obstacles such as digital literacy, lack of technology and resources that can cause problems. The informants were also disagreed on what age that the computer should be introduced as a writing tool in school, but they all agree that it is a beneficial tool in writing instruction as long as the purposewell thought out.

Inaccurate instructions have been shown to interfere with or override the effects of otherwise effective behavioral contingencies. This effect may be mediated by such factors as the discriminability of current contingencies, histories with accurate and inaccurate instructions, and consequences associated with following instructions. The current experiment investigated the effects of instructions (both accurate and inaccurate) on response patterns when paired with feedback regarding correspondence between responding and instructions, feedback indicating potential point loss for non-correspondence, and point loss for non-correspondence. Inaccurate instructions produced only small and temporary disruptions in response patterns, as did the addition of feedback alone and feedback indicating potential point loss. The introduction of escalating point losses contingent on non-correspondence, ranging from 20%-50% of points earned, produced changes in response patterns that corresponded to the inaccurate instructions. These outcomes indicate that the imposition of direct consequences for noncompliance may alter the effects of other contingencies. Depending on the point at which point losses disrupt responding, such effects may be interpreted in terms of point loss avoidance or, alternatively, maximizing point gains.

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A Predictor Response Process model (see Ployhart, 2006) and research findings were leveraged to formulate research questions about, and generate construct validity evidence for, a new situational judgment test (SJT) designed to measure declarative and strategic knowledge. The first question asked if SJT response instructions (i.e., 'Should Do', 'Would Do') moderated the validity of an SJT in a maximum performance context. The second question asked what the upper-bound criterion-related validity coefficient is for SJTs in talent selection contexts in which typical performance is the criterion of interest. The third question asked whether the SJT used in the present study was fair for gender and ethnic-based subgroups according to Cleary's (1968) definition of test fairness. Participants were randomly assigned to complete an SJT with either 'Should Do' or 'Would Do' response instructions and their maximum decision making performance outcomes were captured during a moderate fidelity poker simulation. The findings of this study suggested knowledge, as measured by the SJT, interacted with response instructions when predicting aggregate and average performance outcomes such that the 'Should Do' SJT had stronger criterion-related validity coefficients than the 'Would Do' version. The findings also suggested the uncorrected upper-bound criterion-related validity coefficient for SJTs in selection contexts is at least moderate to strong ([beta] = .478). Moreover, the SJT was fair according to Cleary's definition of test fairness. The implications of these findings are discussed.

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