Yes / Avoidable hospital mortality is often attributable to inadequate patient vital signs monitoring, and failure to recognise or respond to clinical deterioration. The processes involved with vital sign collection and charting; their integration, interpretation and analysis; and the delivery of decision support regarding subsequent clinical care are subject to potential error and/or failure. Objective To determine whether introducing an electronic physiological surveillance system (EPSS), specifically designed to improve the collection and clinical use of vital signs data, reduced hospital mortality. Methods A pragmatic, retrospective, observational study of seasonally adjusted in-hospital mortality rates in three main hospital specialties was undertaken before, during and after the sequential deployment and ongoing use of a hospital-wide EPSS in two large unconnected acute general hospitals in England. The EPSS, which uses wireless handheld computing devices, replaced a paper-based vital sign charting and clinical escalation system. Results During EPSS implementation, crude mortality fell from a baseline of 7.75% (2168/27 959) to 6.42% (1904/29 676) in one hospital (estimated 397 fewer deaths), and from 7.57% (1648/21 771) to 6.15% (1614/26 241) at the second (estimated 372 fewer deaths). At both hospitals, multiyear statistical process control analyses revealed abrupt and sustained mortality reductions, coincident with the deployment and increasing use of the system. The cumulative total of excess deaths reduced in all specialties with increasing use of the system across the hospital. Conclusions The use of technology specifically designed to improve the accuracy, reliability and availability of patients’ vital signs and early warning scores, and thereby the recognition of and response to patient deterioration, is associated with reduced mortality in this study.

Yes / Objectives The Computer-Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of healthcare practitioners (staff) and service users and carers (SU/C) on (1) the potential value, unintended consequences and concerns associated with CARS and practitioner views on (2) the issues to consider before embedding CARS into routine practice. Setting This study was conducted in two National Health Service (NHS) hospital trusts in the North of England. Both had in-house information technology (IT) development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital trusts. Participants We conducted eight focus groups with 45 healthcare practitioners and two with 11 SU/Cs in two NHS acute hospitals. Results Staff and SU/Cs recognised the potential of CARS but were clear that the score should not replace or undermine clinical judgments. Staff recognised that CARS could enhance clinical decision-making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests. Conclusion Risk scores are widely used in healthcare, but their development and implementation do not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice. / Health Foundation, National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)

Yes / Objectives There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. Design Logistic regression model development and external validation study. Setting Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)—model development data; York Hospital (YH)—external validation data). Participants Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission. Results The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00). Conclusions We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily 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

The hypothesis is that the recorded noise-imprints of a vehicle at an intersection can be used to identify and accurately time the driving modes of deceleration, idle, slow cruise, and acceleration. This is proven by analyzing and comparing noise-imprints of vehicles at an uncontrolled intersection marked first with a "stop" sign, and then by a "yield" and an experimental "dead slow" sign. By relating the duration of each driving mode to known relations, the overall efficiency of an intersection can be characterized. A new technique for studying various types of traffic conditions at intersections is the result. Initial noise-imprint analysis and comparison shows that a "yield" sign is to be preferred over a "stop" sign to decrease travel time, air pollution emissions, gasoline consumption, and wear-and-tear on the car. The experimental "dead slow" sign is used as a demonstration of the noise-imprint technique upon an unknown situation. The efficiency of a "dead slow" sign proved to be less than that of a "yield" sign, but still greater than that of a "stop" sign.

M.S.

The purpose of this thesis is to define the historical commercial center. To write this history, it was necessary to identify the developmental factors affecting the form and/or placement of the building sign. Historic photographs of the Indianapolis commercial center and other primary sources were used to document the popular sign forms of that era.Sign history is not a subject that is well represented in preservation or urban planning literature. Thus, the preservation and/or adaptive use of historic commercial districts often lacks strong references to the district's building sign heritage. This history is a guide for those professionals whose job it is to develop design guidelines and sign ordinances for early 20th-century historic commercial districts. / Department of Architecture

No description available.

The purpose of the study was to investigate social workers' perceptions of using Signs of Safety in their daily practical work. This in relation to the approach's purpose to put children's safety first. Six semi-structured interviews were conducted with social workers within the child and youth unit of social services in two municipalities. The data was then analyzed through a thematic analysis. Using system theory as the framework, the study found that management support, organizational conditions, education, and supervision were important factors for effective implementation. Furthermore, the study showed that Signs of Safety has helped social workers build alliances with families, increase efficiency and focus, and change their role in relation to the families. The study's key findings highlight the difficulties in shifting mindsets and working methods, as well as how Signs of Safety has contributed to social workers transitioning from authority figures to fellow humans. / Studiens syfte var att undersöka socialsekreterarnas uppfattning av att använda Signs of Safety i det dagliga praktiska arbetet. Detta i förhållande till förhållningssättets syfte att sätta barnens trygghet i centrum. Sex semistrukturerade intervjuer genomfördes med socialsekreterare inom socialtjänstens barn- och ungdomsenhet i två kommuner. Därefter analyserades empirin genom en tematisk analys. Studiens teoretiska utgångspunkt var systemteorin. Studien visade på att stöd från ledningen, organisatoriska förutsättningar, utbildning och handledning har varit viktiga faktorer för att kunna använda förhållningssättet ändamålsenligt. Vidare visade studien att Signs of Safety har bidragit till att socialsekreterarna kunnat skapa allians med familjerna, ökat effektiviteten och fokuset samt fått en förändrad roll gentemot familjerna. Studiens viktigaste fynd handlar om svårigheterna kring att ställa om tanke- och arbetssätt samt hur Signs of Safety bidragit till att socialsekreterarna gått från myndighetsperson till medmänniska.

Lo Ka Yu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 334-341). / Abstracts in English and Chinese. / Lo Ka Yu. / 論文擇要 --- p.i / Abstract --- p.ii / Acknowledgments --- p.iii / Table of Content --- p.iv / List of Figures --- p.vi / List of Tables --- p.xv / Introduction --- p.1 / Chapter 1.1 --- Questions raised --- p.1 / Chapter 1.2 --- Literature in Chinese wood carving and symbolic language --- p.11 / Chapter 1.3 --- Methodology and field work --- p.26 / Chapter 1.4 --- Content of the thesis --- p.29 / Jixiang 吉祥 carvings --- p.30 / Chapter 2.1 --- An exhibition of wishes --- p.30 / Chapter 2.2 --- Chinese: People of symbols --- p.32 / Chapter 2.3 --- Chinese Sense of Auspiciousness --- p.37 / Chapter 2.4 --- Chinese House: symbols and jixiang 吉祥 --- p.41 / Chapter 2.5 --- Jixiang 吉祥 motifs in wood carvings --- p.44 / Chapter 2.6 --- "Motifs, symbols and symbolic language" --- p.47 / Domestic Decorations --- p.55 / Chapter 3.1 --- Tai Fu Tai 大夫第，San Tin 新田 --- p.57 / Chapter 3.2 --- "No. 123 village house, San Tin 新田" --- p.104 / Chapter 3.3 --- Ching Shu Hin 清暑軒，Ping Shan 屏山 --- p.107 / Chapter 3.4 --- "No. 93 village house, Shui Tsan Tin Tsuen 水盞田村" --- p.141 / Chapter 3.5 --- "No. 32&33 village houses, Ha Tin Liu Ha 下田寮下" --- p.143 / Ceremonial Buildings --- p.147 / Chapter 4.1 --- Man Ancestral Hall 文氏宗祠，San Tin 新田 --- p.149 / Chapter 4.2 --- Man Lun Fung ancestral hall 麟峰文公祠，San Tin 新田 --- p.155 / Chapter 4.3 --- Kun Ting Study Hall 覲廷書室，Ping Shan 屏山 --- p.171 / Chapter 4.4 --- Wai Hing Study Hall 渭卿書室，Ping Shan 屏山 --- p.198 / Chapter 4.5 --- Yan Dun Kong Study Hall 仁敦岡書室，Ping Shan 屏山 --- p.201 / Chapter 4.6 --- Sin Sui Study Hall 善述書室，Lung Yeuk Tau 龍躍頭 --- p.217 / Religious Buildings --- p.246 / Chapter 5.1 --- Tung Shan Temple 東山古廟，San Tin 新田 --- p.248 / Chapter 5.2 --- Kwan Tai Temple 關帝古廟，Tai O 大澳 --- p.251 / Chapter 5.3 --- "Yeung Hau Temple 楊侯古廟, Tai O 大澳" --- p.262 / Symbolic Language of Wood Carvings --- p.277 / Chapter 6.1 --- Symbols - pictorial vocabularies --- p.277 / Chapter 6.2 --- Symbolic meanings --- p.284 / Chapter 6.3 --- Reading the Symbolic language --- p.287 / Chapter 6.4 --- Dynamics of Symbolic Language --- p.312 / Conclusion --- p.316 / Appendix I --- p.319 / Appendix II --- p.320 / Appendix III --- p.321 / Appendix IV --- p.323 / Appendix V --- p.326 / Appendix VI --- p.327 / Bibliography --- p.334 / Manuscripts before 1911 --- p.334 / Works after 1911 --- p.336 / Other References --- p.341

Changeable Message Signs (CMS) are commonly utilized by transportation agencies to inform motorists of traffic, roadway, and environmental conditions. They may be used to provide information, such as delay and alternate route guidance, in the event of an incident, construction or a roadway closure. The effectiveness of CMS in managing freeway traffic, however, is a function of many factors including the number of CMS installations, the location of CMS, the messages displayed, varied traffic network characteristics, and drivers' response to incident conditions and CMS information. The objective of this thesis is to develop a CMS location planning model that can be used by transportation agencies to develop a CMS location plan that could achieve the largest long-term benefit to the system. This research is mainly motivated by the lack of systematic, robust and practical methods for locating CMS. State-of-practice methods rely mostly on the practitioner's experience and judgement. Other methods fail to incorporate reasonable driver behaviour models, consider time-varying demand, allow for computational efficiency on large networks, or consider the spatial variation of incidents on a traffic network. A new CMS location optimization model has been developed that is unique in both model realism and computational efficiency. The model incorporates several components to estimate incident delay, predict driver response, estimate network-wide benefit, and choose those CMS locations that would provide the most benefit. Deterministic queuing methods are used in conjunction with historic incident characteristics to approximate the delay impact of an incident with and without CMS. A discrete choice model is used to predict the rate at which drivers would switch from the incident route to a less congested alternative under CMS information. A network traffic assignment model is then incorporated in an attempt to estimate the resulting traffic induced by incidents. Genetic algorithms are utilized as an optimization technique to choose a set of CMS that would provide the most benefit. An extensive computational analysis was performed on both a hypothetical network and a segment of Highway 401 through Toronto. A sensitivity analysis was performed to test the model's response to parameter and data estimation errors. The model was found to be most sensitive to the diversion model parameters. The model produced reasonable results with locations selected upstream of major freeway interchange diversion points. Considering the additional components included in the proposed model, and its ability to consider more location schemes, the proposed model may be considered superior to previous CMS location models.