A retrospective review of strong opioid use in the last 6 days of life of patients with HIV/AIDS or cancer at the in-patients unit of St. Francis Hospice

Bibliography: leaves 101-108.The study was prompted by nursing concern at St Francis Hospice that, in HIV-positive patients, the use of opioids for symptom-control may shorten life, while I felt that pain was not recognized and therefore analgesia was withheld until the HIV-positive patients were close to their natural death. Objective: To compare pain control and sedation practices for terminally ill patients with HIV or cancer

Designing for practice-based context-awareness in ubiquitous e-health environments

Existing approaches for supporting context-aware knowledge sharing in ubiquitous healthcare give little attention to practice-based structures of knowledge representation. They guide knowledge re-use at an abstract level and hardly incorporate details of actionable tasks and processes necessary for accomplishing work in a real-world context. This paper presents a context-aware model for supporting clinical knowledge sharing across organizational and geographical boundaries in ubiquitous e-health. The model draws on activity and situation awareness theories as well as the Belief-Desire Intention and Case-based Reasoning techniques in intelligent systems with the goal of enabling clinicians in disparate locations to gain a common representation of relevant situational information in each other's work contexts based on the notion of practice. We discuss the conceptual design of the model, present a formal approach for representing practice as context in a ubiquitous healthcare environment, and describe an application scenario and a prototype system to evaluate the proposed approach

Semantic data integration and knowledge graph creation at scale

Contrary to data, knowledge is often abstract. Concrete knowledge can be achieved through the inclusion of semantics in the data models, highlighting the role of data integration. The massive growing number of data, in recent years, has promoted the demand for scaling up data management techniques; materializing data integration, a.k.a., knowledge graph creation falls in that category. In this thesis, we investigate efficient methods and techniques for materializing data integration. We formalize the process of materializing data integration. We formally define the characteristics of a materialized data integration system that merge the data operators and sources. Owing to this formalism, both layers of data integration, including data and schema-level integration, are formalized in the context of mapping assertions. We explore optimization opportunities for improving the materialization of data integration systems. We recognize three angles including intra/inter-mapping assertions from which the materialization can be improved. Accordingly, we propose source-based, mapping-based, and inter-mapping assertion groups of optimization techniques. We utilize our proposed techniques in three real-world projects. We illustrate how applying these optimization techniques contribute to meeting the objectives of the mentioned projects. Furthermore, we study the parameters impacting the performance of materialization of data integration. Relying on reported parameters and the presumably impacting parameters, we build four groups of testbeds. We empirically study the performances of these different testbeds in the presence and absence of our proposed techniques, in terms of execution time. We observe that the savings can be up to 75%. Lastly, we contribute to facilitating the process of declarative data integration system definition. We propose two data operation function signatures in Function Ontology (FnO). The first set of functions is designed to perform the task of entity alignment by resorting to an entity and relation linking tool. The second library consists of domain-specific functions to align genomic entities by harmonizing their representations. Finally, we introduce a tool equipped with a user interface to facilitate the process of defining declarative mapping rules by allowing users to explore the data sources and unified schema while defining their correspondences.Im Gegensatz zu den Daten ist das Wissen oft abstrakt. Konkretes Wissen kann durch die Einbeziehung von Semantik in die Datenmodelle erreicht werden, was die Rolle der Datenintegration unterstreicht. Die massiv wachsende Zahl von Daten hat in den letzten Jahren die Nachfrage nach einer Ausweitung der Datenverwaltungstechnikengef¨ordert; die materialisierende Datenintegration, auch bekannt als die Erstellung von Wissensgraphen, f¨allt in diese Kategorie. In dieser Arbeit untersuchen wir effiziente Methoden und Techniken zur Materialisierung der Datenintegration. Wir formalisieren den Prozess der Materialisierung der Datenintegration. Wir definieren formal die Eigenschaften eines materialisierten Datenintegrationssystems, so dass die Datenoperatoren und -quellen zusammengef¨uhrt werden. Dank dieses Formalismus werden beide Ebenen der Datenintegration, einschließlich der Integration auf Daten- und Schemaebene, im Kontext von Mapping-Assertions formalisiert. Wir untersuchen die Optimierungsm¨oglichkeiten zur Verbesserung der Materialisierung von Datenintegrationssystemen. Wir erkennen drei Gesichtspunkte, einschließlich Intra-/Inter-Mapping-Assertions, unter denen die Materialisierung verbessert werden kann. Dementsprechend schlagen wir quellenbasierte, mappingbasierte und inter-mapping Assertionsgruppen von Optimierungstechniken vor. Wir setzen die von uns vorgeschlagenen Techniken in drei Forschungsprojekte ein. Wir veranschaulichen, wie die Anwendung dieser Optimierungstechniken dazu beitr¨agt, die Ziele der genannten Projekte zu erreichen. Wir untersuchen die Parameter, die sich auf die Leistung der Materialisierung der Datenintegration auswirken. Auf der Grundlage der gemeldeten Parameter und der vermutlich ausschlaggebenden Parameter erstellen wir vier Gruppen von Testumgebungen. Wir untersuchen empirisch die Leistung dieser verschiedenen Testbeds mit und ohne die von uns vorgeschlagenen Techniken in Bezug auf die Ausf¨uhrungszeit. Wir stellen fest, dass die Einsparungen bis zu 75% betragen k¨onnen. Schließlich tragen wir zur Erleichterung des Prozesses der deklarativen Definition von Datenintegrationssystemen bei, indem wir zwei Funktionssignaturen f¨ur Datenoperationen in der Function Ontology (FnO) vorschlagen. Die erste Gruppe von Funktionen ist f¨ur die Aufgabe des Entit¨atsabgleichs konzipiert, w¨ahrend die zweite Bibliothek aus dom¨anenspezifischen Funktionen zum Abgleich genomischer Entit¨aten durch Harmonisierung ihrer Darstellungen besteht. Schließlich stellen wir ein Tool vor, das mit einer Benutzeroberfl¨ache ausgestattet ist, um den Prozess der Definition deklarativer Mapping-Regeln zu erleichtern, indem es den Benutzern erm¨oglicht, die Datenquellen und das einheitliche Schema zu erkunden

Screening for foot problems in children: is this practice justifiable?

Podiatry screening of children is a common practice, which occurs largely without adequate data to support the need for such activity. Such programs may be either formalised, or more ad hoc in nature, depending upon the use of guidelines or existing models. Although often not used, the well-established criteria for assessing the merits of screening programs can greatly increase the understanding as to whether such practices are actually worthwhile. This review examines the purpose of community health screening in the Australian context, as occurs for tuberculosis, breast, cervical and prostate cancers, and then examines podiatry screening practices for children with reference to the criteria of the World Health Organisation (WHO). Topically, the issue of paediatric foot posture forms the focus of this review, as it presents with great frequency to a range of clinicians. Comparison is made with developmental dysplasia of the hip, in which instance the WHO criteria are well met. Considering that the burden of the condition being screened for must be demonstrable, and that early identification must be found to be beneficial, in order to justify a screening program, there is no sound support for either continuing or establishing podiatry screenings for children

Triple Helix, Fall 2018

Table of Contents: Science Agenda: The Politics of Grant Writing / by Kavya Rajesh (p. 4) -- From the Experts / by Katherine Bruner (p. 5) -- 3D Printed Drugs: The Future of Pharmaceuticals / by Ethan Wang (p. 6) -- Computerized Markets: Wall Street Takeover / by James Kiraly (p. 10) -- The Evolution of Fear / by Alisha Ahmed (p. 14) -- ADDing Up / by Victor Liaw (p. 18) -- The Clone Wars / by Jina Zhou (p. 22) -- Physician-Assisted Suicide: Drawing the Line / by Haley Wolf (p. 26) -- Supervised Injection Sites / by Alex Gajewski (p. 30) -- On Emerging Medicalization and Health Care / by Patrick Lee (p. 33) -- The Future of Human Gene Modifications / by Elizabeth Robinson (p. 36)College of Natural SciencesUT LibrariesLiberal Art

Conflict resolution in clinical treatments

Dissertação de mestrado integrado em Engenharia InformáticaCurrently, in the health area, there is a need for systems that provide support for the decision of health professionals through specific recommendations for each patient based on Clinical Practice Guidelines (CPGs) for automatic interpretation. CPGs are documents that have enormous importance in the daily life of health professionals, playing a key role in reducing variations in medical practice, improving the quality of health care, and reducing health care costs. These documents reflect knowledge about how best to diagnose and treat diseases in the form of a list of clinical recommendations. However, there may be conflicts and interactions in the application of these clinical recommendations, that which in their maximum exponent may impair the patient’s clinical condition. These conflicts are transported to decision support systems, creating the need to develop computational methods to solve these same conflicts. In the case of multimorbid patients, this resolution of conflicts can be very problematic because these patients suffer from several pathologies at the same time, and that the use of a drug for one particular pathology may have a detrimental effect on the application of another drug in another pathology. Therefore, the objective of this dissertation topic is the determination of conflicts and interactions between drugs and the determination of these same alternatives.Atualmente na área da saúde, existe uma necessidade de existirem sistemas que forneçam apoio à decisão dos profissionais de saúde através de recomendações específicas para cada paciente com base em protocolos clínicos para interpretação automática. Os protocolos clínicos são documentos que têm enorme importância no dia-a-dia dos profissionais de saúde, desempenhando um papel fundamental na redução das variações na prática médica, na melhoria da qualidade dos cuidados de saúde e na redução dos custos de saúde. Estes documentos reflectem o conhecimento sobre a melhor forma de diagnosticar e tratar doenças na forma de uma lista de recomendações clínicas. Contudo, podem existir conflitos e interações na aplicação destas recomendações clínicas, que no seu expoente máximo poderão levar a um agravamento do estado clínico do paciente, nomeadamente no caso da aplicação de diferentes fármacos. Estes conflitos são transportados para os sistemas de apoio à decisão, criando a necessidade de desenvolver métodos computacionais de resolução destes mesmos conflitos. No caso dos pacientes multimórbidos esta resolução de conflitos pode ser bastante problemática devido ao facto destes pacientes sofrerem de várias patologias ao mesmo tempo, e que a utilização de um fármaco para uma determinada patologia possa vir a ter um efeito nocivo na aplicação de outro fármaco noutra patologia. Sendo assim, o objetivo deste tema de dissertação é a determinação dos conflitos e interações entre fármacos e a determinação dessas mesmas alternativas

From Bit To Bedside: A Practical Framework For Artificial Intelligence Product Development In Healthcare

Artificial Intelligence (AI) in healthcare holds great potential to expand access to high-quality medical care, whilst reducing overall systemic costs. Despite hitting the headlines regularly and many publications of proofs-of-concept, certified products are failing to breakthrough to the clinic. AI in healthcare is a multi-party process with deep knowledge required in multiple individual domains. The lack of understanding of the specific challenges in the domain is, therefore, the major contributor to the failure to deliver on the big promises. Thus, we present a decision perspective framework, for the development of AI-driven biomedical products, from conception to market launch. Our framework highlights the risks, objectives and key results which are typically required to proceed through a three-phase process to the market launch of a validated medical AI product. We focus on issues related to Clinical validation, Regulatory affairs, Data strategy and Algorithmic development. The development process we propose for AI in healthcare software strongly diverges from modern consumer software development processes. We highlight the key time points to guide founders, investors and key stakeholders throughout their relevant part of the process. Our framework should be seen as a template for innovation frameworks, which can be used to coordinate team communications and responsibilities towards a reasonable product development roadmap, thus unlocking the potential of AI in medicine.Comment: 30 pages, 4 figure