A Collaborative Filtering Probabilistic Approach for Recommendation to Large Homogeneous and Automatically Detected Groups

In the collaborative filtering recommender systems (CFRS) field, recommendation to group of users is mainly focused on stablished, occasional or random groups. These groups have a little number of users: relatives, friends, colleagues, etc. Our proposal deals with large numbers of automatically detected groups. Marketing and electronic commerce are typical targets of large homogenous groups. Large groups present a major difficulty in terms of automatically achieving homogeneity, equilibrated size and accurate recommendations. We provide a method that combines diverse machine learning algorithms in an original way: homogeneous groups are detected by means of a clustering based on hidden factors instead of ratings. Predictions are made using a virtual user model, and virtual users are obtained by performing a hidden factors aggregation. Additionally, this paper selects the most appropriate dimensionality reduction for the explained RS aim. We conduct a set of experiments to catch the maximum cumulative deviation of the ratings information. Results show an improvement on recommendations made to large homogeneous groups. It is also shown the desirability of designing specific methods and algorithms to deal with automatically detected groups

Pathways to non-complex assistive technology for HACC clients in WA : full report

The project aims to identify, evaluate and make recommendations to improve the pathways by which West Australian (WA) Home and Community Care (HACC) clients access daily living equipment. Otherwise known as assistive technology (AT), these devices are largely non-complex and often low cost. Funded by HACC and conducted within the context of the WA Assessment Framework (WAAF), the project seeks to answer the following question:&nbsp; &nbsp; How can aids and equipment be most effectively assessed, accessed, funded and used?The research is designed to inform WA state government policy and Commonwealth HACC government policy in relation to the funding of HACC client access to assistive technology. Whilst set in WA, the topic and findings have relevance to HACC in other Australian states and territories, as well as other aspects of aged care policy, other sectors such as disability, and other areas of inquiry such as competency standards and consumer self-direction.</div

Array comparative genomic hybridisation and the newborn intensive care unit: Sociological perspectives on mainstreaming medical genetics

This thesis presents the findings of a UK-based ethnography of the mainstreaming of array comparative genomic hybridisation in the neonatal intensive care unit. Mainstreaming refers to the strategies employed to embed genetic/genomic technologies for patient benefit, incorporating genome-wide methods in everyday, mundane clinical work, beyond the specialist genetic realm. It draws on observations in the laboratory and the clinic alongside interviews with members of the extended bioclinical collective (Bourett, 2005). This constructs an ethnography of the activity of doing chromosomal microarray (Mol, 2002). I describe how three important traditions in sociological thought – namely (medical) uncertainty, processes of classification and categorisation and expertise – can be applied to the activity of mainstreaming. In the laboratory, I explore the role of standardisation and how despite calls for rigid adherence to technical rules, it is the subversion of standards – through appeals to expertise – that renders the technology workable for the messy clinical context. I continue by describing the dividing practices of the clinic, which designate infants as (potentially) genetically problematic, demonstrating how discourses between professionals and with parents serve to seek the assent of parents for chromosomal microarray testing through a highly directive process. I show how rhetorical discourse devices are using in ‘consent conversations’ as a tool in information sharing and as a means of persuasion. For the parents of infants having aCGH testing, uncertainty around decisions to test and the information genetic testing can generate are woven into personal narratives of restitution, chaos and quest (Frank,1995). I conclude by reflecting upon how the ability and means by which uncertainty is tolerated differs vastly between the laboratory, the clinic and the family and the way in which diverging practices enact ontology in medicine as bound to specific sites and situations (Mol, 2002)

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Using Digital Health Technology to Optimise Older People’s Pain Self-Management Capabilities: A Mixed Methods Study (The DigiTech Pain Project)

Background Arthritic pain is a major cause of illness and disability among older people. As the use of smartphones and apps increases in the lives of older people, there is an opportunity to explore the role of these apps in helping older people better manage their arthritic pain. Aim To explore the feasibility and acceptability of older people using an arthritic pain selfmanagement app to improve their pain symptoms. Methods A parallel convergent, mixed methods design underpinned by Bandura’s Self-Efficacy Theory and the Technology Acceptance Model 2; comprising of the following five studies: (i) Study 1a: an integrative review; (ii) Study 1b: a systematic review; (iii) Study 2a: a phase I feasibility study of pre–post-test design; (iv) Study 2b: a qualitative sub-study involving participants of study; and (v) Study 3: a qualitative interview study with primary care and allied health clinicians. The data from these studies was integrated to answer the project’s research questions. Results Study 1a revealed paucity of evidence on use of apps for older people’s pain selfmanagement. Study 1b indicated that few publicly available pain self-management apps are based on robust evidence. Eighteen older people were recruited into Study 2a, 80% via snowballing. Over 59% of participants were provided face-to-face app download and use training, none had used a pain self-management app in the past. Telephone-based survey and interview data collection was found to be acceptable to older people. Almost 90% of study 2a participants (n=16) took part in study 2b sharing their experiences of using the intervention app. Following four themes emerged: (i) Apps are valuable selfmanagement tool, but they do have the potential for harm; (ii) pain self-management apps need to be strictly relevant to the user; (iii) Clinicians’ involvement is crucial; and (iv) pain self-management apps must be designed with the end user in mind. Study 3 recruited seventeen (n=17) primary care and allied health clinicians who shared their perceptions and attitudes regarding app use by their older patients for pain self-management. Four themes emerged: (i) self-management apps are a potentially useful tool but require careful consideration; (ii) clinicians’ involvement is crucial yet potentially onerous; (iii) no single app is right for every older person; and (iv) patient data access is beneficial but caution is needed for real-time data access. Meta-inference of the data from all five studies indicated that an app intervention involving older people was both feasible and acceptable, with the following caveats: snowballing recruitment may be required; and access to app download and use training is an important element to implement into the study design. Older people and primary care clinicians were keen to engage with pain self-management apps; however, they wanted these apps to offer high level usefulness, adaptability and information sharing features. Future pain self-management apps need to be underpinned by robust evidence, while providing appropriate support and resources to clinicians. Conclusion While older people and their clinicians welcomed the opportunity to use pain self-management apps, their engagement ought to be supported by systems level policies, and high-quality apps. Collaboration among clinicians, older people, researchers and app developers ought to be considered when developing, researching and integrating pain self-management apps

An Analysis of Patients Undergoing Hip and Knee Arthroplasties in an Accountable Care Organization

Background. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures, with over one million executed each year in the United States (U.S.) (Steiner et al., 2012). By 2030, THA and TKA are projected to become the most frequently performed elective surgical procedures in the U.S. (Cram et al., 2012; Kurtz et al., 2009). Many of the previous studies on THA and TKA procedures have focused on women, primarily because they are at increased risks of developing knee osteoarthritis and sustaining hip fractures (Cummings et al., 1990; Hedlund et al., 1987; Hinton et al., 1995; Myers et al., 1991; Ray et al., 1997; Schrøder & Erlandsen, 1993; Srikanth et al., 2005). However, there is increasing evidence suggesting that there are differences in postoperative outcomes between male and female patients undergoing these procedures (Dalury et al., 2009; Dzupa et al., 2002; Elliott et al., 2003; Endo et al., 2005; Fox et al., 1994; Fransen et al., 2002; Lavernia et al., 2009; Lim et al., 2015; MacDonald et al., 2008; Ritter et al., 2008; Schrøder & Erlandsen, 1993; Trombetti et al., 2002). Purpose. To compare post-surgical outcomes after THA and TKA procedures between male and female patients part of a physician-led Accountable Care Organization (ACO) participating in the Medicare Shared Savings Program (MSSP) located in the western U.S. and to determine whether this MSSP ACO has been successful in decreasing these patients’ total costs of health care. Methods. The physician-led MSSP ACO provided cost and health risk data on their male and female beneficiaries who underwent THA and TKA procedures between the years 2016 and 2018. Health risk data only analyzed patients during the postoperative period. One hundred fifty-six men and 291 women were analyzed in this study. Results. Most patients who underwent THA and TKA procedures between 2016 and 2018 in this MSSP ACO had Medicare insurance (n=329; 81.7%) and were predominantly Non-Hispanic White (n=365; 81.7%). Over three years (2016-2018), men had a greater average risk stratification score than women (17.7 vs. 15.7), indicating that men undergoing THA and TKA procedures have worse overall health than women undergoing the same procedures. Women had greater total costs of health care than men between 2016 and 2017; however, in 2018, men had greater total costs of care than women. When the patient sample was divided by insurance types, Medicare-only patients had lower total costs of care than dual-eligible patients-those with both Medicare and Medicaid insurance- for all three years. Over the three years, the MSSP ACO was successful in decreasing the total costs of care for its male and female patients who underwent THA and TKA procedures (5.66% and 18.4%, respectively). Also, Medicare-only patients’ average total cost of care decreased by 11.47%, and dual-eligible patients’ average total cost of care decreased by 20.7%. Conclusion. Male sex/gender was linked with worse health after undergoing THA and TKA procedures. This MSSP ACO was able to decrease its beneficiaries’ total costs of care over three years. Thus, MSSP ACOs may show promise in reducing health care costs for their beneficiaries. Policymakers should offer more support to MSSP ACOs for helping them realize increased revenues

Embodied Expertise: The Science and Affect of Psychotherapy.

This project examines the epistemic tools by which psychotherapists in competing orientations understand and treat mental illness. I compare the expert practices of clinicians adopting a psychodynamic (also known as psychoanalytic) approach with those of “evidence-based” therapists (for example, cognitive behavioral and dialectical behavioral). Data from 18 months of ethnographic observations in a psychiatry residency program, and 60 in-depth interviews, inform my argument that these clinicians embody distinct forms of expertise that have both professional and social implications. I show that the former adopt an ‘affective-relational’ orientation that values emotions as sources of knowledge, and the therapeutic relationship as a tool for insight and treatment. In contrast, the latter rely on a ‘techno-scientific’ approach that revolves around inscription, quantification, and time-limited interventions. Drawing on scholarship in social studies of science, medical sociology, the sociology of professions, and the sociology of knowledge, I suggest that these health workers’ practices help illuminate questions about jurisdiction and autonomy, credibility, and the making of social knowledge. First, my data indicates that maintaining autonomy can detract from a group’s ability to succeed in contests of jurisdiction. Second, this project shows that whereas practitioners of psychoanalytic therapy emphasize clinical wisdom and self-reflexivity as legitimating tools, their colleagues in cognitive behavioral approaches assert scientific and institutional credibility. Lastly, this research illuminates the value of subjectivity in the process of knowledge-making by establishing the (spatio-temporally specific) epistemic role of emotions. My research captures the profession of talk therapy in transition, and argues that this has implications beyond the institutional realm. Drawing on the work of Foucault, I suggest that the therapy room is one important locus for the transformation of ‘modern selves.’ I argue that therapists promote distinct versions of what it means to be a ‘well-functioning’ human being as they take either ‘developmental’ (in psychodynamic therapy) or ‘precipitating’ (in cognitive and behavioral interventions) events as their platform of intervention. This project proposes that whether they construct historical narratives linking past and present, or classify, change and measure parts of selves (behaviors, thoughts, emotions), these therapies promote powerful technologies for shaping the ‘normal.’PHDSociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/102492/1/mcraciun_1.pd

Biomarkers for classification and risk assessment of pancreatic cystic neoplasms

Pancreatic cystic lesions (PCLs) are increasing incidental findings due to increased ageing of the population and widespread use of imaging. The main problem in clinical practice has to do with distinguishing the high-risk premalignant and malignant cysts that require surgical treatment from the benign or low-grade dysplastic cysts, which should not be over-treated and might not even require surveillance. The goal of the present work is to perform a comprehensive analysis of biomarkers and diagnostic approaches by Endoscopic Ultrasound with Fine-needle Aspiration (EUS-FNA), in a cohort of patients harboring mostly low-risk cysts under surveillance, which are far more frequent in clinical practice. The PCF analysis performed in this cohort includes studies of genomics (DNA mutations), epigenomics (methylation analysis), metabolomics (glucose), and proteomics (CEA, chromogranin A, NSE), with putative biomarkers encompassing the diagnosis of mucinous and malignant cysts, that require surveillance and surgical resection, respectively. We performed a first meta-analysis comparing current diagnostic methods - CEA and cytology - with KRAS mutations for the diagnosis of mucinous cysts. CEA was the best test for clinically significant cysts (AUC=0.69), cytology performed better in malignant cysts (AUC=0.78), surpassing KRAS mutations (AUC=0.53 and AUC=0.56, respectively). In a second meta-analysis we compared the accuracy of molecular analysis versus micro forceps biopsy (MFB) in the diagnosis of PCLs. The two approaches were identical for diagnosing benign cysts, but molecular analysis was superior for diagnosing both low and high-risk mucinous cysts. In addition to these two meta-analyses, we performed a retrospective study evaluating the added value of KRAS and GNAS mutations in PCF of 52 frozen PCF samples. We conclude that, as compared with conventional tests, these had no added value in the differential diagnosis of PCLs. In another publication, we compared glucose level in PCF with CEA in 82 patients. For mucinous cyst diagnosis, a CEA >192 ng/ml showed an AUC of 0.84 while glucose <50 mg/dl revealed an AUC of 0.86. Besides its higher accuracy, PCF glucose evaluated “on site” with a glucometer is easy, immediate, and requires a minimal amount of PCF. In the next study we sought to determine whether a second EUS-FNA changed the diagnosis or management of pancreatic cysts. We compared the outcome of 105 patients with a single EUS-FNA with that of 23 patients who had a second EUS-FNA. EUS-FNA may be recommended, as it changed management toward surgery in approximately 20% of the patients, particularly with diagnosis of cystic NETs. Following these results, we explored the role of EUS-FNA in small PCLs (<3 cm) in 115 patients with PCLs <3 cm who underwent EUS-FNA. 19/115 were submitted to surgery with 15 malignant or premalignant lesions and the remaining 4 were benign lesions. We conclude that EUS-FNA in lesions <3 cm may improve outcome and cost-effectiveness of surveillance programs, as it confirmed malignancy in 2 out of 5 resected lesions, while it also diagnosed benign cysts who could be released from these programs. In a pilot study with 16 patients, including 4 cystic NETs we aimed at assessing the value of Chromogranin A (CroA) and neuron-specific enolase (NSE) levels in PCF. CroA and NSE levels were higher in cystic NETs with an AUC of 0.94 for CroA and 1 for NSE. These are promising biomarkers to identify pancreatic cystic NETs. Finally, we studied epigenetic changes in the diagnosis of malignant cysts. Methylation changes of GNAS locus were evaluated to understand whether they may contribute to malignant progression of PCLs. Fifty-two samples of PCF were studied. We observed that GNAS locus methylation changes were significantly associated with malignancy. This is the first study to identify methylation changes in the GNAS locus improving diagnosis of malignant PCLs. We end this work proposing a revised diagnostic organogram of PCLs established by current guidelines, that incorporates the results obtained in this dissertation’s research.As lesões quísticas pancreáticas (PCL) têm incidência crescente devido ao envelhecimento da população e ao aumento da utilização dos métodos de imagem. Na prática clínica pretende-se distinguir os quistos mucinosos, de alto risco e malignos, que requerem tratamento cirúrgico, dos quistos benignos ou pré-malignos de baixo risco, que no máximo requerem vigilância. O objetivo do presente trabalho é analisar de forma abrangente, biomarcadores em líquido de quisto pancreático (PCF) obtido por Ecoendoscopia com punção (EUS-FNA), numa coorte de quistos predominantemente de baixo risco sob vigilância imagiológica, que são os mais comuns na prática clínica. A análise de PCF nesta coorte inclui estudos de genómica (mutações no DNA), epigenómica (análise de metilação), metabolómica (glicose) e proteómica (CEA, cromogranina A, NSE), com avaliação de biomarcadores para diagnóstico de quistos mucinosos e quistos malignos, que beneficiam de vigilância e ressecção cirúrgica, respetivamente. Numa primeira meta-análise comparámos a metodologia diagnóstica atual - CEA e citologia - com as mutações do KRAS para diagnóstico dos quistos mucinosos. O CEA foi o melhor teste em quistos clinicamente significativos (AUC=0.69), e a citologia em quistos malignos (AUC=0.78), superando as mutações do KRAS (AUC=0.53 e AUC=0.56, respetivamente). Numa segunda meta-análise comparámos a precisão diagnóstica da análise molecular versus biópsia com micropinça (MFB) no diagnóstico de PCL. As duas abordagens foram idênticas em quistos benignos, mas a análise molecular foi superior em quistos mucinosos tanto de baixo como de alto risco. Além das duas meta-análises, realizámos um estudo retrospetivo para avaliar o valor das mutações do KRAS e do GNAS em 52 amostras de PCF congeladas. Concluímos que não têm valor adicional no diagnóstico diferencial das PCL, relativamente aos testes convencionais. Noutra publicação comparámos o nível de glicose em PCF com o CEA para diagnóstico de quistos mucinosos em 82 doentes. O CEA >192 ng/ml apresentou uma AUC de 0.84 e a glicose <50 mg/dl de 0.86. Além da maior precisão diagnóstica, a glicose avaliada in loco com um glicosímetro, é fácil, imediata e requer um volume mínimo de PCF. No estudo seguinte, avaliámos se uma segunda EUS-FNA alterou o diagnóstico ou a decisão de quistos pancreáticos. Comparámos 105 doentes com uma única EUS-FNA com 23 doentes com uma segunda EUS-FNA. Esta pode ser recomendada, pois cerca de 20% dos doentes foram referenciados para cirurgia após repetição da EUS-FNA, incluindo dois com tumores neuroendócrinos (NET) quísticos. Seguidamente, explorámos o papel da EUS-FNA em pequenas PCL (<3 cm), num estudo com 115 PCL <3 cm. 19/115 foram operadas, correspondendo a 15 lesões malignas ou pré-malignas e 4 benignas. Concluímos que a EUS-FNA em quistos com <3 cm pode melhorar o diagnóstico e o custo-efetividade, pois confirmou malignidade em lesões ressecadas, e diagnosticou quistos benignos que podem ser libertados de vigilância. Num estudo piloto com 16 doentes, incluindo 4 com NET quísticos, avaliámos o valor diagnóstico da cromogranina A (CroA) e da enolase específica neuronal (NSE) em PCF. Os níveis de CroA e NSE foram mais elevados nos NET quísticos, com uma AUC de 0.94 para a CroA e 1 para a NSE. Estes revelaram-se biomarcadores promissores Por fim, estudámos alterações epigenéticas no diagnóstico de quistos malignos. Analisámos a metilação do locus GNAS em PCF para perceber se se associa à progressão maligna de PCL. Estudámos 52 amostras e observámos que a alteração da metilação se associou significativamente a malignidade. Trata-se do primeiro trabalho a avaliar alterações de metilação no locus GNAS no diagnóstico de PCL. Terminamos este trabalho com uma proposta de revisão do organograma de diagnóstico das PCL baseado nas guidelines atuais, que incorpora os resultados desta tese