Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Optimal management of bio-based energy supply chains under parametric uncertainty through a data-driven decision-support framework

This paper addresses the optimal management of a multi-objective bio-based energy supply chain network subjected to multiple sources of uncertainty. The complexity to obtain an optimal solution using traditional uncertainty management methods dramatically increases with the number of uncertain factors considered. Such a complexity produces that, if tractable, the problem is solved after a large computational effort. Therefore, in this work a data-driven decision-making framework is proposed to address this issue. Such a framework exploits machine learning techniques to efficiently approximate the optimal management decisions considering a set of uncertain parameters that continuously influence the process behavior as an input. A design of computer experiments technique is used in order to combine these parameters and produce a matrix of representative information. These data are used to optimize the deterministic multi-objective bio-based energy network problem through conventional optimization methods, leading to a detailed (but elementary) map of the optimal management decisions based on the uncertain parameters. Afterwards, the detailed data-driven relations are described/identified using an Ordinary Kriging meta-model. The result exhibits a very high accuracy of the parametric meta-models for predicting the optimal decision variables in comparison with the traditional stochastic approach. Besides, and more importantly, a dramatic reduction of the computational effort required to obtain these optimal values in response to the change of the uncertain parameters is achieved. Thus the use of the proposed data-driven decision tool promotes a time-effective optimal decision making, which represents a step forward to use data-driven strategy in large-scale/complex industrial problems.Peer ReviewedPostprint (published version

The Association between Use of Online Social Networks to Find Sex Partners and Sexually Transmitted Infection Diagnosis among Young Men Who Have Sex with Men and Transgender Women Living with HIV.

We conducted a cross-sectional analysis of baseline data from the Adolescent Trials Network for HIV/AIDS Interventions to examine the association between the use of social media sites to find sex partners and recent diagnosis of sexually transmitted infections (STIs) among 13- to 24-year-old men who have sex with men and transgender women living with HIV. We used linear regression to determine the relationship between the number of STIs and the number of social media sites used to find sex partners with each type of sex act included in the analysis. Secondary analyses substituted frequency of social media site use for number of social media sites. Among 741 participants, for every 1 social media account used to find sex partners, there was a 2.53% (95% confidence interval: 0.28-5.54) increase in STIs. This association was mediated through condomless receptive anal intercourse or condomless insertive anal intercourse but not barrierless oral intercourse. Similar but attenuated associations were found when frequency of social media site use was substituted for number of social media sites. Future research should examine innovative interventions on these social media sites with respect for its users

The use of social media for improving energy consumption awareness and efficiency: An overview of existing tools

Raising consumers’ awareness of energy consumption is one of the first steps in encouraging the adoption of energy saving behaviours that result in energy efficiency. Green information systems are becoming recognised as a solution to many environmental problems although information technology (e.g. disposal of IT devices) has also been associated with causing detrimental effects on the environment. Researchers and practitioners have begun to focus on Green ICT but there is little scholarly research on the use of ICT tools such as social media from an energy efficiency context to raise consumer awareness and improve their engagement in tackling environmental issues. Therefore, the aim of this paper is to explore the use of social media and existing tools for the interaction of people on energy saving discussions and for generating awareness and engagement (which thereby leads to energy efficiency behaviour). In this paper the authors provide a state of the art review around the concept of energy awareness, models of consumer engagement, and more importantly the use of social media in the energy efficiency context. This research is based on a desk-based normative review and seeks to provide a better understanding to both scholars and practitioners involved in the use of ICT for driving energy consumer awareness and engagement for energy efficiency.This work evolved in the context of the project DAREED (Decision support Advisor for innovative business models and useR engagement for smart Energy Efficient Districts), www.dareed.eu, a project co-funded by the EC within FP7, Grant agreement no: 609082

Attachment and problematic Facebook use in adolescents: the mediating role of metacognitions

Background and aims: Recent research used attachment theory and the metacognitive tenet as frameworks to explain problematic Facebook use (PFU). This study aims to test, in a single model, the role of different attachment styles and metacognitions in PFU among adolescents. Methods: Two separate studies were conducted in order to establish the link between security (Study 1) and insecurity (Study 2), metacognitions, and PFU. A total of 369 and 442 Italian adolescents (age: 14–20 years old) participated in Study 1 and Study 2, respectively. Results: Path analyses revealed the relative importance of different attachment dimensions with mother and father in predicting PFU and the mediating role of metacognitions between attachment styles and PFU. Discussion and conclusion: In conclusion, since attachment styles and PFU may significantly affect adolescents’ development and well-being, the results of this study may provide some practical indications for researchers and practitioners