Architecture for clinical decision support system (CDSS) using high risk pregnancy ontology

Shortage of medical professionals in the rural area has been one of the reasons why maternal mortality is still very high.Midwife family program had been introduced to overcome the shortage but the lack of skills in recognizing high risk pregnancy becomes another factor of high maternal mortality rate.A good prenatal care program will help to identify the danger in time and provide early management.Therefore, this paper provides solution by introducing a new architecture of clinical decision support system (CDSS) in the domain of high risk pregnancy. The proposed architecture is composed of seven main components.The ontological approach was used to develop the knowledge repository in the CDSS architecture.The need for CDSS was investigated through interview session, questionnaire distribution and observation.In addition, the comparison with other CDSSs approach is also highlighted in the paper

Efficient Decision Support Systems

This series is directed to diverse managerial professionals who are leading the transformation of individual domains by using expert information and domain knowledge to drive decision support systems (DSSs). The series offers a broad range of subjects addressed in specific areas such as health care, business management, banking, agriculture, environmental improvement, natural resource and spatial management, aviation administration, and hybrid applications of information technology aimed to interdisciplinary issues. This book series is composed of three volumes: Volume 1 consists of general concepts and methodology of DSSs; Volume 2 consists of applications of DSSs in the biomedical domain; Volume 3 consists of hybrid applications of DSSs in multidisciplinary domains. The book is shaped decision support strategies in the new infrastructure that assists the readers in full use of the creative technology to manipulate input data and to transform information into useful decisions for decision makers

Adaptive Leadership Practices: High School Leadership in Maine During the COVID-19 Crisis

This research focuses on leadership decisions by high school administrators in Maine in response to school closures and subsequent reopening plans due the Covid-19 pandemic. The purpose of this study was to learn the degree to which adaptive leadership was used as a leadership approach in response to a unique, complex and dynamic set of challenges, and to discover how the theories of constructive development influenced administrators’ comfort with adaptive work. Adaptive leadership is identified as the focus for this study based on the unprecedented magnitude of adaptive challenges caused by the Covid-19 pandemic for school systems throughout the state of Maine. High schools were intentionally chosen as the environment for inquiry due to organizational dynamics this study identifies as a barrier to adaptive leadership (Bowles & Gintis, 1978). To understand how high school administrators led during the Covid-19 crisis, the researcher interviewed fourteen principals throughout Maine using a two-part interview protocol. The first part focused on the administrator’s professional history and development as a school leader, while the second part was conducted to better understand how administrators implemented collaborative and adaptive leadership strategies from the months of March 2020 to the reopening of schools. Interviews were transcribed and coded for emerging themes related to adaptive leadership and cognitive development theory

Stories within Immersive Virtual Environments

[eng] How can we use immersive and interactive technologies to portray stories?How can we take advantage of the fact that within immersive virtual en-vironments people tend to respond realistically to virtual situations andevents to develop narrative content? Stories in such a media would allowthe participant to contribute to the story and interact with the virtualcharacters while the narrative plot would not change, or change only upto how it was decided a priori. Participants in such a narrative would beable to freely interact within the virtual environments and yet still beaware of the main trust of the stories presented. How can we preserve the‘respond as if it is real’ phenomenon induced by these technologies, butalso develop an unfolding plot in this environment? In other words, canwe develop a story, conserving the structure, its psychological and cul-tural richness and the emotional and cognitive involvement it supposes,in an interactive and immersive audiovisual space?In recent years Virtual Reality therapy has shown that an Immersive Vir-tual Environment (IVE) with a predetermined plot can be experienced asan interactive narrative. For example, in the context of Post TraumaticStress Disorder treatment, the reactions of the participants and the thera-peutic impact suggest that an IVE is a qualitatively different experiencethan classical audiovisual content. However, the methods to develop suchkind of content are not systematic, and the consistency of the experienceis only granted by a therapist or operator controlling in real time theunfolding narrative. Can a story with a strong classical plot be renderedin an automated and interactive immersive virtual environment?..[cat] Podem emprar la realitat virtual immersiva per contar històries? Com po-dem aprofitar el fet que dins dels entorns virtuals immersius les personestendeixen a respondre de manera realista a les situacions i esdevenimentsvirtuals per desenvolupar històries? Els participants en aquest tipus denarrativa podrien interactuar lliurement amb els entorns virtuals i noobstant això experimentarien les històries presentades com a plausibles iconsistents. Una història en aquest medi audiovisual permetria als parti-cipants interactuar amb els personatges virtuals i contribuir activamentals esdeveniments escenificats en l’entorn virtual. Malgrat això, la tramaestablerta a priori no canviaria, o canviaria només dins els marges es-tablerts per l’autor. Com podem preservar el fet que hom tendeix a "re-spondre com si fos real" induït per aquestes tecnologies mentre desenvolu-pem una trama en aquests entorns? En altres paraules, podem desenvolu-par una història conservant-ne l’estructura, la riquesa cultural i psicolò-gica i la implicació emocional i cognitiva que suposa, en una realitatvirtual immersiva i interactiva?Recentment la teràpia de realitat virtual ha mostrat que un entorn vir-tual amb un guió preestablert pot ser percebut com una narració inter-activa. Per exemple, en el context del tractament de Trastorns per EstrèsPostraumàtic, les reaccions i impactes terapèutics suggereixen que pro-voca una sensació de realitat que en fa una experiència qualitativamentdiferent als continguts audiovisuals clàssics. No obstant això, la consistèn-cia de l’experiència tan sols pot ser garantida si un un terapeuta o op-erador controla en temps real el flux dels esdeveniments constituint elguió narratiu. Podem representar un guió clàssic en un entorn virtualautomatitzat?..

Integrating Technology Acceptance Model and Health Belief Model Factors to Better Estimate Intelligent Tutoring System Use for Surge Capacity Public Health Events and Training

The U.S. public health system is continually challenged by unexpected epidemiological events that pose significant risks to the health of the community and require a commensurate surge in the public health system capacity to stem the spread of the disease. The complexity and even changing nature of funding and surge events drives agencies to innovate in order to maintain and support a competent workforce as well as update, or evolve the knowledge, skills and abilities (KSA) necessary to prevent, mitigate, or even eliminate the health crisis arising from a disease. This research investigates the capability of an agent-based, online personalized (AOP) intelligent tutoring system (ITS) that adaptively uses aptitude treatment interaction (ATI) to deliver public health training and assure competency. Also, presented is a conceptual model that combines Davis\u27 Technology Acceptance Model (TAM) and the Public Health Service\u27s Health Behavior Model (HBM) concepts to understand actual use of new technology in the public health sector. TAM is used to evaluate the effectiveness and the behavioral intent to use the system. HBM is used to explain and predict the preventative health behavior of actual use of the ITS. Our findings indicate the use of the ITS increases participant performance while providing a high level of acceptance, ease of use, and competency assurance. Without the determination of casual sequence, the TAM/HBM conceptual model demonstrated the best fit for predicting actual use of an ITS with the constructs of attitude, cues to action, and perceived ease of use showing the most influence. However, discussion of our findings indicates limited potential for an ITS to make a major contribution to adding workforce surge capacity unless members are directed to utilize it and technology barriers in the current public health IT infrastructure overcome

Use Case Oriented Medical Visual Information Retrieval & System Evaluation

Large amounts of medical visual data are produced daily in hospitals, while new imaging techniques continue to emerge. In addition, many images are made available continuously via publications in the scientific literature and can also be valuable for clinical routine, research and education. Information retrieval systems are useful tools to provide access to the biomedical literature and fulfil the information needs of medical professionals. The tools developed in this thesis can potentially help clinicians make decisions about difficult diagnoses via a case-based retrieval system based on a use case associated with a specific evaluation task. This system retrieves articles from the biomedical literature when querying with a case description and attached images. This thesis proposes a multimodal approach for medical case-based retrieval with focus on the integration of visual information connected to text. Furthermore, the ImageCLEFmed evaluation campaign was organised during this thesis promoting medical retrieval system evaluation

Clinical decision support in emergency medicine : exploring the prerequisites

A clinical decision support system is a technical system that combines individual patient data and evidence-based clinical knowledge to give advice and support to clinicians. For quite a long time, the emergence of such systems has been predicted and expected to impact health care dramatically by improving both quality and productivity. Three factors make Swedish emergency medicine an interesting context which could be mature for the introduction of clinical decision support systems. Firstly, Sweden is a leader in the implementation of health care information technology, and the coverage of electronic health records is around 100% in the country. Secondly, emergency medicine is a field with high patient turnover, frequent decisions, and substantial impact on patient outcome. Thirdly, although there are abundant publications on clinical decision support system development and implementation in general, there is less knowledge of such systems in the urgent care context. Therefore, this doctoral project aimed to explore the prerequisites prior to implementation of clinical decision support systems in emergency medicine. This thesis is based on a mixed-methods design and consists of four individual studies. Proctor’s conceptual model of implementation research was used as a framework for the project. Study I included semi-structured interviews with 16 medical doctors and nurses from nine Swedish emergency departments. Content analysis was used to describe factors affecting vital sign data quality in emergency care. Study II extracted vital signs from 330 000 emergency department visits to assess the effects of different documentation workflows on data quality. Study III prospectively explored 200 vital sign measurements from 50 emergency care visits to evaluate the impact of manual and automated documentation on vital sign data quality. Study III also used data from an adapted NASA TLX questionnaire to compare the workload of clinical staff (n=70) in manual and automatic documentation. Study IV used semi-structured interviews with 14 emergency medicine physicians from three different sites. Content analysis was used to explore participants’ expectations and concerns regarding clinical decision support systems. There are three main results and conclusions from the research. Firstly, documentation of vital signs in the emergency department is still surprisingly paper-based, which makes vital sign data unfit for reuse in clinical decision support. Secondly, automation of vital sign documentation is feasible in emergency care and should improve data quality and reduce workload. Thirdly, enthusiasts towards decision support are at risk of disappointment with the level of innovation in the currently available decision support systems, and this may affect the implementation strategy negatively