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

An Automated System for Generating Situation-Specific Decision Support in Clinical Order Entry from Local Empirical Data

Indiana University-Purdue University Indianapolis (IUPUI)Clinical Decision Support is one of the only aspects of health information technology that has demonstrated decreased costs and increased quality in healthcare delivery, yet it is extremely expensive and time-consuming to create, maintain, and localize. Consequently, a majority of health care systems do not utilize it, and even when it is available it is frequently incorrect. Therefore it is important to look beyond traditional guideline-based decision support to more readily available resources in order to bring this technology into widespread use. This study proposes that the wisdom of physicians within a practice is a rich, untapped knowledge source that can be harnessed for this purpose. I hypothesize and demonstrate that this wisdom is reflected by order entry data well enough to partially reconstruct the knowledge behind treatment decisions. Automated reconstruction of such knowledge is used to produce dynamic, situation-specific treatment suggestions, in a similar vein to Amazon.com shopping recommendations. This approach is appealing because: it is local (so it reflects local standards); it fits into workflow more readily than the traditional local-wisdom approach (viz. the curbside consult); and, it is free (the data are already being captured). This work develops several new machine-learning algorithms and novel applications of existing algorithms, focusing on an approach called Bayesian network structure learning. I develop: an approach to produce dynamic, rank-ordered situation-specific treatment menus from treatment data; statistical machinery to evaluate their accuracy using retrospective simulation; a novel algorithm which is an order of magnitude faster than existing algorithms; a principled approach to choosing smaller, more optimal, domain-specific subsystems; and a new method to discover temporal relationships in the data. The result is a comprehensive approach for extracting knowledge from order-entry data to produce situation-specific treatment menus, which is applied to order-entry data at Wishard Hospital in Indianapolis. Retrospective simulations find that, in a large variety of clinical situations, a short menu will contain the clinicians' desired next actions. A prospective survey additionally finds that such menus aid physicians in writing order sets (in completeness and speed). This study demonstrates that clinical knowledge can be successfully extracted from treatment data for decision support

Effects of Anxiety Treatment Using Coping Cat on Problem Behaviors in the Classroom

Children with comorbid anxiety disorders and externalizing problem behaviors and disorders pose an interesting challenge for clinicians. These children are at the greatest risk for the poorest outcomes in several areas of functioning including academics, interpersonal relationships, and emotional regulation. The current single subject research study was implemented to evaluate the effect of an anxiety reduction intervention, Coping Cat, on participants’ anxiety symptoms and behavior problems. The design included a baseline phase, an intervention phase, and a maintenance phase following the implementation of the intervention. Across all three phases, one or more trained research assistants collected behavioral observation data twice per week. Additionally, during both the baseline and maintenance phases, students and teachers completed rating forms, including a broad behavior measure and narrow anxiety and depression measures. Participants included two eleven-year-old students and one twelve-year-old student; two students were African American, one Caucasian. Each of the three students had at least one anxiety diagnosis and one externalizing diagnosis. It was hypothesized that the successful treatment of the participants’ anxiety symptoms would reduce externalizing symptoms. Results were consistent with this hypothesis. Across participants, there was an overall decrease in the level of externalizing problem behaviors observed in the classroom during the course of the intervention and following the intervention. It was also hypothesized that the participants would experience a reduction of anxiety symptomatology. These data were somewhat variable, depending on scale and rater

Web-Interface for querying and visualizing Alcoholic Liver Disease Patients’ data from database using GraphQL

Ο αλκοολισμός αποτελεί́ ένα από τα σοβαρότερα και συχνότερα προβλήματα που αντιμετωπίζουν οι σύγχρονες κοινωνίες. 5%-10% του πληθυσμού στις ευρωπαϊκές χώρες κάνει κατάχρηση αλκοόλ, με την παρατεταμένη κατανάλωση αλκοόλ να επιφέρει ίνωση και κίρρωση του ήπατος (αλκοολική νόσος, Alcohol Liver Disease, ALD). Η αλκοολική νόσος συνίσταται στην ανάπτυξη του λιπώδους ήπατος, στην αλκοολική ηπατίτιδα, και τελικά στην κίρρωση του ήπατος. Τα πρώτα στάδια της ίνωσης και της αλκοολικής ηπατίτιδας είναι ασυμπωματικά ενώ όταν τελικά εκδηλωθεί η νόσος, η κλινική εικόνα είναι οξεία. Στην κλινική πράξη η διάγνωση της ALD βασίζεται στο ιστορικό χρήσης αλκοόλ, στην συμπτωματολογία του ασθενούς, και σε εργαστηριακές εξετάσεις (π.χ. ηπατικά ένζυμα, αρτηριακή πίεση, γλυκόζη αίματος, κ.α.). Η διπλωματική εργασία αποσκοπεί στη δημιουργία μιας βάσης δεδομένων για την συλλογή και ταξινόμηση όλων των εργαστηριακών, κλινικών, κ.α. εξετάσεων των ασθενών. Η αναζήτηση δεδομένων και δημιουργία γραφημάτων γίνεται σε πραγματικό χρόνο μέσω της χρήσης GraphQL επερωτήσεων. Η σχεδίαση της διεπαφής λαμβάνει υπόψη την αλλαγή των δεδομένων καθώς επίσης και την επαναχρησιμοποίηση σε διαφορετικού είδους δεδομένα από άλλα πειράματα και τη χρήση από άλλα υπολογιστικά συστήματα. Με αυτό το βιοπληροφορικό εργαλείο θα απλοποιηθεί η διαδικασία επιλογής δεδομένων, ανάλυσης και προβολής με χρήση γραφημάτων και διαγραμμάτων όλων των δεδομένων από ιατρούς και ερευνητές. Αυτό έχει ως αποτέλεσμα το εργαλείο να διευκολύνει την καθημερινότητα των ιατρών και ερευνητών ώστε να επικεντρώνονται περισσότερο στην ουσία της έρευνας, δηλαδή στην εξαγωγή συμπερασμάτων για τις βασικότερες κατηγορίες των δεδομένων που οδηγούν τους ασθενείς στην πάθηση της αλκοολικής ηπατικής νόσου, και λιγότερο στις διαδικασίες.Alcoholism is one of the most serious and most common problems faced by modern societies. Approximately, 5%-10% of the population in European countries do alcohol abuse, with prolonged alcohol consumption causing liver fibrosis and cirrhosis (alcoholic liver disease, ALD). Alcoholic disease is the development of fatty liver, alcoholic hepatitis, and finally cirrhosis of the liver. The early stages of fibrosis and alcoholic hepatitis are symptomless, and when the disease is finally manifested, the clinical picture is acute. In clinical practice, the diagnosis of ALD is based on the historical alcohol ingestion, patient symptomatology and laboratory tests (e.g. liver enzymes, blood pressure, blood glucose, etc.). The dissertation aims to create a database for the collection and classification of all laboratorial, clinical, etc. examinations of patients. Data search and graph plots and charts are created in real-time with the use of GraphQL queries and middleware query caching. The design process of the interface takes into account data changes as well as reusability of this tool in different kind of data from other tests or experiments and can be used in all types computing systems as it is containerized and responsive. This bioinformatic tool will help physicians and researchers to simplify the process of data selection, analysis and visualization by using graphs and diagrams of all data. As a result, the tool facilitates the day-to-day physicians and researchers schedule and as has the effect of letting them focus more on the essence of research, i.e. to draw conclusions about the main categories of information that lead patients to alcoholic liver disease, and less on processes

Sharing and viewing segments of electronic patient records service (SVSEPRS) using multidimensional database model

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The concentration on healthcare information technology has never been determined than it is today. This awareness arises from the efforts to accomplish the extreme utilization of Electronic Health Record (EHR). Due to the greater mobility of the population, EHR will be constructed and continuously updated from the contribution of one or many EPRs that are created and stored at different healthcare locations such as acute Hospitals, community services, Mental Health and Social Services. The challenge is to provide healthcare professionals, remotely among heterogeneous interoperable systems, with a complete view of the selective relevant and vital EPRs fragments of each patient during their care. Obtaining extensive EPRs at the point of delivery, together with ability to search for and view vital, valuable, accurate and relevant EPRs fragments can be still challenging. It is needed to reduce redundancy, enhance the quality of medical decision making, decrease the time needed to navigate through very high number of EPRs, which consequently promote the workflow and ease the extra work needed by clinicians. These demands was evaluated through introducing a system model named SVSEPRS (Searching and Viewing Segments of Electronic Patient Records Service) to enable healthcare providers supply high quality and more efficient services, redundant clinical diagnostic tests. Also inappropriate medical decision making process should be avoided via allowing all patients‟ previous clinical tests and healthcare information to be shared between various healthcare organizations. Multidimensional data model, which lie at the core of On-Line Analytical Processing (OLAP) systems can handle the duplication of healthcare services. This is done by allowing quick search and access to vital and relevant fragments from scattered EPRs to view more comprehensive picture and promote advances in the diagnosis and treatment of illnesses. SVSEPRS is a web based system model that helps participant to search for and view virtual EPR segments, using an endowed and well structured Centralised Multidimensional Search Mapping (CMDSM). This defines different quantitative values (measures), and descriptive categories (dimensions) allows clinicians to slice and dice or drill down to more detailed levels or roll up to higher levels to meet clinicians required fragment

Applying Organizational Learning Theories to Continuous Improvement Practices Through Self-Study Methodology to Better Reflect upon and Understand Factors that Influence School Improvement Efforts

The purpose of this self-study is to better understand and address the factors that influence continuous improvement efforts led by the researcher/practitioner. To this end, this study applies Bolman and Deal’s 4-frame model of organizational learning lenses to school improvement indicators on the Illinois 5Essentials Survey. Through taking Bolman and Deal’s Online 4-frame Self-assessment, I am able to identify the organizational learning lens least integrated into my own leadership worldview. The organizational learning lenses that comprise Bolman and Deal’s 4-frame model are the structural, symbolic, human resource, and political lenses. I then apply core tenets of my least integrated lens to low-performing school improvement efforts through reflective journaling on prompts derived from a summation of core attributes of the identified lens to low-performing school improvement indicators of the 5Essentials Survey. After collecting the journaling data, it is coded to determine the prevalence of the different organizational learning theories that underpin the least integrated lens in my leadership approach to school improvement. From there, the following broader research questions are considered:How do the most prevalent organizational learning theories from my least integrated 4-frame-lens inform continuous improvement efforts in regard to this 5Essentials survey topic? Based upon identified theories and concepts from my lowest percentile Bolman and Deal lens, what factors am I considering or not considering when engaging in continuous improvement concerning this 5Essential survey topic? By deliberately applying under-considered principles to self-study reflection on continuous improvement efforts, I can more holistically articulate and understand factors that influence these efforts

An Integrated, Secured, Open-Source Medical Prototype for Collaborative Patient Management on the Internet

Conventional approaches to building critical and secured systems are based on the use of commercial tools for development and maintenance. Changes in the marketplace and the acceptance of the open-source model have brought this assumption into question. The combination of open-source\u27s rapid rise and the introduction of pervasive computing has made the computing industry more receptive to open-source tools and products. The open-source model allows systems to be controlled by a single individual or a small developer group that reduces dependence on individual experts. The availability of free system source codes, an expanding commercial support market, and increasing global collaborative projects makes open-source an important development in the computing environment and an exciting innovation in software engineering. Open-source projects require a level of modeling to successfully implement a solution. This study implemented a Web application prototype that models medical business logic and state that is secured. The researcher adopted the object-oriented design methodology and prototyping that improved security and lowered overall development cost. The open-source community had played an increasingly significant role in the business plans of established computing companies, in university research labs, and in the development of new companies focused on open-source support and integration issues. The openness of the Internet presents both system development and privacy issues. The availability of free tools and instructions on how to compromise systems is alarming within the online community. Thus, open-source security tools are helping protect people\u27s privacy by enforcing authentication, confidentiality, and information integrity to prevent unauthorized access. Open-source growth motivated this research to develop a medical prototype for online collaboration. Open-source tools including PHP, MySQL, Apache Web Server, and the Linux operating system were used to develop the secured application through prototyping. The main contribution of this study is that it demonstrated the exclusive use of open-source software and tools for an online application. The researcher hypothesized that open-source tools like PHP, MySQL, XML, and LINUX are the answer to building dynamic multi-tiers and cost effective systems faster. The research also explored major tools available for open-source software development

Thinking differently about local economic development and governance in secondary cities in South Africa - A conceptual analysis of the possibilities of problem driven iterative adaption (PDIA)

Local economic development successes and failures at municipal level, and specifically in secondary cities in South Africa, is deeply influenced by the constitutional imperatives for establishing developmental local government. The local planning, economic development and policy frameworks introduced between 1999 and 2006 were largely based on, and moulded according to, the wave of new public management paradigms and public sector reform 'good governance best practises' implemented in South Africa post the 1994 democratic elections. The study makes two claims about municipal designs and practises, one that the governance design for these expressions of developmental local government in South Africa has been driven by solution based and theoretical mechanisms rooted in primarily new public management frameworks and development approaches. The second claim is that this development approach manifested in practise in specific plans and frameworks which municipal governments and entities are required to implement and this implementation is characterised by mimicry and isomorphism through compliance, specifically in intermediate cites The motivation for the study, and the third claim which the study investigates, is that the implementation of these plans in practise is not doing so well in terms of delivering the results as envisaged, and secondary cities and towns are often in economic, social and service delivery crises and exhibit very high levels of spatial exclusion despite the local economic development profiles and governance arrangements in these settings increasingly being a matter of policy discussion and debate. The study then introduces a proposed alternative by focusing on implementation at local level and explores how things might be done differently. It looks at the possible contribution of the current search for more effective public service reform, generally referred to as 'doing development differently' or 'smart(er) development', to this local economic development debate. Through a conceptual analysis and application of the approaches and methodologies introduced by problem driven iterative adaption, the study identifies possible different approaches for local economic development in secondary cities and explains what it looks like. The study concludes that doing local economic differently in intermediate settings in South Africa can provide more realistic expectations for the results of local economic development initiatives through fundamentally rephrasing the problem as one that matters, and make recommendations for approaches through which problem driven iterative adaptation processes and practises can be introduced in the context of the institutional constraints present in these intermediate settings

Fourth Annual Workshop on Space Operations Applications and Research (SOAR 90)

The proceedings of the SOAR workshop are presented. The technical areas included are as follows: Automation and Robotics; Environmental Interactions; Human Factors; Intelligent Systems; and Life Sciences. NASA and Air Force programmatic overviews and panel sessions were also held in each technical area