Stakeholder Perspectives on Clinical Decision Support Tools to Inform Clinical Artificial Intelligence Implementation: Protocol for a Framework Synthesis for Qualitative Evidence

BACKGROUND: Quantitative systematic reviews have identified clinical artificial intelligence (AI)-enabled tools with adequate performance for real-world implementation. To our knowledge, no published report or protocol synthesizes the full breadth of stakeholder perspectives. The absence of such a rigorous foundation perpetuates the "AI chasm," which continues to delay patient benefit. OBJECTIVE: The aim of this research is to synthesize stakeholder perspectives of computerized clinical decision support tools in any health care setting. Synthesized findings will inform future research and the implementation of AI into health care services. METHODS: The search strategy will use MEDLINE (Ovid), Scopus, CINAHL (EBSCO), ACM Digital Library, and Science Citation Index (Web of Science). Following deduplication, title, abstract, and full text screening will be performed by 2 independent reviewers with a third topic expert arbitrating. The quality of included studies will be appraised to support interpretation. Best-fit framework synthesis will be performed, with line-by-line coding completed by 2 independent reviewers. Where appropriate, these findings will be assigned to 1 of 22 a priori themes defined by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework. New domains will be inductively generated for outlying findings. The placement of findings within themes will be reviewed iteratively by a study advisory group including patient and lay representatives. RESULTS: Study registration was obtained from PROSPERO (CRD42021256005) in May 2021. Final searches were executed in April, and screening is ongoing at the time of writing. Full text data analysis is due to be completed in October 2021. We anticipate that the study will be submitted for open-access publication in late 2021. CONCLUSIONS: This paper describes the protocol for a qualitative evidence synthesis aiming to define barriers and facilitators to the implementation of computerized clinical decision support tools from all relevant stakeholders. The results of this study are intended to expedite the delivery of patient benefit from AI-enabled clinical tools. TRIAL REGISTRATION: PROSPERO CRD42021256005; https://tinyurl.com/r4x3thvp. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33145

Self-esteem and traumatic stress severity in individuals from individualists and collectivists’ perspectives

It is evident that traumatic stress influences cultures differently but how this happens is still unclear. It may be assumed that the differences in PTSD severity between independent and interdependent cultures may exist due to the differential influence of individual self-esteem. Although some international research is prevalent, none address the issue of self-esteem and the cultural element of independent vs interdependent specifically and to the knowledge of the researcher no similar South African research exists. To investigate whether independent or interdependent classification mediates the influence of individual self-esteem on traumatic stress severity, a quantitative correlational design is used. Based on a sample size of N=197, an independent sample t-test – with unequal group sizes - suggested that individuals from independent and interdependent cultures reportedly expressed post-traumatic symptomology similarly. Results from the ANCOVA have indicated that individual self-esteem does not influence traumatic stress severity and that independently classified White English speaking participants between the ages of 21-30 are more likely to experience higher levels of traumatic stress severity as opposed to interdependently classified Coloured Afrikaans speaking participants between the ages of 21-30. Finally, chi-square analysis indicated that ethnicity cannot be deemed as a variable that can predict culture classification. However, the varying home language preferences in cultures suggest a possibility of varying ethnic identities within each of the ethnic groups

Scaling readiness: Concepts, practices, and implementation.

Scaling Readiness is an approach that can support organizations, projects, and programs in achieving their ambitions to scale innovations and achieve impact. Scaling Readiness encourages critical reflection on how ready innovations are for scaling, and what appropriate actions could accelerate or enhance scaling

Beyond financial repression and regulatory capture: the recomposition of European financial ecosystems after the crisis. LEQS Paper No. 147/2019 September 2019

The financial crisis has radically changed the political economy of the European financial system. The evolution of relations between European states and their respective financial systems has given rise to two competing narratives. On the one hand, government agencies are often described as being at the mercy of the financial sector, regularly hijacking political, regulatory and supervisory processes. This trend is often referred to as "regulatory capture" and would explain the "soft touch" regulation and bank bailout. On the other hand, governments are portrayed as subverting markets and abusing the financial system for their benefit, mainly to obtain better financing conditions and allocate credit to the economy on preferential terms, a trend called "financial repression" that is considered corrosive to the proper functioning of free markets and a source of capital misallocation. This paper takes a critical look at this debate and argues that the relationship between governments and financial systems in Europe cannot be reduced to the polar notions of "capture" and "repression", but that the channels of pressure and influence between governments and their financial systems have often been bi-directional and mutually reinforcing

Report from GI-Dagstuhl Seminar 16394: Software Performance Engineering in the DevOps World

This report documents the program and the outcomes of GI-Dagstuhl Seminar 16394 "Software Performance Engineering in the DevOps World". The seminar addressed the problem of performance-aware DevOps. Both, DevOps and performance engineering have been growing trends over the past one to two years, in no small part due to the rise in importance of identifying performance anomalies in the operations (Ops) of cloud and big data systems and feeding these back to the development (Dev). However, so far, the research community has treated software engineering, performance engineering, and cloud computing mostly as individual research areas. We aimed to identify cross-community collaboration, and to set the path for long-lasting collaborations towards performance-aware DevOps. The main goal of the seminar was to bring together young researchers (PhD students in a later stage of their PhD, as well as PostDocs or Junior Professors) in the areas of (i) software engineering, (ii) performance engineering, and (iii) cloud computing and big data to present their current research projects, to exchange experience and expertise, to discuss research challenges, and to develop ideas for future collaborations

Development of a new balanced evaluation framework for service improvement.

The study of service improvement within healthcare is no longer in its infancy. A plethora of books and journal publications have presented their own interpretations of the meanings, significance and application of service improvement. Despite such endeavours, there are still few studies that look at how we measure the impact of such service improvement to quantify the practical effect of improvement. At organisational level, organisations and project leaders often undertake evaluation in a piecemeal way, as part of a project or initiative. Whilst this can help assess the benefits or otherwise of a particular piece of work, the findings of the evaluation often remain within the project and are not disseminated across the wider organisations. This, in turn, means that opportunities for learning are diminished. This project builds on previous work and adds a new and unique contribution to the body of service improvement knowledge. It critically reviewed existing evaluation frameworks to inform the development of a unique balanced framework for service improvement initiatives, which is accessible and usable for change agents and their colleagues to evaluate effectiveness. The project began with an examination of the political environment surrounding the evaluation of service improvement, followed by a review of both existing service improvement evaluation frameworks. The review yielded few resources and highlighted a gap in the body of knowledge. Following this, primary data was collected from the organisation, which led to the following research questions: – What is understood by measurement and evaluation? – Are measurement and evaluation, interdependent, or mutually exclusive? – What elements are missing from the current evaluation models presented? – Could an evaluation framework model work in practice? This led to a qualitative action research, which used focus-group meetings and one-to-one discussions to provide observation, reflection and feedback, in order to develop an understanding of measurement and evaluation, in relation to organisational improvement and to provide a robust evaluation framework for organisational use. The findings were analysed, using thematic analysis and revealed the need for an evaluation framework that is user-friendly, replicable and incorporates the views of users and carers. On the basis of the findings, recommendations are made for the improvement of practice and also the need for further longitudinal research, in relation to embedding and evaluating the impact of the framework within the organisation

Improving National and Homeland Security through a proposed Laboratory for Information Globalization and Harmonization Technologies (LIGHT)

A recent National Research Council study found that: "Although there are many private and public databases that contain information potentially relevant to counter terrorism programs, they lack the necessary context definitions (i.e., metadata) and access tools to enable interoperation with other databases and the extraction of meaningful and timely information" [NRC02, p.304, emphasis added] That sentence succinctly describes the objectives of this project. Improved access and use of information are essential to better identify and anticipate threats, protect against and respond to threats, and enhance national and homeland security (NHS), as well as other national priority areas, such as Economic Prosperity and a Vibrant Civil Society (ECS) and Advances in Science and Engineering (ASE). This project focuses on the creation and contributions of a Laboratory for Information Globalization and Harmonization Technologies (LIGHT) with two interrelated goals: (1) Theory and Technologies: To research, design, develop, test, and implement theory and technologies for improving the reliability, quality, and responsiveness of automated mechanisms for reasoning and resolving semantic differences that hinder the rapid and effective integration (int) of systems and data (dmc) across multiple autonomous sources, and the use of that information by public and private agencies involved in national and homeland security and the other national priority areas involving complex and interdependent social systems (soc). This work builds on our research on the COntext INterchange (COIN) project, which focused on the integration of diverse distributed heterogeneous information sources using ontologies, databases, context mediation algorithms, and wrapper technologies to overcome information representational conflicts. The COIN approach makes it substantially easier and more transparent for individual receivers (e.g., applications, users) to access and exploit distributed sources. Receivers specify their desired context to reduce ambiguities in the interpretation of information coming from heterogeneous sources. This approach significantly reduces the overhead involved in the integration of multiple sources, improves data quality, increases the speed of integration, and simplifies maintenance in an environment of changing source and receiver context - which will lead to an effective and novel distributed information grid infrastructure. This research also builds on our Global System for Sustainable Development (GSSD), an Internet platform for information generation, provision, and integration of multiple domains, regions, languages, and epistemologies relevant to international relations and national security. (2) National Priority Studies: To experiment with and test the developed theory and technologies on practical problems of data integration in national priority areas. Particular focus will be on national and homeland security, including data sources about conflict and war, modes of instability and threat, international and regional demographic, economic, and military statistics, money flows, and contextualizing terrorism defense and response. Although LIGHT will leverage the results of our successful prior research projects, this will be the first research effort to simultaneously and effectively address ontological and temporal information conflicts as well as dramatically enhance information quality. Addressing problems of national priorities in such rapidly changing complex environments requires extraction of observations from disparate sources, using different interpretations, at different points in times, for different purposes, with different biases, and for a wide range of different uses and users. This research will focus on integrating information both over individual domains and across multiple domains. Another innovation is the concept and implementation of Collaborative Domain Spaces (CDS), within which applications in a common domain can share, analyze, modify, and develop information. Applications also can span multiple domains via Linked CDSs. The PIs have considerable experience with these research areas and the organization and management of such large scale international and diverse research projects. The PIs come from three different Schools at MIT: Management, Engineering, and Humanities, Arts & Social Sciences. The faculty and graduate students come from about a dozen nationalities and diverse ethnic, racial, and religious backgrounds. The currently identified external collaborators come from over 20 different organizations and many different countries, industrial as well as developing. Specific efforts are proposed to engage even more women, underrepresented minorities, and persons with disabilities. The anticipated results apply to any complex domain that relies on heterogeneous distributed data to address and resolve compelling problems. This initiative is supported by international collaborators from (a) scientific and research institutions, (b) business and industry, and (c) national and international agencies. Research products include: a System for Harmonized Information Processing (SHIP), a software platform, and diverse applications in research and education which are anticipated to significantly impact the way complex organizations, and society in general, understand and manage critical challenges in NHS, ECS, and ASE