Analysis and Visualization Methods for Data-Driven Longitudinal Patient Summary

Digitization of health records has opened avenues for intensive research in the fields of health informatics. Power of machine learning, statistical analysis and visual analytics could be utilized to make optimal use of this information. The proposed project is to develop an interactive visualization tool that summarizes a patient's medical history, highlighting all his/her important events based on the knowledge of similar patients. Given a set of patients with common conditions, statistical analysis can be used to develop models that prioritize features based on associations between features and condition-specific outcome measures. This manuscript in particular describes the model developed to prioritize a patient's events from his medical history. The model is trained with the population of patients and their events. Their correlations with the outcome variable are calculated to identify the important events in a specific cohort. This correlation score can be used to prioritize the events associated with an individual patient. This model is one of the models that will be used to summarize an individual patient's medical data via interactive visualization methods.Master of Science in Information Scienc

The Secondary Use of Longitudinal Critical Care Data

Aims To examine the strengths and limitations of a novel United Kingdom (UK) critical care data resource that repurposes routinely collected physiological data for research. Exemplar clinical research studies will be developed to explore the unique longitudinal nature of the resource. Objectives - To evaluate the suitability of the National Institute for Health Research (NIHR) Critical Care theme of the Health Informatics Collaborative (CCHIC) data model as a representation of the Electronic Health Record (EHR) for secondary research use. - To conduct a data quality evaluation of data stored within the CC-HIC research database. - To use the CC-HIC research database to conduct two clinical research studies that make use of the longitudinal data supported by the CC-HIC: - The association between cumulative exposure to excess oxygen and outcomes in the critically ill. - The association between different morphologies of longitudinal physiology—in particular organ dysfunction—and outcomes in sepsis. The CC-HIC The EHR is now routinely used for the delivery of patient care throughout the United Kingdom (UK). This has presented the opportunity to learn from a large volume of routinely collected data. The CC-HIC data model represents 255 distinct clinical concepts including demographics, outcomes and granular longitudinal physiology. This model is used to harmonise EHR data of 12 contributing Intensive Care Units (ICUs). This thesis evaluates the suitability of the CC-HIC data model in this role and the quality of data within. While representing an important first step in this field, the CC-HIC data model lacks the necessary normalisation and semantic expressivity to excel in this role. The quality of the CC-HIC research database was variable between contributing sites. High levels of missing data, missing meta-data, non-standardised units and temporal drop out of submitted data are amongst the most challenging features to tackle. It is the principal finding of this thesis that the CC-HIC should transition towards implementing internationally agreed standards for interoperability. Exemplar Clinical Studies Two exemplar studies are presented, each designed to make use of the longitudinal data made available by the CC-HIC and address domains that are both contemporaneous and of importance to the critical care community. Exposure to Excess Oxygen Longitudinal data from the CC-HIC cohort were used to explore the association between the cumulative exposure to excess oxygen and outcomes in the critically ill. A small (likely less than 1% absolute risk reduction) dose-independent association was found between exposure to excess oxygen and mortality. The lack of dosedependency challenges a causal interpretation of these findings. Physiological Morphologies in Sepsis The joint modelling paradigm was applied to explore the different longitudinal profiles of organ failure in sepsis, while accounting for informative censoring from patient death. The rate of change of organ failure was found to play a more significan't role in outcomes than the absolute value of organ failure at a given moment. This has important implications for how the critical care community views the evolution of physiology in sepsis. DECOVID The Decoding COVID-19 (DECOVID) project is presented as future work. DECOVID is a collaborative data sharing project that pools clinical data from two large NHS trusts in England. Many of the lessons learnt from the prior work with the CC-HIC fed into the development of the DECOVID data model and its quality evaluation

Pluralism within Parameters : towards a mature evaluative historiography of science

Historiography of science is in its current self-image a non-evaluative discipline. Its main goal is to understand past processes of knowledge formation on their own terms. In the last few decades this approach has greatly improved our understanding of the phenomenon of science. Yet, something strange in going on. Reading present-day historiography of science it is as if no one ever made a mistake. We may wonder why there has been development in science at all, if no mistake has ever stood in need of correction. I argue that it is possible to add an evaluative dimension to historiography of science without relinquishing the many insights won in the past few decades. Such an evaluative stance requires a radical comparative approach towards assessments of past science. I argue that this comparativism is not incompatible to relationalism but complementary to it. Next to this I argue that, if we take the wish to reduce uncertainty as the primary force of change in science, a proper conceptualization of the notion of error, which is now surprisingly lacking, becomes possible. The results of my thesis endow historians of science with a set of analytical possibilities, which, if used, will significantly strengthen the historiographical output of the field.NWOPhilosophy of Knowledge and Cognitio

Applying the Free-Energy Principle to Complex Adaptive Systems

The free energy principle is a mathematical theory of the behaviour of self-organising systems that originally gained prominence as a unified model of the brain. Since then, the theory has been applied to a plethora of biological phenomena, extending from single-celled and multicellular organisms through to niche construction and human culture, and even the emergence of life itself. The free energy principle tells us that perception and action operate synergistically to minimize an organism’s exposure to surprising biological states, which are more likely to lead to decay. A key corollary of this hypothesis is active inference—the idea that all behavior involves the selective sampling of sensory data so that we experience what we expect to (in order to avoid surprises). Simply put, we act upon the world to fulfill our expectations. It is now widely recognized that the implications of the free energy principle for our understanding of the human mind and behavior are far-reaching and profound. To date, however, its capacity to extend beyond our brain—to more generally explain living and other complex adaptive systems—has only just begun to be explored. The aim of this collection is to showcase the breadth of the free energy principle as a unified theory of complex adaptive systems—conscious, social, living, or not

Maintaining a focus on work-related opportunities at higher ages

Individuals with a strong focus on opportunities believe that they will have many new goals, plans, options, and possibilities in their personal future. This dissertation consists of four empirical studies that investigated which person- and context-related factors help individuals to maintain a focus on work-related opportunities, especially at higher ages. In addition, relationships between focus on opportunities and important work outcomes were examined. In Study 1, two dimensions of the concept of future time perspective were adapted to the occupational context: Perceptions of the length of personal remaining time at work and focus on opportunities at work. Relationships between these dimensions and age as well as two important work characteristics, job complexity and job control, were examined. Hierarchical moderated regression analyses and structural equation modeling of data collected from 176 employees of various occupations (mean age = 39 years, standard deviation = 13, range = 19 to 60 years) showed that age was negatively related to both remaining time and focus on opportunities. Job complexity and control were positively related to focus on opportunities and moderated the negative relationship between age and focus on opportunities, such that the relationship was weaker at high compared to low levels of job complexity and control. Study 2 investigated the interplay between age, job complexity, and the use of a successful aging strategy entitled selection, optimization, and compensation (SOC) in predicting focus on opportunities at work. First, it was expected that employees in high-complexity jobs are better able to maintain a focus on opportunities at higher ages than employees in low-complexity jobs. Second, it was expected that SOC strategy use is more strongly positively related to focus on opportunities in low-complexity jobs than in high-complexity jobs. Third, it was expected that employees in low-complexity jobs with high levels of SOC strategy use are better able to maintain a focus on opportunities at higher ages than employees in low-complexity jobs with low levels of SOC strategy use. Data were collected from 133 employees of one company (mean age = 38 years, standard deviation = 13, range = 16 to 65 years). Results of a hierarchical moderated regression analysis supported the three main assumptions. Study 3 investigated focus on opportunities as a mediator of the relationships between age and work performance and between job complexity and work performance. In addition, it was expected that job complexity buffers the negative relationship between age and focus on opportunities and moderates the negative and indirect effect of age on work performance (through focus on opportunities), such that the indirect effect is weaker for employees in high-complexity jobs than for employees in low-complexity jobs. Results of simple and moderated mediation analyses with data of 168 employees from 41 organizations (mean age = 40 years, standard deviation = 10, range = 19 to 64 years) and peer-ratings of work performance supported the assumptions for overall work performance as well as for more specific work performance dimensions (i.e., task, career, and citizenship performance). In Study 4, focus on opportunities was investigated as a mediator of the relationships between business owners’ age and venture growth and between mental health and venture growth. In addition, it was expected that mental health buffers the negative relationship between age and focus on opportunities and moderates the negative and indirect effect of age on venture growth (through focus on opportunities), such that the indirect effect is weaker for business owners high in mental health than for business owners low in mental health. Simple and moderated mediation analyses with data collected from 84 small business owners (mean age = 44 years, standard deviation = 10, range = 24 to 74 years) supported the assumptions. In conclusion, focus on opportunities at work is an important concept to better understand the role of age in the work context. Future research should conceptualize focus on opportunities as an aspect of older adults’ positive psychological capital and apply longitudinal designs.Personen mit einem hoch ausgeprägten "Fokus auf Möglichkeiten" (englisch focus on opportunities) erwarten, dass sie viele neue Ziele, Pläne, Optionen und Möglichkeiten in ihrer persönlichen Zukunft haben werden. Die vorliegende Dissertation enthält vier empirische Studien, in denen untersucht wurde, welche Personen- und Kontextfaktoren dazu beitragen, einen Fokus auf arbeitsbezogene Möglichkeiten, insbesondere mit zunehmendem Alter, aufrechtzuerhalten. Weiterhin wurden Zusammenhänge zwischen Fokus auf Möglichkeiten und wichtigen Erfolgsmaßen im Arbeitskontext untersucht. In Studie 1 wurden zwei Dimensionen des Konzepts der persönlichen Zukunftsperspektive auf den Arbeitskontext übertragen: die Wahrnehmung der Länge der persönlichen verbleibenden Zeit und Fokus auf Möglichkeiten im Arbeitskontext. Die Zusammenhänge zwischen diesen beiden Dimensionen und Alter sowie zwei wichtigen Arbeitsmerkmalen, Arbeitskomplexität und Handlungsspielraum, wurden untersucht. Hierarchisch moderierte Regressionsanalysen und ein Strukturgleichungsmodell mit Daten von 176 Erwerbstätigen aus verschiedenen Berufen (mittleres Alter = 39 Jahre, Standardabweichung = 13, Altersspanne = 19 bis 60 Jahre) zeigten, dass das Alter negativ mit verbleibender Zeit und Fokus auf Möglichkeiten zusammenhing. Arbeitskomplexität und Handlungsspielraum hingen positiv mit Fokus auf Möglichkeiten zusammen und moderierten den negativen Zusammenhang zwischen Alter und Fokus auf Möglichkeiten. Der Zusammenhang fiel schwächer bei hoher Arbeitskomplexität und hohem Handlungsspielraum aus als bei geringer Arbeitskomplexität und geringem Handlungsspielraum. Studie 2 untersuchte das Zusammenspiel zwischen Alter, Arbeitskomplexität und der Nutzung einer Strategie erfolgreichen Alterns – Selektion, Optimierung und Kompensation (SOK) – hinsichtlich der Vorhersage von Fokus auf Möglichkeiten im Arbeitskontext. Erstens wurde erwartet, dass Erwerbstätige in komplexen Tätigkeiten besser einen Fokus auf Möglichkeiten mit zunehmendem Alter aufrechterhalten können als Erwerbstätige in weniger komplexen Tätigkeiten. Zweitens wurde erwartet, dass die Nutzung der SOK-Strategie stärker positiv mit Fokus auf Möglichkeiten in weniger komplexen Tätigkeiten zusammenhängt als in komplexen Tätigkeiten. Drittens wurde erwartet, dass Erwerbstätige in weniger komplexen Tätigkeiten mit hoher SOK-Strategie-Nutzung eher einen Fokus auf Möglichkeiten mit zunehmendem Alter aufrechterhalten können als Erwerbstätige in weniger komplexen Tätigen mit geringer SOK-Strategie-Nutzung. Die Daten wurden von 133 Mitarbeitern eines Unternehmens (mittleres Alter = 38 Jahre, Standardabweichung = 13, Altersspanne = 16 bis 65 Jahre) erhoben. Die Ergebnisse einer hierarchisch moderierten Regressionsanalyse bestätigten die drei Hauptannahmen. Studie 3 untersuchte Fokus auf Möglichkeiten als Mediator in den Beziehungen zwischen Alter und Arbeitsleistung sowie zwischen Arbeitskomplexität und Arbeitsleistung. Außerdem wurde erwartet, dass Arbeitskomplexität den negativen Zusammenhang zwischen Alter und Fokus auf Möglichkeiten abpuffert sowie den negativen und indirekten Effekt von Alter auf Arbeitsleistung (über Fokus auf Möglichkeiten) moderiert, so dass der indirekte Effekt schwächer für Erwerbstätige in Tätigkeiten mit hoher Arbeitskomplexität als für Erwerbstätige in Tätigkeiten mit geringer Arbeitskomplexität ausfällt. Die Ergebnisse einfacher und moderierter Mediationsanalysen mit Daten von 168 Erwerbstätigen aus 41 Organisationen (mittleres Alter = 40 Jahre, Standardabweichung = 10, Altersspanne = 19 bis 64 Jahre) und Kollegeneinschätzungen von Arbeitsleistung bestätigten die Annahmen für allgemeine Arbeitsleistung sowie für spezifischere Arbeitsleistungsdimensionen (Aufgabenleistung, Karriereleistung, und besonderes Engagement für die Organisation). In Studie 4 wurde Fokus auf Möglichkeiten als Mediator in den Beziehungen zwischen dem Alter von Kleinunternehmern und Unternehmenswachstum sowie zwischen psychischer Gesundheit und Unternehmenswachstum untersucht. Außerdem wurde erwartet, dass psychische Gesundheit den negativen Zusammenhang zwischen Alter und Fokus auf Möglichkeiten abpuffert sowie den negativen und indirekten Effekt von Alter auf Unternehmenswachstum (durch Fokus auf Möglichkeiten) moderiert, so dass der indirekte Effekt schwächer ausfällt für Kleinunternehmer mit hoher psychischer Gesundheit als für Kleinunternehmer mit geringer psychischer Gesundheit. Einfache und moderierte Mediationsanalysen mit Daten von 84 Kleinunternehmern (mittleres Alter = 44 Jahre, Standardabweichung = 10, Altersspanne = 24 bis 74 Jahre) erbrachten Unterstützung für die Annahmen. Zusammengefasst stellt Fokus auf Möglichkeiten ein wichtiges Konzept dar, um die Rolle des Alters im Arbeitskontext besser zu verstehen. Zukünftige Forschung sollte Fokus auf Möglichkeiten als einen Aspekt positiven psychologischen Kapitals älterer Erwerbstätiger konzeptualisieren und Längsschnittsdesigns anwenden

An investigation into metaphoric competence in the L2: A linguistic approach

Within the field of L2 metaphoric competence (MC) research, Low’s (1988) and Littlemore and Low’s (2006a, 2006b) metaphor-related skills and (sub)competences have existed for 29 and 11 years respectively, but have never been elicited or used to develop tests. Consequently, the extent to which they are underpinned by more fundamental (sub)constructs is unclear. With a few exceptions (e.g., Littlemore, 2001), L2 MC tests to date have been limited in scope (e.g., Aleshtar & Dowlatabadi, 2014; Azuma, 2005; Hashemian & Nezhad, 2007; Zhao, Yu, & Yang, 2014). Available research shows that L2 MC correlates with L2 vocabulary knowledge and proficiency (Aleshtar & Dowlatabadi, 2014; Zhao et al., 2014), but negligibly with time spent in an L2 immersion setting (Azuma, 2005). However, the ability of these measures to predict L2 MC is unknown, as is the change in the receptive/productive correlation strength as L2 proficiency increases. In response to these gaps, a large battery of L2 MC tests aimed at eliciting Low’s (1988) and Littlemore and Low’s (2006a, 2006b) constructs was developed and administered to 112 NNSs of English (L1 Chinese) and 31 English NSs, along with vocabulary knowledge and (NNSs only) general proficiency tests. Data cleaning showed inherent, operationalisation problems. Exploratory Factor Analysis revealed four metaphor-related factors, with MANOVA and independent samples t-tests showing statistical NNS and NS differences for only one of these: English Grammatical Metaphoric Competence. Multiple regression revealed that the Oxford Online Placement Test best predicted L2 receptive MC, whereas L2 vocabulary depth measured by the Word Associates Test (Read, 1998) best predicted L2 productive MC. Time spent living in the UK had no predictive power, and the receptive/productive correlation weakened with increased L2 proficiency. Implications for theory, test development, the transferability of models and predictors (e.g., to NNSs with other L1s) and EFL teaching are discussed

The development of bottom-up and top-down interaction in the processing of goal-directed action

The study of action-cognition is driven by the assumption that what one can do motorically depends on what one can conceive of mentally, given a set of external opportunities (Rosenbaum, Cohen, & Jax, 2007). Therefore, a comprehensive theory of action development ought to integrate perceptual aspects of action processing with conceptual changes that give rise to increasingly abstract behaviours. How and why children progress to higher levels of organization in the processing and coordination of purposeful behaviour is a question that has been at the core of developmental research for decades. Various competences underlying early action processing and decision-making have been identified and linked to sophisticated mental operations later in life. However, considerably less is known about the relationships between perceptual and conceptual abilities and how they interact to shape action development. Goal-pursuit is achieved with increasing efficiency during the preschool period. In fact, by the age of first grade children show substantial abilities to regulate actions into hierarchically structured sequences of events that can be transferred across contexts (e.g., Levy, 1980; Bell & Livesey, 1985; Livesey & Morgan, 1991). The aim of this project was to investigate the perceptual and conceptual processes that drive these remarkable advances as they emerge during the preschool years. The studies in this thesis investigate top-down and bottom-up interactions in the processing of actions at various levels of abstraction. Employing a range of novel paradigms, the results of four studies highlight considerable advances in preschoolers’ abilities to organise actions in terms of goal hierarchies. Findings further highlight that the ability to extract structure at a basic level is readily achieved early in life, while higher-level action comprehension and planning abilities continue to develop throughout the childhood years