49,954 research outputs found

    A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

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    BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

    Transport of video over partial order connections

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    A Partial Order and partial reliable Connection (POC) is an end-to-end transport connection authorized to deliver objects in an order that can differ from the transmitted one. Such a connection is also authorized to lose some objects. The POC concept is motivated by the fact that heterogeneous best-effort networks such as Internet are plagued by unordered delivery of packets and losses, which tax the performances of current applications and protocols. It has been shown, in several research works, that out of order delivery is able to alleviate (with respect to CO service) the use of end systems’ communication resources. In this paper, the efficiency of out-of-sequence delivery on MPEG video streams processing is studied. Firstly, the transport constraints (in terms of order and reliability) that can be relaxed by MPEG video decoders, for improving video transport, are detailed. Then, we analyze the performance gain induced by this approach in terms of blocking times and recovered errors. We demonstrate that POC connections fill not only the conceptual gap between TCP and UDP but also provide real performance improvements for the transport of multimedia streams such MPEG video

    Decomposition Strategies for Constructive Preference Elicitation

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    We tackle the problem of constructive preference elicitation, that is the problem of learning user preferences over very large decision problems, involving a combinatorial space of possible outcomes. In this setting, the suggested configuration is synthesized on-the-fly by solving a constrained optimization problem, while the preferences are learned itera tively by interacting with the user. Previous work has shown that Coactive Learning is a suitable method for learning user preferences in constructive scenarios. In Coactive Learning the user provides feedback to the algorithm in the form of an improvement to a suggested configuration. When the problem involves many decision variables and constraints, this type of interaction poses a significant cognitive burden on the user. We propose a decomposition technique for large preference-based decision problems relying exclusively on inference and feedback over partial configurations. This has the clear advantage of drastically reducing the user cognitive load. Additionally, part-wise inference can be (up to exponentially) less computationally demanding than inference over full configurations. We discuss the theoretical implications of working with parts and present promising empirical results on one synthetic and two realistic constructive problems.Comment: Accepted at the Thirty-Second AAAI Conference on Artificial Intelligence (AAAI-18

    Taming Numbers and Durations in the Model Checking Integrated Planning System

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    The Model Checking Integrated Planning System (MIPS) is a temporal least commitment heuristic search planner based on a flexible object-oriented workbench architecture. Its design clearly separates explicit and symbolic directed exploration algorithms from the set of on-line and off-line computed estimates and associated data structures. MIPS has shown distinguished performance in the last two international planning competitions. In the last event the description language was extended from pure propositional planning to include numerical state variables, action durations, and plan quality objective functions. Plans were no longer sequences of actions but time-stamped schedules. As a participant of the fully automated track of the competition, MIPS has proven to be a general system; in each track and every benchmark domain it efficiently computed plans of remarkable quality. This article introduces and analyzes the most important algorithmic novelties that were necessary to tackle the new layers of expressiveness in the benchmark problems and to achieve a high level of performance. The extensions include critical path analysis of sequentially generated plans to generate corresponding optimal parallel plans. The linear time algorithm to compute the parallel plan bypasses known NP hardness results for partial ordering by scheduling plans with respect to the set of actions and the imposed precedence relations. The efficiency of this algorithm also allows us to improve the exploration guidance: for each encountered planning state the corresponding approximate sequential plan is scheduled. One major strength of MIPS is its static analysis phase that grounds and simplifies parameterized predicates, functions and operators, that infers knowledge to minimize the state description length, and that detects domain object symmetries. The latter aspect is analyzed in detail. MIPS has been developed to serve as a complete and optimal state space planner, with admissible estimates, exploration engines and branching cuts. In the competition version, however, certain performance compromises had to be made, including floating point arithmetic, weighted heuristic search exploration according to an inadmissible estimate and parameterized optimization

    An agent-based dynamic information network for supply chain management

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    One of the main research issues in supply chain management is to improve the global efficiency of supply chains. However, the improvement efforts often fail because supply chains are complex, are subject to frequent changes, and collaboration and information sharing in the supply chains are often infeasible. This paper presents a practical collaboration framework for supply chain management wherein multi-agent systems form dynamic information networks and coordinate their production and order planning according to synchronized estimation of market demands. In the framework, agents employ an iterative relaxation contract net protocol to find the most desirable suppliers by using data envelopment analysis. Furthermore, the chain of buyers and suppliers, from the end markets to raw material suppliers, form dynamic information networks for synchronized planning. This paper presents an agent-based dynamic information network for supply chain management and discusses the associated pros and cons

    Datacenter Traffic Control: Understanding Techniques and Trade-offs

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    Datacenters provide cost-effective and flexible access to scalable compute and storage resources necessary for today's cloud computing needs. A typical datacenter is made up of thousands of servers connected with a large network and usually managed by one operator. To provide quality access to the variety of applications and services hosted on datacenters and maximize performance, it deems necessary to use datacenter networks effectively and efficiently. Datacenter traffic is often a mix of several classes with different priorities and requirements. This includes user-generated interactive traffic, traffic with deadlines, and long-running traffic. To this end, custom transport protocols and traffic management techniques have been developed to improve datacenter network performance. In this tutorial paper, we review the general architecture of datacenter networks, various topologies proposed for them, their traffic properties, general traffic control challenges in datacenters and general traffic control objectives. The purpose of this paper is to bring out the important characteristics of traffic control in datacenters and not to survey all existing solutions (as it is virtually impossible due to massive body of existing research). We hope to provide readers with a wide range of options and factors while considering a variety of traffic control mechanisms. We discuss various characteristics of datacenter traffic control including management schemes, transmission control, traffic shaping, prioritization, load balancing, multipathing, and traffic scheduling. Next, we point to several open challenges as well as new and interesting networking paradigms. At the end of this paper, we briefly review inter-datacenter networks that connect geographically dispersed datacenters which have been receiving increasing attention recently and pose interesting and novel research problems.Comment: Accepted for Publication in IEEE Communications Surveys and Tutorial
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