1,032 research outputs found
A clinical decision support system for detecting and mitigating potentially inappropriate medications
Background: Medication errors are a leading cause of preventable harm to patients. In older adults, the impact of ageing on the therapeutic effectiveness and safety of drugs is a significant concern, especially for those over 65. Consequently, certain medications called Potentially Inappropriate Medications (PIMs) can be dangerous in the elderly and should be avoided. Tackling PIMs by health professionals and patients can be time-consuming and error-prone, as the criteria underlying the definition of PIMs are complex and subject to frequent updates. Moreover, the criteria are not available in a representation that health systems can interpret and reason with directly.
Objectives: This thesis aims to demonstrate the feasibility of using an ontology/rule-based approach in a clinical knowledge base to identify potentially inappropriate medication(PIM). In addition, how constraint solvers can be used effectively to suggest alternative medications and administration schedules to solve or minimise PIM undesirable side effects.
Methodology: To address these objectives, we propose a novel integrated approach using formal rules to represent the PIMs criteria and inference engines to perform the reasoning presented in the context of a Clinical Decision Support System (CDSS). The approach aims to detect, solve, or minimise undesirable side-effects of PIMs through an ontology (knowledge base) and inference engines incorporating multiple reasoning approaches.
Contributions: The main contribution lies in the framework to formalise PIMs, including the steps required to define guideline requisites to create inference rules to detect and propose alternative drugs to inappropriate medications. No formalisation of the selected guideline (Beers Criteria) can be found in the literature, and hence, this thesis provides a novel ontology for it. Moreover, our process of minimising undesirable side effects offers a novel approach that enhances and optimises the drug rescheduling process, providing a more accurate way to minimise the effect of drug interactions in clinical practice
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Cancer Care in Pandemic Times: Building Inclusive Local Health Security in Africa and India
This is a book about improving cancer care in Africa and India that is a child of its pandemic times. It has been collaboratively researched and written by colleagues in Kenya, Tanzania, India and the UK, working within a cross-country, multidisciplinary research project, Innovation for Cancer Care in Africa (ICCA). Since this was a health-focused research project, ICCA researchers during the pandemic not only continued to work on the cancer research project but were also called upon by their governments to respond to immediate pandemic needs. In combining these two concerns, for improving cancer care and responding to pandemic needs, our original project aims have been challenged, deepened and reworked. ICCA’s initial collaborative research focus included—against the grain of most global health literature—the potential role of enhanced local production of essential healthcare supplies for improving cancer care in African countries. The pandemic experience has strikingly validated these earlier findings on the importance of industrial development for health care. The pandemic crystallised for researchers and policymakers an often overlooked phenomenon: global health security is built on the foundations of strong local health security. We argue in this book that new analytical thinking from social scientists and others is required on how to build local health security. We use the “lens” of original research on cancer care in East Africa and India to build up an understanding of the scope for the development of stronger synergies between local health industries and health care, in order to strengthen local health security and develop tools for policy making. The rethinking and reimagining presented here is required for different African countries, for India and the wider world, and this research on cancer care has taught us that this imperative goes much wider than infectious diseases
Interdisciplinarity in the Scholarly Life Cycle
This open access book illustrates how interdisciplinary research develops over the lifetime of a scholar: not in a single project, but as an attitude that trickles down, or spirals up, into research. This book presents how interdisciplinary work has inspired shifts in how the contributors read, value concepts, critically combine methods, cope with knowledge hierarchies, write in style, and collaborate. Drawing on extensive examples from the humanities and social sciences, the editors and chapter authors show how they started, tried to open up, dealt with inconsistencies, had to adapt, and ultimately learned and grew as researchers. The book offers valuable insights into the conditions and complexities present for interdisciplinary research to be successful in an academic setting. This is an open access book
Computational and human-based methods for knowledge discovery over knowledge graphs
The modern world has evolved, accompanied by the huge exploitation of data and information. Daily, increasing volumes of data from various sources and formats are stored, resulting in a challenging strategy to manage and integrate them to discover new knowledge. The appropriate use of data in various sectors of society, such as education, healthcare, e-commerce, and industry, provides advantages for decision support in these areas. However, knowledge discovery becomes challenging since data may come from heterogeneous sources with important information hidden. Thus, new approaches that adapt to the new challenges of knowledge discovery in such heterogeneous data environments are required. The semantic web and knowledge graphs (KGs) are becoming increasingly relevant on the road to knowledge discovery. This thesis tackles the problem of knowledge discovery over KGs built from heterogeneous data sources. We provide a neuro-symbolic artificial intelligence system that integrates symbolic and sub-symbolic frameworks to exploit the semantics encoded in a KG and its structure. The symbolic system relies on existing approaches of deductive databases to make explicit, implicit knowledge encoded in a KG. The proposed deductive database can derive new statements to ego networks given an abstract target prediction. Thus, minimizes data sparsity in KGs. In addition, a sub-symbolic system relies on knowledge graph embedding (KGE) models. KGE models are commonly applied in the KG completion task to represent entities in a KG in a low-dimensional vector space. However, KGE models are known to suffer from data sparsity, and a symbolic system assists in overcoming this fact. The proposed approach discovers knowledge given a target prediction in a KG and extracts unknown implicit information related to the target prediction. As a proof of concept, we have implemented the neuro-symbolic system on top of a KG for lung cancer to predict polypharmacy treatment effectiveness. The symbolic system implements a deductive system to deduce pharmacokinetic drug-drug interactions encoded in a set of rules through the Datalog program. Additionally, the sub-symbolic system predicts treatment effectiveness using a KGE model, which preserves the KG structure. An ablation study on the components of our approach is conducted, considering state-of-the-art KGE methods. The observed results provide evidence for the benefits of the neuro-symbolic integration of our approach, where the neuro-symbolic system for an abstract target prediction exhibits improved results. The enhancement of the results occurs because the symbolic system increases the prediction capacity of the sub-symbolic system. Moreover, the proposed neuro-symbolic artificial intelligence system in Industry 4.0 (I4.0) is evaluated, demonstrating its effectiveness in determining relatedness among standards and analyzing their properties to detect unknown relations in the I4.0KG. The results achieved allow us to conclude that the proposed neuro-symbolic approach for an abstract target prediction improves the prediction capability of KGE models by minimizing data sparsity in KGs
Older men’s experiences of masculine identities across the lifespan.
Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.The primary focus of this research was to investigate how men have experienced
their masculinity across their life journeys as men, as revealed in retrospective accounts of
life transitions. The research especially sought to understand how masculine identities were
narrated and negotiated across the lifespan in retrospective accounts as, to date, most
research on masculinity has adopted a cross-sectional perspective that does not consider the
challenges of ageing in producing and maintaining a masculine identity across the lifespan.
With a theoretical framework combining thematic analysis (TA) and interpretative
phenomenological analysis (IPA), and honouring the idiographic commitment of IPA to
small samples of very detailed interviews, multiple in-depth narrative interviews were
undertaken with 10 men who were 60 years or older. These volunteers were sampled with
purposive and convenience snowballing. Although the research took place in a specific
context of South Africa in which the population is highly diverse and complex, the sample
was relatively homogenous due to the research (1) an intentional focus on exploring ageing
for men who previously had access to access to resources and the (2) the location of the
study in retirement villages that are still racially homogenous a quarter of a century after
apartheid. In-depth, repeated, partly unstructured interviews were used to access
retrospective accounts of masculine identities across the lifespan. Five areas were focused
on in the analysis: productivity along the lifespan, family / relationships, health in the
present and over the lifespan, ageing and living in Africa.
The men defined themselves by traditional masculine identities and did not freely
volunteer non-traditional masculine experiences. Their accounts of masculinity were
oriented to the lifespan social clock, in other words, to accounting for achieving various
milestones (or not) of masculinity on schedule (or not). Although these older men did not
fulfil the hegemonic or dominant ideals, such as being young and virile, they did not present
themselves as being invisible or genderless.
Various strategies were used to protect, maintain and reframe their masculine
identities, for example, stoic acceptance, denial and relying on their wives to bridge the gap,
such as accessing medical intervention, while the men were able to continue
Mostly the men presented their masculine identities as being consistent with
dominant norms and unchallenged (denying age-related decline by omission). Where the
men spoke of being in subjugated positions they often followed this account in various ways in which the subjugated position was discounted and their hegemonic status re-established
by emphasising hegemonic qualities that they possessed or subscribed to. In the present
study, men avoided discussing the inevitability of old age when recounting their life journey
as men retrospectively. However, the perspective of time is still an important concept in
understanding how they produced their masculinity.
The present study shows that social expectations for masculine identities are
dynamic, evolve over the lifespan and are sensitive to the “social clock”, in other words, to
normative expectations about what men should do and achieve at different life stages. Men
are pressured to achieve masculine developmental social expectations on time, despite it
becoming increasingly difficult to maintain the accepted standards of hegemonic and
dominant masculinities. The implications for understanding masculinity in relation to ageing
are discussed
Gender and sexuality diverse women’s experiences of sexual and gendered embodiment in the context of cancer
This thesis has explored the cancer and cancer care experiences of gender and sexuality diverse (GSD) women. It has examined how participants navigated the embodied intersections of their cancer, gender, and sexual identities in the context of predominantly cisheteronormative medical systems and constructions of cancer. This analysis was guided by a social constructionist epistemology in conjunction with a thematic discourse analysis, and by way of semi-structured and Photo-elicitation interviews, aimed to foreground the complex and diverse nature of GSD women’s survivorship experiences. It has drawn on a queer theoretical sensibility to question dominant cisheteronormative discourses in cancer care, and the construction of non-normative subjectivities in cancer culture. This facilitated the questioning of cancer survivorship as a heteronormative temporal relation tied to a form of recovery reliant on gender conformity, optimism, and neoliberal health logics, ultimately arguing for the queer temporality of survivorship itself. While this is a growing field of study, the existing literature suggests that GSD women (and LGBTQI populations in general) face a disproportionate cancer burden compared to their heterosexual counterparts, and overall unique challenges across all stages of the cancer continuum. The research findings presented in this thesis have examined the specificities of those challenges. Assumptions of heterosexuality, and cisgender embodiment, identity and expression were prevalent across GSD women’s stories and had implications for survivorship at multiple levels. A number of GSD women described feeling invisibilised by the “pinkification” of “women’s” cancers. They did not feel represented by the coding of cisheteronormative femininity present in available information, resources, and support, which emphasised the reinstatement or recovery of “ideal” cisheteronormative femininity. Many GSD women described feeling stripped of their agency in health decision-making in that they felt pressure to undergo breast reconstruction after mastectomy or compelled to cover up the signs of illness with wigs, make-up, and prostheses; whilst a number rejected these pressures and found freedom or gender affirmation in doing so. Assumptions of cisheteronormativity extended also to GSD women’s renegotiation of sexual embodiment after cancer, wherein their sexual concerns were often not understood by health providers nor captured by the available resources, which privileged coital (penis-vagina) heterosexual sex. Whilst some GSD women were able to renegotiate sex and intimacy on their own terms, others described feelings of loss in the absence of sexual renegotiation. The biographical disruption posed by cancer enabled some GSD women to reprioritise their lives, whereas others felt pressured to “optimise” their cancer experience
Human Rights at the Intersections
At a time when states are increasingly hostile to the international rights regime, human rights activists have turned to non-state and sub-state actors to begin the implementation of human rights law. This complicates the conventional analysis of relationships between local actors, global norms, and cosmopolitanism. The contributions in this open access collection examine the “lived realities of human rights” and critically engage with debates on gender, sexuality, localism and cosmopolitanism, weaving insights from multiple disciplines into a broader call for interdisciplinary scholarship informed by practice. Overall, the contributors argue that the power of human rights depends on their ability to be continuously broadened and re-imagined in locales around the world. It is only on this basis that human rights can remain relevant and be effectively used to push local, national and international institutions to put in place structural reforms that advance equity and pluralism in these perilous times. The eBook editions of this book are available open access under a CC BY-NC-ND 4.0 licence on bloomsburycollections.com
Nature-Based Solutions for Cities
Nature-based solutions (NBS) are increasingly being adopted to address climate change, health, and urban sustainability, yet ensuring they are effective and inclusive remains a challenge. Addressing these challenges through chapters by leading experts in both global south and north contexts, this forward-looking book advances the science of NBS in cities and discusses the frontiers for next-generation urban NBS
Managing healthcare transformation towards P5 medicine (Published in Frontiers in Medicine)
Health and social care systems around the world are facing radical organizational, methodological and technological paradigm changes to meet the requirements for improving quality and safety of care as well as efficiency and efficacy of care processes. In this they’re trying to manage the challenges of ongoing demographic changes towards aging, multi-diseased societies, development of human resources, a health and social services consumerism, medical and biomedical progress, and exploding costs for health-related R&D as well as health services delivery. Furthermore, they intend to achieve sustainability of global health systems by transforming them towards intelligent, adaptive and proactive systems focusing on health and wellness with optimized quality and safety outcomes.
The outcome is a transformed health and wellness ecosystem combining the approaches of translational medicine, 5P medicine (personalized, preventive, predictive, participative precision medicine) and digital health towards ubiquitous personalized health services realized independent of time and location. It considers individual health status, conditions, genetic and genomic dispositions in personal social, occupational, environmental and behavioural context, thus turning health and social care from reactive to proactive. This requires the advancement communication and cooperation among the business actors from different domains (disciplines) with different methodologies, terminologies/ontologies, education, skills and experiences from data level (data sharing) to concept/knowledge level (knowledge sharing). The challenge here is the understanding and the formal as well as consistent representation of the world of sciences and practices, i.e. of multidisciplinary and dynamic systems in variable context, for enabling mapping between the different disciplines, methodologies, perspectives, intentions, languages, etc. Based on a framework for dynamically, use-case-specifically and context aware representing multi-domain ecosystems including their development process, systems, models and artefacts can be consistently represented, harmonized and integrated. The response to that problem is the formal representation of health and social care ecosystems through an system-oriented, architecture-centric, ontology-based and policy-driven model and framework, addressing all domains and development process views contributing to the system and context in question.
Accordingly, this Research Topic would like to address this change towards 5P medicine. Specifically, areas of interest include, but are not limited:
• A multidisciplinary approach to the transformation of health and social systems
• Success factors for sustainable P5 ecosystems
• AI and robotics in transformed health ecosystems
• Transformed health ecosystems challenges for security, privacy and trust
• Modelling digital health systems
• Ethical challenges of personalized digital health
• Knowledge representation and management of transformed health ecosystems
Table of Contents:
04 Editorial: Managing healthcare transformation towards P5
medicine
Bernd Blobel and Dipak Kalra
06 Transformation of Health and Social Care Systems—An
Interdisciplinary Approach Toward a Foundational
Architecture
Bernd Blobel, Frank Oemig, Pekka Ruotsalainen and Diego M. Lopez
26 Transformed Health Ecosystems—Challenges for Security,
Privacy, and Trust
Pekka Ruotsalainen and Bernd Blobel
36 Success Factors for Scaling Up the Adoption of Digital
Therapeutics Towards the Realization of P5 Medicine
Alexandra Prodan, Lucas Deimel, Johannes Ahlqvist, Strahil Birov,
Rainer Thiel, Meeri Toivanen, Zoi Kolitsi and Dipak Kalra
49 EU-Funded Telemedicine Projects – Assessment of, and
Lessons Learned From, in the Light of the SARS-CoV-2
Pandemic
Laura Paleari, Virginia Malini, Gabriella Paoli, Stefano Scillieri,
Claudia Bighin, Bernd Blobel and Mauro Giacomini
60 A Review of Artificial Intelligence and Robotics in
Transformed Health Ecosystems
Kerstin Denecke and Claude R. Baudoin
73 Modeling digital health systems to foster interoperability
Frank Oemig and Bernd Blobel
89 Challenges and solutions for transforming health ecosystems
in low- and middle-income countries through artificial
intelligence
Diego M. LĂłpez, Carolina Rico-Olarte, Bernd Blobel and Carol Hullin
111 Linguistic and ontological challenges of multiple domains
contributing to transformed health ecosystems
Markus Kreuzthaler, Mathias Brochhausen, Cilia Zayas, Bernd Blobel
and Stefan Schulz
126 The ethical challenges of personalized digital health
Els Maeckelberghe, Kinga Zdunek, Sara Marceglia, Bobbie Farsides
and Michael Rigb
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