Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data

<p>Abstract</p> <p>Background</p> <p>No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach.</p> <p>Methods</p> <p>A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered.</p> <p>Results</p> <p>Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments.</p> <p>Conclusions</p> <p>Our technical advance is the development and use of automated event-based knowledge elicitation to identify suboptimal OR management decisions that decrease the efficiency of use of OR time. The adapted scenarios can be used in future decision-making.</p

Using case-based reasoning to detect risk scenarios of elderly people living alone at home

In today's ageing societies, the proportion of elderly people living alone in their own homes is dramatically increasing. Smart homes provide the appropriate environment for keeping them independent and, therefore, enhancing their quality of life. One of the most important re-\ud quirements of these systems is that they have to provide a pervasive environment without disrupting elderly people's daily activities. The present paper introduces a CBR agent used within a commercial Smart Home system, designed for detecting domestic accidents that may lead to serious complications if the elderly resident is not attended quickly. The approach is based on cases composed of event sequences. Each event sequence represents the different locations visited by the resident during his/her daily activities. Using this approach, the system can decide\ud whether the current sequence represent an unsafe scenario or not. It does so by comparing the current sequence with previously stored sequences. Several experiments have been conducted with different CBR agent con-\ud figurations in order to test this approach. Results from these experiments show that the proposed approach is able to detect unsafe scenarios

Ecotoxicological mechanisms and models in an impact analysis tool for oil spills

Contains fulltext : 91748.pdf (publisher's version ) (Closed access)15 p

In vitro assay shows that PCB metabolites completely saturate thyroid hormone transport capacity in blood of wild polar bears (Ursus maritimus)

Persistent chemicals accumulate in the arctic environment due to their chemical reactivity and physicochemical properties and polychlorinated biphenyls (PCBs) are the most concentrated pollutant class in polar bears (Ursus maritimus). Metabolism of PCB and polybrominated biphenyl ether (PBDE) flame-retardants alter their toxicological properties and these metabolites are known to interfere with the binding of thyroid hormone (TH) to transthyretin (TTR) in rodents and humans. In polar bear plasma samples no binding of