Reasoning about Benefits and Costs of Interaction with Users in Real-time Decision Making Environments with Application to Healthcare Scenarios

This thesis examines the problem of having an intelligent agent reasoning about interaction with users in real-time decision making environments. Our work is motivated by the models of Fleming and Cheng, which reason about interaction sensitive to both expected quality of decision (following interaction) and cost of bothering users. In particular, we are interested in dynamic, time critical scenarios. This leads first of all to a novel process known as strategy regeneration, whereby the parameter values representing the users and the task at hand are refreshed periodically, in order to make effective decisions about which users to interact with, for the best decision making. We also introduce two new parameters that are modeled: each user's lack of expertise (with the task at hand) and the level of criticality of each task. These factors are then integrated into the process of reasoning about interaction to choose the best overall strategy, deciding which users to ask to resolve the current task. We illustrate the value of our framework for the application of decision making in hospital emergency room scenarios and offer validation of the approach, both through examples and from simulations. To sum up, we provide a framework for reasoning about interaction with users through user modeling for dynamic environments. In addition, we present some insights into how to improve the process of hospital emergency room decision making

Resveratrol suppresses gastric cancer cell proliferation and survival through inhibition of PIM-1 kinase activity

The proviral integration site for Moloney murine leukemia virus (PIM) family of serine/threonine-specific kinases consist of three isoforms, that regulate proliferation, apoptosis, metabolism, invasion, and metastasis of cancer cells. Among these, abnormally elevated kinase activity of PIM-1 contributes to the progression of gastric cancer and predicts poor prognosis and a low survival rate in gastric cancer patients. In the present study, we found that resveratrol, one of the representative chemopreventive and anticarcinogenic phytochemicals, directly binds to PIM-1 and thereby inhibits its catalytic activity in human gastric cancer SNU-601 cells. This resulted in suppression of phosphorylation of the proapoptotic Bad, a known substrate of PIM-1. Resveratrol, by inactivating PIM-1, also inhibited anchorage-independent growth and proliferation of SNU-601 cells. To understand the molecular interaction between resveratrol and PIM-1, we conducted docking simulation and found that resveratrol directly binds to the PIM-1 at the ATP-binding pocket. In conclusion, the proapototic and anti-proliferative effects of resveratrol in gastric cancer cells are likely to be mediated through suppression of PIM-1 kinase activity, which may represent a novel mechanism underlying its chemopreventive and anticarcinogenic actions.

Advancing nursing informatics in the next decade: Recommendations from an international survey

© 2016 IMIA and IOS Press. In the summer of 2015, the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA NISIG) Student Working Group developed and distributed an international survey of current and future trends in nursing informatics. The survey was developed based on current literature on nursing informatics trends and translated into six languages. Respondents were from 31 different countries in Asia, Africa, North and Central America, South America, Europe, and Australia. This paper presents the results of responses to the survey question: "What should be done (at a country or organizational level) to advance nursing informatics in the next 5-10 years?" (n responders=272). Using thematic qualitative analysis, responses were grouped into five key themes: 1) Education and training; 2) Research; 3) Practice; 4) Visibility; and 5) Collaboration and integration. We also provide actionable recommendations for advancing nursing informatics in the next decade

Current trends in nursing informatics: Results of an international survey

© 2016 IMIA and IOS Press. Nursing informatics (NI) can help provide effective and safe healthcare. This study aimed to describe current research trends in NI. In the summer 2015, the IMIA-NI Students Working Group created and distributed an online international survey of the current NI trends. A total of 402 responses were submitted from 44 countries. We identified a top five NI research areas: standardized terminologies, mobile health, clinical decision support, patient safety and big data research. NI research funding was considered to be difficult to acquire by the respondents. Overall, current NI research on education, clinical practice, administration and theory is still scarce, with theory being the least common. Further research is needed to explain the impact of these trends and the needs from clinical practice

The current state of Nursing Informatics – An international cross-sectional survey

An international survey to explore current and future trends in Nursing Informatics (NI) was done in 2015. This article explores responses to questions about: what should be done to further develop NI as an independent discipline; existing policies and standards influencing NI; perceived support towards NI as a discipline; and advice from NI specialists to students and emerging professionals. Nurse and allied health professionals in academia and practice were reached with snowball sampling. Open-ended questions were analysed with thematic content analysis and the mean and standard deviation is reported for the perceived support towards NI (scale ranging from 1 (not at all supportive) to 10 (very supportive)). A total of 507 respondents from 46 countries responded to the survey. Respondents reported mediocre support towards NI from the environment (M 5.79, SD 2.60). Results showed that NI education needs development to better meet practice demands, that current NI resources seem insufficient, that NI expertise is not used to its full potential in health institutions and the community, and that NI needs to show its value through research and increase visibility to be recognised among stakeholders worldwide. In conclusion, there is a need to clarify NI as a discipline and a need for strong leadership to impact policy making. An increase in NI teaching at undergraduate level in nursing as well as an increase in postgraduate NI programmes worldwide would better support practice demands. National policies and international white papers in NI are needed to guide resource distribution to better support practice.An international survey to explore current and future trends in Nursing Informatics (NI) was done in 2015. This article explores responses to questions about: what should be done to further develop NI as an independent discipline; existing policies and standards influencing NI; perceived support towards NI as a discipline; and advice from NI specialists to students and emerging professionals. Nurse and allied health professionals in academia and practice were reached with snowball sampling. Open-ended questions were analysed with thematic content analysis and the mean and standard deviation is reported for the perceived support towards NI (scale ranging from 1 (not at all supportive) to 10 (very supportive)). A total of 507 respondents from 46 countries responded to the survey. Respondents reported mediocre support towards NI from the environment (M 5.79, SD 2.60). Results showed that NI education needs development to better meet practice demands, that current NI resources seem insufficient, that NI expertise is not used to its full potential in health institutions and the community, and that NI needs to show its value through research and increase visibility to be recognised among stakeholders worldwide. In conclusion, there is a need to clarify NI as a discipline and a need for strong leadership to impact policy making. An increase in NI teaching at undergraduate level in nursing as well as an increase in postgraduate NI programmes worldwide would better support practice demands. National policies and international white papers in NI are needed to guide resource distribution to better support practice

The current state of Nursing Informatics - an international cross-sectional survey

An international survey to explore current and future trends in Nursing Informatics (NI) was done in 2015. This article explores responses to questions about: what should be done to further develop NI as an independent discipline; existing policies and standards influencing NI; perceived support towards NI as a discipline; and advice from NI specialists to students and emerging professionals.Nurse and allied health professionals in academia and practice were reached with snowball sampling. Open-ended questions were analysed with thematic content analysis and the mean and standard deviation is reported for the perceived support towards NI (scale ranging from 1 (not at all supportive) to 10 (very supportive)).A total of 507 respondents from 46 countries responded to the survey. Respondents reported mediocre support towards NI from the environment (M 5.79, SD 2.60). Results showed that NI education needs development to better meet practice demands, that current NI resources seem insufficient, that NI expertise is not used to its full potential in health institutions and the community, and that NI needs to show its value through research and increase visibility to be recognised among stakeholders worldwide.In conclusion, there is a need to clarify NI as a discipline and a need for strong leadership to impact policy making. An increase in NI teaching at undergraduate level in nursing as well as an increase in postgraduate NI programmes worldwide would better support practice demands. National policies and international white papers in NI are needed to guide resource distribution to better support practice.</p

Nurses and Midwives in the Digital Age

This follow-up survey on trends in Nursing Informatics (NI) was conducted by the International Medical Informatics Association (IMIA) Student and Emerging Professionals (SEP) group as a cross-sectional study in 2019. There were 455 responses from 24 countries. Based on the findings NI research is evolving rapidly. Current ten most common trends include: clinical quality measures, clinical decision support, big data, artificial intelligence, care coordination, education and competencies, patient safety, mobile health, description of nursing practices and evaluation of patient outcomes. The findings help support the efforts to efficiently use resources in the promotion of health care activities, to support the development of informatics education and to grow NI as a profession.</p

Creating a Smartphone Application for Image-Assisted Dietary Assessment among Older Adults with Type 2 Diabetes

Thesis (Ph.D.)--University of Washington, 2017In the United States, the population of those aged 65 or over numbered 44.7 million in 2013 and is anticipated to reach approximately 74 million people by 2030. More than one in four people in the United States aged 65 years and older have diabetes. For diabetes care, medical nutrition therapy (MNT) is recommended as a clinically effective intervention. For personalized MNT, it is essential for dietitians to assess the nutritional status of patients with a variety of dietary data (i.e., meal patterns, food choices, and overall dietary balance). However, it is difficult to obtain accurate information because traditional dietary assessment methods (e.g., 24-hour dietary recall (24HR), food records) are based on self-reported data. In particular, those methods might be inappropriate for older adults because they have special considerations with diminished functional statuses (i.e., diminished vision and memory loss). To address this problem, previous researchers have developed and validated dietary assessment methods using images of food items for improving the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability and feasibility of image-assisted dietary assessment methods for older adults with diabetes and their satisfaction with the methods. To my knowledge, no studies evaluated the image-assisted dietary assessment methods with both health providers (i.e., dietitians) and patients (i.e., older adults with diabetes), though both are essential stakeholders in the dietary assessment process. Further, little is known about the usability and feasibility of smartphone applications for an image-assisted dietary assessment, though a smartphone is the device that can perform multiple tasks (i.e., capturing, viewing, and transmitting images) required for an image-assisted dietary assessment. Filling these gaps may reduce errors in self-reporting by older adults with diabetes and result in more accurate dietary assessments. The overall aim of this research is to assess whether a smartphone application can improve the accuracy of traditional dietary assessment methods among older adults with type 2 diabetes. To achieve the overall aim, I created a food record app for dietary assessments (FRADA), a smartphone application for capturing, viewing, and transmitting images of food and beverages, and I evaluated the usability and feasibility of FRADA and the satisfaction of older adults with diabetes with the application. Further, I evaluated the satisfaction of dietitians with an image-assisted, 24-hour dietary recall interview. The findings of this research support the evidence that image-assisted dietary assessments using FRADA could be potentially used to improve the accuracy of a traditional dietary assessment method by reducing errors in self-reporting. Also, this study reveals design opportunities to facilitate communications be- tween older adults and dietitians for better dietary assessments. To my knowledge, this is the first attempt to evaluate a smartphone application with both older adults and dietitians through a lab-based and deployment study based on 24-hour dietary recall interviews. The aims of this study are: - Aim 1: To create a smartphone application for image-assisted dietary assessments and determine the usability of the application for older adults with diabetes. - Aim 2: To determine the feasibility of the smartphone application in older adults with diabetes for image-assisted dietary assessments. - Aim 3: To determine the satisfaction of older adults with diabetes with the smartphone application for image-assisted dietary assessments and determine the satisfaction of dietitians with image-assisted 24-hour dietary recall interviews

Essential properties and explanation effectiveness of explainable artificial intelligence in healthcare: A systematic review

Background: Significant advancements in the field of information technology have influenced the creation of trustworthy explainable artificial intelligence (XAI) in healthcare. Despite improved performance of XAI, XAI techniques have not yet been integrated into real-time patient care. Objective: The aim of this systematic review is to understand the trends and gaps in research on XAI through an assessment of the essential properties of XAI and an evaluation of explanation effectiveness in the healthcare field. Methods: A search of PubMed and Embase databases for relevant peer-reviewed articles on development of an XAI model using clinical data and evaluating explanation effectiveness published between January 1, 2011, and April 30, 2022, was conducted. All retrieved papers were screened independently by the two authors. Relevant papers were also reviewed for identification of the essential properties of XAI (e.g., stakeholders and objectives of XAI, quality of personalized explanations) and the measures of explanation effectiveness (e.g., mental model, user satisfaction, trust assessment, task performance, and correctability). Results: Six out of 882 articles met the criteria for eligibility. Artificial Intelligence (AI) users were the most frequently described stakeholders. XAI served various purposes, including evaluation, justification, improvement, and learning from AI. Evaluation of the quality of personalized explanations was based on fidelity, explanatory power, interpretability, and plausibility. User satisfaction was the most frequently used measure of explanation effectiveness, followed by trust assessment, correctability, and task performance. The methods of assessing these measures also varied. Conclusion: XAI research should address the lack of a comprehensive and agreed-upon framework for explaining XAI and standardized approaches for evaluating the effectiveness of the explanation that XAI provides to diverse AI stakeholders