691 research outputs found
On the equivalence between standard and sequentially ordered hidden Markov models
Chopin (2007) introduced a sequentially ordered hidden Markov model, for
which states are ordered according to their order of appearance, and claimed
that such a model is a re-parametrisation of a standard Markov model. This note
gives a formal proof that this equivalence holds in Bayesian terms, as both
formulations generate equivalent posterior distributions, but does not hold in
Frequentist terms, as both formulations generate incompatible likelihood
functions. Perhaps surprisingly, this shows that Bayesian re-parametrisation
and Frequentist re-parametrisation are not identical concepts
HEALTH INFORMATION STANDARDISATION AS A BASIS FOR LEARNING HEALTH SYSTEMS
PhD ThesisStandardisation of healthcare has been the focus of hospital management and clinicians since the
1990’s. Electronic health records were already intended to provide clinicians with real-time access to
clinical knowledge and care plans while also recording and storing vast amounts of patient data. It took
more than three decades for electronic health records to start to become ubiquitous in all aspects of
healthcare. Learning health systems are the next stage in health information systems whose potential
benefits have been promoted for more than a decade - yet few are seen in clinical practice. Clinical care
process specifications are a primary form of clinical documentation used in all aspects of healthcare,
but they lack standardisation. This thesis contends that this lack of standardisation was inherited by
electronic health records and that this is a significant issue holding back the development and adoption
of learning health systems. Standardisation of clinical documents is used to mitigate issues in electronic
health records as a basis for enabling learning health systems. One type of clinical document, the
caremap, is standardised in order to achieve an effective approach to containing resources and ensuring
consistency and quality. This led not only to improved clinicians’ comprehension and acceptance of the
clinical document, but also to reduced time expended in developing complicated learning health systems
built using the input of clinical experts
A Comprehensive Scoping Review of Bayesian Networks in Healthcare: Past, Present and Future
No comprehensive review of Bayesian networks (BNs) in healthcare has been
published in the past, making it difficult to organize the research
contributions in the present and identify challenges and neglected areas that
need to be addressed in the future. This unique and novel scoping review of BNs
in healthcare provides an analytical framework for comprehensively
characterizing the domain and its current state. The review shows that: (1) BNs
in healthcare are not used to their full potential; (2) a generic BN
development process is lacking; (3) limitations exists in the way BNs in
healthcare are presented in the literature, which impacts understanding,
consensus towards systematic methodologies, practice and adoption of BNs; and
(4) a gap exists between having an accurate BN and a useful BN that impacts
clinical practice. This review empowers researchers and clinicians with an
analytical framework and findings that will enable understanding of the need to
address the problems of restricted aims of BNs, ad hoc BN development methods,
and the lack of BN adoption in practice. To map the way forward, the paper
proposes future research directions and makes recommendations regarding BN
development methods and adoption in practice
The relationship between EQ-5D, HAQ and pain in patients with rheumatoid arthritis: further validation and development of the limited dependent variable, mixture model approach
Objective: To provide robust estimates of EQ-5D as a function of the Health Assessment Questionnaire (HAQ) and pain in patients with rheumatoid arthritis.
Method: Repeated observations of patients diagnosed with RA in a US observational cohort (n=100,398 observations) who provided data on HAQ, pain on a visual analogue scale and the EQ-5D questionnaire. We use a bespoke mixture modelling approach to appropriately reflect the characteristics of the EQ-5D instrument and compare this to results from linear regression.
Results: The addition of pain alongside HAQ as an explanatory variable substantially improves explanatory power. The preferred model is a four component mixture. Unlike the linear regression it exhibits very good fit to the data, does not suffer from problems of bias or predict values outside the feasible range.
Conclusions: It is appropriate to model the relationship between HAQ and EQ-5D but only if suitable statistical methods are applied. Linear models underestimate the QALY benefits, and therefore the cost effectiveness, of therapies. The bespoke mixture model approach outlined here overcomes this problem. The addition of pain as an explanatory variable greatly improves the estimates
Engaging stakeholders in research to address water-energy-food (WEF) nexus challenges
The water–energy–food (WEF) nexus has become a popular, and potentially powerful, frame through which to analyse interactions and interdependencies between these three systems. Though the case for transdisciplinary research in this space has been made, the extent of stakeholder engagement in research remains limited with stakeholders most commonly incorporated in research as end-users. Yet, stakeholders interact with nexus issues in a variety of ways, consequently there is much that collaboration might offer to develop nexus research and enhance its application. This paper outlines four aspects of nexus research and considers the value and potential challenges for transdisciplinary research in each. We focus on assessing and visualising nexus systems; understanding governance and capacity building; the importance of scale; and the implications of future change. The paper then proceeds to describe a novel mixed-method study that deeply integrates stakeholder knowledge with insights from multiple disciplines. We argue that mixed-method research designs—in this case orientated around a number of cases studies—are best suited to understanding and addressing real-world nexus challenges, with their inevitable complex, non-linear system characteristics. Moreover, integrating multiple forms of knowledge in the manner described in this paper enables research to assess the potential for, and processes of, scaling-up innovations in the nexus space, to contribute insights to policy and decision making
Bluetooth Smartphone Apps: Are they the most private and effective solution for COVID-19 contact tracing?
Many digital solutions mainly involving Bluetooth technology are being
proposed for Contact Tracing Apps (CTA) to reduce the spread of COVID-19.
Concerns have been raised regarding privacy, consent, uptake required in a
given population, and the degree to which use of CTAs can impact individual
behaviours. However, very few groups have taken a holistic approach and
presented a combined solution. None has presented their CTA in such a way as to
ensure that even the most suggestible member of our community does not become
complacent and assume that CTA operates as an invisible shield, making us and
our families impenetrable or immune to the disease. We propose to build on some
of the digital solutions already under development that, with addition of a
Bayesian model that predicts likelihood for infection supplemented by
traditional symptom and contact tracing, that can enable us to reach 90% of a
population. When combined with an effective communication strategy and social
distancing, we believe solutions like the one proposed here can have a very
beneficial effect on containing the spread of this pandemic
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