A Method for Representing Contextualized Information (MeRCI) to Improve Situational Awareness Among Electronic Message Brokering System Dashboard Users

Electronic health information brokering systems are of interest to public health informatics because they emphasize how data can be effectively shared and utilized across healthcare institutions and among providers so as to improve the quality of care, increase efficiency, and reduce costs (Lumpkin, 2002). In the domain of public health (PH) specifically, where complete and timely reporting of data is critical for all epidemiological and disease surveillance activities (Langmuir, 1976), it is imperative to ensure proper functioning of the electronic information exchange infrastructure. Receiving multiple types of data, in various formats from numerous sources, and triaging them to the appropriate surveillance system is no easy task for a department of health, whether at state, local or federal level (Magnuson, 2005). The administrators of the electronic message brokering system, and the coordinators of surveillance systems in each public health jurisdiction, are responsible for ensuring that the data is received, archived, validated and triaged appropriately in a timely and complete fashion. This requires continuous monitoring of trends in messaging and system performance and active responses to aberrations. To achieve this, administrators depend heavily on dashboards to provide awareness of exchange system status and its reporting at any point of time. Unfortunately, current dashboards do not offer the context or cognitive support needed for interpreting the information presented. As research has demonstrated in other domains, in order to make sense of the data and react, dashboard users are required to draw upon domain knowledge, higher level association between domains, operational rules, organizational missions, personal objectives, tasks at hand, priorities, past experiences, historic events, recent events, psychosocial and political constructs, and more (Resnick, 2005; Mirhaji, Srinivasan, Casscells, & Arafat, 2004). The burden of ‘interpretation’ always falls on the cognitive system of the human operator, which is prone to error and malfunctioning when risk and emergency overwhelm psychological factors (Parsa, Richesson, Smith, Zhang, & Srinivasan, 2004; Parsa, Zhang, Smith, Majid, Casscells, & Lillibridge, 2003). On the basis of the surveillance literature it can be seen that meaningful and holistic interpretation of data requires the generation of higher-level explanations based on knowledge and expertise from numerous principles (Parsa, Richesson, & Srinivasan, 2004; Parsa, Richesson, Smith, Zhang, & Srinivasan, 2004), while context is essential to illustrate the ‘big picture’ view of dynamic and complex problems (Parsa, Zhang, Smith, Majid, Casscells, & Lillibridge, 2003). These reservations imply that the process for building health information dashboards should consider not only user functions, tasks and goals but also the user’s situational awareness (SA) requirements. This vision adds a new layer to information representation that needs to be accounted for when conceptualizing the implementation of health information dashboards. A review of the literature reveals a lack of methods to design for situational awareness in dashboard systems in complex domains (Resnick, 2005; Li, 2007). This research introduces a new method to present contextualized information that can improve user SA. I present the design rationale, method, and results of an evaluation study that measures the situational awareness generated by adopting this new context-driven representation model

A Web Services architecture for UMLS Knowledge Sources.

A web service is a collection of industry standards to enable reusability of services and interoperability of heterogeneous applications. The UMLS Knowledge Source (UMLSKS) Server provides remote access to the UMLSKS and related resources. We propose a Web Services Architecture that encapsulates UMLSKS-API and makes it available in distributed and heterogeneous environments. This is the first step towards intelligent and automatic UMLS services discovery and invocation by computer systems in distributed environments such as web

Genetic analysis of patients with Fuchs endothelial corneal dystrophy in India

<p>Abstract</p> <p>Background</p> <p>Mutations in <it>COL8A2 </it>gene which encodes the collagen alpha-2 (VIII) chain have been identified in both familial and sporadic cases of Fuchs endothelial corneal dystrophy (FECD). Heterozygous mutations in the <it>SLC4A11 </it>gene are also known to cause late-onset FECD. Therefore we screened for <it>COL8A2</it>, <it>SLC4A11 </it>gene variants in Indian FECD patients.</p> <p>Methods</p> <p>Eighty patients with clinically diagnosed FECD and 100 age matched normal individuals were recruited. Genomic DNA was isolated from peripheral blood leukocytes. Mutations in <it>COL8A2</it>, <it>SLC4A11 </it>coding regions were screened using bi-directional sequencing. Fischer's exact test or Pearson's chi squared test were used to predict the statistical association of genotypes with the phenotype.</p> <p>Results</p> <p>Screening of <it>COL8A2 </it>gene revealed 2 novel c.1610G>A, c.1643A>G and 3 reported variations c.112G>A, c.464G>A and c.1485G>A. In <it>SLC4A11 </it>gene, novel c.1659C>T, c.1974C>T and reported c.405G>A, c.481A>C and c.639G>A variants were identified. However all the variations in both the genes were also present in unaffected controls.</p> <p>Conclusions</p> <p>This is the first study analysing <it>COL8A2 </it>gene in Indian patients with FECD. No pathogenic mutations were identified in <it>COL8A2</it>. Merely silent changes, which showed statistically insignificant association with FECD, were identified in the screening of <it>SLC4A11 </it>gene. These results suggest that <it>COL8A2</it>, <it>SLC4A11 </it>genes may not be responsible for FECD in patients examined in this study.</p

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Prediction of cancer using customised fuzzy rough machine learning approaches

This Letter proposes a customised approach for attribute selection applied to the fuzzy rough quick reduct algorithm. The unbalanced data is balanced using synthetic minority oversampling technique. The huge dimensionality of the cancer data is reduced using a correlation-based filter. The dimensionality reduced balanced attribute gene subset is used to compute the final minimal reduct set using a customised fuzzy triangular norm operator on the fuzzy rough quick reduct algorithm. The customised fuzzy triangular norm operator is used with a Lukasiewicz fuzzy implicator to compute the fuzzy approximation. The customised operator selects the least number of informative feature genes from the dimensionality reduced datasets. Classification accuracy using leave-one-out cross validation of 94.85, 76.54, 98.11, and 99.13% is obtained using a customised function for Lukasiewicz triangular norm operator on leukemia, central nervous system, lung, and ovarian datasets, respectively. Performance analysis of the conventional fuzzy rough quick reduct and the proposed method are performed using parameters such as classification accuracy, precision, recall, F-measure, scatter plots, receiver operating characteristic area, McNemar test, chi-squared test, Matthew's correlation coefficient and false discovery rate that are used to prove that the proposed approach performs better than available methods in the literature

Müşterilerin Dijital Bankacılık Üzerine Görüşlerini Etkileyen Faktörler: Ampirik Bir Araştırma

In this liberal global economy, technology has substituted all the aspects of the conventional and established style of life, and the banking field is no special case for this dynamic phenomenon. In India, digital banking is expanding at an expeditious pace propelled by marketing master plans assumed by many commercial banks. Traditional and customary banking can never be subverted despite aggressive responses to digital banking. The prime objective of this study and article is to brief the digital banking customer’s perspective on “whether digital banking is a supplement or substitution to the traditional way of banking?” The theoretical framework comprises the factors that affect digital banking: they are Service quality, Customers persuasion, demographic variables, and Existing technology, respectively. The population of this project is from Karaikal, Tamil Nadu, India, and was studied using systematic random sampling. The statistical values are obtained using Correlation, Regression analysis, and One Way ANOVA. The proposed study evaluates various factors impacting digital banking and suggests a few steps to take digital banking one step ahead.Mevcut liberal küresel ekonomide teknoloji, geleneksel ve yerleşik yaşam tarzının tüm yönlerinde yerini almıştır ve bankacılık alanı bu dinamik fenomenin dışında kalamaz. Hindistan'da dijital bankacılık, birçok ticari bankanın üstlendiği pazarlama mastır planlarının teşvikiyle hızla genişliyor. Dijital bankacılığa yönelik girişken tepkilere rağmen, geleneksel ve alışılmış bankacılık asla çökertilemez. Bu çalışmanın ve makalenin temel amacı, dijital bankacılık müşterisinin “dijital bankacılık geleneksel bankacılığın tamamlayıcısı mı?, yoksa ikamesi mi?” konusundaki bakış açısını özetlemektir. Teorik çerçeve, dijital bankacılığı etkileyen faktörleri içermektedir: Bunlar sırasıyla hizmet kalitesi, müşterilerin ikna edilebilirliği, demografik değişkenler ve mevcut teknolojidir. Bu projenin evreni Karaikal, Tamil Nadu, Hindistan'dır ve sistematik rastgele örnekleme kullanılarak çalışılmıştır. İstatistiksel değerler korelasyon, regresyon analizi ve tek yönlü ANOVA kullanılarak elde edilmiştir. Çalışmanın sonucu, dijital bankacılığı etkileyen çeşitli faktörleri değerlendirmekte ve dijital bankacılığı bir adım öne çıkarmak için birkaç adım atılmasını önermektedir