Does an Eye Tracker Tell the Truth About Visualizations?: Findings While Investigating Visualizations for Decision Making

For information visualization researchers, eye tracking has been a useful tool to investigate research participants’ underlying cognitive processes by tracking their eye movements while they interact with visual techniques. We used an eye tracker to better understand why participants with a variant of a tabular visualization called ‘SimulSort’ outperformed ones with a conventional table and typical one-column sorting feature (i.e., Typical Sorting). The collected eye-tracking data certainly shed light on the detailed cognitive processes of the participants; SimulSort helped with decision-making tasks by promoting efficient browsing behavior and compensatory decision-making strategies. However, more interestingly, we also found unexpected eye-tracking patterns with Simul- Sort. We investigated the cause of the unexpected patterns through a crowdsourcing-based study (i.e., Experiment 2), which elicited an important limitation of the eye tracking method: incapability of capturing peripheral vision. This particular result would be a caveat for other visualization researchers who plan to use an eye tracker in their studies. In addition, the method to use a testing stimulus (i.e., influential column) in Experiment 2 to verify the existence of such limitations would be useful for researchers who would like to verify their eye tracking results

Health promotion interventions for community-dwelling older people with mild or pre-frailty : a systematic review and meta-analysis

BACKGROUND: Mild or pre-frailty is common and associated with increased risks of hospitalisation, functional decline, moves to long-term care, and death. Little is known about the effectiveness of health promotion in reducing these risks. This systematic review aimed to synthesise randomised controlled trials (RCTs) evaluating home and community-based health promotion interventions for older people with mild/pre-frailty. METHODS: We searched 20 bibliographic databases and 3 trials registers (January 1990 - May 2016) using mild/pre-frailty and associated terms. We included randomised controlled and crossover trials of health promotion interventions for community-dwelling older people (65+ years) with mild/pre-frailty and excluded studies focussing on populations in hospital, long term care facilities or with a specific condition. Risk of bias was assessed by two reviewers using the Cochrane Risk of Bias tool. We pooled study results using standardised mean differences (SMD) where possible and used narrative synthesis where insufficient outcome data were available. RESULTS: We included 10 articles reporting on seven trials (total n = 506 participants) and included five trials in a meta-analysis. Studies were predominantly small, of limited quality and six studies tested group exercise alone. One study additionally investigated a nutrition and exercise intervention and one evaluated telemonitoring. Interventions of exercise in groups showed mixed effects on functioning (no effects on self-reported functioning SMD 0.19 (95% CI -0.57 to 0.95) n = 3 studies; positive effects on performance-based functioning SMD 0.37 (95% CI 0.07 to 0.68) n = 3 studies). No studies assessed moves to long-term care or hospitalisations. CONCLUSIONS: Currently the evidence base is of insufficient size, quality and breadth to recommend specific health promotion interventions for older people with mild or pre- frailty. High quality studies of rigorously developed interventions are needed

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT.

BACKGROUND: Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES: (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN: Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT: Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT: Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING: Community settings in London and Hertfordshire, UK. PARTICIPANTS: A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES: Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS: We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS: Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK: A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information

Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Background: With a higher proportion of older people in the UK population, new approaches are needed to reduce emergency hospital admissions, thereby shifting care delivery out of hospital when possible and safe. Study aim: To evaluate the introduction of predictive risk stratification in primary care. Objectives: To (1) measure the effects on service usage, particularly emergency admissions to hospital; (2) assess the effects of the Predictive RIsk Stratification Model (PRISM) on quality of life and satisfaction; (3) assess the technical performance of PRISM; (4) estimate the costs of PRISM implementation and its effects; and (5) describe the processes of change associated with PRISM. Design: Randomised stepped-wedge trial with economic and qualitative components. Setting: Abertawe Bro Morgannwg University Health Board, south Wales. Participants: Patients registered with 32 participating general practices. Intervention: PRISM software, which stratifies patients into four (emergency admission) risk groups; practice-based training; and clinical support. Main outcome measures: Primary outcome – emergency hospital admissions. Secondary outcomes – emergency department (ED) and outpatient attendances, general practitioner (GP) activity, time in hospital, quality of life, satisfaction and costs. Data sources: Routine anonymised linked health service use data, self-completed questionnaires and staff focus groups and interviews. Results: Across 230,099 participants, PRISM implementation led to increased emergency admissions to hospital [ΔL = 0.011, 95% confidence interval (CI) 0.010 to 0.013], ED attendances (ΔL = 0.030, 95% CI 0.028 to 0.032), GP event-days (ΔL = 0.011, 95% CI 0.007 to 0.014), outpatient visits (ΔL = 0.055, 95% CI 0.051 to 0.058) and time spent in hospital (ΔL = 0.029, 95% CI 0.026 to 0.031). Quality-of-life scores related to mental health were similar between phases (Δ = –0.720, 95% CI –1.469 to 0.030); physical health scores improved in the intervention phase (Δ = 1.465, 95% CI 0.774 to 2.157); and satisfaction levels were lower (Δ = –0.074, 95% CI – 0.133 to –0.015). PRISM implementation cost £0.12 per patient per year and costs of health-care use per patient were higher in the intervention phase (Δ = £76, 95% CI £46 to £106). There was no evidence of any significant difference in deaths between phases (9.58 per 1000 patients per year in the control phase and 9.25 per 1000 patients per year in the intervention phase). PRISM showed good general technical performance, comparable with existing risk prediction tools (c-statistic of 0.749). Qualitative data showed low use by GPs and practice staff, although they all reported using PRISM to generate lists of patients to target for prioritised care to meet Quality and Outcomes Framework (QOF) targets. Limitations: In Wales during the study period, QOF targets were introduced into general practice to encourage targeting care to those at highest risk of emergency admission to hospital. Within this dynamic context, we therefore evaluated the combined effects of PRISM and this contemporaneous policy initiative. Conclusions: Introduction of PRISM increased emergency episodes, hospitalisation and costs across, and within, risk levels without clear evidence of benefits to patients. Future research: (1) Evaluation of targeting of different services to different levels of risk; (2) investigation of effects on vulnerable populations and health inequalities; (3) secondary analysis of the Predictive Risk Stratification: A Trial in Chronic Conditions Management data set by health condition type; and (4) acceptability of predictive risk stratification to patients and practitioners. Trial and study registration: Current Controlled Trials ISRCTN55538212 and PROSPERO CRD42015016874. Funding: The National Institute for Health Research Health Services Delivery and Research programme

Development model for commercial office real estate in Thailand's green market

Thesis: S.M. in Real Estate Development, Massachusetts Institute of Technology, Program in Real Estate Development in conjunction with the Center for Real Estate, 2016.880-01Cataloged from PDF version of thesis.Includes bibliographical references (pages 75-76).In recent years, global interest in the effects of climate change have increased dramatically. Private industries are becoming aware of the needs to address environmental impacts of development. Thailand's commercial real estate industry has been under little pressure despite being responsible for over 40% of all the energy consumption in Thailand. The real estate industry is in a distinct position to address the issue of energy consumption and the barriers to green building adoption. As part of the corporations' marketing strategy, green certification is a branding approach that limits the environmental impact of real estate development. By conforming to the LEED criteria, the green certified building introduces a new office product and building management paradigm to mainstream commercial real estate development. However, the barriers to green buildings continue to exist, including the ability to deliver green projects within appropriate cost expectations. Modifications must be made to traditional project management practices for project managers to deliver green construction projects. The objective of this paper is to recommend specific modifications to traditional building practices in Thailand with the goal of optimizing the delivery of cost-efficient green office buildings. Through the analysis of five LEED certified offices, this thesis explores the innovation sources, delivery methods, contractual forms, and risk allocation in implementing of Grade A green office buildings. The thesis finds that the private sector plays a crucial role in advancing green development practices. Project success motivates the government to encourage innovation through regulation and training. The projects that illustrate the most innovative method comprise of small and multi-disciplinary development team structures with a heavyweight project manager. An examination of the implementation process of green certified office buildings reveals that much of the anticipated risks related to innovation's stage of green adoption is related to educational gaps in the industry. Specific provisions which include incentive and penalty systems designed for constant adjustments help to mitigate risks and regulate relationship between developers and consultants. In implementing green construction practices, design phase could also incorporate environmental analysis by an in-house team with energy and sustainability backgrounds who inspire collaboration of generalists and a specialized workforce.by Peerati Upatising.S.M. in Real Estate Developmen

Home telemonitoring effects on frailty transitions, hospitalizations and emergency department visits, and cost among older adults: Evaluation of a clinical trial

The U.S. Census Bureau predicted that 1 in 5 people in the U.S. would be over 65 by 2030, making older adults the fastest growing segment of the population by number ( U.S. Census Bureau National Population Projections, 2012). Aging comes with increased incidence of chronic diseases, such as cardiovascular disease, chronic obstructive pulmonary disease, and diabetes. This is a major reason healthcare expenditures are distorted. In 2002, the top 5% of patients were responsible for 49% of the healthcare expenses in U.S. population and 43% of the top 5% spenders were from people 65 and over. Additionally, the average healthcare expense for elderly people in the U.S. was $11,089 per year, while for younger adults (ages 19-64), the annual average was$3,352 (Stanton, 2006). Therefore, it is crucial that we find a suitable care model for this population and determine who benefits most from this intervention to ensure quality care is provided at a good value. Telemonitoring has emerged as a potential solution to efficiently and effectively manage care of older adults through the use of audio, video, and other telecommunication technology to monitor patient status at a distance. There have been numerous publications on telemonitoring that focused on individual benefits as well as system-wide benefits, such as effects on costs and use of health services. However, the evaluations of older adults with multiple chronic diseases are understudied. This research is based on data from a randomized controlled trial conducted at Mayo Clinic called the Tele-ERA trial. The primary aim of the clinical trial was to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department (ED) visits in an at-risk population 60 years of age or older with multiple medical conditions. First, we evaluated the effect of home telemonitoring in reducing the decline to a worsened frailty state and death since frailty is highly prevalent in older adults and confers a high risk for falls, disability, hospitalization, and mortality. The evidence did not indicate a difference between telemonitoring and usual care group. Second, we investigated how elderly participants who were telemonitored compared with those receiving usual care in the rate at which inpatient hospital and emergency department visit incidence changed over time. We also estimated how other personal characteristics impacted the rate of change. The evidence showed that an average telemonitoring participant did not significantly differ from usual care participant on the combined hospital and ED visit rate, but the intervention reduced the incident rate for ED visits and increased the incident rate for inpatient hospital visits. Key personal characteristics that lowered the rate of combined hospital and ED visits were being male, married, frail at baseline, living alone, and/or a having higher than Elder Risk Assessment (ERA) index of 15. Among those with a higher than average ERA Index score, telemonitoring is associated with a higher rate of combined visits. Third, we analyzed the cost consequence for participants in telemonitoring and usual care groups by examining the total cost of care as well as inpatient, outpatient, and ED costs. The result indicated that the estimated mean total cost difference between the two groups did not differ even though the mean estimated inpatient and outpatient costs were lower and ED costs were higher for telemonitoring group compared to usual care

Linear programming using neural networks

We propose and analyze two classes of neural network models for solving linear programming (LP) problems. Our first models use the penalty function method to find solutions to the LP problems. We introduce a family of penalty functions that transform linear programming problems into unconstrained optimization problems. Subsequently, using a method from variable structure systems theory, we derive bounds on the weight parameters of the penalty functions for which the given linear program and the associated unconstrained optimization problems have the same solution. In our second model, we combine the gradient projection and the penalty function methods. For this model, we also derive the bound on the weight parameter of the penalty function resulting in the exact solution. Both proposed neural network models for solving linear programming problems are interpreted from the variable structure systems viewpoint. Simulation examples are given to illustrate the results obtained. We derive and compare the complexity of our models with the complexity of existing models

Effects of home telemonitoring on transitions between frailty states and death for older adults: a randomized controlled trial

Benjavan Upatising,1 Gregory J Hanson,2 Young L Kim,3 Stephen S Cha,4 Yuehwern Yih,1 Paul Y Takahashi21School of Industrial Engineering, Purdue University, West Lafayette, IN, USA; 2Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; 3School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; 4Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USABackground: Two primary objectives when caring for older adults are to slow the decline to a worsened frailty state and to prevent disability. Telemedicine may be one method of improving care in this population. We conducted a secondary analysis of the Tele-ERA study to evaluate the effect of home telemonitoring in reducing the rate of deterioration into a frailty state and death in older adults with comorbid health problems.Methods: This trial involved 205 adults over the age of 60 years with a high risk of hospitalization and emergency department visits. For 12 months, the intervention group received usual medical care and telemonitoring case management, and the control group received usual care alone. The primary outcome was frailty, which was based on five criteria, ie, weight loss, weakness, exhaustion, low activity, and slow gait speed. Participants were classified as frail if they met three or more criteria; prefrail if they met 1–2 criteria; and not frail if they met no criteria. Both groups were assessed for frailty at baseline, and at 6 and 12 months. Frailty transition analyses were performed using a multiple logistic regression method. Kaplan–Meier and Cox proportional hazards methods were used to evaluate each frailty criteria for mortality and to compute unadjusted hazard ratios associated with being telemonitored, respectively. A retrospective power analysis was computed.Results: During the first 6 months, 19 (25%) telemonitoring participants declined in frailty status or died, compared with 17 (19%) in usual care (odds ratio 1.41, 95% confidence interval [CI] 0.65–3.06, P = 0.38). In the subsequent 6 months, there was no transition to a frailty state, but seven (7%) participants from the telemonitoring and one (1%) from usual care group died (odds ratio 5.94, 95% CI 0.52–68.48, P = 0.15). Gait speed (hazards ratio 3.49, 95% CI 1.42–8.58) and low activity (hazards ratio 3.10, 95% CI 1.25–7.71) were shown to predict mortality.Conclusion: This study did not provide sufficient evidence to show that the telemonitoring group did better than usual care in reducing the decline of frailty states and death. Transitions occurred primarily in the first 6 months.Keywords: telemedicine, high-risk elderly persons, frailty transition, functional declin