Development and Validation of the MedITNet Assessment Framework: Improving Risk Management of Medical IT Networks

The use of networked medical devices can provide a number of benefits such as improved patient safety, reduced costs of care and a reduction in adverse events. Traditionally, medical devices were placed onto a proprietary IT network provided by the manufacturer of the device. Today, medical devices are increasingly designed for incorporation into a hospital’s general IT network enabling devices to exchange critical information. However, this can introduce risks and negate the potential benefits to patients. While the IEC 80001-1 standard has been developed to aid Healthcare Delivery Organisations (HDOs) in addressing these risks, HDOs may struggle to understand and implement the requirements. The MedITNet framework has been developed to allow HDOs to assess the capability of their risk management processes against the requirements of IEC 80001-1. MedITNet provides a flexible assessment framework enabling HDOs to gain a greater understanding of the requirements of the standard and to improve risk management processes by determining their current state and highlighting areas for improvement. This paper examines the challenges faced by HDOs in the risk management of medical IT networks and briefly explains the components of the MedITNet framework and how the framework addresses these challenges. This paper also details how Action Design Research (ADR) was used in the development and validation of MedITNet

The MedITNet Assessment Framework: Development and Validation of a Framework for Improving Risk Management of Medical IT Networks

Medical devices are increasingly designed for incorporation into a hospital’s IT network allowing devices to exchange critical information. However, connecting devices in this way can introduce risks potentially negating the benefits to patients. While the IEC 80001-1 standard has been developed to aid Healthcare Delivery Organisations (HDOs) in addressing these risks, HDOs often struggle to understand and implement the requirements. The MedITNet framework has been developed to allow HDOs to assess the capability of their risk management processes against the requirements of IEC 80001-1. MedITNet provides a flexible assessment framework enabling HDOs to gain a understanding of the requirements of the standard and to improve risk management processes by determining their current state and highlighting areas for improvement. This paper examines the challenges faced by HDOs in the risk management of medical IT networks and explains the components of the MedITNet framework and how the framework addresses these challenges. The use of Action Design Research (ADR) in the development and validation of MedITNet are also discussed focusing on a pilot implementation of the assessment method and expert review of the overall framework. The changes to the framework and its components as a result of the validation process are also discussed

Temporal Course of the Tourette Syndrome Clinical Triad

Background: Tourette syndrome (TS) is a disorder characterized by childhood onset of motor and phonic tics, often with improvement of tic symptoms by young adult years. The temporal course of tics and commonly comorbid behavioral symptoms is still not well characterized. Methods: In order to clarify the time course of tics and comorbid attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD) in TS, we administered a brief survey regarding the course of symptoms at a single point in time to 53 TS patients aged 13–31 years. Results: Mean age (±SD) at symptom onset was 7.9 (±3.6) years for tics, 7.9 (±3.5) for ADHD, and 9.2 (±5.0) for OCD. Age at peak symptom severity was 12.3 (±4.6) years for tics, 10.8 (±3.8) for ADHD, and 12.6 (±5.5) for OCD. Tics, ADHD, and OCD were reported to be no longer present in 32.0%, 22.8%, and 21.0% of subjects, respectively. Decline in symptom severity began at age 14.7 (±3.7) years for tics, 13.9 (±2.9) for ADHD, and 15.1 (±5.0) for OCD. Remission of symptoms occurred at age 17.4 (±3.8) years for tics, 17.4 (±1.3) for ADHD, and 15.6 (±2.3) for OCD. Discussion: Our data confirm and expand previously reported TS spectrum symptom milestones and may guide design of future research aimed at improving the course of TS. Keywords: Tourette, obsessive compulsive disorder, attention deficit hyperactivity disorder, tic Citation: Shprecher DR, Rubenstein LA, Gannon K, et al. Temporal course of the Tourette syndrome clinical triad. Tremor Other Hyperkinet Mov. 2014; 4. doi: 10.7916/D8HD7SV

Challenges for Requirements Development: An Industry Perspective

It is well recognised that software requirements must accurately reflect the needs of a target domain, however, challenges still exist in effectively acheiving this. This paper reports on the results of an industry-based study investigating factors that affect the communication of requirements between the development team and other stakeholders during requirements development. Challenges found in practice are related to common obstacles reported in the literature. The paper concludes with a discussion of the findings including implications for Software Process Improvement (SPI) in requirements developmen

The Sync-Up Process to Improve the Multiple Stakeholder Communication of Requirements Analysis in Embedded Medical Software Development

The development of embedded medical software is different from ordinary software development as it needs to be coordinated with the hardware development. A typical embedded system project involves multiple stakeholders such as the business unit, software developers, hardware engineers and firmware developers. Agile methods have been successfully adopted in generic software engineering, and more recently in embedded medical software development. In this research, a systematic review has been performed to identify the challenges of embedded medical and safety-critical software development domains. From the challenges identified, this research focuses on the challenge of multiple stakeholder communication in embedded medical software development. Additionally, agile practices which have been successfully adopted in the embedded safety-critical domains have been investigated. This thesis describes the development and evaluation of a process (Sync-Up) to improve multiple stakeholder communication for embedded medical software development during requirement analysis. Through this research, the following contribution to knowledge has been made in the area of embedded medical domain. The development of the Sync-Up process to assist multiple stakeholder communication of embedded medical software development. The Sync-Up process is evaluated through both expert review by leading experts, and a case study conducted in an embedded company. Findings from the evaluations undertaken show a positive outcome during the requirement analysis phase of the Sync-Up process

Broad and Luminous [OIII] and [NII] in Globular Cluster ULXs

We consider an accretion-disc origin for the broad and luminous forbidden-line emission observed in ultraluminous X-ray (ULX) sources CXOJ033831.8-352604 and XMMU 122939.7+075333 in globular clusters hosted by elliptical galaxies NGC 1399 and NGC 4472, respectively. We will refer to the latter by the globular cluster name RZ2109. The first has strong [OIII] and [NII], the second only [OIII]. Both H$\alpha$ and H$\beta$ are very weak or undetected in both objects. We assume that the large line widths are due to Keplerian rotation around a compact object and derive expressions for maximum line luminosities. These idealized models require central masses $\gtrsim100$ and \gtrsim30000\Msun for CXOJ033831.8-352604 and RZ2109, respectively. An independent, bootstrap argument for the total disc mass yields, for both systems, M_{\mathrm{disc}}\gtrsim10^{-4}\Msun for a purely metallic disc (and two orders of magnitude larger for solar metallicities). If Roche-lobe overflow is implicated, viscous time-scales are $\gtrsim300$ yr. Standard disc theory then offers another limit on the central masses. Lobe radii for a \sim1\Msun donor are $\gtrsim10^{13}$ cm. We therefore rule out Roche-lobe overflow of a white dwarf in both systems. Red giants could fill the necessary lobes. Whether they are too metal-poor to produce the strong forbidden lines without strong hydrogen emission is unclear.Comment: Accepted to MNRAS Letters, 5 pages, 6 figure

Expert Performance By Athletes In The Verbal Estimation Of Spatial Extents Does Not Alter Their Perceptual Metric Of Space

Athletes often give more accurate estimates of egocentric distance along the ground than do non-athletes. To explore whether cognitive calibration was accompanied by perceptual change, athletes and non-athletes made verbal height and distance estimates and also did a perceptual matching task between perceived egocentric distances and frontal vertical extents. Both groups were well calibrated for height estimation for poles viewed frontally, but athletes were much better calibrated at estimating longer egocentric distances (which are systematically underestimated by non-athletes). Athletes were more likely to have learned specific units of ground distance from relevant sports contexts. Both groups reported using human height as a metric for vertical extent. For non-athletes, verbal underestimation of ground distance corresponded to predictions based on perceptual matches between egocentric distances and vertical extents in conjunction with human-height-based verbal estimates of vertical extents. For athletes, the verbal scaling of egocentric distances of 10 m or more was more accurate and was not predicted by their egocentric distance matches to vertical extents

A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging.

Purpose:High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods:The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results:The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions:Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance:Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening

Farm Management Practices Used by Wheat Producers in the Western Great Plains: Estimating Their Productivity and Profitability

Changes in government farm programs and the introduction of new technology offer wheat producers in the western Great Plains a variety of management practices to alleviate biotic and agronomic constraints inherent in a wheat monoculture. Producers have adopted alternative tillage systems, crop diversification, and insect-resistant varieties in response to the hot, semiarid growing conditions and increased pest pressure. The objective of this study was to determine if those practices generated positive impacts on wheat yield and corresponding net returns. Panel data collected from a group of 141 producers over a four-year period (N = 564) were analyzed using econometric models. The most significant impacts were from crop diversification, which on average more than doubled returns from $29 to$69 per acre compared to a wheat monoculture. Pest-resistant varieties increased returns by 59%, from $32 to$51 per acre. The use of no-till reduced returns by an average of $13 per acre, but when combined with a modest level of crop diversity, returns approached breakeven. Stakeholders should aspire to increase the profitability of no-till to increase its adoption in this environmentally sensitive region

Unilateral thoracoscopic surgical approach for diffuse emphysema

AbstractWe evaluated the use of a lateral thoracoscopic approach for lung reduction surgery in patients with diffuse emphysema. Sixty-seven patients with a mean age of 61.9 years underwent operation. Operative side was determined by preoperative imaging. The procedures were laser ablation in 10 patients and stapler resection in 57 patients. Ten patients, including six of the 10 patients in the laser-only group had poor outcome (death or hospitalization longer than 30 days), leading us to abandon the laser technique. Of the remaining 57 patients undergoing primary stapled resection, duration of chest tube placement averaged 13 days (range 3 to 53 days) with a mean hospital stay of 17 days (range 6 to 99 days). Seven patients required ventilation for longer than 72 hours, six patients underwent conversion of the procedure to open thoracotomy, four patients acquired arrhythmias, and three patients were treated for empyema. There was one early death (1.7%), from cardiopulmonary failure. Forty patients returned for 3-month evaluation. Significant ( p < 0.0001) improvements were seen in forced vital capacity (2.69 L after vs 2.26 L before) and forced expiration volume in 1 second (1.04 L after vs 0.82 L before), with 25 of 40 patients (63%) showing an improvement of more than 20%. Lung volume measures, in particular residual volume, fell significantly. Arterial blood gas analysis revealed that carbon dioxide tension fell significantly in patients with preoperative hypercapnia (carbon dioxide tension >45 mm Hg, p = 0.018). Six-minute walk test results improved (894 feet after vs 784 feet before, p = 0.002), and symptomatic benefit was confirmed by significant improvement in the dyspnea index. The combination of both hypercapnia and reduced single-breath diffusing capacity for carbon monoxide was significantly more frequent ( p = 0.0026) and was 86% specific (5 of 6 patients) in predicting serious postoperative risk. We conclude that the lateral thoracoscopic surgical approach to diffuse emphysema offers significant improvement in pulmonary mechanics and functional impairment. Patients with a combination of hypercapnia and reduced single-breath diffusing capacity for carbon monoxide should not be considered for this procedure because of significant perioperative risk. (J THORAC CARDIOVASC SURG 1996;111:308-16