A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review

© Kelsey Flott, Ryan Callahan, Ara Darzi, Erik Mayer.Background: Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways. Objective: The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways. Methods: We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework. Results: We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway. Conclusions: The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system

The Equivalence Theorem in Effective Theories

The famous equivalence theorem is reexamined in order to make it applicable to the case of intrinsically quantum infinite-component effective theories. We slightly modify the formulation of this theorem and prove it basing on the notion of generating functional for Green functions. This allows one to trace (directly in terms of graphs) the mutual cancelation of different groups of contributions.Comment: 21 pages, 7 figures; v2: Section 4 is modified, plus minor corrections in other sections, version accepted for publication in PR

Lehr- und Lernformen in der Hochschulbildung für das Berufsfeld Ökolandbau

Organic farming requires specific skills and competences such as systems thinking or action competence. Academic education should guide students in their development of these skills. Problem based learning or learning in reality seem appropriate. An innovative teaching module developed by the University of Applied Sciences Eberswalde in close collaboration with a network of regional organic agribusinesses for its Bachelor Programme “Organic Farming and Marketing” is discussed

Data handling methods and target detection results for multibeam and sidescan data collected as part of the search for SwissAir Flight 111

The crash of SwissAir Flight 111, off Nova Scotia in September 1998, triggered one of the largest seabed search surveys in Canadian history. The primary search tools used were sidescan sonars (both conventional and focussed types) and multibeam sonars. The processed search data needed to be distributed on a daily basis to other elements of the fleet for precise location of divers and other optical seabed search instruments (including laser linescan and ROV video). As a result of the glacial history of the region, many natural targets, similar in gross nature to aircraft debris were present. These included widespread linear bedrock outcrop patterns together with near ubiquitous glacial erratic boulders. Because of the severely broken-up nature of the remaining aircraft debris, sidescan imaging alone was often insufficient to unambiguously identify targets. The complementary attributes of higher resolution, but poorly located, sidescan imagery together with slightly lower resolution, but excellently navigated multibeam sonar proved to be one of critical factors in the success of the search. It proved necessary to rely heavily on the regional context of the seabed (provided by the multibeam sonar bathymetry and backscatter imagery) to separate natural geomorphic targets from anomalous anthropogenic debris. In order to confidently prove or disprove a potential target, the interpreter required simultaneous access to the full resolution sidescan data in the geographic context of the multibeam framework. Specific software tools had to be adapted or developed shipboard to provide this capability. Whilst developed specifically for this application, these survey tools can provide improved processing speed and confidence as part of more general mine hunting, hydrographic, engineering or scientific surveys

N-body decomposition of bipartite networks

In this paper, we present a method to project co-authorship networks, that accounts in detail for the geometrical structure of scientists collaborations. By restricting the scope to 3-body interactions, we focus on the number of triangles in the system, and show the importance of multi-scientists (more than 2) collaborations in the social network. This motivates the introduction of generalized networks, where basic connections are not binary, but involve arbitrary number of components. We focus on the 3-body case, and study numerically the percolation transition.Comment: 5 pages, submitted to PR

Ethical difficulties in clinical practice : experiences of European doctors

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services. Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK. Results: Survey respondents (n = 656, response rate 43%) ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority (17.6%) reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decisionmaking capacity (94.8%), disagreement among caregivers (81.2%) and limitation of treatment at the end of life (79.3%). The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct (47.5%), someone capable of providing specific advice (41.1%), help in weighing outcomes (36%) and clarification of the issues (35.9%). Few of the types of help expected to be useful varied among countries. Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries

Investigating prostate cancer tumour-stroma interactions - clinical and biological insights from an evolutionary game

BACKGROUND: Tumours are made up of a mixed population of different types of cells that include normal structures as well as ones associated with the malignancy, and there are multiple interactions between the malignant cells and the local microenvironment. These intercellular interactions, modulated by the microenvironment, effect tumour progression and represent a largely under appreciated therapeutic target. We use observations of primary tumor biology from prostate cancer to extrapolate a mathematical model: specifically; it has been observed that in prostate cancer three disparate cellular outcomes predominate: (i) the tumour remains well differentiated and clinically indolent - in this case the local stromal cells may act to restrain the growth of the cancer; (ii) early in its genesis the tumour acquires a highly malignant phenotype, growing rapidly and displacing the original stromal population (often referred to as small cell prostate cancer) - these less common aggressive tumours are relatively independent of the local microenvironment; and, (iii) the tumour co-opts the local stroma - taking on a classic stromagenic phenotype where interactions with the local microenvironment are critical to the cancer growth. METHODS: We present an evolutionary game theoretical construct that models the influence of tumour-stroma interactions in driving these outcomes. We consider three characteristic and distinct cellular populations: stromal cells, tumour cells that are self-reliant in terms of microenvironmental factors and tumour cells that depend on the environment for resources but can also co-opt stroma. 
RESULTS: Using evolutionary game theory we explore a number of different scenarios that elucidate the impact of tumour-stromal interactions on the dynamics of prostate cancer growth and progression and how different treatments in the metastatic setting can affect different types of tumors.
CONCLUSIONS: The tumour microenvironment plays a crucial role selecting the traits of the tumour cells that will determine prostate cancer progression. Equally important, treatments like hormone therapy affect the selection of these cancer phenotypes making it very important to understand how they impact prostate cancer’s somatic evolution

Infinitesimal Variations of Hodge Structure at Infinity

By analyzing the local and infinitesimal behavior of degenerating polarized variations of Hodge structure the notion of infinitesimal variation of Hodge structure at infinity is introduced. It is shown that all such structures can be integrated to polarized variations of Hodge structure and that, conversely, all are limits of infinitesimal variations of Hodge structure (IVHS) at finite points. As an illustration of the rich information encoded in this new structure, some instances of the maximal dimension problem for this type of infinitesimal variation are presented and contrasted with the "classical" case of IVHS at finite points

Study of the transition from pairing vibrational to pairing rotational regimes between magic numbers N=50 and N=82, with two-nucleon transfer

Absolute values of two-particle transfer cross sections along the Sn-isotopic chain from closed shell to closed shell (100Sn,132Sn) are calculated taking properly into account nuclear correlations, as well as the successive, simultaneous and non-orthogonality contributions to the differential cross sections. The results are compared with systematic, homogeneous bombarding conditions (p, t) data. The observed agreement, almost within statistical errors and without free parameters, testify to the fact that theory is able to be quantitative in its predictions