Modeling requirement driven architecture of adaptive healthcare system based on semiotics

In order to improve the quality of healthcare services, the integrated large-scale medical information system is needed to adapt to the changing medical environment. In this paper, we propose a requirement driven architecture of healthcare information system with hierarchical architecture. The system operates through the mapping mechanism between these layers and thus can organize functions dynamically adapting to user’s requirement. Furthermore, we introduce the organizational semiotics methods to capture and analyze user’s requirement through ontology chart and norms. Based on these results, the structure of user’s requirement pattern (URP) is established as the driven factor of our system. Our research makes a contribution to design architecture of healthcare system which can adapt to the changing medical environment.

Cross-layer design for multiuser MIMO MRC systems with feedback constraints

Cross-layer techniques represent efficient means to enhance throughput and increase the transmission reliability of wireless communication systems. In this paper, a cross-layer design of aggressive adaptive modulation and coding (A-AMC), truncated automatic repeat request (T-ARQ), and user scheduling is proposed for multiuser multiple-input-multiple-output (MIMO) maximal ratio combining (MRC) systems, where the impacts of feedback delay (FD) and limited feedback (LF) on channel state information (CSI) are also considered. The A-AMC and T-ARQ mechanism selects the appropriate modulation and coding schemes (MCSs) to achieve higher spectral efficiency while satisfying the service requirement on the packet loss rate (PLR), profiting from the feasibility of using different MCSs to retransmit a packet, which is destined to a scheduled user selected to exploit multiuser diversity and enhance the system's performance in terms of both transmission efficiency and fairness. The system's performance is evaluated in terms of the average PLR, average spectral efficiency (ASE), outage probability, and average packet delay, which are derived in closed form, considering transmissions over Rayleigh-fading channels. Numerical results and comparisons are provided and show that A-AMC combined with T-ARQ yields higher spectral efficiency than the conventional scheme based on adaptive modulation and coding (AMC), while keeping the achieved PLR closer to the system's requirement and reducing delay. Furthermore, the effects of the number of ARQ retransmissions, numbers of transmit and receive antennas, normalized FD, and cardinality of the beamforming weight vector codebook are studied and discussed.

Cross-layer design for MIMO systems over spatially correlated and keyhole Nakagami-m fading channels

Cross-layer design is a generic designation for a set of efficient adaptive transmission schemes, across multiple layers of the protocol stack, that are aimed at enhancing the spectral efficiency and increasing the transmission reliability of wireless communication systems. In this paper, one such cross-layer design scheme that combines physical layer adaptive modulation and coding (AMC) with link layer truncated automatic repeat request (T-ARQ) is proposed for multiple-input multiple-output (MIMO) systems employing orthogonal space--time block coding (OSTBC). The performance of the proposed cross-layer design is evaluated in terms of achievable average spectral efficiency (ASE), average packet loss rate (PLR) and outage probability, for which analytical expressions are derived, considering transmission over two types of MIMO fading channels, namely, spatially correlated Nakagami-m fading channels and keyhole Nakagami-m fading channels. Furthermore, the effects of the maximum number of ARQ retransmissions, numbers of transmit and receive antennas, Nakagami fading parameter and spatial correlation parameters, are studied and discussed based on numerical results and comparisons. Copyright © 2009 John Wiley & Sons, Ltd.

Cross-layer design of enhanced AMC with truncated ARQ protocols

Using a cross-layer approach, two enhancement techniques applied for adaptive modulation and coding (AMC) with truncated automatic repeat request (T-ARQ) are investigated, namely, aggressive AMC (A-AMC) and constellation rearrangement (CoRe). Aggressive AMC selects the appropriate modulation and coding schemes (MCS) to achieve higher spectral efficiency, profiting from the feasibility of using different MCSs for retransmitting a packet, whereas in the CoRe-based AMC, retransmissions of the same data packet are performed using different mappings so as to provide different degrees of protection to the bits involved, thus achieving mapping diversity gain. The performance of both schemes is evaluated in terms of average spectral efficiency and average packet loss rate, which are derived in closed-form considering transmission over Nakagami-m fading channels. Numerical results and comparisons are provided. In particular, it is shown that A-AMC combined with T-ARQ yields higher spectral efficiency than the AMC-based conventional scheme while keeping the achieved packet loss rate closer to the system's requirement, and that it can achieve larger spectral efficiency objectives than that of the scheme using AMC along with CoRe.

Knowledge-based design cost estimation through extending industry foundation classes

In order to overcome divergence of estimation with the same data, the proposed digital costing process adopts an integrated design of information system to design the process knowledge and costing system together. By employing and extending a widely used international standard, industry foundation classes, the system can provide an integrated process which can harvest information and knowledge of current quantity surveying practice of costing method and data. Knowledge of quantification is encoded from literatures, motivation case and standards. It can reduce the time consumption of current manual practice. The further development will represent the pricing process in a Bayesian Network based knowledge representation approach. The hybrid types of knowledge representation can produce a reliable estimation for construction project. In a practical term, the knowledge management of quantity surveying can improve the system of construction estimation. The theoretical significance of this study lies in the fact that its content and conclusion make it possible to develop an automatic estimation system based on hybrid knowledge representation approach.

Change escalation processes and complex adaptive systems: from incremental reconfigurations to discontinuous restructuring

This study examines when “incremental” change is likely to trigger “discontinuous” change, using the lens of complex adaptive systems theory. Going beyond the simulations and case studies through which complex adaptive systems have been approached so far, we study the relationship between incremental organizational reconfigurations and discontinuous organizational restructurings using a large-scale database of U.S. Fortune 50 industrial corporations. We develop two types of escalation process in organizations: accumulation and perturbation. Under ordinary conditions, it is perturbation rather than the accumulation that is more likely to trigger subsequent discontinuous change. Consistent with complex adaptive systems theory, organizations are more sensitive to both accumulation and perturbation in conditions of heightened disequilibrium. Contrary to expectations, highly interconnected organizations are not more liable to discontinuous change. We conclude with implications for further research, especially the need to attend to the potential role of managerial design and coping when transferring complex adaptive systems theory from natural systems to organizational systems.

Missing steps in a staircase: a qualitative study of the perspectives of key stakeholders on the use of adaptive designs in confirmatory trials

Background Despite the promising benefits of adaptive designs (ADs), their routine use, especially in confirmatory trials, is lagging behind the prominence given to them in the statistical literature. Much of the previous research to understand barriers and potential facilitators to the use of ADs has been driven from a pharmaceutical drug development perspective, with little focus on trials in the public sector. In this paper, we explore key stakeholders’ experiences, perceptions and views on barriers and facilitators to the use of ADs in publicly funded confirmatory trials. Methods Semi-structured, in-depth interviews of key stakeholders in clinical trials research (CTU directors, funding board and panel members, statisticians, regulators, chief investigators, data monitoring committee members and health economists) were conducted through telephone or face-to-face sessions, predominantly in the UK. We purposively selected participants sequentially to optimise maximum variation in views and experiences. We employed the framework approach to analyse the qualitative data. Results We interviewed 27 participants. We found some of the perceived barriers to be: lack of knowledge and experience coupled with paucity of case studies, lack of applied training, degree of reluctance to use ADs, lack of bridge funding and time to support design work, lack of statistical expertise, some anxiety about the impact of early trial stopping on researchers’ employment contracts, lack of understanding of acceptable scope of ADs and when ADs are appropriate, and statistical and practical complexities. Reluctance to use ADs seemed to be influenced by: therapeutic area, unfamiliarity, concerns about their robustness in decision-making and acceptability of findings to change practice, perceived complexities and proposed type of AD, among others. Conclusions There are still considerable multifaceted, individual and organisational obstacles to be addressed to improve uptake, and successful implementation of ADs when appropriate. Nevertheless, inferred positive change in attitudes and receptiveness towards the appropriate use of ADs by public funders are supportive and are a stepping stone for the future utilisation of ADs by researchers.

Cross-sector surveys assessing perceptions of key stakeholders towards barriers, concerns and facilitators to the appropriate use of adaptive designs in confirmatory trials

Background Appropriately conducted adaptive designs (ADs) offer many potential advantages over conventional trials. They make better use of accruing data, potentially saving time, trial participants, and limited resources compared to conventional, fixed sample size designs. However, one can argue that ADs are not implemented as often as they should be, particularly in publicly funded confirmatory trials. This study explored barriers, concerns, and potential facilitators to the appropriate use of ADs in confirmatory trials among key stakeholders. Methods We conducted three cross-sectional, online parallel surveys between November 2014 and January 2015. The surveys were based upon findings drawn from in-depth interviews of key research stakeholders, predominantly in the UK, and targeted Clinical Trials Units (CTUs), public funders, and private sector organisations. Response rates were as follows: 30(55 %) UK CTUs, 17(68 %) private sector, and 86(41 %) public funders. A Rating Scale Model was used to rank barriers and concerns in order of perceived importance for prioritisation. Results Top-ranked barriers included the lack of bridge funding accessible to UK CTUs to support the design of ADs, limited practical implementation knowledge, preference for traditional mainstream designs, difficulties in marketing ADs to key stakeholders, time constraints to support ADs relative to competing priorities, lack of applied training, and insufficient access to case studies of undertaken ADs to facilitate practical learning and successful implementation. Associated practical complexities and inadequate data management infrastructure to support ADs were reported as more pronounced in the private sector. For funders of public research, the inadequate description of the rationale, scope, and decision-making criteria to guide the planned AD in grant proposals by researchers were all viewed as major obstacles. Conclusions There are still persistent and important perceptions of individual and organisational obstacles hampering the use of ADs in confirmatory trials research. Stakeholder perceptions about barriers are largely consistent across sectors, with a few exceptions that reflect differences in organisations’ funding structures, experiences and characterisation of study interventions. Most barriers appear connected to a lack of practical implementation knowledge and applied training, and limited access to case studies to facilitate practical learning. Keywords: Adaptive designs; flexible designs; barriers; surveys; confirmatory trials; Phase 3; clinical trials; early stopping; interim analyses