Ontology modeling for generation of clinical pathways

Purpose: Increasing costs of health care, fuelled by demand for high quality, cost-effective healthcare has drove hospitals to streamline their patient care delivery systems. One such systematic approach is the adaptation of Clinical Pathways (CP) as a tool to increase the quality of healthcare delivery. However, most organizations still rely on are paper-based pathway guidelines or specifications, which have limitations in process management and as a result can influence patient safety outcomes. In this paper, we present a method for generating clinical pathways based on organizational semiotics by capturing knowledge from syntactic, semantic and pragmatic to social level. Design/methodology/approach: The proposed modeling approach to generation of CPs adopts organizational semiotics and enables the generation of semantically rich representation of CP knowledge. Semantic Analysis Method (SAM) is applied to explicitly represent the semantics of the concepts, their relationships and patterns of behavior in terms of an ontology chart. Norm Analysis Method (NAM) is adopted to identify and formally specify patterns of behavior and rules that govern the actions identified on the ontology chart. Information collected during semantic and norm analysis is integrated to guide the generation of CPs using best practice represented in BPMN thus enabling the automation of CP. Findings: This research confirms the necessity of taking into consideration social aspects in designing information systems and automating CP. The complexity of healthcare processes can be best tackled by analyzing stakeholders, which we treat as social agents, their goals and patterns of action within the agent network. Originality/value: The current modeling methods describe CPs from a structural aspect comprising activities, properties and interrelationships. However, these methods lack a mechanism to describe possible patterns of human behavior and the conditions under which the behavior will occur. To overcome this weakness, a semiotic approach to generation of clinical pathway is introduced. The CP generated from SAM together with norms will enrich the knowledge representation of the domain through ontology modeling, which allows the recognition of human responsibilities and obligations and more importantly, the ultimate power of decision making in exceptional circumstances.

Expression of cyclooxygenase-2 in intestine of pigs of different ages and hygiene status

Prostaglandins (PG) are bioactive lipids derived from the metabolism of membrane polyunsaturated fatty acids (PUFA), and play important roles in a number of biological processes including cell division, immune responses and wound healing. Cyclooxygenase (COX) is the key enzyme in PG synthesis from arachidonic acid. The hypothesis of the present study was that expression of COX-2 in porcine intestine was dependent on the microbial load and the age of piglets. Piglets were obtained from sows raised either on outdoor free-range farms or on indoor commercial farms, and littermates were divided into three treatments: One group of piglets suckled the sow, a second group was put into an isolator and fed a milk formula, and a third group was put into the isolator fed milk formula and injected with broad spectrum antibiotics. Samples were collected from the 75% level of the small intestine at day 5, 28 and 56 of age. Tissue section from four piglets from each of these six treatment groups was analysed by immunofluorescence for COX-2 and type-IV collagen (basement membrane, defining lamina propria (LP)). Image analysis was used to determine the number of positive pixels expressing LP and epithelial COX-2. COX-2 expressing cells were observed in LP and epithelium in all porcine intestinal samples. When analysing images obtained on day 28, injection of antibiotics seemed to reduce the COX-2 expression in intestinal samples of piglets when compared to other treatments (P=0.053). No significant effect of farm, treatments or age of piglets was observed on COX-2 expressing data when analysing all data of images obtained at day 28 and 56. By double-labelling experiments, COX-2 was found not to be expressed on cell co-expressing CD45, CD16, CD163 or CD2, thus indicating that mucosal leukocytes, including dendritic cells, macrophages and NK cells did not express COX-2. Future research should investigate the role of COX-2 expression in the digestive tract in relation to pig health.

Wave activity in the tropical tropopause layer in seven reanalysis and four chemistry climate model data sets

Sub-seasonal variability including equatorial waves significantly influence the dehydration and transport processes in the tropical tropopause layer (TTL). This study investigates the wave activity in the TTL in 7 reanalysis data sets (RAs; NCEP1, NCEP2, ERA40, ERA-Interim, JRA25, MERRA, and CFSR) and 4 chemistry climate models (CCMs; CCSRNIES, CMAM, MRI, and WACCM) using the zonal wave number-frequency spectral analysis method with equatorially symmetric-antisymmetric decomposition. Analyses are made for temperature and horizontal winds at 100 hPa in the RAs and CCMs and for outgoing longwave radiation (OLR), which is a proxy for convective activity that generates tropopause-level disturbances, in satellite data and the CCMs. Particular focus is placed on equatorial Kelvin waves, mixed Rossby-gravity (MRG) waves, and the Madden-Julian Oscillation (MJO). The wave activity is defined as the variance, i.e., the power spectral density integrated in a particular zonal wave number-frequency region. It is found that the TTL wave activities show significant difference among the RAs, ranging from ∼0.7 (for NCEP1 and NCEP2) to ∼1.4 (for ERA-Interim, MERRA, and CFSR) with respect to the averages from the RAs. The TTL activities in the CCMs lie generally within the range of those in the RAs, with a few exceptions. However, the spectral features in OLR for all the CCMs are very different from those in the observations, and the OLR wave activities are too low for CCSRNIES, CMAM, and MRI. It is concluded that the broad range of wave activity found in the different RAs decreases our confidence in their validity and in particular their value for validation of CCM performance in the TTL, thereby limiting our quantitative understanding of the dehydration and transport processes in the TTL.

Understanding the spatial mass transfer behaviour of a pulsating jet HMV system: vortex generation and characterisation

The flow patterns generated by a pulsating jet used to study hydrodynamic modulated voltammetry (HMV) are investigated. It is shown that the pronounced edge effect reported previously is the result of the generation of a vortex ring from the pulsating jet. This vortex behaviour of the pulsating jet system is imaged using a number of visualisation techniques. These include a dye system and an electrochemically generated bubble stream. In each case a toroidal vortex ring was observed. Image analysis revealed that the velocity of this motion was of the order of 250 mm s−1 with a corresponding Reynolds number of the order of 1200. This motion, in conjunction with the electrode structure, is used to explain the strong ‘ring and halo’ features detected by electrochemical mapping of the system reported previously.

On the detection and attribution of gravity waves generated by the 20 March 2015 solar eclipse

Internal gravity waves are generated as adjustment radiation whenever a sudden change in forcing causes the atmosphere to depart from its large-scale balanced state. Such a forcing anomaly occurs during a solar eclipse, when the Moon’s shadow cools part of the Earth’s surface. The resulting atmospheric gravity waves are associated with pressure and temperature perturbations, which in principle are detectable both at the surface and aloft. In this study, surface pressure and temperature data from two UK sites at Reading and Lerwick are analysed for eclipse-driven gravity-wave perturbations during the 20 March 2015 solar eclipse over north-west Europe. Radiosonde wind data from the same two sites are also analysed using a moving parcel analysis method, to determine the periodicities of the waves aloft. On this occasion, the perturbations both at the surface and aloft are found not to be confidently attributable to eclipse-driven gravity waves. We conclude that the complex synoptic weather conditions over the UK at the time of this particular eclipse helped to mask any eclipse-driven gravity waves.

Rainfastness of poly(vinyl alcohol) deposits on Vicia faba leaf surfaces: from laboratory-scale washing to simulated rain

Rainfastness is the ability of agrochemical deposits to resist wash-off by rain and other related environmental phenomena. This work reports laboratory-scale and raintower studies of the rainfastness of fluorescently labeled poly(vinyl alcohol) (PVA) using fluorescent microscopy combined with image analysis. Samples of hydrolyzed PVA exhibit improved rainfastness over a threshold molecular weight, which correlates with PVA film dissolution, swelling, and crystalline properties. It was also established that the rainfastness of PVA scaled with the molecular weight over this threshold. These PVA samples were further characterized in order to determine the effect of the crystallinity on rainfastness. The quantification of rainfastness is of great interest to the field of agrochemical formulation development in order to improve the efficacy of pesticides and their adjuvants.