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.

Detecting insect pollinator declines on regional and global scales.

Recently there has been considerable concern about declines in bee communities in agricultural and natural habitats. The value of pollination to agriculture, provided primarily by bees, is >$200 billion/year worldwide, and in natural ecosystems it is thought to be even greater. However, no monitoring program exists to accurately detect declines in abundance of insect pollinators; thus, it is difficult to quantify the status of bee communities or estimate the extent of declines. We used data from 11 multiyear studies of bee communities to devise a program to monitor pollinators at regional, national, or international scales. In these studies, 7 different methods for sampling bees were used and bees were sampled on 3 different continents. We estimated that a monitoring program with 200–250 sampling locations each sampled twice over 5 years would provide sufficient power to detect small (2–5%) annual declines in the number of species and in total abundance and would cost U.S.$2,000,000. To detect declines as small as 1% annually over the same period would require >300 sampling locations. Given the role of pollinators in food security and ecosystem function, we recommend establishment of integrated regional and international monitoring programs to detect changes in pollinator communities.

Stratospheric variability and tropospheric annular‐mode timescales

Climate models tend to exhibit much too persistent Southern Annular Mode (SAM) circulation anomalies in summer, compared to observations. Theoretical arguments suggest this bias may lead to an overly strong model response to anthropogenic forcing during this season, which is of interest since the largest observed changes in Southern Hemisphere high‐latitude climate over the last few decades have occurred in summer, and are congruent with the SAM. The origin of this model bias is examined here in the case of the Canadian Middle Atmosphere Model, using a novel technique to quantify the influence of stratospheric variability on tropospheric annular‐mode timescales. Part of the model bias is shown to be attributable to the too‐late breakdown of the stratospheric polar vortex, which allows the tropospheric influence of stratospheric variability to extend into early summer. However, the analysis also reveals an enhanced summertime persistence of the model’s SAM that is unrelated to either stratospheric variability or the bias in model stratospheric climatology, and is thus of tropospheric origin. No such feature is evident in the Northern Hemisphere. The effect of stratospheric variability in lengthening tropospheric annular‐mode timescales is evident in both hemispheres. While in the Southern Hemisphere the effect is restricted to late‐spring/early summer, in the Northern Hemisphere it can occur throughout the winter‐spring season, with the seasonality of peak timescales exhibiting considerable variability between different 50 year sections of the same simulation.

An exploratory study into the putative prebiotic activity of fructans isolated from Agave angustifolia and the associated anticancer activity

Linear Inulin type fructan (ITF) prebiotics have a putative role in the prevention of colorectal cancer, whereas relatively little is known about branched fructans. This study aims to investigate the fermentation properties and potential prebiotic activity of branched fructans derived from Agave angustifolia Haw, using the Simulator of Human Intestinal Microbial Ecosystem (SHIME) model. The proximal, transverse and distal vessels were used to investigate fructan fermentation throughout the colon and to assess the alterations of the microbial composition and fermentation metabolites (short chain fatty acids and ammonia). The influence on bioactivity of the fermentation supernatant was assessed by MTT, Comet and transepithelial electrical resistance (TER), respectively. Addition of Agave fructan to the SHIME model significantly increased (P<0.05), bifidobacteria populations (proximal and transverse), SCFA concentrations (proximal, transverse and distal) and decreased ammonia concentrations in the distal vessel. Furthermore, the fermentation supernatant significantly (P<0.05) increased the TER of a Caco-2 cell monolayer (%) and decreased fluorescein-based paracellular flux, suggesting enhanced barrier function and reduced epithelial barrier permeability (proximal and distal vessel). While cytotoxicity and genotoxicity remained unaltered in response to the presence of Agave fructans. To conclude, branched Agave fructans show indications of prebiotic activity, particularly in relation to colon health by exerting a positive influence on gut barrier function, an important aspect of colon carcinogenesis.

Southern annular mode dynamics in observations and models, Part I: The influence of climatological zonal wind biases in a comprehensive GCM

A common bias among global climate models (GCMs) is that they exhibit tropospheric southern annular mode (SAM) variability that is much too persistent in the Southern Hemisphere (SH) summertime. This is of concern for the ability to accurately predict future SH circulation changes, so it is important that it be understood and alleviated. In this two-part study, specifically targeted experiments with the Canadian Middle Atmosphere Model (CMAM) are used to improve understanding of the enhanced summertime SAM persistence. Given the ubiquity of this bias among comprehensive GCMs, it is likely that the results will be relevant for other climate models. Here, in Part I, the influence of climatological circulation biases on SAM variability is assessed, with a particular focus on two common biases that could enhance summertime SAM persistence: the too-late breakdown of the Antarctic stratospheric vortex and the equatorward bias in the SH tropospheric midlatitude jet. Four simulations are used to investigate the role of each of these biases in CMAM. Nudging and bias correcting procedures are used to systematically remove zonal-mean stratospheric variability and/or remove climatological zonal wind biases. The SAM time-scale bias is not alleviated by improving either the timing of the stratospheric vortex breakdown or the climatological jet structure. Even in the absence of stratospheric variability and with an improved climatological circulation, the model time scales are biased long. This points toward a bias in internal tropospheric dynamics that is not caused by the tropospheric jet structure bias. The underlying cause of this is examined in more detail in Part II of this study.

Southern annular mode dynamics in observations and models, Part II: Eddy feedbacks

Many global climate models (GCMs) have trouble simulating Southern Annular Mode (SAM) variability correctly, particularly in the Southern Hemisphere summer season where it tends to be too persistent. In this two part study, a suite of experiments with the Canadian Middle Atmosphere Model (CMAM) is analyzed to improve our understanding of the dynamics of SAM variability and its deficiencies in GCMs. Here, an examination of the eddy-mean flow feedbacks is presented by quantification of the feedback strength as a function of zonal scale and season using a new methodology that accounts for intraseasonal forcing of the SAM. In the observed atmosphere, in the summer season, a strong negative feedback by planetary scale waves, in particular zonal wavenumber 3, is found in a localized region in the south west Pacific. It cancels a large proportion of the positive feedback by synoptic and smaller scale eddies in the zonal mean, resulting in a very weak overall eddy feedback on the SAM. CMAM is deficient in this negative feedback by planetary scale waves, making a substantial contribution to its bias in summertime SAM persistence. Furthermore, this bias is not alleviated by artificially improving the climatological circulation, suggesting that climatological circulation biases are not the cause of the planetary wave feedback deficiency in the model. Analysis of the summertime eddy feedbacks in the CMIP-5 models confirms that this is indeed a common problem among GCMs, suggesting that understanding this planetary wave feedback and the reason for its deficiency in GCMs is key to improving the fidelity of simulated SAM variability in the summer season.

Neural and psychological maturation of decision-making in adolescence and young adulthood

We examined the maturation of decision-making from early adolescence to mid-adulthood using fMRI of a variant of the Iowa gambling task. We have previously shown that performance in this task relies on sensitivity to accumulating negative outcomes in ventromedial PFC and dorsolateral PFC. Here, we further formalize outcome evaluation (as driven by prediction errors [PE], using a reinforcement learning model) and examine its development. Task performance improved significantly during adolescence, stabilizing in adulthood. Performance relied on greater impact of negative compared with positive PEs, the relative impact of which matured from adolescence into adulthood. Adolescents also showed increased exploratory behavior, expressed as a propensity to shift responding between options independently of outcome quality, whereas adults showed no systematic shifting patterns. The correlation between PE representation and improved performance strengthened with age for activation in ventral and dorsal PFC, ventral striatum, and temporal and parietal cortices. There was a medial-lateral distinction in the prefrontal substrates of effective PE utilization between adults and adolescents: Increased utilization of negative PEs, a hallmark of successful performance in the task, was associated with increased activation in ventromedial PFC in adults, but decreased activation in ventrolateral PFC and striatum in adolescents. These results suggest that adults and adolescents engage qualitatively distinct neural and psychological processes during decision-making, the development of which is not exclusively dependent on reward-processing maturation.

Post-occupancy evaluation studies in recently refurbished office building: energy performance and employees' satisfaction

Existing buildings contribute greatly to global energy use and greenhouse gas emissions. In the UK, about 18% of carbon emissions are generated by non-domestic buildings; sustainable building refurbishment can play an important role in reducing carbon emissions. This paper looks at the performance of a recently refurbished 5-storey office building in London, in terms of energy consumption as well as occupants’ satisfaction. Pre- and post-occupancy evaluation studies were conducted using online questionnaire surveys and energy consumption evaluation. Results from pre-occupancy and post-occupancy evaluation studies showed that employees, in general, were more satisfied with their work environment at the refurbished building than with that of their previous office. Employees’ self-reported productivity improved after the move to Elms House. These surveys showed a positive relationship between employees’ satisfaction with their work environment and their self-reported productivity, well-being and enjoyment at work. The factor that contributed to increasing employee satisfaction the most was: better use of interior space. Although the refurbishment was a success in terms of reducing energy consumption per m2, the performance gap was almost 3 times greater than that estimated. Unregulated loads, problems with building control, ineffective use of space and occupants’ behaviour are argued to be reasons for this gap.

Runge-Kutta IMEX schemes for the Horizontally Explicit/Vertically Implicit (HEVI) solution of wave equations

Many operational weather forecasting centres use semi-implicit time-stepping schemes because of their good efficiency. However, as computers become ever more parallel, horizontally explicit solutions of the equations of atmospheric motion might become an attractive alternative due to the additional inter-processor communication of implicit methods. Implicit and explicit (IMEX) time-stepping schemes have long been combined in models of the atmosphere using semi-implicit, split-explicit or HEVI splitting. However, most studies of the accuracy and stability of IMEX schemes have been limited to the parabolic case of advection–diffusion equations. We demonstrate how a number of Runge–Kutta IMEX schemes can be used to solve hyperbolic wave equations either semi-implicitly or HEVI. A new form of HEVI splitting is proposed, UfPreb, which dramatically improves accuracy and stability of simulations of gravity waves in stratified flow. As a consequence it is found that there are HEVI schemes that do not lose accuracy in comparison to semi-implicit ones. The stability limits of a number of variations of trapezoidal implicit and some Runge–Kutta IMEX schemes are found and the schemes are tested on two vertical slice cases using the compressible Boussinesq equations split into various combinations of implicit and explicit terms. Some of the Runge–Kutta schemes are found to be beneficial over trapezoidal, especially since they damp high frequencies without dropping to first-order accuracy. We test schemes that are not formally accurate for stiff systems but in stiff limits (nearly incompressible) and find that they can perform well. The scheme ARK2(2,3,2) performs the best in the tests.

Balanced excitation and inhibition: Model based analysis of local field potentials

We have developed a model of the local field potential (LFP) based on the conservation of charge, the independence principle of ionic flows and the classical Hodgkin–Huxley (HH) type intracellular model of synaptic activity. Insights were gained through the simulation of the HH intracellular model on the nonlinear relationship between the balance of synaptic conductances and that of post-synaptic currents. The latter is dependent not only on the former, but also on the temporal lag between the excitatory and inhibitory conductances, as well as the strength of the afferent signal. The proposed LFP model provides a method for decomposing the LFP recordings near the soma of layer IV pyramidal neurons in the barrel cortex of anaesthetised rats into two highly correlated components with opposite polarity. The temporal dynamics and the proportional balance of the two components are comparable to the excitatory and inhibitory post-synaptic currents computed from the HH model. This suggests that the two components of the LFP reflect the underlying excitatory and inhibitory post-synaptic currents of the local neural population. We further used the model to decompose a sequence of evoked LFP responses under repetitive electrical stimulation (5 Hz) of the whisker pad. We found that as neural responses adapted, the excitatory and inhibitory components also adapted proportionately, while the temporal lag between the onsets of the two components increased during frequency adaptation. Our results demonstrated that the balance between neural excitation and inhibition can be investigated using extracellular recordings. Extension of the model to incorporate multiple compartments should allow more quantitative interpretations of surface Electroencephalography (EEG) recordings into components reflecting the excitatory, inhibitory and passive ionic current flows generated by local neural populations.

Early and late stimulus-evoked cortical hemodynamic responses provide insight into the neurogenic nature of neurovascular coupling

Understanding neurovascular coupling is a prerequisite for the interpretation of results obtained from modern neuroimaging techniques. This study investigated the hemodynamic and neural responses in rat somatosensory cortex elicited by 16 seconds electrical whisker stimuli. Hemodynamics were measured by optical imaging spectroscopy and neural activity by multichannel electrophysiology. Previous studies have suggested that the whisker-evoked hemodynamic response contains two mechanisms, a transient ‘backwards’ dilation of the middle cerebral artery, followed by an increase in blood volume localized to the site of neural activity. To distinguish between the mechanisms responsible for these aspects of the response, we presented whisker stimuli during normocapnia (‘control’), and during a high level of hypercapnia. Hypercapnia was used to ‘predilate’ arteries and thus possibly ‘inhibit’ aspects of the response related to the ‘early’ mechanism. Indeed, hemodynamic data suggested that the transient stimulus-evoked response was absent under hypercapnia. However, evoked neural responses were also altered during hypercapnia and convolution of the neural responses from both the normocapnic and hypercapnic conditions with a canonical impulse response function, suggested that neurovascular coupling was similar in both conditions. Although data did not clearly dissociate early and late vascular responses, they suggest that the neurovascular coupling relationship is neurogenic in origin.

A dynamic model of neurovascular coupling: Implications for blood vessel dilation and constriction

Neurovascular coupling in response to stimulation of the rat barrel cortex was investigated using concurrent multichannel electrophysiology and laser Doppler flowmetry. The data were used to build a linear dynamic model relating neural activity to blood flow. Local field potential time series were subject to current source density analysis, and the time series of a layer IV sink of the barrel cortex was used as the input to the model. The model output was the time series of the changes in regional cerebral blood flow (CBF). We show that this model can provide excellent fit of the CBF responses for stimulus durations of up to 16 s. The structure of the model consisted of two coupled components representing vascular dilation and constriction. The complex temporal characteristics of the CBF time series were reproduced by the relatively simple balance of these two components. We show that the impulse response obtained under the 16-s duration stimulation condition generalised to provide a good prediction to the data from the shorter duration stimulation conditions. Furthermore, by optimising three out of the total of nine model parameters, the variability in the data can be well accounted for over a wide range of stimulus conditions. By establishing linearity, classic system analysis methods can be used to generate and explore a range of equivalent model structures (e.g., feed-forward or feedback) to guide the experimental investigation of the control of vascular dilation and constriction following stimulation.

Does neural input or processing play a greater role in the magnitude of neuroimaging signals?

An important constraint on how hemodynamic neuroimaging signals such as fMRI can be interpreted in terms of the underlying evoked activity is an understanding of neurovascular coupling mechanisms that actually generate hemodynamic responses. The predominant view at present is that the hemodynamic response is most correlated with synaptic input and subsequent neural processing rather than spiking output. It is still not clear whether input or processing is more important in the generation of hemodynamics responses. In order to investigate this we measured the hemodynamic and neural responses to electrical whisker pad stimuli in rat whisker barrel somatosensory cortex both before and after the local cortical injections of the GABAA agonist muscimol. Muscimol would not be expected to affect the thalamocortical input into the cortex but would inhibit subsequent intra-cortical processing. Pre-muscimol infusion whisker stimuli elicited the expected neural and accompanying hemodynamic responses to that reported previously. Following infusion of muscimol, although the temporal profile of neural responses to each pulse of the stimulus train was similar, the average response was reduced in magnitude by ∼79% compared to that elicited pre-infusion. The whisker-evoked hemodynamic responses were reduced by a commensurate magnitude suggesting that, although the neurovascular coupling relationships were similar for synaptic input as well as for cortical processing, the magnitude of the overall response is dominated by processing rather than from that produced from the thalamocortical input alone.

The resting-state neurovascular coupling relationship: rapid changes in spontaneous neural activity in the somatosensory cortex are associated with haemodynamic fluctuations that resemble stimulus-evoked haemodynamics

Although promise exists for patterns of resting-state blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) brain connectivity to be used as biomarkers of early brain pathology, a full understanding of the nature of the relationship between neural activity and spontaneous fMRI BOLD fluctuations is required before such data can be correctly interpreted. To investigate this issue, we combined electrophysiological recordings of rapid changes in multi-laminar local field potentials from the somatosensory cortex of anaesthetized rats with concurrent two-dimensional optical imaging spectroscopy measurements of resting-state haemodynamics that underlie fluctuations in the BOLD fMRI signal. After neural ‘events’ were identified, their time points served to indicate the start of an epoch in the accompanying haemodynamic fluctuations. Multiple epochs for both neural ‘events’ and the accompanying haemodynamic fluctuations were averaged. We found that the averaged epochs of resting-state haemodynamic fluctuations taken after neural ‘events’ closely resembled the temporal profile of stimulus-evoked cortical haemodynamics. Furthermore, we were able to demonstrate that averaged epochs of resting-state haemodynamic fluctuations resembling the temporal profile of stimulus-evoked haemodynamics could also be found after peaks in neural activity filtered into specific electroencephalographic frequency bands (theta, alpha, beta, and gamma). This technique allows investigation of resting-state neurovascular coupling using methodologies that are directly comparable to that developed for investigating stimulus-evoked neurovascular responses.