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.

An ontological approach to competency management

Competency management is a very important part of a well-functioning organisation. Unfortunately competency descriptions are not uniformly specified nor defined across borders: National, sectorial or organisational, leading to an opaque competency description market with a multitude of competency frameworks and competency benchmarks. An ontology is a formalised description of a domain, which enables automated reasoning engines to be built which by utilising the interrelations between entities can make “intelligent” choices in different situations within the domain. Introducing formalised competency ontologies automated tools, such as skill gap analysis, training suggestion generation, job search and recruitment, can be developed, which compare and contrast different competency descriptions on the semantic level. The major problem with defining a common formalised ontology for competencies is that there are so many viewpoints of competencies and competency frameworks. Work within the TRACE project has focused on finding common trends within different competency frameworks in order to allow an intermediate competency description to be made, which other frameworks can reference. This research has shown that competencies can be divided up into “knowledge”, “skills” and what we call “others”. An ontology has been created based on this with a simple structure of different “kinds” of “knowledges” and “skills” using semantic interrelations to define the basic semantic structure of the ontology. A prototype tool for analysing a skill gap analysis has been developed. Personal profiles can be produced using the tool and a skill gap analysis is performed on a desired competency profile by using an ontologically based inference engine, which is able to list closest fit and possible proficiency gaps

Networks of contextualised ontologies for the Semantic Web

Currently many ontologies are available for addressing different domains. However, it is not always possible to deploy such ontologies to support collaborative working, so that their full potential can be exploited to implement intelligent cooperative applications capable of reasoning over a network of context-specific ontologies. The main problem arises from the fact that presently ontologies are created in an isolated way to address specific needs. However we foresee the need for a network of ontologies which will support the next generation of intelligent applications/devices, and, the vision of Ambient Intelligence. The main objective of this paper is to motivate the design of a networked ontology (Meta) model which formalises ways of connecting available ontologies so that they are easy to search, to characterise and to maintain. The aim is to make explicit the virtual and implicit network of ontologies serving the Semantic Web.

On the generation mechanisms of short-scale unbalanced modes in rotating two-layer flows with vertical shear

We report on the results of a laboratory investigation using a rotating two-layer annulus experiment, which exhibits both large-scale vortical modes and short-scale divergent modes. A sophisticated visualization method allows us to observe the flow at very high spatial and temporal resolution. The balanced long-wavelength modes appear only when the Froude number is supercritical (i.e. $F\,{>}\,F_\mathrm{critical}\,{\equiv}\, \upi^2/2$), and are therefore consistent with generation by a baroclinic instability. The unbalanced short-wavelength modes appear locally in every single baroclinically unstable flow, providing perhaps the first direct experimental evidence that all evolving vortical flows will tend to emit freely propagating inertia–gravity waves. The short-wavelength modes also appear in certain baroclinically stable flows. We infer the generation mechanisms of the short-scale waves, both for the baro-clinically unstable case in which they co-exist with a large-scale wave, and for the baroclinically stable case in which they exist alone. The two possible mechanisms considered are spontaneous adjustment of the large-scale flow, and Kelvin–Helmholtz shear instability. Short modes in the baroclinically stable regime are generated only when the Richardson number is subcritical (i.e. $\hbox{\it Ri}\,{<}\,\hbox{\it Ri}_\mathrm{critical}\,{\equiv}\, 1$), and are therefore consistent with generation by a Kelvin–Helmholtz instability. We calculate five indicators of short-wave generation in the baroclinically unstable regime, using data from a quasi-geostrophic numerical model of the annulus. There is excellent agreement between the spatial locations of short-wave emission observed in the laboratory, and regions in which the model Lighthill/Ford inertia–gravity wave source term is large. We infer that the short waves in the baroclinically unstable fluid are freely propagating inertia–gravity waves generated by spontaneous adjustment of the large-scale flow.

Spontaneous generation and impact of inertia-gravity waves in a stratified, two-layer shear flow

Inertia-gravity waves exist ubiquitously throughout the stratified parts of the atmosphere and ocean. They are generated by local velocity shears, interactions with topography, and as geostrophic (or spontaneous) adjustment radiation. Relatively little is known about the details of their interaction with the large-scale flow, however. We report on a joint model/laboratory study of a flow in which inertia-gravity waves are generated as spontaneous adjustment radiation by an evolving large-scale mode. We show that their subsequent impact upon the large-scale dynamics is generally small. However, near a potential transition from one large-scale mode to another, in a flow which is simultaneously baroclinically-unstable to more than one mode, the inertia-gravity waves may strongly influence the selection of the mode which actually occurs.

Developing the next-generation climate system models: challenges and achievements

Although climate models have been improving in accuracy and efficiency over the past few decades, it now seems that these incremental improvements may be slowing. As tera/petascale computing becomes massively parallel, our legacy codes are less suitable, and even with the increased resolution that we are now beginning to use, these models cannot represent the multiscale nature of the climate system. This paper argues that it may be time to reconsider the use of adaptive mesh refinement for weather and climate forecasting in order to achieve good scaling and representation of the wide range of spatial scales in the atmosphere and ocean. Furthermore, the challenge of introducing living organisms and human responses into climate system models is only just beginning to be tackled. We do not yet have a clear framework in which to approach the problem, but it is likely to cover such a huge number of different scales and processes that radically different methods may have to be considered. The challenges of multiscale modelling and petascale computing provide an opportunity to consider a fresh approach to numerical modelling of the climate (or Earth) system, which takes advantage of the computational fluid dynamics developments in other fields and brings new perspectives on how to incorporate Earth system processes. This paper reviews some of the current issues in climate (and, by implication, Earth) system modelling, and asks the question whether a new generation of models is needed to tackle these problems.

Questions of Friendship and Degrees of Transnationality among Second-Generation Return Migrants to Barbados

While the academic literature has demonstrated the importance of social networks in relation to the process of migration, investigations have rarely examined in detail the personal-social adjustment issues that migrants and return migrants face. This study examines the context and types of friendship pattern that young return migrants from Britain cultivate in Barbados. The research centres on a wholly under-researched demographic groupyoung return migrants or second-generation Barbadians who have decided to return to the birthplace of their parents. The investigation is based on 51 in-depth interviews carried out with these young returnees to Barbados. Presenting a taxonomy of friendship types, it is argued that, for the 'Bajan-Brits' under study, the cultivation of new friendships is highly problematic. The research identifies what we refer to as the 'insular transnational', the 'we are different' and the 'all-inclusive transnational' friendship types among the young returnees. Our analysis also shows that problems of friendship are highly gendered, with females reporting the most problems due to what is perceived as sexual and workplace competition. It is stressed that these circumstances exemplify the essentially 'hybrid', 'liminal' and 'in-between' positionality of these second-generation migrants within contemporary Barbadian society.

'Black skins-white masks': Postcolonial reflections on 'race', gender and second generation return migration to the Caribbean

This paper illustrates the opportunities afforded by the adoption of postcolonial discourse in development geography, drawing specifically on issues of transnationalism, hybridity and inbetweeness. The utility of such notions and associated approaches is illustrated by the authors' current research on the migration of young, second generation and foreign-born 'Bajan-Brits' to the small Caribbean island nation of Barbados, the homeland of their parents. Focussing on issues of 'race' and gender, the paper examines the experiences of return migration among this cohort from an interpretative perspective framed within postcolonial discourse. It argues that notwithstanding the considerable sociocultural problems of adjustment encountered, these Bajan-Brit 'returnees' may be seen as occupying positions of relative economic privilege. Theirs is a liminal space derived by virtue of having been born and/or raised in the UK and being of the black 'race'. Accordingly, they are demonstrated to be both advantaged and disadvantaged; both transnational and national; and black but, in some senses, symbolically white.

Quality of Life Issues and Second-Generation Migration: the Case of 'Bajan-Brit Returnees'

This paper forms part of research that is investigating the migration of young Bajan-Brits to Barbados. Specifically, it explores the role of quality of life issues in the decision-making processes of young Bajan-Brits as they negotiate their 'return' to Barbados. The research, based on 51 in-depth qualitative interviews conducted with an under-researched cohort of young Bajan-Brits living in Barbados, argues from a 'lure of home' conceptualisation that the return of young Bajan-Brits to Barbados can best be understood from the context of a search for a better quality of life in the face of social and economic disenfranchisement in the UK context. Subsequently, the paper examines the extent to which the quality of life factors which formed the basis of return to Barbados have in fact been realised on the part of young Bajan-Brits in their adjustment to life in Barbados. The paper ultimately argues that despite problems of adjustment, young Bajan-Brits have generally been successful in actualising a better quality of life in Barbados. Copyright (C) 2009 John Wiley & Sons, Ltd.

"Mad dogs and transnational migrants?" Bajan-Brit second-generation migrants and accusations of madness

Second-generation British-Barbadians ("Bajan-Brits'') returning to the land of their parents are frequently accused by indigenous Barbadian nationals of being mad. Narratives of the migrants reflect four major sets of factors: (1) madness as perceived behavioral and cultural differences; (2) explanations that relate to the historical-clinical circumstances surrounding the incidence of mental ill health among first-generation West Indian migrants to the United Kingdom; (3) madness as a pathology of alienation that is attendant on living in Barbados; and (4) madness as "othering,'' "outing,'' and "fixity.'' British second-generation "returning nationals'' to the Caribbean, living as they do in the plural world of the land of their parents' birth, after having been raised in the colonial "Mother Country,'' exhibit hybridity and in-betweenness. Accusations of madness serve to fix the position of these young migrants outside the mainstream of indigenous Barbadian society. Our analysis invokes recent postcolonial writings dealing with "strange encounters'' to theorize that the madness accusation serves to "other'' the young Bajan-Brit migrants in a strongly postcolonial context.