Clinical decision support system for point of care use: ontology driven design and software implementation

OBJECTIVES: The objective of this research was to design a clinical decision support system (CDSS) that supports heterogeneous clinical decision problems and runs on multiple computing platforms. Meeting this objective required a novel design to create an extendable and easy to maintain clinical CDSS for point of care support. The proposed solution was evaluated in a proof of concept implementation. METHODS: Based on our earlier research with the design of a mobile CDSS for emergency triage we used ontology-driven design to represent essential components of a CDSS. Models of clinical decision problems were derived from the ontology and they were processed into executable applications during runtime. This allowed scaling applications' functionality to the capabilities of computing platforms. A prototype of the system was implemented using the extended client-server architecture and Web services to distribute the functions of the system and to make it operational in limited connectivity conditions. RESULTS: The proposed design provided a common framework that facilitated development of diversified clinical applications running seamlessly on a variety of computing platforms. It was prototyped for two clinical decision problems and settings (triage of acute pain in the emergency department and postoperative management of radical prostatectomy on the hospital ward) and implemented on two computing platforms-desktop and handheld computers. CONCLUSIONS: The requirement of the CDSS heterogeneity was satisfied with ontology-driven design. Processing of application models described with the help of ontological models allowed having a complex system running on multiple computing platforms with different capabilities. Finally, separation of models and runtime components contributed to improved extensibility and maintainability of the system.

Open-source mapping and services for Web-based land-cover validation

Monitoring land-cover changes on sites of conservation importance allows environmental problems to be detected, solutions to be developed and the effectiveness of actions to be assessed. However, the remoteness of many sites or a lack of resources means these data are frequently not available. Remote sensing may provide a solution, but large-scale mapping and change detection may not be appropriate, necessitating site-level assessments. These need to be easy to undertake, rapid and cheap. We present an example of a Web-based solution based on free and open-source software and standards (including PostGIS, OpenLayers, Web Map Services, Web Feature Services and GeoServer) to support assessments of land-cover change (and validation of global land-cover maps). Authorised users are provided with means to assess land-cover visually and may optionally provide uncertainty information at various levels: from a general rating of their confidence in an assessment to a quantification of the proportions of land-cover types within a reference area. Versions of this tool have been developed for the TREES-3 initiative (Simonetti, Beuchle and Eva, 2011). This monitors tropical land-cover change through ground-truthing at latitude / longitude degree confluence points, and for monitoring of change within and around Important Bird Areas (IBAs) by Birdlife International and the Royal Society for the Protection of Birds (RSPB). In this paper we present results from the second of these applications. We also present further details on the potential use of the land-cover change assessment tool on sites of recognised conservation importance, in combination with NDVI and other time series data from the eStation (a system for receiving, processing and disseminating environmental data). We show how the tool can be used to increase the usability of earth observation data by local stakeholders and experts, and assist in evaluating the impact of protection regimes on land-cover change.

Public and private hospital services reform:an investigation in Iranian hospitals

This research aimed to present a model of efficiency for selected public and private hospitals of East Azerbaijani province of Iran by making use of DEA approach in order to recognize and suggest the best practice standards. In other words, its aim was to suggest a suitable context to develop efficient hospital systems while maintaining the quality of care at minimum expenditures. It is recommended for inefficient hospitals to make use of the followings: transferring, selling, or renting idle/unused beds; transferring excess doctors and nurses to the efficient hospitals or other health centers; pensioning off, early retirement clinic officers, technicians/technologists, and other technical staff. The saving obtained from the above approaches could be used to improve remuneration for remaining staff and quality of health care services of hospitals, rural and urban health centers, support communities to start or sustain systematic risk and resource pooling and cost sharing mechanisms for protecting beneficiaries against unexpected health care costs, compensate the capital depreciation, increasing investments, and improve diseases prevention services and facilities in the provincial and national levels.

Servitization of manufacture:exploring the deployment and skills of people critical to the delivery of advanced services

Purpose - This "research note" sets out to fuel the debate around the practices and technologies within operations that are critical to success with servitization. It presents a study of four companies which are delivering advanced services and reports on the organisation and skill-sets of people within these. Design/methodology/approach - This has been case-based research at four manufacturers leading in their delivery of services. Findings - It describes the desirable behaviour of people in the front-line of service delivery, identifies the supporting skill-sets, how these people are organised, and explains why all these factors are so important. Originality/value - This paper contributes to the understanding of the servitization process and, in particular, the implications to broader operations of the firm. © 2013 Emerald Group Publishing Limited. All rights reserved.

Leadership in high-value services for manufacturers:people and the delivery of advanced services

This short paper sets out to further develop the debate around the practices and technologies within operations that are critical to success with servitization. This paper draws findings from four companies that are leading in their delivery of advanced services, and reports on the organisation and skill-sets of people within these organisations. In particular it examines the roles and activities of people within the front-office, identifies the skill-sets that are espoused as being critical, and then seeks to present the rational that explains this importance. It concludes by proposing a working hypothesis for future studies in this field.

Purchasing green transport and logistics services:implications for small business

Considering its strong environmental impact, logistics plays a critical role in green supply chain management. It provides strategic links in the supply chain and is an essential function in the delivery of green products to the consumer. There is a general consensus on the fact that more environmentally sustainable companies may be achieved only if transport and logistics activities also become greener. To achieve this objective, buyer companies need to incorporate green considerations in the purchasing of transport and logistics services. This appears particularly challenging for small and medium sized enterprises (SMEs) because of their traditional lack of managerial, organisational and financial resources that often result in failure to adopt an environmental perspective. In the extant literature, green purchasing has received increased attention over the past decade and the strategic importance of introducing green aspects into purchasing practices has been recognised. However, little has been written in relation to purchasing green transport and logistics services. The aim of this paper is to explore practices in the buying of green transport and logistics services and to derive implications for small buyer companies. The paper analyses how general environmental company ambitions and environmental purchasing practices are reflected when green transport and logistics services are purchased in three different European countries (Italy, Ireland and Sweden) using a multiple case study research approach. The results of the paper indicate that while the case companies show a relatively high concern for green issues at corporate level, a lower importance is attributed to green issues at the purchasing function level. When green concerns in the purchasing of transport and logistics services are analysed the level of importance decreases further. Thus, a conflicting attitude is evident between the overall corporate level and the purchasing of transport and logistics services specifically. This suggests that there is potential for improvement especially in the area of green collaboration in buyer and supplier relationships.

Divided care and the Third Way:user involvement in statutory and voluntary sector cancer services

In health care, as in much of the public sphere, the voluntary sector is playing an increasingly large role in the funding, provision and delivery of services and nowhere is this more apparent than in cancer care. Simultaneously the growth of privatisation, marketisation and consumerism has engendered a rise in the promotion of 'user involvement' in health care. These changes in the organisation and delivery of health care, in part inspired by the 'Third Way' and the promotion of public and citizen participation, are particularly apparent in the British National Health Service. This paper presents initial findings from a three-year study of user involvement in cancer services. Using both case study and survey data, we explore the variation in the definition, aims, usefulness and mechanisms for involving users in the evaluation and development of cancer services across three Health Authorities in South West England. The findings have important implications for understanding shifts in power, autonomy and responsibility between patients, carers, clinicians and health service managers. The absence of any common definition of user involvement or its purpose underlines the limited trust between the different actors in the system and highlights the potentially negative impact of a Third Way health service.

Preface

The Semantic Web has come a long way since its inception in 2001, especially in terms of technical development and research progress. However, adoption by non- technical practitioners is still an ongoing process, and in some areas this process is just now starting. Emergency response is an area where reliability and timeliness of information and technologies is of essence. Therefore it is quite natural that more widespread adoption in this area has not been seen until now, when Semantic Web technologies are mature enough to support the high requirements of the application area. Nevertheless, to leverage the full potential of Semantic Web research results for this application area, there is need for an arena where practitioners and researchers can meet and exchange ideas and results. Our intention is for this workshop, and hopefully coming workshops in the same series, to be such an arena for discussion. The Extended Semantic Web Conference (ESWC - formerly the European Semantic Web conference) is one of the major research conferences in the Semantic Web field, whereas this is a suitable location for this workshop in order to discuss the application of Semantic Web technology to our specific area of applications. Hence, we chose to arrange our first SMILE workshop at ESWC 2013. However, this workshop does not focus solely on semantic technologies for emergency response, but rather Semantic Web technologies in combination with technologies and principles for what is sometimes called the "social web". Social media has already been used successfully in many cases, as a tool for supporting emergency response. The aim of this workshop is therefore to take this to the next level and answer questions like: "how can we make sense of, and furthermore make use of, all the data that is produced by different kinds of social media platforms in an emergency situation?" For the first edition of this workshop the chairs collected the following main topics of interest: • Semantic Annotation for understanding the content and context of social media streams. • Integration of Social Media with Linked Data. • Interactive Interfaces and visual analytics methodologies for managing multiple large-scale, dynamic, evolving datasets. • Stream reasoning and event detection. • Social Data Mining. • Collaborative tools and services for Citizens, Organisations, Communities. • Privacy, ethics, trustworthiness and legal issues in the Social Semantic Web. • Use case analysis, with specific interest for use cases that involve the application of Social Media and Linked Data methodologies in real-life scenarios. All of these, applied in the context of: • Crisis and Disaster Management • Emergency Response • Security and Citizen Journalism The workshop received 6 high-quality paper submissions and based on a thorough review process, thanks to our program committee, the decision was made to accept four of these papers for the workshop (67% acceptance rate). These four papers can be found later in this proceedings volume. Three out of four of these papers particularly discuss the integration and analysis of social media data, using Semantic Web technologies, e.g. for detecting complex events in social media streams, for visualizing and analysing sentiments with respect to certain topics in social media, or for detecting small-scale incidents entirely through the use of social media information. Finally, the fourth paper presents an architecture for using Semantic Web technologies in resource management during a disaster. Additionally, the workshop featured an invited keynote speech by Dr. Tomi Kauppinen from Aalto university. Dr. Kauppinen shared experiences from his work on applying Semantic Web technologies to application fields such as geoinformatics and scientific research, i.e. so-called Linked Science, but also recent ideas and applications in the emergency response field. His input was also highly valuable for the roadmapping discussion, which was held at the end of the workshop. A separate summary of the roadmapping session can be found at the end of these proceedings. Finally, we would like to thank our invited speaker Dr. Tomi Kauppinen, all our program committee members, as well as the workshop chair of ESWC2013, Johanna Völker (University of Mannheim), for helping us to make this first SMILE workshop a highly interesting and successful event!

Roadmapping discussion summary:social media and linked data for emergency response

This paper provides a summary of the Social Media and Linked Data for Emergency Response (SMILE) workshop, co-located with the Extended Semantic Web Conference, at Montpellier, France, 2013. Following paper presentations and question answering sessions, an extensive discussion and roadmapping session was organised which involved the workshop chairs and attendees. Three main topics guided the discussion - challenges, opportunities and showstoppers. In this paper, we present our roadmap towards effectively exploiting social media and semantic web techniques for emergency response and crisis management.

Self-adaptive volunteered services composition through stimulus-and time-awareness

Volunteered Service Composition (VSC) refers to the process of composing volunteered services and resources. These services are typically published to a pool of voluntary resources. Selection and composition decisions tend to encounter numerous uncertainties: service consumers and applications have little control of these services and tend to be uncertain about their level of support for the desired functionalities and non-functionalities. In this paper, we contribute to a self-awareness framework that implements two levels of awareness, Stimulus-awareness and Time-awareness. The former responds to basic changes in the environment while the latter takes into consideration the historical performance of the services. We have used volunteer service computing as an example to demonstrate the benefits that self-awareness can introduce to self-adaptation. We have compared the Stimulus-and Time-awareness approaches with a recent Ranking approach from the literature. The results show that the Time-awareness level has the advantage of satisfying higher number of requests with lower time cost.

Acute Exposure to Terrestrial Trunked Radio (TETRA) has effects on the electroencephalogram and electrocardiogram, consistent with vagal nerve stimulation

BACKGROUND: Terrestrial Trunked Radio (TETRA) is a telecommunications system widely used by police and emergency services around the world. The Stewart Report on mobile telephony and health raised questions about possible health effects associated with TETRA signals. This study investigates possible effects of TETRA signals on the electroencephalogram and electrocardiogram in human volunteers. METHODS: Blinded randomized provocation study with a standardized TETRA signal or sham exposure. In the first of two experiments, police officers had a TETRA set placed first against the left temple and then the upper-left quadrant of the chest and the electroencephalogram was recorded during rest and active cognitive processing. In the second experiment, volunteers were subject to chest exposure of TETRA whilst their electroencephalogram and heart rate variability derived from the electrocardiogram were recorded. RESULTS: In the first experiment, we found that exposure to TETRA had consistent neurophysiological effects on the electroencephalogram, but only during chest exposure, in a pattern suggestive of vagal nerve stimulation. In the second experiment, we observed changes in heart rate variability during exposure to TETRA but the electroencephalogram effects were not replicated. CONCLUSIONS: Observed effects of exposure to TETRA signals on the electroencephalogram (first experiment) and electrocardiogram are consistent with vagal nerve stimulation in the chest by TETRA. However given the small effect on heart rate variability and the lack of consistency on the electroencephalogram, it seems unlikely that this will have a significant impact on health. Long-term monitoring of the health of the police force in relation to TETRA use is on-going.