Cues and knowledge structures used by mental-health professionals when making risk assessments

Background: Research into mental-health risks has tended to focus on epidemiological approaches and to consider pieces of evidence in isolation. Less is known about the particular factors and their patterns of occurrence that influence clinicians’ risk judgements in practice. Aims: To identify the cues used by clinicians to make risk judgements and to explore how these combine within clinicians’ psychological representations of suicide, self-harm, self-neglect, and harm to others. Method: Content analysis was applied to semi-structured interviews conducted with 46 practitioners from various mental-health disciplines, using mind maps to represent the hierarchical relationships of data and concepts. Results: Strong consensus between experts meant their knowledge could be integrated into a single hierarchical structure for each risk. This revealed contrasting emphases between data and concepts underpinning risks, including: reflection and forethought for suicide; motivation for self-harm; situation and context for harm to others; and current presentation for self-neglect. Conclusions: Analysis of experts’ risk-assessment knowledge identified influential cues and their relationships to risks. It can inform development of valid risk-screening decision support systems that combine actuarial evidence with clinical expertise.

An investigation into inductive parameter learning in complex hierarchical knowledge structures representing clinical expertise

This dissertation investigates the very important and current problem of modelling human expertise. This is an apparent issue in any computer system emulating human decision making. It is prominent in Clinical Decision Support Systems (CDSS) due to the complexity of the induction process and the vast number of parameters in most cases. Other issues such as human error and missing or incomplete data present further challenges. In this thesis, the Galatean Risk Screening Tool (GRiST) is used as an example of modelling clinical expertise and parameter elicitation. The tool is a mental health clinical record management system with a top layer of decision support capabilities. It is currently being deployed by several NHS mental health trusts across the UK. The aim of the research is to investigate the problem of parameter elicitation by inducing them from real clinical data rather than from the human experts who provided the decision model. The induced parameters provide an insight into both the data relationships and how experts make decisions themselves. The outcomes help further understand human decision making and, in particular, help GRiST provide more accurate emulations of risk judgements. Although the algorithms and methods presented in this dissertation are applied to GRiST, they can be adopted for other human knowledge engineering domains.

The variance in sales performance explained by the knowledge structures of salespeople

The last major study of sales performance variance explained by salespeople attributes was by Churchill et al. (1985). They examined the effect of role, skills, motivation, personal factors, aptitude, and organizational/environmental factors on sales performance—factors that have dominated the sales performance area. About the same time, Weitz, Sujan, and Sujan (1986) introduced the concepts of salespeople's knowledge structures. Considerable work on the relationship of the elements of knowledge structures and performance can be found in the literature. In this research note, we determine the degree to which sales performance can be explained by knowledge structure variables, a heretofore unexplored area. If knowledge structure variables explain more variance than traditional variables, then this paper would be a call to further research in this area. In examining this research question in a retail context, we find that knowledge structure variables explain 50.2 percent of the variance in sales performance. We also find that variance explained by knowledge structures is significantly different based on gender. The impact of knowledge structures on performance was higher for men than for women. The models using education demonstrated smaller differences.

Discovering knowledge structures in mind maps of mental health risks

This thesis addressed the problem of risk analysis in mental healthcare, with respect to the GRiST project at Aston University. That project provides a risk-screening tool based on the knowledge of 46 experts, captured as mind maps that describe relationships between risks and patterns of behavioural cues. Mind mapping, though, fails to impose control over content, and is not considered to formally represent knowledge. In contrast, this thesis treated GRiSTs mind maps as a rich knowledge base in need of refinement; that process drew on existing techniques for designing databases and knowledge bases. Identifying well-defined mind map concepts, though, was hindered by spelling mistakes, and by ambiguity and lack of coverage in the tools used for researching words. A novel use of the Edit Distance overcame those problems, by assessing similarities between mind map texts, and between spelling mistakes and suggested corrections. That algorithm further identified stems, the shortest text string found in related word-forms. As opposed to existing approaches’ reliance on built-in linguistic knowledge, this thesis devised a novel, more flexible text-based technique. An additional tool, Correspondence Analysis, found patterns in word usage that allowed machines to determine likely intended meanings for ambiguous words. Correspondence Analysis further produced clusters of related concepts, which in turn drove the automatic generation of novel mind maps. Such maps underpinned adjuncts to the mind mapping software used by GRiST; one such new facility generated novel mind maps, to reflect the collected expert knowledge on any specified concept. Mind maps from GRiST are stored as XML, which suggested storing them in an XML database. In fact, the entire approach here is ”XML-centric”, in that all stages rely on XML as far as possible. A XML-based query language allows user to retrieve information from the mind map knowledge base. The approach, it was concluded, will prove valuable to mind mapping in general, and to detecting patterns in any type of digital information.

Ontology ranking based on the analysis of concept structures

In view of the need to provide tools to facilitate the re-use of existing knowledge structures such as ontologies, we present in this paper a system, AKTiveRank, for the ranking of ontologies. AKTiveRank uses as input the search terms provided by a knowledge engineer and, using the output of an ontology search engine, ranks the ontologies. We apply a number of metrics in an attempt to investigate their appropriateness for ranking ontologies, and compare the results with a questionnaire-based human study. Our results show that AKTiveRank will have great utility although there is potential for improvement.

A method for automatically eliciting node weights in a hierarchical knowledge-based structure for reasoning with uncertainty

Hierarchical knowledge structures are frequently used within clinical decision support systems as part of the model for generating intelligent advice. The nodes in the hierarchy inevitably have varying influence on the decisionmaking processes, which needs to be reflected by parameters. If the model has been elicited from human experts, it is not feasible to ask them to estimate the parameters because there will be so many in even moderately-sized structures. This paper describes how the parameters could be obtained from data instead, using only a small number of cases. The original method [1] is applied to a particular web-based clinical decision support system called GRiST, which uses its hierarchical knowledge to quantify the risks associated with mental-health problems. The knowledge was elicited from multidisciplinary mental-health practitioners but the tree has several thousand nodes, all requiring an estimation of their relative influence on the assessment process. The method described in the paper shows how they can be obtained from about 200 cases instead. It greatly reduces the experts’ elicitation tasks and has the potential for being generalised to similar knowledge-engineering domains where relative weightings of node siblings are part of the parameter space.

Ranking ontologies with AKTiveRank

Ontology search and reuse is becoming increasingly important as the quest for methods to reduce the cost of constructing such knowledge structures continues. A number of ontology libraries and search engines are coming to existence to facilitate locating and retrieving potentially relevant ontologies. The number of ontologies available for reuse is steadily growing, and so is the need for methods to evaluate and rank existing ontologies in terms of their relevance to the needs of the knowledge engineer. This paper presents AKTiveRank, a prototype system for ranking ontologies based on a number of structural metrics.

Metrics for ranking ontologies

Representing knowledge using domain ontologies has shown to be a useful mechanism and format for managing and exchanging information. Due to the difficulty and cost of building ontologies, a number of ontology libraries and search engines are coming to existence to facilitate reusing such knowledge structures. The need for ontology ranking techniques is becoming crucial as the number of ontologies available for reuse is continuing to grow. In this paper we present AKTiveRank, a prototype system for ranking ontologies based on the analysis of their structures. We describe the metrics used in the ranking system and present an experiment on ranking ontologies returned by a popular search engine for an example query.

Purchase decision-making in fair trade and the ethical 'gap':'is there a fair trade twix?'

Children are increasingly being recognised as a significant force in the retail market place, as primary consumers, influencers of others, and as future customers. This paper adds to the literature on children as consumers by exploring their attitudinal responses to a specific group of products: Fair Trade lines. There has been no research to date that has specifically addressed children as consumers of Fair Trade or the ethical purchase decision-making process in this area. The methodological approach taken here is an essentially interpretive and naturalistic analysis of two focus groups of school children. The analysis found that there is an urgent need to develop meaningful Fair Trade brands that combine strong brand knowledge and positive brand images to bridge the ethical purchase gap between the formation of clear ethical attitudes and actual ethical purchase behaviour. Such an approach would both capture more of the children’s primary market and influence future purchase behaviour. It is argued that Fair Trade actors should coordinate new marketing communications campaigns that build brand knowledge structures holistically around the Fair Trade process and that extend beyond merely raising consumer awareness.

Marking high-technology market evolution through the foci of market stories:the case of local area networks

Previous research suggests that changing consumer and producer knowledge structures play a role in market evolution and that the sociocognitive processes of product markets are revealed in the sensemaking stories of market actors that are rebroadcasted in commercial publications. In this article, the authors lend further support to the story-based nature of market sensemaking and the use of the sociocognitive approach in explaining the evolution of high-technology markets. They examine the content (i.e., subject matter or topic) and volume (i.e., the number) of market stories and the extent to which content and volume of market stories evolve as a technology emerges. Data were obtained from a content analysis of 10,412 article abstracts, published in key trade journals, pertaining to Local Area Network (LAN) technologies and spanning the period 1981 to 2000. Hypotheses concerning the evolving nature (content and volume) of market stories in technology evolution are tested. The analysis identified four categories of market stories - technical, product availability, product adoption, and product discontinuation. The findings show that the emerging technology passes initially through a 'technical-intensive' phase whereby technology related stories dominate, through a 'supply-push' phase, in which stories presenting products embracing the technology tend to exceed technical stories while there is a rise in the number of product adoption reference stories, to a 'product-focus' phase, with stories predominantly focusing on product availability. Overall story volume declines when a technology matures as the need for sensemaking reduces. When stories about product discontinuation surface, these signal the decline of current technology. New technologies that fail to maintain the 'product-focus' stage also reflect limited market acceptance. The article also discusses the theoretical and managerial implications of the study's findings. © 2002 Elsevier Science Inc. All rights reserved.

Designing multiple user perspectives and functionality for clinical decision support systems

Clinical Decision Support Systems (CDSSs) need to disseminate expertise in formats that suit different end users and with functionality tuned to the context of assessment. This paper reports research into a method for designing and implementing knowledge structures that facilitate the required flexibility. A psychological model of expertise is represented using a series of formally specified and linked XML trees that capture increasing elements of the model, starting with hierarchical structuring, incorporating reasoning with uncertainty, and ending with delivering the final CDSS. The method was applied to the Galatean Risk and Safety Tool, GRiST, which is a web-based clinical decision support system (www.egrist.org) for assessing mental-health risks. Results of its clinical implementation demonstrate that the method can produce a system that is able to deliver expertise targetted and formatted for specific patient groups, different clinical disciplines, and alternative assessment settings. The approach may be useful for developing other real-world systems using human expertise and is currently being applied to a logistics domain. © 2013 Polish Information Processing Society.

The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of 'knowledge structures' when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

Bottom-up risk regulation? How nanotechnology risk knowledge gaps challenge federal and state environmental agencies

Nanotechnologies have been called the "Next Industrial Revolution." At the same time, scientists are raising concerns about the potential health and environmental risks related to the nano-sized materials used in nanotechnologies. Analyses suggest that current U.S. federal regulatory structures are not likely to adequately address these risks in a proactive manner. Given these trends, the premise of this paper is that state and local-level agencies will likely deal with many "end-of-pipe" issues as nanomaterials enter environmental media without prior toxicity testing, federal standards, or emissions controls. In this paper we (1) briefly describe potential environmental risks and benefits related to emerging nanotechnologies; (2) outline the capacities of the Toxic Substances Control Act, the Clean Air Act, the Clean Water Act, and the Resources Conservation and Recovery Act to address potential nanotechnology risks, and how risk data gaps challenge these regulations; (3) outline some of the key data gaps that challenge state-level regulatory capacities to address nanotechnologies' potential risks, using Wisconsin as a case study; and (4) discuss advantages and disadvantages of state versus federal approaches to nanotechnology risk regulation. In summary, we suggest some ways government agencies can be better prepared to address nanotechnology risk knowledge gaps and risk management.

Strategic orientations in practice:Exploring the strategic belief structures of line-managers embedded in practice

Recently researchers have started to investigate the cognitive strategic orientations of individual top managers and have pointed out these may be key in determining the direction and success of their organizations in terms of performance, but they have been unable to effectively operationalize this notion in empirical research and this is holding up knowledge development. To make a contribution that helps overcome this limitation a theoretical framework is developed which specifies the different possible cognitive strategic orientations of top managers as well as those of managers at lower organizational levels involved in the strategy process. This theoretical framework is investigated in the empirical phase of the study into strategic orientations in practice. Additional contributions to knowledge of strategic orientation are made in three main domains. Firstly, current knowledge of strategic orientation is largely limited to analysis at the level of the firm whereas there is a lack of understanding of any relationships with practice at lower organizational levels. The exploratory research undertaken for this thesis contributes to new knowledge of different rational, developmental and interactive strategic orientations of front-line managers and this contributes to a cognitive explanation for emergent strategy linked to strategy processes embedded in practice. In theorising the presence of different strategic orientations in practice the discussion highlights the importance of network and spatial embeddedness within enacted environments. Secondly, a contribution to further knowledge of the links between strategy processes and the content of strategies within a retail context is made. The research highlights different strategy processes used in practice by retail front-line managers in a branch network of stores and these are linked to consequences such as different objectives, performance expectations and the fulfilment of personal goals. Thirdly, a contribution to research methodology is made by addressing problems associated with the comparison of cognitive maps.

Cognitive structures, strategies and instruction

This thesis is organised into three parts. In Part 1 relevant literature is reviewed and three critical components in the development of a cognitive approach to instruction are identified. These three components are considered to be the structure of the subject-matter, the learner's cognitive structures, and the learner's cognitive strategies which act as control and transfer devices between the instructional materials and the learner's cognitive structures. Six experiments are described in Part 2 which is divided into two methodologically distinct units. The three experiments of Unit 1 examined how learning from materials constructed from concept name by concept attribute matrices is influenced by learner or experimenter controlled sequence and organisation. The results suggested that the relationships between input organisation, output organisation and recall are complex and highlighted the importance of investigating organisational strategies at both acquisition and recall. The role of subjects previously acquired knowledge and skills in relation to the instructional material was considered to be an important factor. The three experiments of Unit 2 utilised a "diagramming relationships methodology" which was devised as one means of investigating the processes by which new information is assimilated into an individual's cognitive structure. The methodology was found to be useful in identifying cognitive strategies related to successful task performance. The results suggested that errors could be minimised and comprehension improved on the diagramming relationships task by instructing subjects in ways which induced successful processing operations. Part 3 of this thesis highlights salient issues raised by the experimental work within the framework outlined in Part 1 and discusses potential implications for future theoretical developments and research.