Aid decision algorithms to estimate the risk in congenital heart surgery

Background and objective: In this paper, we have tested the suitability of using different artificial intelligence-based algorithms for decision support when classifying the risk of congenital heart surgery. In this sense, classification of those surgical risks provides enormous benefits as the a priori estimation of surgical outcomes depending on either the type of disease or the type of repair, and other elements that influence the final result. This preventive estimation may help to avoid future complications, or even death. Methods: We have evaluated four machine learning algorithms to achieve our objective: multilayer perceptron, self-organizing map, radial basis function networks and decision trees. The architectures implemented have the aim of classifying among three types of surgical risk: low complexity, medium complexity and high complexity. Results: Accuracy outcomes achieved range between 80% and 99%, being the multilayer perceptron method the one that offered a higher hit ratio. Conclusions: According to the results, it is feasible to develop a clinical decision support system using the evaluated algorithms. Such system would help cardiology specialists, paediatricians and surgeons to forecast the level of risk related to a congenital heart disease surgery.

Study of management decision making by ward sisters in a hospital and the effects on decision making after the implementation of a decision support sytem

This thesis considers management decision making at the ward level in hospitals especially by ward sisters, and the effectiveness of the intervention of a decision support system. Nursing practice theories were related to organisation and management theories in order to conceptualise a decision making framework for nurse manpower planning and deployment at the ward level. Decision and systems theories were explored to understand the concepts of decision making and the realities of power in an organisation. In essence, the hypothesis was concerned with changes in patterns of decision making that could occur with the intervention of a decision support system and that the degree of change would be governed by a set of `difficulty' factors within wards in a hospital. During the course of the study, a classification of ward management decision making was created, together with the development and validation of measuring instruments to test the research hypothesis. The decision support system used was rigorously evaluated to test whether benefits did accrue from its implementation. Quantitative results from sample wards together with qualitative information collected, were used to test this hypothesis and the outcomes postulated were supported by these findings. The main conclusion from this research is that a more rational approach to management decision making is feasible, using information from a decision support system. However, wards and ward sisters that need the most assistance, where the `difficulty' factors in the organisation are highest, benefit the least from this type of system. Organisational reviews are needed on these identified wards, involving managers and doctors, to reduce the levels of un-coordinated activities and disruption.

Planning and decision-making for energy recovery from waste at the sub-regional level

This research project has developed a novel decision support system using Geographical Information Systems and Multi Criteria Decision Analysis and used it to develop and evaluate energy-from-waste policy options. The system was validated by applying it to the UK administrative areas of Cornwall and Warwickshire. Different strategies have been defined by the size and number of the facilities, as well as the technology chosen. Using sensitivity on the results from the decision support system, it was found that key decision criteria included those affected by cost, energy efficiency, transport impacts and air/dioxin emissions. The conclusions of this work are that distributed small-scale energy-from-waste facilities score most highly overall and that scale is more important than technology design in determining overall policy impact. This project makes its primary contribution to energy-from-waste planning by its development of a Decision Support System that can be used to assist waste disposal authorities to identify preferred energy-from-waste options that have been tailored specifically to the socio-geographic characteristics of their jurisdictional areas. The project also highlights the potential of energy-from-waste policies that are seldom given enough attention to in the UK, namely those of a smaller-scale and distributed nature that often have technology designed specifically to cater for this market.

Knowledge engineering for mental-health risk assessment and decision support

Mental-health risk assessment practice in the UK is mainly paper-based, with little standardisation in the tools that are used across the Services. The tools that are available tend to rely on minimal sets of items and unsophisticated scoring methods to identify at-risk individuals. This means the reasoning by which an outcome has been determined remains uncertain. Consequently, there is little provision for: including the patient as an active party in the assessment process, identifying underlying causes of risk, and eecting shared decision-making. This thesis develops a tool-chain for the formulation and deployment of a computerised clinical decision support system for mental-health risk assessment. The resultant tool, GRiST, will be based on consensual domain expert knowledge that will be validated as part of the research, and will incorporate a proven psychological model of classication for risk computation. GRiST will have an ambitious remit of being a platform that can be used over the Internet, by both the clinician and the layperson, in multiple settings, and in the assessment of patients with varying demographics. Flexibility will therefore be a guiding principle in the development of the platform, to the extent that GRiST will present an assessment environment that is tailored to the circumstances in which it nds itself. XML and XSLT will be the key technologies that help deliver this exibility.

Decision support for lifecycle planning and risk management of small-scale biomass combined heat and power (bCHP) projects in the UK

Biomass is projected to account for approximately half of the new energy production required to achieve the 2020 primary energy target in the UK. Combined heat and power (CHP) bioenergy systems are not only a highly efficient method of energy conversion, at smaller-scales a significant proportion of the heat produced can be effectively utilised for hot water, space heating or industrial heating purposes. However, there are many barriers to project development and this has greatly inhibited deployment in the UK. Project viability is highly subjective to changes in policy, regulation, the finance market and the low cost incumbent; a high carbon centralised energy system. Unidentified or unmitigated barriers occurring during the project lifecycle may not only negatively impact on the project but could ultimately lead to project failure. The research develops a decision support system (DSS) for small-scale (500 kWe to 10 MWe) biomass combustion CHP project development and risk management in the early stages of a potential project’s lifecycle. By supporting developers in the early stages of project development with financial, scheduling and risk management analysis, the research aims to reduce the barriers identified and streamline decision-making. A fuzzy methodology is also applied throughout the developed DSS to support developers in handling the uncertain or approximate information often held at the early stages of the project lifecycle. The DSS is applied to a case study of a recently failed (2011) small-scale biomass CHP project to demonstrate its applicability and benefits. The application highlights that the proposed development within the case study was not viable. Moreover, further analysis of the possible barriers with the DSS confirmed that some possible modifications to be project could have improved this, such as a possible change of feedstock to a waste or residue, addressing the unnecessary land lease cost or by increasing heat utilisation onsite. This analysis is further supported by a practitioner evaluation survey that confirms the research contribution and objectives are achieved.

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.

A sustainable supply chain study of the Indian bioenergy sector

In India, more than one third of the population do not currently have access to modern energy services. Biomass to energy, known as bioenergy, has immense potential for addressing India’s energy poverty. Small scale decentralised bioenergy systems require low investment compared to other renewable technologies and have environmental and social benefits over fossil fuels. Though they have historically been promoted in India through favourable policies, many studies argue that the sector’s potential is underutilised due to sustainable supply chain barriers. Moreover, a significant research gap exists. This research addresses the gap by analysing the potential sustainable supply chain risks of decentralised small scale bioenergy projects. This was achieved through four research objectives, using various research methods along with multiple data collection techniques. Firstly, a conceptual framework was developed to identify and analyse these risks. The framework is founded on existing literature and gathered inputs from practitioners and experts. Following this, sustainability and supply chain issues within the sector were explored. Sustainability issues were collated into 27 objectives, and supply chain issues were categorised according to related processes. Finally, the framework was validated against an actual bioenergy development in Jodhpur, India. Applying the framework to the action research project had some significant impacts upon the project’s design. These include the development of water conservation arrangements, the insertion of auxiliary arrangements, measures to increase upstream supply chain resilience, and the development of a first aid action plan. More widely, the developed framework and identified issues will help practitioners to take necessary precautionary measures and address them quickly and cost effectively. The framework contributes to the bioenergy decision support system literature and the sustainable supply chain management field by incorporating risk analysis and introducing the concept of global and organisational sustainability in supply chains. The sustainability issues identified contribute to existing knowledge through the exploration of a small scale and developing country context. The analysis gives new insights into potential risks affecting the whole bioenergy supply chain.

Bioenergy decision support systems:worth the effort?

The purpose of this research is to explore the disparity between the existing model-orientated bioenergy decision support system (DSS) functions and what is desired by practitioners, in particular bioenergy project developers. This research has compiled the published bioenergy project development models, to highlight the characteristics emphasised by academics. When contrasted against a UK practitioner’s perspective through the administration of a Likert style questionnaire, it is clear that the general DSS issues still persist. Finally, the research suggests how this ’theory-practice’ divide could be addressed. The research contribute

A Multi-agent Framework for Distributed Decision-making Systems

An approach of building distributed decision support systems is proposed. There is defined a framework of a distributed DSS and examined questions of problem formulation and solving using artificial intellectual agents in system core.

Towards the Problems of an Evaluation of Data Uncertainty in Decision Support Systems

The question of forming aim-oriented description of an object domain of decision support process is outlined. Two main problems of an estimation and evaluation of data and knowledge uncertainty in decision support systems – straight and reverse, are formulated. Three conditions being the formalized criteria of aimoriented constructing of input, internal and output spaces of some decision support system are proposed. Definitions of appeared and hidden data uncertainties on some measuring scale are given.

Probabilistic multiple model neural network based leak detection system:experimental study

This paper presents an effective decision making system for leak detection based on multiple generalized linear models and clustering techniques. The training data for the proposed decision system is obtained by setting up an experimental pipeline fully operational distribution system. The system is also equipped with data logging for three variables; namely, inlet pressure, outlet pressure, and outlet flow. The experimental setup is designed such that multi-operational conditions of the distribution system, including multi pressure and multi flow can be obtained. We then statistically tested and showed that pressure and flow variables can be used as signature of leak under the designed multi-operational conditions. It is then shown that the detection of leakages based on the training and testing of the proposed multi model decision system with pre data clustering, under multi operational conditions produces better recognition rates in comparison to the training based on the single model approach. This decision system is then equipped with the estimation of confidence limits and a method is proposed for using these confidence limits for obtaining more robust leakage recognition results.

Integrating service user and practitioner expertise within a web-based system for collaborative mental-health risk and safety management

Objectives: To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. Methods: An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Results: Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs' preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. Conclusion: The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance. Practice Implications: The GRiST web-based DSS (www.egrist.org) links and integrates myGRaCE self-assessments with GRiST practitioner assessments for supporting collaborative and self-managed healthcare.

An inconsistency control system based on incomplete pairwise comparison matrices

Incomplete pairwise comparison matrix was introduced by Harker in 1987 for the case in which the decision maker does not fill in the whole matrix completely due to, e.g., time limitations. However, incomplete matrices occur in a natural way even if the decision maker provides a completely filled in matrix in the end. In each step of the total n(n–1)/2, an incomplete pairwise comparison is given, except for the last one where the matrix turns into complete. Recent results on incomplete matrices make it possible to estimate inconsistency indices CR and CM by the computation of tight lower bounds in each step of the filling in process. Additional information on ordinal inconsistency is also provided. Results can be applied in any decision support system based on pairwise comparison matrices. The decision maker gets an immediate feedback in case of mistypes, possibly causing a high level of inconsistency.

Consistency of the decision-maker in pair-wise comparisons

Most authors assume that the natural behaviour of the decision-maker is being inconsistent. This paper investigates the main sources of inconsistency and analyses methods for reducing or eliminating inconsistency. Decision support systems can contain interactive modules for that purpose. In a system with consistency control, there are three stages. First, consistency should be checked: a consistency measure is needed. Secondly, approval or rejection has to be decided: a threshold value of inconsistency measure is needed. Finally, if inconsistency is ‘high’, corrections have to be made: an inconsistency reducing method is needed. This paper reviews the difficulties in all stages. An entirely different approach is to elaborate a decision support system in order to force the decision-maker to give consistent values in each step of answering pair-wise comparison questions. An interactive questioning procedure resulting in consistent (sub) matrices has been demonstrated.

MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis

Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.