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.

Supporting decision-making for self-adaptive systems:from goal models to dynamic decision networks

Context/Motivation - Different modeling techniques have been used to model requirements and decision-making of self-adaptive systems (SASs). Specifically, goal models have been prolific in supporting decision-making depending on partial and total fulfilment of functional (goals) and non-functional requirements (softgoals). Different goalrealization strategies can have different effects on softgoals which are specified with weighted contribution-links. The final decision about what strategy to use is based, among other reasons, on a utility function that takes into account the weighted sum of the different effects on softgoals. Questions/Problems - One of the main challenges about decisionmaking in self-adaptive systems is to deal with uncertainty during runtime. New techniques are needed to systematically revise the current model when empirical evidence becomes available from the deployment. Principal ideas/results - In this paper we enrich the decision-making supported by goal models by using Dynamic Decision Networks (DDNs). Goal realization strategies and their impact on softgoals have a correspondence with decision alternatives and conditional probabilities and expected utilities in the DDNs respectively. Our novel approach allows the specification of preferences over the softgoals and supports reasoning about partial satisfaction of softgoals using probabilities. We report results of the application of the approach on two different cases. Our early results suggest the decision-making process of SASs can be improved by using DDNs. © 2013 Springer-Verlag.

Measurement of implicit leadership theories and their effect on leadership processes and outcomes

The leadership categorisation theory suggests that followers rely on a hierarchical cognitive structure in perceiving leaders and the leadership process, which consists of three levels; superordinate, basic and subordinate. The predominant view is that followers rely on Implicit Leadership Theories (ILTs) at the basic level in making judgments about managers. The thesis examines whether this presumption is true by proposing and testing two competing conceptualisations; namely the congruence between the basic level ILTs (general leader) and actual manager perceptions, and subordinate level ILTs (job-specific leader) and actual manager. The conceptualisation at the job-specific level builds on context-related assertions of the ILT explanatory models: leadership categorisation, information processing and connectionist network theories. Further, the thesis addresses the effects of ILT congruence at the group level. The hypothesised model suggests that Leader-Member Exchange (LMX) will act as a mediator between ILT congruence and outcomes. Three studies examined the proposed model. The first was cross-sectional with 175 students reporting on work experience during a 1-year industrial placement. The second was longitudinal and had a sample of 343 students engaging in a business simulation in groups with formal leadership. The final study was a cross-sectional survey in several organisations with a sample of 178. A novel approach was taken to congruence analysis; the hypothesised models were tested using Latent Congruence Modelling (LCM), which accounts for measurement error and overcomes the majority of limitations of traditional approaches. The first two studies confirm the traditional theorised view that employees rely on basic-level ILTs in making judgments about their managers with important implications, and show that LMX mediates the relationship between ILT congruence and work-related outcomes (performance, job satisfaction, well-being, task satisfaction, intragroup conflict, group satisfaction, team realness, team-member exchange, group performance). The third study confirms this with conflict, well-being, self-rated performance and commitment as outcomes.

A simultaneous examination of the effects of salesperson relationship-building activities and marketing activities on retail buyers' purchase decisions

Firms’ contemporary selling practices often not only demand that salespeople meet sales quotas, but also that they build strong, profitable relationships with customers. Given the belief that relationship-building activities can develop closer customer ties and improve sales performance, scholars have increasingly studied salesperson behaviors aimed at nurturing buyer-salesperson relations. However, while previous sales research has investigated the effects of a number of relational activities on performance outcomes in isolation, knowledge about their effectiveness in comparison to other important performance drivers is virtually absent. The present study provides some first theoretical and empirical insights into this research gap by simultaneously examining the role of specific salesperson relationship-building activities, and product-focused variables, in retail buyers’ new product purchase decisions. Following an extensive literature review, a two-part qualitative field study was conducted to explore salesperson relationship-building activities that are regarded as important by retail buyers. Two key relational behaviors were suggested by the customer-centric and retail industry-specific data; salesperson consultation (communication-based) and salesperson helping behavior (action-based). Drawing on this as well as extant literature, a conceptual framework was developed concerning the influences of these relationship-building activities and other product-focused factors on retail buyers’ new product acceptance. The study’s quantitative component contained a mail and web survey of U.S. retail buyers, resulting in a total dataset of 192 responses. After a comprehensive measure validation process, the theoretical hypotheses were tested using logistic regression analysis. Contrary to existing assertions, the results suggest that salesperson relationship-building activities themselves do not directly and/or indirectly influence purchase decisions, but instead can moderate the effects of product-focused determinants on retail buyers’ new product selections. Data on actual purchase decisions provide a high level of external validity to the findings. The study closes with a concluding discussion, including theoretical and managerial implications of the findings, limitations of the research, and directions for future inquiry.

The role of models@run.time in supporting on-the-fly interoperability

Models at runtime can be defined as abstract representations of a system, including its structure and behaviour, which exist in tandem with the given system during the actual execution time of that system. Furthermore, these models should be causally connected to the system being modelled, offering a reflective capability. Significant advances have been made in recent years in applying this concept, most notably in adaptive systems. In this paper we argue that a similar approach can also be used to support the dynamic generation of software artefacts at execution time. An important area where this is relevant is the generation of software mediators to tackle the crucial problem of interoperability in distributed systems. We refer to this approach as emergent middleware, representing a fundamentally new approach to resolving interoperability problems in the complex distributed systems of today. In this context, the runtime models are used to capture meta-information about the underlying networked systems that need to interoperate, including their interfaces and additional knowledge about their associated behaviour. This is supplemented by ontological information to enable semantic reasoning. This paper focuses on this novel use of models at runtime, examining in detail the nature of such runtime models coupled with consideration of the supportive algorithms and tools that extract this knowledge and use it to synthesise the appropriate emergent middleware.

A view of the dynamic software product line landscape

Dynamic software product lines extend the concept of conventional SPLs by enabling software-variant generation at runtime. Recent studies yield insights into the current state of the DSPL field, research trends, and major gaps to address.

Towards requirements aware systems:run-time resolution of design-time assumptions

In earlier work we proposed the idea of requirements-aware systems that could introspect about the extent to which their goals were being satisfied at runtime. When combined with requirements monitoring and self adaptive capabilities, requirements awareness should help optimize goal satisfaction even in the presence of changing run-time context. In this paper we describe initial progress towards the realization of requirements-aware systems with REAssuRE. REAssuRE focuses on explicit representation of assumptions made at design time. When such assumptions are shown not to hold, REAssuRE can trigger system adaptations to alternative goal realization strategies.

Modeling and validating dynamic adaptation

This paper discusses preliminary work on modeling and validation dynamic adaptation. The proposed approach is on the use of aspect-oriented modeling (AOM) and models at runtime. Our approach covers design and runtime phases. At design-time, a base model and different variant architecture models are designed and the adaptation model is built. Crucially, the adaptation model includes invariant properties and constraints that allow the validation of the adaptation rules before execution. During runtime, the adaptation model is processed to produce a correct system configuration that can be executed.

An aspect-oriented and model-driven approach for managing dynamic variability

Constructing and executing distributed systems that can adapt to their operating context in order to sustain provided services and the service qualities are complex tasks. Managing adaptation of multiple, interacting services is particularly difficult since these services tend to be distributed across the system, interdependent and sometimes tangled with other services. Furthermore, the exponential growth of the number of potential system configurations derived from the variabilities of each service need to be handled. Current practices of writing low-level reconfiguration scripts as part of the system code to handle run time adaptation are both error prone and time consuming and make adaptive systems difficult to validate and evolve. In this paper, we propose to combine model driven and aspect oriented techniques to better cope with the complexities of adaptive systems construction and execution, and to handle the problem of exponential growth of the number of possible configurations. Combining these techniques allows us to use high level domain abstractions, simplify the representation of variants and limit the problem pertaining to the combinatorial explosion of possible configurations. In our approach we also use models at runtime to generate the adaptation logic by comparing the current configuration of the system to a composed model representing the configuration we want to reach. © 2008 Springer-Verlag Berlin Heidelberg.

Using architecture models to support the generation and operation of component-based adaptive systems

Modelling architectural information is particularly important because of the acknowledged crucial role of software architecture in raising the level of abstraction during development. In the MDE area, the level of abstraction of models has frequently been related to low-level design concepts. However, model-driven techniques can be further exploited to model software artefacts that take into account the architecture of the system and its changes according to variations of the environment. In this paper, we propose model-driven techniques and dynamic variability as concepts useful for modelling the dynamic fluctuation of the environment and its impact on the architecture. Using the mappings from the models to implementation, generative techniques allow the (semi) automatic generation of artefacts making the process more efficient and promoting software reuse. The automatic generation of configurations and reconfigurations from models provides the basis for safer execution. The architectural perspective offered by the models shift focus away from implementation details to the whole view of the system and its runtime change promoting high-level analysis. © 2009 Springer Berlin Heidelberg.

Market-awareness in service-based systems

Service-based systems are applications built by composing pre-existing services. During design time and according to the specifications, a set of services is selected. Both, service providers and consumers exist in a service market that is constantly changing. Service providers continuously change their quality of services (QoS), and service consumers can update their specifications according to what the market is offering. Therefore, during runtime, the services are periodically and manually checked to verify if they still satisfy the specifications. Unfortunately, humans are overwhelmed with the degree of changes exhibited by the service market. Consequently, verification of the compliance specification and execution of the corresponding adaptations when deviations are detected cannot be carried out in a manual fashion. In this work, we propose a framework to enable online awareness of changes in the service market in both consumers and providers by representing them as active software agents. At runtime, consumer agents concretize QoS specifications according to the available market knowledge. Services agents are collectively aware of themselves and of the consumers' requests. Moreover, they can create and maintain virtual organizations to react actively to demands that come from the market. In this paper we show preliminary results that allow us to conclude that the creation and adaptation of service-based systems can be carried out by a self-organized service market system. © 2012 IEEE.

Mitigating the obsolescence of quality specifications models in service-based systems

Requirements-aware systems address the need to reason about uncertainty at runtime to support adaptation decisions, by representing quality of services (QoS) requirements for service-based systems (SBS) with precise values in run-time queryable model specification. However, current approaches do not support updating of the specification to reflect changes in the service market, like newly available services or improved QoS of existing ones. Thus, even if the specification models reflect design-time acceptable requirements they may become obsolete and miss opportunities for system improvement by self-adaptation. This articles proposes to distinguish "abstract" and "concrete" specification models: the former consists of linguistic variables (e.g. "fast") agreed upon at design time, and the latter consists of precise numeric values (e.g. "2ms") that are dynamically calculated at run-time, thus incorporating up-to-date QoS information. If and when freshly calculated concrete specifications are not satisfied anymore by the current service configuration, an adaptation is triggered. The approach was validated using four simulated SBS that use services from a previously published, real-world dataset; in all cases, the system was able to detect unsatisfied requirements at run-time and trigger suitable adaptations. Ongoing work focuses on policies to determine recalculation of specifications. This approach will allow engineers to build SBS that can be protected against market-caused obsolescence of their requirements specifications. © 2012 IEEE.

Run-time model evaluation for requirements model-driven self-adaptation

A self-adaptive system adjusts its configuration to tolerate changes in its operating environment. To date, requirements modeling methodologies for self-adaptive systems have necessitated analysis of all potential system configurations, and the circumstances under which each is to be adopted. We argue that, by explicitly capturing and modelling uncertainty in the operating environment, and by verifying and analysing this model at runtime, it is possible for a system to adapt to tolerate some conditions that were not fully considered at design time. We showcase in this paper our tools and research results. © 2012 IEEE.

Satisfying requirements for pervasive service compositions

Pervasive environments are characterised by highly heterogeneous services and mobile devices with dynamic availability. Approaches such as that proposed by the Connect project provide means to enable such systems to be discovered and composed, through mediation where necessary. As services appear and disappear, the set of feasible compositions changes. In such a pervasive environment, a designer encounters two related challenges: what goals it is reasonable to pursue in the current context and how to use the services presently available to achieve his goals. This paper proposes an approach to design service compositions, facilitating an interactive process to find the trade-off between the possible and the desirable. Following our approach, the system finds at runtime, where possible, compositions related to the developer's requirements. This process can realise the intent the developer specifies at design time, taking into account the services available at runtime, without a prohibitive level of pre-specification, inappropriate for such dynamic environments. © 2012 ACM.

Self-explanation in adaptive systems

The behaviour of self adaptive systems can be emergent. The difficulty in predicting the system's behaviour means that there is scope for the system to surprise its customers and its developers. Because its behaviour is emergent, a self-adaptive system needs to garner confidence in its customers and it needs to resolve any surprise on the part of the developer during testing and mainteinance. We believe that these two functions can only be achieved if a self-adaptive system is also capable of self-explanation. We argue a self-adaptive system's behaviour needs to be explained in terms of satisfaction of its requirements. Since self-adaptive system requirements may themselves be emergent, a means needs to be found to explain the current behaviour of the system and the reasons that brought that behaviour about. We propose the use of goal-based models during runtime to offer self-explanation of how a system is meeting its requirements, and why the means of meeting these were chosen. We discuss the results of early experiments in self-explanation, and set out future work. © 2012 C.E.S.A.M.E.S.