An ICT-based closed-loop model to improve care for heart failure patients

Durante las últimas décadas se ha producido un fenómeno global de envejecimiento en la población. Esta tendencia se puede observar prácticamente en todos los países del mundo y se debe principalmente a los avances en la medicina, y a los descensos en las tasas de fertilidad y mortalidad. El envejecimiento de la población tiene un gran impacto en la salud de los ciudadanos, y a menudo es la causa de aparición de enfermedades crónicas. Este tipo de enfermedades supone una amenaza y una carga importantes para la sociedad, especialmente en aspectos como la mortalidad o los gastos en los sistemas sanitarios. Entre las enfermedades cardiovasculares, la insuficiencia cardíaca es probablemente la condición con mayor prevalencia y afecta a 23-26 millones de personas en todo el mundo. Normalmente, la insuficiencia cardíaca presenta un mal pronóstico y una tasa de supervivencia bajas, en algunos casos peores que algún tipo de cáncer. Además, suele ser la causa de hospitalizaciones frecuentes y es una de las enfermedades más costosas para los sistemas sanitarios. La tendencia al envejecimiento de la población y la creciente incidencia de las enfermedades crónicas están llevando a una situación en la que los sistemas de salud no son capaces de hacer frente a la demanda de la sociedad. Los servicios de salud existentes tendrán que adaptarse para ser efectivos y sostenibles en el futuro. Es necesario identificar nuevos paradigmas de cuidado de pacientes, así como mecanismos para la provisión de servicios que ayuden a transformar estos sistemas sanitarios. En este contexto, esta tesis se plantea la búsqueda de soluciones, basadas en las Tecnologías de la Información y la Comunicación (TIC), que contribuyan a realizar la transformación en los sistemas sanitarios. En concreto, la tesis se centra en abordar los problemas de una de las enfermedades con mayor impacto en estos sistemas: la insuficiencia cardíaca. Las siguientes hipótesis constituyen la base para la realización de este trabajo de investigación: 1. Es posible definir un modelo basado en el paradigma de lazo cerrado y herramientas TIC que formalice el diseño de mejores servicios para pacientes con insuficiencia cardíaca. 2. El modelo de lazo cerrado definido se puede utilizar para definir un servicio real que ayude a gestionar la insuficiencia cardíaca crónica. 3. La introducción, la adopción y el uso de un servicio basado en el modelo definido se traducirá en mejoras en el estado de salud de los pacientes que sufren insuficiencia cardíaca. a. La utilización de un sistema basado en el modelo de lazo cerrado definido mejorará la experiencia del usuario de los pacientes. La definición del modelo planteado se ha basado en el estándar ISO / EN 13940- Sistema de conceptos para dar soporte a la continuidad de la asistencia. Comprende un conjunto de conceptos, procesos, flujos de trabajo, y servicios como componentes principales, y representa una formalización de los servicios para los pacientes con insuficiencia cardíaca. Para evaluar el modelo definido se ha definido un servicio real basado en el mismo, además de la implementación de un sistema de apoyo a dicho servicio. El diseño e implementación de dicho sistema se realizó siguiendo la metodología de Diseño Orientado a Objetivos. El objetivo de la evaluación consistía en investigar el efecto que tiene un servicio basado en el modelo de lazo cerrado sobre el estado de salud de los pacientes con insuficiencia cardíaca. La evaluación se realizó en el marco de un estudio clínico observacional. El análisis de los resultados ha comprendido métodos de análisis cuantitativos y cualitativos. El análisis cuantitativo se ha centrado en determinar el estado de salud de los pacientes en base a datos objetivos (obtenidos en pruebas de laboratorio o exámenes médicos). Para realizar este análisis se definieron dos índices específicos: el índice de estabilidad y el índice de la evolución del estado de salud. El análisis cualitativo ha evaluado la autopercepción del estado de salud de los pacientes en términos de calidad de vida, auto-cuidado, el conocimiento, la ansiedad y la depresión, así como niveles de conocimiento. Se ha basado en los datos recogidos mediante varios cuestionarios o instrumentos estándar (i.e. EQ-5D, la Escala de Ansiedad y Depresión (HADS), el Cuestionario de Cardiomiopatía de Kansas City (KCCQ), la Escala Holandesa de Conocimiento de Insuficiencia Cardíaca (DHFKS), y la Escala Europea de Autocuidado en Insuficiencia Cardíaca (EHFScBS), así como cuestionarios dedicados no estandarizados de experiencia de usuario. Los resultados obtenidos en ambos análisis, cuantitativo y cualitativo, se compararon con el fin de evaluar la correlación entre el estado de salud objetivo y subjetivo de los pacientes. Los resultados de la validación demostraron que el modelo propuesto tiene efectos positivos en el cuidado de los pacientes con insuficiencia cardíaca y contribuye a mejorar su estado de salud. Asimismo, ratificaron al modelo como instrumento válido para la definición de servicios mejorados para la gestión de esta enfermedad. ABSTRACT During the last decades we have witnessed a global aging phenomenon in the population. This can be observed in practically every country in the world, and it is mainly caused by the advances in medicine, and the decrease of mortality and fertility rates. Population aging has an important impact on citizens’ health and it is often the cause for chronic diseases, which constitute global burden and threat to the society in terms of mortality and healthcare expenditure. Among chronic diseases, Chronic Heart Failure (CHF) or Heart Failure (HF) is probably the one with highest prevalence, affecting between 23 and 26 million people worldwide. Heart failure is a chronic, long-term and serious condition with very poor prognosis and worse survival rates than some type of cancers. Additionally, it is often the cause of frequent hospitalizations and one of the most expensive conditions for the healthcare systems. The aging trends in the population and the increasing incidence of chronic diseases are leading to a situation where healthcare systems are not able to cope with the society demand. Current healthcare services will have to be adapted and redefined in order to be effective and sustainable in the future. There is a need to find new paradigms for patients’ care, and to identify new mechanisms for services’ provision that help to transform the healthcare systems. In this context, this thesis aims to explore new solutions, based on ICT, that contribute to achieve the needed transformation within the healthcare systems. In particular, it focuses on addressing the problems of one of the diseases with higher impact within these systems: Heart Failure. The following hypotheses represent the basis to the elaboration of this research: 1. It is possible to define a model based on a closed-loop paradigm and ICT tools that formalises the design of enhanced healthcare services for chronic heart failure patients. 2. The described closed-loop model can be exemplified in a real service that supports the management of chronic heart failure disease. 3. The introduction, adoption and use of a service based on the outlined model will result in improvements in the health status of patients suffering heart failure. 4. The user experience of patients when utilizing a system based on the defined closed-loop model will be enhanced. The definition of the closed-loop model for health care support of heart failure patients have been based on the standard ISO/EN 13940 System of concepts to support continuity of care. It includes a set of concept, processes and workflows, and services as main components, and it represent a formalization of services for heart failure patients. In order to be validated, the proposed closed-loop model has been instantiated into a real service and a supporting IT system. The design and implementation of the system followed the user centred design methodology Goal Oriented Design. The validation, that included an observational clinical study, aimed to investigate the effect that a service based on the closed-loop model had on heart failure patients’ health status. The analysis of results comprised quantitative and qualitative analysis methods. The quantitative analysis was focused on determining the health status of patients based on objective data (obtained in lab tests or physical examinations). Two specific indexes where defined and considered in this analysis: the stability index and the health status evolution index. The qualitative analysis assessed the self-perception of patients’ health status in terms of quality of life, self-care, knowledge, anxiety and depression, as well as knowledge levels. It was based on the data gathered through several standard instruments (i.e. EQ-5D, the Hospital Anxiety and Depression Scale, the Kansas City Cardiomyopathy Questionnaire, the Dutch Heart Failure Knowledge Scale, and the European Heart Failure Self-care Behaviour Scale) as well as dedicated non-standardized user experience questionnaires. The results obtained in both analyses, quantitative and qualitative, were compared in order to assess the correlation between the objective and subjective health status of patients. The results of the validation showed that the proposed model contributed to improve the health status of the patients and had a positive effect on the patients’ care. It also proved that the model is a valid instrument for designing enhanced healthcare services for heart failure patients.

Development of a Strengths-Based Model for Insurance Automobile, Property, and Casualty Claims Operations

ABSTRACT \ Employers know that to have a successful organization, they must have the right people in the right jobs. But how will they know whom to place where? The development of a model based upon an individual's personality traits and strengths, and how to best use them, is a good place to start. Employees working in positions in which their traits and strengths are maximized enjoy work more, are more efficient, and are less apt to be absent or to look for work elsewhere. It is a mutually beneficial process of selection for both employers and employees. This model illustrates the process in an automobile and property insurance claims operation through utilization of the Myers-Briggs Type Indicators and the StrengthsFinder Profiles.

Analysis of cardiac ventricular wall motion based on a three-dimensional electromechanical biventricular model

This paper describes a biventricular model, which couples the electrical and mechanical properties of the heart, and computer simulations of ventricular wall motion and deformation by means of a biventricular model. In the constructed electromechanical model, the mechanical analysis was based on composite material theory and the finite-element method; the propagation of electrical excitation was simulated using an electrical heart model, and the resulting active forces were used to calculate ventricular wall motion. Regional deformation and Lagrangian strain tensors were calculated during the systole phase. Displacements, minimum principal strains and torsion angle were used to describe the motion of the two ventricles. The simulations showed that during the period of systole, (1) the right ventricular free wall moves towards the septum, and at the same time, the base and middle of the free wall move towards the apex, which reduces the volume of the right ventricle; the minimum principle strain (E3) is largest at the apex, then at the middle of the free wall and its direction is in the approximate direction of the epicardial muscle fibres; (2) the base and middle of the left ventricular free wall move towards the apex and the apex remains almost static; the torsion angle is largest at the apex; the minimum principle strain E3 is largest at the apex and its direction on the surface of the middle wall of the left ventricle is roughly in the fibre orientation. These results are in good accordance with results obtained from MR tagging images reported in the literature. This study suggests that such an electromechanical biventricular model has the potential to be used to assess the mechanical function of the two ventricles, and also could improve the accuracy ECG simulation when it is used in heart torso model-based body surface potential simulation studies.

A fuzzy AHP based integer linear programming model for the multi-criteria transshipment problem

Purpose – The purpose of this research is to develop a holistic approach to maximize the customer service level while minimizing the logistics cost by using an integrated multiple criteria decision making (MCDM) method for the contemporary transshipment problem. Unlike the prevalent optimization techniques, this paper proposes an integrated approach which considers both quantitative and qualitative factors in order to maximize the benefits of service deliverers and customers under uncertain environments. Design/methodology/approach – This paper proposes a fuzzy-based integer linear programming model, based on the existing literature and validated with an example case. The model integrates the developed fuzzy modification of the analytic hierarchy process (FAHP), and solves the multi-criteria transshipment problem. Findings – This paper provides several novel insights about how to transform a company from a cost-based model to a service-dominated model by using an integrated MCDM method. It suggests that the contemporary customer-driven supply chain remains and increases its competitiveness from two aspects: optimizing the cost and providing the best service simultaneously. Research limitations/implications – This research used one illustrative industry case to exemplify the developed method. Considering the generalization of the research findings and the complexity of the transshipment service network, more cases across multiple industries are necessary to further enhance the validity of the research output. Practical implications – The paper includes implications for the evaluation and selection of transshipment service suppliers, the construction of optimal transshipment network as well as managing the network. Originality/value – The major advantages of this generic approach are that both quantitative and qualitative factors under fuzzy environment are considered simultaneously and also the viewpoints of service deliverers and customers are focused. Therefore, it is believed that it is useful and applicable for the transshipment service network design.

Computational model of bladder tissue based on its measured optical properties

Urinary bladder diseases are a common problem throughout the world and often difficult to accurately diagnose. Furthermore, they pose a heavy financial burden on health services. Urinary bladder tissue from male pigs was spectrophotometrically measured and the resulting data used to calculate the absorption, transmission, and reflectance parameters, along with the derived coefficients of scattering and absorption. These were employed to create a "generic" computational bladder model based on optical properties, simulating the propagation of photons through the tissue at different wavelengths. Using the Monte-Carlo method and fluorescence spectra of UV and blue excited wavelength, diagnostically important biomarkers were modeled. Additionally, the multifunctional noninvasive diagnostics system "LAKK-M" was used to gather fluorescence data to further provide essential comparisons. The ultimate goal of the study was to successfully simulate the effects of varying excited radiation wavelengths on bladder tissue to determine the effectiveness of photonics diagnostic devices. With increased accuracy, this model could be used to reliably aid in differentiating healthy and pathological tissues within the bladder and potentially other hollow organs.

Case Based Heuristic Selection for Timetabling Problems

This paper presents a case-based heuristic selection approach for automated university course and exam timetabling. The method described in this paper is motivated by the goal of developing timetabling systems that are fundamentally more general than the current state of the art. Heuristics that worked well in previous similar situations are memorized in a case base and are retrieved for solving the problem in hand. Knowledge discovery techniques are employed in two distinct scenarios. Firstly, we model the problem and the problem solving situations along with specific heuristics for those problems. Secondly, we refine the case base and discard cases which prove to be non-useful in solving new problems. Experimental results are presented and analyzed. It is shown that case based reasoning can act effectively as an intelligent approach to learn which heuristics work well for particular timetabling situations. We conclude by outlining and discussing potential research issues in this critical area of knowledge discovery for different difficult timetabling problems.

Case Based Heuristic Selection for Timetabling Problems

This paper presents a case-based heuristic selection approach for automated university course and exam timetabling. The method described in this paper is motivated by the goal of developing timetabling systems that are fundamentally more general than the current state of the art. Heuristics that worked well in previous similar situations are memorized in a case base and are retrieved for solving the problem in hand. Knowledge discovery techniques are employed in two distinct scenarios. Firstly, we model the problem and the problem solving situations along with specific heuristics for those problems. Secondly, we refine the case base and discard cases which prove to be non-useful in solving new problems. Experimental results are presented and analyzed. It is shown that case based reasoning can act effectively as an intelligent approach to learn which heuristics work well for particular timetabling situations. We conclude by outlining and discussing potential research issues in this critical area of knowledge discovery for different difficult timetabling problems.

‘‘Model age-based” and ‘‘copy when uncertain” biases in children’s social learning of a novel task

Theoretical models of social learning predict that individuals can benefit from using strategies that specify when and whom to copy. Here the interaction of two social learning strategies, model age-based biased copying and copy when uncertain, was investigated. Uncertainty was created via a systematic manipulation of demonstration efficacy (completeness) and efficiency (causal relevance of some actions). The participants, 4- to 6-year-old children (N = 140), viewed both an adult model and a child model, each of whom used a different tool on a novel task. They did so in a complete condition, a near-complete condition, a partial demonstration condition, or a no-demonstration condition. Half of the demonstrations in each condition incorporated causally irrelevant actions by the models. Social transmission was assessed by first responses but also through children’s continued fidelity, the hallmark of social traditions. Results revealed a bias to copy the child model both on first response and in continued interactions. Demonstration efficacy and efficiency did not affect choice of model at first response but did influence solution exploration across trials, with demonstrations containing causally irrelevant actions decreasing exploration of alternative methods. These results imply that uncertain environments can result in canalized social learning from specific classes of mode

Chest Breadths to Predict Individuals' Age - A Case Based View

It is well known that rib cage dimensions depend on the gender and vary with the age of the individual. Under this setting it is therefore possible to assume that a computational approach to the problem may be thought out and, consequently, this work will focus on the development of an Artificial Intelligence grounded decision support system to predict individual’s age, based on such measurements. On the one hand, using some basic image processing techniques it were extracted such descriptions from chest X-rays (i.e., its maximum width and height). On the other hand, the computational framework was built on top of a Logic Programming Case Base approach to knowledge representation and reasoning, which caters for the handling of incomplete, unknown, or even contradictory information. Furthermore, clustering methods based on similarity analysis among cases were used to distinguish and aggregate collections of historical data in order to reduce the search space, therefore enhancing the cases retrieval and the overall computational process. The accuracy of the proposed model is satisfactory, close to 90%.

Prognosis of bearing failure based on health state estimation

This paper proposes a new prognosis model based on the technique for health state estimation of machines for accurate assessment of the remnant life. For the evaluation of health stages of machines, the Support Vector Machine (SVM) classifier was employed to obtain the probability of each health state. Two case studies involving bearing failures were used to validate the proposed model. Simulated bearing failure data and experimental data from an accelerated bearing test rig were used to train and test the model. The result obtained is very encouraging and shows that the proposed prognostic model produces promising results and has the potential to be used as an estimation tool for machine remnant life prediction.

Fundamental solution and discrete random walk model for time-space fractional diffusion equation

In this paper, we consider a time-space fractional diffusion equation of distributed order (TSFDEDO). The TSFDEDO is obtained from the standard advection-dispersion equation by replacing the first-order time derivative by the Caputo fractional derivative of order α∈(0,1], the first-order and second-order space derivatives by the Riesz fractional derivatives of orders β 1∈(0,1) and β 2∈(1,2], respectively. We derive the fundamental solution for the TSFDEDO with an initial condition (TSFDEDO-IC). The fundamental solution can be interpreted as a spatial probability density function evolving in time. We also investigate a discrete random walk model based on an explicit finite difference approximation for the TSFDEDO-IC.

Open standards-based system integration for asset management decision support

Over the last decade, system integration has grown in popularity as it allows organisations to streamline business processes. Traditionally, system integration has been conducted through point-to-point solutions – as a new integration scenario requirement arises, a custom solution is built between the relevant systems. Bus-based solutions are now preferred, whereby all systems communicate via an intermediary system such as an enterprise service bus, using a common data exchange model. This research investigates the use of a common data exchange model based on open standards, specifically MIMOSA OSA-EAI, for asset management system integration. A case study is conducted that involves the integration of processes between a SCADA, maintenance decision support and work management system. A diverse number of software platforms are employed in developing the final solution, all tied together through MIMOSA OSA-EAI-based XML web services. The lessons learned from the exercise are presented throughout the paper.

Model interoperability in building information modelling

The exchange of design models in the design and construction industry is evolving away from 2-dimensional computer-aided design (CAD) and paper towards semantically-rich 3-dimensional digital models. This approach, known as Building Information Modelling (BIM), is anticipated to become the primary means of information exchange between the various parties involved in construction projects. From a technical perspective, the domain represents an interesting study in model-based interoperability, since the models are large and complex, and the industry is one in which collaboration is a vital part of business. In this paper, we present our experiences with issues of model-based interoperability in exchanging building information models between various tools, and in implementing tools which consume BIM models, particularly using the industry standard IFC data modelling format. We report on the successes and challenges in these endeavours, as the industry endeavours to move further towards fully digitised information exchange.

On model typing

Where object-oriented languages deal with objects as described by classes, model-driven development uses models, as graphs of interconnected objects, described by metamodels. A number of new languages have been and continue to be developed for this model- based paradigm, both for model transformation and for general programming using models. Many of these use single-object approaches to typing, derived from solutions found in object-oriented systems, while others use metamodels as model types, but without a clear notion of polymorphism. Both of these approaches lead to brittle and overly restrictive reuse characteristics. In this paper we propose a simple extension to object-oriented typing to better cater for a model-oriented context, including a simple strategy for typing models as a collection of interconnected objects. We suggest extensions to existing type system formalisms to support these concepts and their manipulation. Using a simple example we show how this extended approach permits more flexible reuse, while preserving type safety.

Performance analysis of IEEE 802.11 DCF based WNCS networks

Wireless network technologies, such as IEEE 802.11 based wireless local area networks (WLANs), have been adopted in wireless networked control systems (WNCS) for real-time applications. Distributed real-time control requires satisfaction of (soft) real-time performance from the underlying networks for delivery of real-time traffic. However, IEEE 802.11 networks are not designed for WNCS applications. They neither inherently provide quality-of-service (QoS) support, nor explicitly consider the characteristics of the real-time traffic on networked control systems (NCS), i.e., periodic round-trip traffic. Therefore, the adoption of 802.11 networks in real-time WNCSs causes challenging problems for network design and performance analysis. Theoretical methodologies are yet to be developed for computing the best achievable WNCS network performance under the constraints of real-time control requirements. Focusing on IEEE 802.11 distributed coordination function (DCF) based WNCSs, this paper analyses several important NCS network performance indices, such as throughput capacity, round trip time and packet loss ratio under the periodic round trip traffic pattern, a unique feature of typical NCSs. Considering periodic round trip traffic, an analytical model based on Markov chain theory is developed for deriving these performance indices under a critical real-time traffic condition, at which the real-time performance constraints are marginally satisfied. Case studies are also carried out to validate the theoretical development.