Improving follow-up of abnormal cancer screens using electronic health records: trust but verify test result communication.

BACKGROUND: Early detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs) remains a challenge. In our previous work, we found 40% of positive FOBT results eligible for colonoscopy had no documented response by a treating clinician at two weeks despite procedures for electronic result notification. We determined if technical and/or workflow-related aspects of automated communication in the electronic health record could lead to the lack of response. METHODS: Using both qualitative and quantitative methods, we evaluated positive FOBT communication in the electronic health record of a large, urban facility between May 2008 and March 2009. We identified the source of test result communication breakdown, and developed an intervention to fix the problem. Explicit medical record reviews measured timely follow-up (defined as response within 30 days of positive FOBT) pre- and post-intervention. RESULTS: Data from 11 interviews and tracking information from 490 FOBT alerts revealed that the software intended to alert primary care practitioners (PCPs) of positive FOBT results was not configured correctly and over a third of positive FOBTs were not transmitted to PCPs. Upon correction of the technical problem, lack of timely follow-up decreased immediately from 29.9% to 5.4% (p<0.01) and was sustained at month 4 following the intervention. CONCLUSION: Electronic communication of positive FOBT results should be monitored to avoid limiting colorectal cancer screening benefits. Robust quality assurance and oversight systems are needed to achieve this. Our methods may be useful for others seeking to improve follow-up of FOBTs in their systems.

Mobility and bandwidth prediction in virtualized LTE systems: Architecture and challenges

Long Term Evolution (LTE) represents the fourth generation (4G) technology which is capable of providing high data rates as well as support of high speed mobility. The EU FP7 Mobile Cloud Networking (MCN) project integrates the use of cloud computing concepts in LTE mobile networks in order to increase LTE's performance. In this way a shared distributed virtualized LTE mobile network is built that can optimize the utilization of virtualized computing, storage and network resources and minimize communication delays. Two important features that can be used in such a virtualized system to improve its performance are the user mobility and bandwidth prediction. This paper introduces the architecture and challenges that are associated with user mobility and bandwidth prediction approaches in virtualized LTE systems.

When the systems fail to communicate. Cerebral resting state networks in schizophrenia spectrum disorders.

There have been numerous attempts to reveal the neurobiological basis of schizophrenia spectrum disorders. Results however, remain as heterogeneous as the schizophrenia spectrum disorders itself. Therefore, one aim of this thesis was to divide patients affected by this disorder into subgroups in order to homogenize the results of future studies. In a first study it is suggested that psychopathological rating scales should focus on symptoms-clusters that may have a common neurophysiological background. The here presented Bern Psychopathology Scale (BPS) proposes that alterations in three wellknown brain systems (motor, language, and affective) are largely leading to the communication failures observable on a behavioral level, but also - as repeatedly hypothesized - to dysconnectivity within and between brain systems in schizophrenia spectrum disorders. The external validity of the motor domain in the BPS was tested against the objective measure of 24 hours wrist actigraphy, in a second study. The subjective, the quantitative, as well as the global rating of the degree of motor disorders in this patient group showed significant correlations to the acquired motor activity. This result confirmed in a first step the practicability of the motor domain of the BPS, but needs further validation regarding pathological brain alterations. Finally, in a third study (independent from the two other studies), two cerebral Resting State Networks frequently altered in schizophrenia were investigated for the first time using simultaneous EEG/fMRI: The well-known default mode network and the left working memory network. Besides the changes in these fMRI-based networks, there are well-documented findings that patients exhibit alterations in EEG spectra compared to healthy controls. However, only through the multimodal approach it was possible to discover that patients with schizophrenia spectrum disorders have a slower driving frequency of the Resting State Networks compared to the matched healthy controls. Such a dysfunctional coupling between neuronal frequency and functional brain organization could explain in a uni- or multifactorial way (dysfunctional cross-frequency coupling, maturational effects, vigilance fluctuations, task-related suppression), how the typical psychotic symptoms might occur. To conclude, the major contributions presented in this thesis were on one hand the development of a psychopathology rating scale that is based on the assumption of dysfunctional brain networks, as well as the new evidence of a dysfunctional triggering frequency of Resting State Networks from the simultaneous EEG/fMRI study in patients affected by a schizophrenia spectrum disorder.

Enhancing multidirectional communication for cognitive cities

This paper presents the technical background and functionality of a meta-application (meta-app) for cognitive cities. This app enhances communication and thereby facilitates e-governance. This paper focuses on a user-centered implementation of the Fuzzy Analytical Hierarchy Process (FAHP) by presenting its technical specifications in relation with cognitive cities. For didactical reasons, a use case from the user perspective is included. Finally the findings are summed up and future work is presented

Towards Information-Centric Wireless Multi-hop Communication

Information-centric networking (ICN) addresses drawbacks of the Internet protocol, namely scalability and security. ICN is a promising approach for wireless communication because it enables seamless mobile communication, where intermediate or source nodes may change, as well as quick recovery from collisions. In this work, we study wireless multi-hop communication in Content-Centric Networking (CCN), which is a popular ICN architecture. We propose to use two broadcast faces that can be used in alternating order along the path to support multi-hop communication between any nodes in the network. By slightly modifying CCN, we can reduce the number of duplicate Interests by 93.4 % and the number of collisions by 61.4 %. Furthermore, we describe and evaluate different strategies for prefix registration based on overhearing. Strategies that configure prefixes only on one of the two faces can result in at least 27.3 % faster data transmissions.

Adaptive Interest Lifetimes for Information-Centric Wireless Multi-hop Communication

Information-centric networking (ICN) is a promising approach for wireless communication because users can exploit the broadcast nature of the wireless medium to quickly find desired content at nearby nodes. However, wireless multi-hop communication is prone to collisions and it is crucial to quickly detect and react to them to optimize transmission times and a void spurious retransmissions. Several adaptive retransmission timers have been used in related ICN literature but they have not been compared and evaluated in wireless multi-hop environments. In this work, we evaluate existing algorithms in wireless multi-hop communication. We find that existing algorithms are not optimized for wireless communication but slight modificati ons can result in considerably better performance without increasing the number of transmitted Interests.

Tattoo: a multifaceted medium of communication

This article suggests the systems theoretical distinction of form/medium as a useful tool for distinguishing social phenomena that might look as if they stem from the same process. This is shown to be the case for the tattoo and tattooing. The tattoo is conceived as a medium of communication through which different forms of communication emerge. Tattooing is one of these forms of communication that shapes the medium in a particular way. The current article sheds a special light on its intricate, communicational constellation, for which the concept of parallax is suggested. Law, medicine and cosmetics as other forms of communication use the medium of tattoo in their own way as well. The form/medium distinction allows us to grasp these different forms of communication, while it shows that they share the tattoo as medium. The article’s ultimate goal is to illustrate that the tattoo figures as a multifaceted medium of communication.

Information-centric communication in mobile and wireless networks

Information-centric networking (ICN) is a new communication paradigm that has been proposed to cope with drawbacks of host-based communication protocols, namely scalability and security. In this thesis, we base our work on Named Data Networking (NDN), which is a popular ICN architecture, and investigate NDN in the context of wireless and mobile ad hoc networks. In a first part, we focus on NDN efficiency (and potential improvements) in wireless environments by investigating NDN in wireless one-hop communication, i.e., without any routing protocols. A basic requirement to initiate informationcentric communication is the knowledge of existing and available content names. Therefore, we develop three opportunistic content discovery algorithms and evaluate them in diverse scenarios for different node densities and content distributions. After content names are known, requesters can retrieve content opportunistically from any neighbor node that provides the content. However, in case of short contact times to content sources, content retrieval may be disrupted. Therefore, we develop a requester application that keeps meta information of disrupted content retrievals and enables resume operations when a new content source has been found. Besides message efficiency, we also evaluate power consumption of information-centric broadcast and unicast communication. Based on our findings, we develop two mechanisms to increase efficiency of information-centric wireless one-hop communication. The first approach called Dynamic Unicast (DU) avoids broadcast communication whenever possible since broadcast transmissions result in more duplicate Data transmissions, lower data rates and higher energy consumption on mobile nodes, which are not interested in overheard Data, compared to unicast communication. Hence, DU uses broadcast communication only until a content source has been found and then retrieves content directly via unicast from the same source. The second approach called RC-NDN targets efficiency of wireless broadcast communication by reducing the number of duplicate Data transmissions. In particular, RC-NDN is a Data encoding scheme for content sources that increases diversity in wireless broadcast transmissions such that multiple concurrent requesters can profit from each others’ (overheard) message transmissions. If requesters and content sources are not in one-hop distance to each other, requests need to be forwarded via multi-hop routing. Therefore, in a second part of this thesis, we investigate information-centric wireless multi-hop communication. First, we consider multi-hop broadcast communication in the context of rather static community networks. We introduce the concept of preferred forwarders, which relay Interest messages slightly faster than non-preferred forwarders to reduce redundant duplicate message transmissions. While this approach works well in static networks, the performance may degrade in mobile networks if preferred forwarders may regularly move away. Thus, to enable routing in mobile ad hoc networks, we extend DU for multi-hop communication. Compared to one-hop communication, multi-hop DU requires efficient path update mechanisms (since multi-hop paths may expire quickly) and new forwarding strategies to maintain NDN benefits (request aggregation and caching) such that only a few messages need to be transmitted over the entire end-to-end path even in case of multiple concurrent requesters. To perform quick retransmission in case of collisions or other transmission errors, we implement and evaluate retransmission timers from related work and compare them to CCNTimer, which is a new algorithm that enables shorter content retrieval times in information-centric wireless multi-hop communication. Yet, in case of intermittent connectivity between requesters and content sources, multi-hop routing protocols may not work because they require continuous end-to-end paths. Therefore, we present agent-based content retrieval (ACR) for delay-tolerant networks. In ACR, requester nodes can delegate content retrieval to mobile agent nodes, which move closer to content sources, can retrieve content and return it to requesters. Thus, ACR exploits the mobility of agent nodes to retrieve content from remote locations. To enable delay-tolerant communication via agents, retrieved content needs to be stored persistently such that requesters can verify its authenticity via original publisher signatures. To achieve this, we develop a persistent caching concept that maintains received popular content in repositories and deletes unpopular content if free space is required. Since our persistent caching concept can complement regular short-term caching in the content store, it can also be used for network caching to store popular delay-tolerant content at edge routers (to reduce network traffic and improve network performance) while real-time traffic can still be maintained and served from the content store.

Competence Monitoring in Project Teams by using Web based portfolio management systems

This paper reports a learning experience related to the acquisition of project management competences. Students from three different universities and backgrounds, cooperate in a common project that drives the learning-teaching process. Previous related works on this initiative have already evaluated the goodness of this multidisciplinary, project-based learning approach in the context of a new educative paradigm. Yet the innovative experience has allowed the authors to define a rubric in order to measure specific competences in project management. The study shows the rubric’s main aspects as well as competence acquisition evaluation alternatives, based in the metrics defined. Key indicators and specific reports obtained from data base fields in the web tool will support this work. As a result, new competences can be assessed, such ones like teamwork, problem solving, communication and leadership. Final goal is to provide an overall competence map to the students at the same time they improve their skills.

Communication-efficient and crash-quiescent Omega with unknown membership

The failure detector class Omega (Ω) provides an eventual leader election functionality, i.e., eventually all correct processes permanently trust the same correct process. An algorithm is communication-efficient if the number of links that carry messages forever is bounded by n, being n the number of processes in the system. It has been defined that an algorithm is crash-quiescent if it eventually stops sending messages to crashed processes. In this regard, it has been recently shown the impossibility of implementing Ω crash quiescently without a majority of correct processes. We say that the membership is unknown if each process pi only knows its own identity and the number of processes in the system (that is, i and n), but pi does not know the identity of the rest of processes of the system. There is a type of link (denoted by ADD link) in which a bounded (but unknown) number of consecutive messages can be delayed or lost. In this work we present the first implementation (to our knowledge) of Ω in partially synchronous systems with ADD links and with unknown membership. Furthermore, it is the first implementation of Ω that combines two very interesting properties: communication-efficiency and crash-quiescence when the majority of processes are correct. Finally, we also obtain with the same algorithm a failure detector () such that every correct process eventually and permanently outputs the set of all correct processes.

Distributed models in P-Systems architectures to reduce computation time

Membrane systems are computational equivalent to Turing machines. However, their distributed and massively parallel nature obtains polynomial solutions opposite to traditional non-polynomial ones. At this point, it is very important to develop dedicated hardware and software implementations exploiting those two membrane systems features. Dealing with distributed implementations of P systems, the bottleneck communication problem has arisen. When the number of membranes grows up, the network gets congested. The purpose of distributed architectures is to reach a compromise between the massively parallel character of the system and the needed evolution step time to transit from one configuration of the system to the next one, solving the bottleneck communication problem. The goal of this paper is twofold. Firstly, to survey in a systematic and uniform way the main results regarding the way membranes can be placed on processors in order to get a software/hardware simulation of P-Systems in a distributed environment. Secondly, we improve some results about the membrane dissolution problem, prove that it is connected, and discuss the possibility of simulating this property in the distributed model. All this yields an improvement in the system parallelism implementation since it gets an increment of the parallelism of the external communication among processors. Proposed ideas improve previous architectures to tackle the communication bottleneck problem, such as reduction of the total time of an evolution step, increase of the number of membranes that could run on a processor and reduction of the number of processors.

Communication Architecture for Tracking and Interoperable Services at Hospitals: A Real Deployment Experience

Any new hospital communication architecture has to support existing services, but at the same time new added features should not affect normal tasks. This article deals with issues regarding old and new systems’ interoperability, as well as the effect the human factor has in a deployed architecture. It also presents valuable information, which is a product of a real scenario. Tracking services are also tested in order to monitor and administer several medical resources.

Influence of Current Pulse Shape on Directly Modulated Systems Performance in Metro Area Optical Networks

Due to the fact that a metro network market is very cost sensitive, direct modulated schemes appear attractive. In this paper a CWDM (Coarse Wavelength Division Multiplexing) system is studied in detail by means of an Optical Communication System Design Software; a detailed study of the modulated current shape (exponential, sine and gaussian) for 2.5 Gb/s CWDM Metropolitan Area Networks is performed to evaluate its tolerance to linear impairments such as signal-to-noise-ratio degradation and dispersion. Point-to-point links are investigated and optimum design parameters are obtained. Through extensive sets of simulation results, it is shown that some of these shape pulses are more tolerant to dispersion when compared with conventional gaussian shape pulses. In order to achieve a low Bit Error Rate (BER), different types of optical transmitters are considered including strongly adiabatic and transient chirp dominated Directly Modulated Lasers (DMLs). We have used fibers with different dispersion characteristics, showing that the system performance depends, strongly, on the chosen DML?fiber couple.

Membrane Dissolution in Distributed Architectures of P-Systems

The goal of this paper is twofold. Firstly, to survey in a systematic and uniform way the main results regarding the way membranes can be placed on processors in order to get a software/hardware simulation of P-Systems in a distributed environment. Secondly, we improve some results about the membrane dissolution problem, prove that it is connected, and discuss the possibility of simulating this property in the distributed model. All this yields an improvement in the system parallelism implementation since it gets an increment of the parallelism of the external communication among processors. Also, the number of processors grows in such a way that is notorious the increment of the parallelism in the application of the evolution rules and the internal communica-tionsstudy because it gets an increment of the parallelism in the application of the evolution rules and the internal communications. Proposed ideas improve previous architectures to tackle the communication bottleneck problem, such as reduction of the total time of an evolution step, increase of the number of membranes that could run on a processor and reduction of the number of processors

A documentation generator for (C)LP systems

We describe lpdoc, a tool which generates documentation manuals automatically from one or more logic program source files, written in Ciao, ISO-Prolog, and other (C)LP languages. It is particularly useful for documenting library modules, for which it automatically generates a rich description of the module interface. However, it can also be used quite successfully to document full applications. A fundamental advantage of using lpdoc is that it helps maintaining a true correspondence between the program and its documentation, and also identifying precisely to what versión of the program a given printed manual corresponds. The quality of the documentation generated can be greatly enhanced by including within the program text assertions (declarations with types, modes, etc. ...) for the predicates in the program, and machine-readable comments. One of the main novelties of lpdoc is that these assertions and comments are written using the Ciao system asseriion language, which is also the language of communication between the compiler and the user and between the components of the compiler. This allows a significant synergy among specification, debugging, documentation, optimization, etc. A simple compatibility library allows conventional (C)LP systems to ignore these assertions and comments and treat normally programs documented in this way. The documentation can be generated interactively from emacs or from the command line, in many formats including texinfo, dvi, ps, pdf, info, ascii, html/css, Unix nroff/man, Windows help, etc., and can include bibliographic citations and images, lpdoc can also genérate "man" pages (Unix man page format), nicely formatted plain ASCII "readme" files, installation scripts useful when the manuals are included in software distributions, brief descriptions in html/css or info formats suitable for inclusión in on-line Índices of manuals, and even complete WWW and info sites containing on-line catalogs of documents and software distributions. The lpdoc manual, all other Ciao system manuals, and parts of this paper are generated by lpdoc.