Integrated clinical pathway management for medical quality improvement-based on a semiotically inspired systems architecture

Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

Participatory research approaches in the development of improved management practices in indigenous chickens production systems with smallholder farmers in Kenya

This thesis is concerned with development of improved management practices in indigenous chicken production systems in a research process that includes participatory approaches with smallholder farmers and other stakeholders in Kenya. The research process involved a wide range of activities that included on-station experiments, field surveys, stakeholder consultations in workshops, seminars and visits, and on-farm farmer participatory research to evaluate the effect of some improved management interventions on production performance of indigenous chickens. The participatory research was greatly informed from collective experiences and lessons of the previous activities. The on-station studies focused on hatching, growth and nutritional characteristics of the indigenous chickens. Four research publications from these studies are included in this thesis. Quantitative statistical analyses were applied and they involved use of growth models estimated with non-linear regressions for the growth characteristics, chi-square determinations to investigate differences among different reciprocal crosses of indigenous chickens and general linear models and covariance determination for the nutrition study. The on-station studies brought greater understanding of performance and production characteristics of indigenous chickens and the influence of management practices on these characteristics. The field surveys and stakeholder consultations helped in understanding the overarching issues affecting the productivity of the indigenous chickens systems and their place in the livelihoods of smallholder farmers. These activities created strong networking opportunities with stakeholders from a wide spectrum. The on-farm farmer participatory research involved selection of 200 farmers in five regions followed by training and introduction of interventions on improved management practices which included housing, vaccination, deworming and feed supplementation. Implementation and monitoring was mainly done by individual farmers continuously for close to one and half years. Six quarterly visits to the farms were made by the research team to monitor and provide support for on-going project activities. The data collected has been analysed for 5 consecutive 3-monthly periods. Descriptive and inferential statistics were applied to analyse the data collected involving treatment applications, production characteristics and flock demography characteristics. Out of the 200 farmers initially selected, 173 had records on treatment applications and flock demography characteristics while 127 farmers had records on production characteristics. The demographic analysis with a dissimilarity index of flock size produced 7 distinct farm groups from among the 173 farms. Two of these farm groups were represented in similar numbers in each of the five regions. The research process also involved a number of dissemination and communication strategies that have brought the process and project outcomes into the domain of accessibility by wider readership locally and globally. These include workshops, seminars, field visits and consultations, local and international conferences, electronic conferencing, publications and personal communication via emailing and conventional posting. A number of research and development proposals were also developed based on the knowledge and experiences gained from the research process. The thesis captures the research process activities and outcomes in 8 chapters which include in ascending order – introduction, theoretical concepts underpinning FPR, research methodology and process, on-station research output, FPR descriptive statistical analysis, FPR inferential statistical analysis on production characteristics, FPR demographic analysis and conclusions. Various research approaches both quantitative and qualitative have been applied in the research process indicating the possibilities and importance of combining both systems for greater understanding of issues being studied. In our case, participatory studies of the improved management of indigenous chickens indicates their potential importance as livelihood assets for poor people.

Physical-chemical and microbiological changes in Cerrado Soil under differing sugarcane harvest management systems

Background: Sugarcane cultivation plays an important role in Brazilian economy, and it is expanding fast, mainly due to the increasing demand for ethanol production. In order to understand the impact of sugarcane cultivation and management, we studied sugarcane under different management regimes (pre-harvest burn and mechanical, unburnt harvest, or green cane), next to a control treatment with native vegetation. The soil bacterial community structure (including an evaluation of the diversity of the ammonia oxidizing (amoA) and denitrifying (nirK) genes), greenhouse gas flow and several soil physicochemical properties were evaluated. Results: Our results indicate that sugarcane cultivation in this region resulted in changes in several soil properties. Moreover, such changes are reflected in the soil microbiota. No significant influence of soil management on greenhouse gas fluxes was found. However, we did find a relationship between the biological changes and the dynamics of soil nutrients. In particular, the burnt cane and green cane treatments had distinct modifications. There were significant differences in the structure of the total bacterial, the ammonia oxidizing and the denitrifying bacterial communities, being that these groups responded differently to the changes in the soil. A combination of physical and chemical factors was correlated to the changes in the structures of the total bacterial communities of the soil. The changes in the structures of the functional groups follow a different pattern than the physicochemical variables. The latter might indicate a strong influence of interactions among different bacterial groups in the N cycle, emphasizing the importance of biological factors in the structuring of these communities. Conclusion: Sugarcane land use significantly impacted the structure of total selected soil bacterial communities and ammonia oxidizing and denitrifier gene diversities in a Cerrado field site in Central Brazil. A high impact of land use was observed in soil under the common burnt cane management. The green cane soil also presented different profiles compared to the control soil, but to at a lesser degree.

A rigorous approach to facilitate and guarantee the correctness of the genetic testing management in human genome information systems

Abstract Background Recent medical and biological technology advances have stimulated the development of new testing systems that have been providing huge, varied amounts of molecular and clinical data. Growing data volumes pose significant challenges for information processing systems in research centers. Additionally, the routines of genomics laboratory are typically characterized by high parallelism in testing and constant procedure changes. Results This paper describes a formal approach to address this challenge through the implementation of a genetic testing management system applied to human genome laboratory. We introduced the Human Genome Research Center Information System (CEGH) in Brazil, a system that is able to support constant changes in human genome testing and can provide patients updated results based on the most recent and validated genetic knowledge. Our approach uses a common repository for process planning to ensure reusability, specification, instantiation, monitoring, and execution of processes, which are defined using a relational database and rigorous control flow specifications based on process algebra (ACP). The main difference between our approach and related works is that we were able to join two important aspects: 1) process scalability achieved through relational database implementation, and 2) correctness of processes using process algebra. Furthermore, the software allows end users to define genetic testing without requiring any knowledge about business process notation or process algebra. Conclusions This paper presents the CEGH information system that is a Laboratory Information Management System (LIMS) based on a formal framework to support genetic testing management for Mendelian disorder studies. We have proved the feasibility and showed usability benefits of a rigorous approach that is able to specify, validate, and perform genetic testing using easy end user interfaces.

Model predictive control in thermal management of multiprocessor systems-on-chip

MultiProcessor Systems-on-Chip (MPSoC) are the core of nowadays and next generation computing platforms. Their relevance in the global market continuously increase, occupying an important role both in everydaylife products (e.g. smartphones, tablets, laptops, cars) and in strategical market sectors as aviation, defense, robotics, medicine. Despite of the incredible performance improvements in the recent years processors manufacturers have had to deal with issues, commonly called “Walls”, that have hindered the processors development. After the famous “Power Wall”, that limited the maximum frequency of a single core and marked the birth of the modern multiprocessors system-on-chip, the “Thermal Wall” and the “Utilization Wall” are the actual key limiter for performance improvements. The former concerns the damaging effects of the high temperature on the chip caused by the large power densities dissipation, whereas the second refers to the impossibility of fully exploiting the computing power of the processor due to the limitations on power and temperature budgets. In this thesis we faced these challenges by developing efficient and reliable solutions able to maximize performance while limiting the maximum temperature below a fixed critical threshold and saving energy. This has been possible by exploiting the Model Predictive Controller (MPC) paradigm that solves an optimization problem subject to constraints in order to find the optimal control decisions for the future interval. A fully-distributedMPC-based thermal controller with a far lower complexity respect to a centralized one has been developed. The control feasibility and interesting properties for the simplification of the control design has been proved by studying a partial differential equation thermal model. Finally, the controller has been efficiently included in more complex control schemes able to minimize energy consumption and deal with mixed-criticalities tasks

Analysis and development of ecologically based approaches to coastal defense

Climate-change related impacts, notably coastal erosion, inundation and flooding from sea level rise and storms, will increase in the coming decades enhancing the risks for coastal populations. Further recourse to coastal armoring and other engineered defenses to address risk reduction will exacerbate threats to coastal ecosystems. Alternatively, protection services provided by healthy ecosystems is emerging as a key element in climate adaptation and disaster risk management. I examined two distinct approaches to coastal defense on the base of their ecological and ecosystem conservation values. First, I analyzed the role of coastal ecosystems in providing services for hazard risk reduction. The value in wave attenuation of coral reefs was quantitatively demonstrated using a meta-analysis approach. Results indicate that coral reefs can provide wave attenuation comparable to hard engineering artificial defenses and at lower costs. Conservation and restoration of existing coral reefs are cost-effective management options for disaster risk reduction. Second, I evaluated the possibility to enhance the ecological value of artificial coastal defense structures (CDS) as habitats for marine communities. I documented the suitability of CDS to support native, ecologically relevant, habitat-forming canopy algae exploring the feasibility of enhancing CDS ecological value by promoting the growth of desired species. Juveniles of Cystoseira barbata can be successfully transplanted at both natural and artificial habitats and not affected by lack of surrounding adult algal individuals nor by substratum orientation. Transplantation success was limited by biotic disturbance from macrograzers on CDS compared to natural habitats. Future work should explore the reasons behind the different ecological functioning of artificial and natural habitats unraveling the factors and mechanisms that cause it. The comprehension of the functioning of systems associated with artificial habitats is the key to allow environmental managers to identify proper mitigation options and to forecast the impact of alternative coastal development plans.

Connectivity management and dynamic context grouping in mobile heterogenous systems

In the last 10 years the number of mobile devices has grown rapidly. Each person usually brings at least two personal devices and researchers says that in a near future this number could raise up to ten devices per person. Moreover, all the devices are becoming more integrated to our life than in the past, therefore the amount of data exchanged increases accordingly to the improvement of people's lifestyle. This is what researchers call Internet of Things. Thus, in the future there will be more than 60 billions of nodes and the current infrastructure is not ready to keep track of all the exchanges of data between them. Therefore, infrastructure improvements have been proposed in the last years, like MobileIP and HIP in order to facilitate the exchange of packets in mobility, however none of them have been optimized for the purpose. In the last years, researchers from Mid Sweden University created The MediaSense Framework. Initially, this framework was based on the Chord protocol in order to route packets in a big network, but the most important change has been the introduction of PGrids in order to create the Overlay and the persistence. Thanks to this technology, a lookup in the trie takes up to 0.5*log(N), where N is the total number of nodes in the network. This result could be improved by further optimizations on the management of the nodes, for example by the dynamic creation of groups of nodes. Moreover, since the nodes move, an underlaying support for connectivity management is needed. SCTP has been selected as one of the most promising upcoming standards for simultaneous multiple connection's management.

Post-project assessment and follow-up support for community managed rural water systems in Panama

The Environmental Health (EH) program of Peace Corps (PC) Panama and a non-governmental organization (NGO) Waterlines have been assisting rural communities in Panama gain access to improved water sources through the practice of community management (CM) model and participatory development. Unfortunately, there is little information available on how a water system is functioning once the construction is complete and the volunteer leaves the community. This is a concern when the recent literature suggests that most communities are not able to indefinitely maintain a rural water system (RWS) without some form of external assistance (Sara and Katz, 1997; Newman et al, 2002; Lockwood, 2002, 2003, 2004; IRC, 2003; Schweitzer, 2009). Recognizing this concern, the EH program director encouraged the author to complete a postproject assessment of the past EH water projects. In order to carry out the investigation, an easy to use monitoring and evaluation tool was developed based on literature review and the author’s three years of field experience in rural Panama. The study methodology consists of benchmark scoring systems to rate the following ten indicators: watershed, source capture, transmission line, storage tank, distribution system, system reliability, willingness to pay, accounting/transparency, maintenance, and active water committee members. The assessment of 28 communities across the country revealed that the current state of physical infrastructure, as well as the financial, managerial and technical capabilities of water committees varied significantly depending on the community. While some communities are enjoying continued service and their water committee completing all of its responsibilities, others have seen their water systems fall apart and be abandoned. Overall, the higher score were more prevalent for all ten indicators. However, even the communities with the highest scores requested some form of additional assistance. The conclusion from the assessment suggests that the EH program should incorporate an institutional support mechanism (ISM) to its sector policy in order to systematically provide follow-up support to rural communities in Panama. A full-time circuit rider with flexible funding would be able to provide additional technical support, training and encouragement to those communities in need.

EVALUATING INFRASTRUCTURE PERFORMANCE TO ASSIST FACILITY MANAGEMENT TOWARD SUSTAINABLE SYSTEMS

Civil infrastructure provides essential services for the development of both society and economy. It is very important to manage systems efficiently to ensure sound performance. However, there are challenges in information extraction from available data, which also necessitates the establishment of methodologies and frameworks to assist stakeholders in the decision making process. This research proposes methodologies to evaluate systems performance by maximizing the use of available information, in an effort to build and maintain sustainable systems. Under the guidance of problem formulation from a holistic view proposed by Mukherjee and Muga, this research specifically investigates problem solving methods that measure and analyze metrics to support decision making. Failures are inevitable in system management. A methodology is developed to describe arrival pattern of failures in order to assist engineers in failure rescues and budget prioritization especially when funding is limited. It reveals that blockage arrivals are not totally random. Smaller meaningful subsets show good random behavior. Additional overtime failure rate is analyzed by applying existing reliability models and non-parametric approaches. A scheme is further proposed to depict rates over the lifetime of a given facility system. Further analysis of sub-data sets is also performed with the discussion of context reduction. Infrastructure condition is another important indicator of systems performance. The challenges in predicting facility condition are the transition probability estimates and model sensitivity analysis. Methods are proposed to estimate transition probabilities by investigating long term behavior of the model and the relationship between transition rates and probabilities. To integrate heterogeneities, model sensitivity is performed for the application of non-homogeneous Markov chains model. Scenarios are investigated by assuming transition probabilities follow a Weibull regressed function and fall within an interval estimate. For each scenario, multiple cases are simulated using a Monte Carlo simulation. Results show that variations on the outputs are sensitive to the probability regression. While for the interval estimate, outputs have similar variations to the inputs. Life cycle cost analysis and life cycle assessment of a sewer system are performed comparing three different pipe types, which are reinforced concrete pipe (RCP) and non-reinforced concrete pipe (NRCP), and vitrified clay pipe (VCP). Life cycle cost analysis is performed for material extraction, construction and rehabilitation phases. In the rehabilitation phase, Markov chains model is applied in the support of rehabilitation strategy. In the life cycle assessment, the Economic Input-Output Life Cycle Assessment (EIO-LCA) tools are used in estimating environmental emissions for all three phases. Emissions are then compared quantitatively among alternatives to support decision making.

Monitoring Programmes, Multiple Stress Analysis and Decision Support for River Basin Management

The identification of plausible causes for water body status deterioration will be much easier if it can build on available, reliable, extensive and comprehensive biogeochemical monitoring data (preferably aggregated in a database). A plausible identification of such causes is a prerequisite for well-informed decisions on which mitigation or remediation measures to take. In this chapter, first a rationale for an extended monitoring programme is provided; it is then compared to the one required by the Water Framework Directive (WFD). This proposal includes a list of relevant parameters that are needed for an integrated, a priori status assessment. Secondly, a few sophisticated statistical tools are described that subsequently allow for the estiation of the magnitude of impairment as well as the likely relative importance of different stressors in a multiple stressed environment. The advantages and restrictions of these rather complicated analytical methods are discussed. Finally, the use of Decision Support Systems (DSS) is advocated with regard to the specific WFD implementation requirements.

Decision-Support tools for assessing land degradation and realising sustainable land management, Study Case of El Mkhachbiya Catchment, Northwest of Tunisia

Land degradation is intrinsically complex and involves decisions by many agencies and individuals, land degradation map- ping should be used as a learning tool through which managers, experts and stakeholders can re-examine their views within a wider semantic context. In this paper, we introduce an analytical framework for mapping land degradation, developed by World Overview for Conservation Approaches and technologies (WOCAT) programs, which aims to develop some thematic maps that serve as an useful tool and including effective information on land degradation and conservation status. Consequently, this methodology would provide an important background for decision-making in order to launch rehabilitation/remediation actions in high-priority intervention areas. As land degradation mapping is a problem-solving task that aims to provide clear information, this study entails the implementation of WOCAT mapping tool, which integrate a set of indicators to appraise the severity of land degradation across a representative watershed. So this work focuses on the use of the most relevant indicators for measuring impacts of different degradation processes in El Mkhachbiya catchment, situated in Northwest of Tunisia and those actions taken to deal with them based on the analysis of operating modes and issues of degradation in different land use systems. This study aims to provide a database for surveillance and monitoring of land degradation, in order to support stakeholders in making appropriate choices and judge guidelines and possible suitable recommendations to remedy the situation in order to promote sustainable development. The approach is illustrated through a case study of an urban watershed in Northwest of Tunisia. Results showed that the main land degradation drivers in the study area were related to natural processes, which were exacerbated by human activities. So the output of this analytical framework enabled a better communication of land degradation issues and concerns in a way relevant for policymakers.

Corporate decision-making: A case study of decision support systems and financial performance in health care organizations

The purpose of this study was twofold: (1) To describe the relation of the intensity of DSS implementation to financial performance as an empirical exploration of improved performance at the organizational level. (2) To describe the relation of the intensity of DSS implementation to the type of organizational decision culture. A multiple case study design was utilized to compare three groups of paired cases. A pattern matching strategy was applied in this study. Four predictions were specified and compared to the empirical data. A progressively upward trend in the scores was predicted for the following theoretical relationships. (1) The greater the number of DSSs, the higher the sophistication index. (2) The greater the number of DSSs, the higher the financial ratios. (3) The greater the number of DSSs, the higher the culture score. (4) The higher the culture score, the higher the financial ratios. The data did not support any of the predicted trends except the relation between the number of DSSs and the financial ratios. The Income/Revenue ratio indicates the efficiency of a company's operations. One would expect that this ratio would be most affected by the operational and financial decision support systems. The majority of the systems measured in the study supported decisions tangential to the patient service areas. The evidence suggested that the type and number of decision support systems affects the bottom line. ^

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.

Engineering Agent Systems for Decision Support

This paper discusses how agent technology can be applied to the design of advanced Information Systems for Decision Support. In particular, it describes the different steps and models that are necessary to engineer Decision Support Systems based on a multiagent architecture. The approach is illustrated by a case study in the traffic management domain.