Interoperabilità tra frammenti E.H.R. e coordinamento semantico

La tesi si propone di esaminare le tematiche della rappresentazione della conoscenza in termini di Electronic Health Record (EHR), della loro interoperabilità nei sistemi di e-Health, e del ruolo del coordinamento semantico nella costruzione di sistemi di e-Health basati su EHR.

Nitrogen-bridged polyphenylene-based materials for electronic applications

Conjugated polymers are macromolecules that possess alternating single and double bonds along the main chain. These polymers combine the optoelectronic properties of semiconductors with the mechanical properties and processing advantages of plastics. In this thesis we discuss the synthesis, characterization and application of polyphenylene-based materials in various electronic devices. Poly(2,7-carbazole)s have the potential to be useful as blue emitters, but also as donor materials in solar cells due to their better hole-accepting properties. However, it is associated with two major drawbacks (1) the emission maximum occurs at 421 nm where the human eye is not very sensitive and (2) the 3- and 6- positions of carbazole are susceptible to chemical or electrochemical degradation. To overcome these problems, the ladder-type nitrogen-bridged polymers are synthesized. The resulting series of polymers, nitrogen-bridged poly(ladder-type tetraphenylene), nitrogen-bridged poly(ladder-type pentaphenylene), nitrogen-bridged poly(ladder-type hexaphenylene) and its derivatives are discussed in the light of photophysical and electrochemical properties and tested in PLEDs, solar cell, and OFETs. A promising trend which has emerged in recent years is the use of well defined oligomers as model compounds for their corresponding polymers. However, the uses of these molecules are many times limited by their solubility and one has to use vapor deposition techniques which require high vacuum and temperature and cannot be used for large area applications. One solution to this problem is the synthesis of small molecules having enough alkyl chain on the backbone so that they can be solution or melt processed and has the ability to form thin films like polymers as well as retain the high ordered structure characteristics of small molecules. Therefore, in the present work soluble ladderized oligomers based on thiophene and carbazole with different end group were made and tested in OFET devices. Carbazole is an attractive raw material for the synthesis of dyes since it is cheap and readily available. Carbazoledioxazine, commercially known as violet 23 is a representative compound of dioxazine pigments. As part of our efforts into developing cheap alternatives to violet 23, the synthesis and characterization of a new series of dyes by Buchwald-type coupling of 3-aminocarbazole with various isomers of chloroanthraquinone are presented.

DEVELOPING A METHOD FOR IDENTIFYING AND REDUCING FUNCTIONAL DISCREPANCIES OF INFORMATION SYSTEMS

Currently more than half of Electronic Health Record (EHR) projects fail. Most of these failures are not due to flawed technology, but rather due to the lack of systematic considerations of human issues. Among the barriers for EHR adoption, function mismatching among users, activities, and systems is a major area that has not been systematically addressed from a human-centered perspective. A theoretical framework called Functional Framework was developed for identifying and reducing functional discrepancies among users, activities, and systems. The Functional Framework is composed of three models – the User Model, the Designer Model, and the Activity Model. The User Model was developed by conducting a survey (N = 32) that identified the functions needed and desired from the user’s perspective. The Designer Model was developed by conducting a systemic review of an Electronic Dental Record (EDR) and its functions. The Activity Model was developed using an ethnographic method called shadowing where EDR users (5 dentists, 5 dental assistants, 5 administrative personnel) were followed quietly and observed for their activities. These three models were combined to form a unified model. From the unified model the work domain ontology was developed by asking users to rate the functions (a total of 190 functions) in the unified model along the dimensions of frequency and criticality in a survey. The functional discrepancies, as indicated by the regions of the Venn diagrams formed by the three models, were consistent with the survey results, especially with user satisfaction. The survey for the Functional Framework indicated the preference of one system over the other (R=0.895). The results of this project showed that the Functional Framework provides a systematic method for identifying, evaluating, and reducing functional discrepancies among users, systems, and activities. Limitations and generalizability of the Functional Framework were discussed.

Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records.

BACKGROUND: We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria. METHODS: We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content. RESULTS: All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified. CONCLUSION: If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.

Assessing the impact of electronic health record technology adoption on hospital labor efficiency

Information technology (IT) in the hospital organization is fast becoming a key asset, particularly in light of recent reform legislation in the United States calling for expanding the role of IT in our health care system. Future payment reductions to hospitals included in current health reform are based on expected improvements in hospital operating efficiency. Since over half of hospital expenses are for labor, improved efficiency in use of labor resources can be critical in meeting this challenge. Policy makers have touted the value of IT investments to improve efficiency in response to payment reductions. ^ This study was the first to directly examine the relationship between electronic health record (EHR) technology and staffing efficiency in hospitals. As the hospital has a myriad of outputs for inpatient and outpatient care, efficiency was measured using an industry standard performance metric – full time equivalent employees per adjusted occupied bed (FTE/AOB). Three hypotheses were tested in this study.^ To operationalize EHR technology adoption, we developed three constructs to model adoption, each of which was tested by separate hypotheses. The first hypothesis that a larger number of EHR applications used by a hospital would be associated with greater staffing efficiency (or lower values of FTE/AOB) was not accepted. Association between staffing efficiency and specific EHR applications was the second hypothesis tested and accepted with some applications showing significant impacts on observed values for FTE/AOB. Finally, the hypothesis that the longer an EHR application was used in a hospital would be associated with greater labor efficiency was not accepted as the model showed few statistically significant relationships to FTE/AOB performance. Generally, there does not appear a strong relationship between EHR usage and improved labor efficiency in hospitals.^ While returns on investment from EHR usage may not come from labor efficiencies, they may be better sought using measures of quality, contribution to an efficient and effective local health care system, and improved customer satisfaction through greater patient throughput.^

Standardization of data collection for the Lifetime Surveillance of Astronaut Health (LSAH)

Problems due to the lack of data standardization and data management have lead to work inefficiencies for the staff working with the vision data for the Lifetime Surveillance of Astronaut Health. Data has been collected over 50 years in a variety of manners and then entered into a software. The lack of communication between the electronic health record (EHR) form designer, epidemiologists, and optometrists has led to some level to confusion on the capability of the EHR system and how its forms can be designed to fit all the needs of the relevant parties. EHR form customizations or form redesigns were found to be critical for using NASA's EHR system in the most beneficial way for its patients, optometrists, and epidemiologists. In order to implement a protocol, data being collected was examined to find the differences in data collection methods. Changes were implemented through the establishment of a process improvement team (PIT). Based on the findings of the PIT, suggestions have been made to improve the current EHR system. If the suggestions are implemented correctly, this will not only improve efficiency of the staff at NASA and its contractors, but set guidelines for changes in other forms such as the vision exam forms. Because NASA is at the forefront of such research and health surveillance the impact of this management change could have a drastic improvement on the collection of and adaptability of the EHR. Accurate data collection from this 50+ year study is ongoing and is going to help current and future generations understand the implications of space flight on human health. It is imperative that the vast amount of information is documented correctly.^

Distribution of diatoms in surface sediments and some limnological characteristics of studied lakes in the Siberian arctic

The investigation of the species composition and ecology of diatoms of modern bottom sediments in water bodies of arctic polygonal tundra in three subregions of North Yakutiya has been carried out. As a result, 161 taxons of diatoms were determined; the determinant role of the depth, conductivity, pH of the water, and geographic latitude in their distribution was confirmed, and two complexes of species with respect to the leading abiotic factors were distinguished. The diatoms of the first complex prefer shallow water bodies of high latitudes with neutral and slightly alkaline water and relatively high conductivity. The second complex is confined to the water bodies of lower latitudes with small conductivity, as well as neutral and slightly acidic water.

(Table 1) Positions of the Mesocena elliptica zone in sediment cores from the Pacific and Indian Oceans

The Mesocena elliptica Ehr. zone in deep-sea sediments of the Pacific Ocean is characterized by a short vertical range at the base of the Pleistocene section. Depending on sedimentation rate this zone lies at various depths below the ocean bottom. M. elliptica is unknown in recent oceanic plankton. In fossil state known species indicate that sediments containing them are of Oligocene-Miocene age. New data obtained in early 1960's show that within a short interval, evidently in Early Pleistocene, M. elliptica was abundant in plankton, primarily in tropical regions. Correlation of paleomagnetic data with results of diatom analysis shows that the Mesocena elliptica zone always lies above the Pliocene-Pleistocene boundary, and that maximum contents of M. elliptica coincide with the Jaramillo event (0.85-0.95 million years ago).

(Table 1) Positions of the Mesocena elliptica zone in sediment cores from the Pacific and Indian Oceans

The Mesocena elliptica Ehr. zone in deep-sea sediments of the Pacific Ocean is characterized by a short vertical range at the base of the Pleistocene section. Depending on sedimentation rate this zone lies at various depths below the ocean bottom. M. elliptica is unknown in recent oceanic plankton. In fossil state known species indicate that sediments containing them are of Oligocene-Miocene age. New data obtained in early 1960's show that within a short interval, evidently in Early Pleistocene, M. elliptica was abundant in plankton, primarily in tropical regions. Correlation of paleomagnetic data with results of diatom analysis shows that the Mesocena elliptica zone always lies above the Pliocene-Pleistocene boundary, and that maximum contents of M. elliptica coincide with the Jaramillo event (0.85-0.95 million years ago).

Identifying the semantics of eligibility criteria of clinical trials based on relevant medical ontologies

An important objective of the INTEGRATE project1 is to build tools that support the efficient execution of post-genomic multi-centric clinical trials in breast cancer, which includes the automatic assessment of the eligibility of patients for available trials. The population suited to be enrolled in a trial is described by a set of free-text eligibility criteria that are both syntactically and semantically complex. At the same time, the assessment of the eligibility of a patient for a trial requires the (machineprocessable) understanding of the semantics of the eligibility criteria in order to further evaluate if the patient data available for example in the hospital EHR satisfies these criteria. This paper presents an analysis of the semantics of the clinical trial eligibility criteria based on relevant medical ontologies in the clinical research domain: SNOMED-CT, LOINC, MedDRA. We detect subsets of these widely-adopted ontologies that characterize the semantics of the eligibility criteria of trials in various clinical domains and compare these sets. Next, we evaluate the occurrence frequency of the concepts in the concrete case of breast cancer (which is our first application domain) in order to provide meaningful priorities for the task of binding/mapping these ontology concepts to the actual patient data. We further assess the effort required to extend our approach to new domains in terms of additional semantic mappings that need to be developed.

Service for the pseudonymization of electronic healthcare records based on ISO/EN 13606 for the secondary use of information

The availability of electronic health data favors scientific advance through the creation of repositories for secondary use. Data anonymization is a mandatory step to comply with current legislation. A service for the pseudonymization of electronic healthcare record (EHR) extracts aimed at facilitating the exchange of clinical information for secondary use in compliance with legislation on data protection is presented. According to ISO/TS 25237, pseudonymization is a particular type of anonymization. This tool performs the anonymizations by maintaining three quasi-identifiers (gender, date of birth and place of residence) with a degree of specification selected by the user. The developed system is based on the ISO/EN 13606 norm using its characteristics specifically favorable for anonymization. The service is made up of two independent modules: the demographic server and the pseudonymizing module. The demographic server supports the permanent storage of the demographic entities and the management of the identifiers. The pseudonymizing module anonymizes the ISO/EN 13606 extracts. The pseudonymizing process consists of four phases: the storage of the demographic information included in the extract, the substitution of the identifiers, the elimination of the demographic information of the extract and the elimination of key data in free-text fields. The described pseudonymizing system was used in three Telemedicine research projects with satisfactory results. A problem was detected with the type of data in a demographic data field and a proposal for modification was prepared for the group in charge of the drawing up and revision of the ISO/EN 13606 norm.

Diseño e implementación de un módulo para la estructuración de notas clínicas

El presente Trabajo Fin de Grado (TFG) surge de la necesidad de disponer de tecnologías que faciliten el Procesamiento de Lenguaje Natural (NLP) en español dentro del sector de la medicina. Centrado concretamente en la extracción de conocimiento de las historias clínicas electrónicas (HCE), que recogen toda la información relacionada con la salud del paciente y en particular, de los documentos recogidos en dichas historias, pretende la obtención de todos los términos relacionados con la medicina. El Procesamiento de Lenguaje Natural permite la obtención de datos estructurados a partir de información no estructurada. Estas técnicas permiten un análisis de texto que genera etiquetas aportando significado semántico a las palabras para la manipulación de información. A partir de la investigación realizada del estado del arte en NLP y de las tecnologías existentes para otras lenguas, se propone como solución un módulo de anotación de términos médicos extraídos de documentos clínicos. Como términos médicos se han considerado síntomas, enfermedades, partes del cuerpo o tratamientos obtenidos de UMLS, una ontología categorizada que agrega distintas fuentes de datos médicos. Se ha realizado el diseño y la implementación del módulo así como el análisis de los resultados obtenidos realizando una evaluación con treinta y dos documentos que contenían 1372 menciones de terminología médica y que han dado un resultado medio de Precisión: 70,4%, Recall: 36,2%, Accuracy: 31,4% y F-Measure: 47,2%.---ABSTRACT---This Final Thesis arises from the need for technologies that facilitate the Natural Language Processing (NLP) in Spanish in the medical sector. Specifically it is focused on extracting knowledge from Electronic Health Records (EHR), which contain all the information related to the patient's health and, in particular, it expects to obtain all the terms related to medicine from the documents contained in these records. Natural Language Processing allows us to obtain structured information from unstructured data. These techniques enable analysis of text generating labels providing semantic meaning to words for handling information. From the investigation of the state of the art in NLP and existing technologies in other languages, an annotation module of medical terms extracted from clinical documents is proposed as a solution. Symptoms, diseases, body parts or treatments are considered part of the medical terms contained in UMLS ontology which is categorized joining different sources of medical data. This project has completed the design and implementation of a module and the analysis of the results have been obtained. Thirty two documents which contain 1372 mentions of medical terminology have been evaluated and the average results obtained are: Precision: 70.4% Recall: 36.2% Accuracy: 31.4% and F-Measure: 47.2%.

Radiolaria in the surface layer of bottom sediments from the northern sector of the Benguela upwelling

Quantitative data on radiolarian assemblages from the Benguela upwelling at 17-25°S were obtained from analysis of 18 bottom sediment samples. The maximum abundance of Radiolaria (20000-40000 individuals per 1 g of sediment) was determined in sediments of the open ocean at depth 2000-4100 m. Species of tropical zones dominate in the assemblages; however content of species of subpolar and moderate zones reaches considerable values. In shelf sediments at depth 60-160 m abundance of Radiolaria (up to 5000 ind./g) is greater than in sediments of the continental slope. In shelf assemblages species of subpolar and temperate zones dominate. A characteristic feature of the shelf upwelling assemblages of Radiolaria is expressed by predominance of Lithomelissa setosa (Joerg.) (up to 50-80% at 23-25°S). L. setosa is a common representative of radiolarian assemblages of subpolar and temperate regions of the World Ocean. It is presumably regarded as an eurybiont species. Probably, it propagates with subantarctic intermediate water masses from the circumantarctic area to the Benguela upwelling region where there are favorable living conditions: subsurface water temperature is not higher than 10°C and there are high concentrations of nutrients.

Johann Rudolph Ahles ausgewählte Gesangswerke mit und ohne Begleitung von Instrumenten.

27. Motette: Unser keiner lebet ihm selber.--28. Dialog: Wer ist der, so von Edom kommet.--29. Ich hab's gewagt.--30. Fürchtet euch nicht.--31. Auf das fest der himmelfahrt.--32. Auf das fest des erzengels Michael.--33. Communion-andacht.--34. Von gnad' und recht. Ps. 101.--35. Cum Maria diluculo.--36. Wir glauben all' an einen Gott.--37. Magnificat.--38. Merk auf mein herz.--39. Zwingt die saiten in cithara.