Ontology modeling for generation of clinical pathways

Purpose: Increasing costs of health care, fuelled by demand for high quality, cost-effective healthcare has drove hospitals to streamline their patient care delivery systems. One such systematic approach is the adaptation of Clinical Pathways (CP) as a tool to increase the quality of healthcare delivery. However, most organizations still rely on are paper-based pathway guidelines or specifications, which have limitations in process management and as a result can influence patient safety outcomes. In this paper, we present a method for generating clinical pathways based on organizational semiotics by capturing knowledge from syntactic, semantic and pragmatic to social level. Design/methodology/approach: The proposed modeling approach to generation of CPs adopts organizational semiotics and enables the generation of semantically rich representation of CP knowledge. Semantic Analysis Method (SAM) is applied to explicitly represent the semantics of the concepts, their relationships and patterns of behavior in terms of an ontology chart. Norm Analysis Method (NAM) is adopted to identify and formally specify patterns of behavior and rules that govern the actions identified on the ontology chart. Information collected during semantic and norm analysis is integrated to guide the generation of CPs using best practice represented in BPMN thus enabling the automation of CP. Findings: This research confirms the necessity of taking into consideration social aspects in designing information systems and automating CP. The complexity of healthcare processes can be best tackled by analyzing stakeholders, which we treat as social agents, their goals and patterns of action within the agent network. Originality/value: The current modeling methods describe CPs from a structural aspect comprising activities, properties and interrelationships. However, these methods lack a mechanism to describe possible patterns of human behavior and the conditions under which the behavior will occur. To overcome this weakness, a semiotic approach to generation of clinical pathway is introduced. The CP generated from SAM together with norms will enrich the knowledge representation of the domain through ontology modeling, which allows the recognition of human responsibilities and obligations and more importantly, the ultimate power of decision making in exceptional circumstances.

Kinematical analysis of redundant drive wire mechanisms with velocity constraint

In this paper, we propose a new velocity constraint type for Redundant Drive Wire Mechanisms. The purpose of this paper is to demonstrate that the proposed velocity constraint module can fix the orientation of the movable part and to use the kinematical analysis method to obtain the moving direction of the movable part. First, we discuss the necessity of using this velocity constraint type and the possible applications of the proposed mechanism. Second, we derive the basic equations of a wire mechanism with this constraint type. Next, we present a method of motion analysis on active and passive constraint spaces, which is used to find the moving direction of a movable part. Finally, we apply the above analysis method on a wire mechanism with a velocity constraint module and on a wire mechanism with four double actuator modules. By evaluating the results, we prove the validity of the proposed constraint type.

Sarkar Bengali typeface

Fiona Ross, Tim Holloway (co-designers) were commissioned by the renowned newspaper and publishing house Anandabazar Patrika (ABP) to design a new low-contrast typeface in a contemporary style for print and screen use in its publications. Ross and Holloway designed ABP's Bengali house typeface (Linotype Bengali - the first digital Bengali font) that has been in daily use in its newspaper since 1982. The design team was augmented by Neelakash Kshetrimayum; OpenType production undertaken by John Hudson. This Bengali typeface is the first fully functional OpenType design for the script. It demonstrates innovative features that resolve problems which hitherto hindered the successful execution of low-contrast Bengali text fonts: this connecting script of over 450 characters has deep verticals, spiralling strokes, wide characters, and intersecting ascenders. The new design has solutions to overcome the necessity to implement wide interlinear spacing and sets more words to the line than has yet been possible. This project therefore combines the use of aesthetic, technical and linguistic skills and is highly visible in newspapers of the largest newspaper group and publishing house in West Bengal in print and on-line. The design and development of Sarkar has positive implications for other non-Latin script designs, just as the Linotype Bengali typeface formed the blueprint for new non-Latin designs three decades ago. Sarkar was released on 31 August 2012 with the launch of Anandabazar Patirka's new newspaper Ebela.

Analysis of the variability of auditory brainstem response components through linear regression

(ABR) is of fundamental importance to the investiga- tion of the auditory system behavior, though its in- terpretation has a subjective nature because of the manual process employed in its study and the clinical experience required for its analysis. When analyzing the ABR, clinicians are often interested in the identi- fication of ABR signal components referred to as Jewett waves. In particular, the detection and study of the time when these waves occur (i.e., the wave la- tency) is a practical tool for the diagnosis of disorders affecting the auditory system. In this context, the aim of this research is to compare ABR manual/visual analysis provided by different examiners. Methods: The ABR data were collected from 10 normal-hearing subjects (5 men and 5 women, from 20 to 52 years). A total of 160 data samples were analyzed and a pair- wise comparison between four distinct examiners was executed. We carried out a statistical study aiming to identify significant differences between assessments provided by the examiners. For this, we used Linear Regression in conjunction with Bootstrap, as a me- thod for evaluating the relation between the responses given by the examiners. Results: The analysis sug- gests agreement among examiners however reveals differences between assessments of the variability of the waves. We quantified the magnitude of the ob- tained wave latency differences and 18% of the inves- tigated waves presented substantial differences (large and moderate) and of these 3.79% were considered not acceptable for the clinical practice. Conclusions: Our results characterize the variability of the manual analysis of ABR data and the necessity of establishing unified standards and protocols for the analysis of these data. These results may also contribute to the validation and development of automatic systems that are employed in the early diagnosis of hearing loss.

The neural bases of the short-term storage of verbal information are anatomically variable across individuals

What are the precise brain regions supporting the short-term retention of verbal information? A previous functional magnetic resonance imaging (fMRI) study suggested that they may be topographically variable across individuals, occurring, in most, in regions posterior to prefrontal cortex (PFC), and that detection of these regions may be best suited to a single-subject (SS) approach to fMRI analysis (Feredoes and Postle, 2007). In contrast, other studies using spatially normalized group-averaged (SNGA) analyses have localized storage-related activity to PFC. To evaluate the necessity of the regions identified by these two methods, we applied repetitive transcranial magnetic stimulation (rTMS) to SS- and SNGA-identified regions throughout the retention period of a delayed letter-recognition task. Results indicated that rTMS targeting SS analysis-identified regions of left perisylvian and sensorimotor cortex impaired performance, whereas rTMS targeting the SNGA-identified region of left caudal PFC had no effect on performance. Our results support the view that the short-term retention of verbal information can be supported by regions associated with acoustic, lexical, phonological, and speech-based representation of information. They also suggest that the brain bases of some cognitive functions may be better detected by SS than by SNGA approaches to fMRI data analysis.

Geoarchaeological investigations of midden-formation processes in the early to late Neolithic levels at Catalhoyuk, Turkey ca. 8550-8370 cal BP.

Anthropogenic midden deposits are remarkably well preserved at the Neolithic settlement of atalhöyük and provide significant archaeological information on the types and nature of activities occurring at the site. To decipher their complex stratigraphy and to investigate formation processes, a combination of geoarchaeological techniques was used. Deposits were investigated from the early ceramic to late Neolithic levels, targeting continuous sequences to examine high resolution and broader scale changes in deposition. Thin-section micromorphology combined with targeted phytolith and geochemical analyses indicates they are composed of a diverse range of ashes and other charred and siliceous plant materials, with inputs of decayed plants and organic matter, fecal waste, and sedimentary aggregates, each with diverse depositional pathways. Activities identified include in situ burning, with a range of different fuel types that may be associated with different activities. The complexity and heterogeneity of the midden deposits, and thus the necessity of employing an integrated microstratigraphic approach is demonstrated, as a prerequisite for cultural and palaeoenvironmental reconstructions.

Wave-activity conservation laws and stability theorems for semi-geostrophic dynamics: part 1. pseudomomentum-based theory

There exists a well-developed body of theory based on quasi-geostrophic (QG) dynamics that is central to our present understanding of large-scale atmospheric and oceanic dynamics. An important question is the extent to which this body of theory may generalize to more accurate dynamical models. As a first step in this process, we here generalize a set of theoretical results, concerning the evolution of disturbances to prescribed basic states, to semi-geostrophic (SG) dynamics. SG dynamics, like QG dynamics, is a Hamiltonian balanced model whose evolution is described by the material conservation of potential vorticity, together with an invertibility principle relating the potential vorticity to the advecting fields. SG dynamics has features that make it a good prototype for balanced models that are more accurate than QG dynamics. In the first part of this two-part study, we derive a pseudomomentum invariant for the SG equations, and use it to obtain: (i) linear and nonlinear generalized Charney–Stern theorems for disturbances to parallel flows; (ii) a finite-amplitude local conservation law for the invariant, obeying the group-velocity property in the WKB limit; and (iii) a wave-mean-flow interaction theorem consisting of generalized Eliassen–Palm flux diagnostics, an elliptic equation for the stream-function tendency, and a non-acceleration theorem. All these results are analogous to their QG forms. The pseudomomentum invariant – a conserved second-order disturbance quantity that is associated with zonal symmetry – is constructed using a variational principle in a similar manner to the QG calculations. Such an approach is possible when the equations of motion under the geostrophic momentum approximation are transformed to isentropic and geostrophic coordinates, in which the ageostrophic advection terms are no longer explicit. Symmetry-related wave-activity invariants such as the pseudomomentum then arise naturally from the Hamiltonian structure of the SG equations. We avoid use of the so-called ‘massless layer’ approach to the modelling of isentropic gradients at the lower boundary, preferring instead to incorporate explicitly those boundary contributions into the wave-activity and stability results. This makes the analogy with QG dynamics most transparent. This paper treats the f-plane Boussinesq form of SG dynamics, and its recent extension to β-plane, compressible flow by Magnusdottir & Schubert. In the limit of small Rossby number, the results reduce to their respective QG forms. Novel features particular to SG dynamics include apparently unnoticed lateral boundary stability criteria in (i), and the necessity of including additional zonal-mean eddy correlation terms besides the zonal-mean potential vorticity fluxes in the wave-mean-flow balance in (iii). In the companion paper, wave-activity conservation laws and stability theorems based on the SG form of the pseudoenergy are presented.

Sometimes they use it, sometimes they don’t: an epistemological discussion of L2 morphological production and its use as a competence measurement

The main goal of all approaches to adult second language acquisition (SLA) is to accurately describe and explain the overall acquisition process. To accomplish this, SLA researchers must come to agree on some key issues. In this commentary, I defend the necessity of the competence/performance distinction and how this relates to why an examination of morphological production presents challenges for SLA research. I suggest that such a methodology is meaningful only when it is dovetailed with procedures that test for related syntactic/semantic knowledge.

Trevor Griffiths' 'Absolute Beginners': socialist humanism and the television studio

This article examines how conventional studio production strategies were active in the construction of political meaning in the 1974 television play 'Absolute Beginners' written by Trevor Griffiths. Produced for the BBC anthology series Fall of Eagles, the play dramatises Lenin's involvement with the Russian Social Democratic Workers Party (RSDWP) and explores the contradictions between personal ethics and political necessity. Through close textual analysis and contextual discussion of other plays in the series, this piece demonstrates how shot patterns and spatial and performative devices in 'Absolute Beginners' supported the drama's socialist-humanist themes. Drawing on existing writing about the studio mode, it argues that the qualities of intimacy and presentational distance that it engendered were highly appropriate for the personal and the political dialectic in 'Absolute Beginners'. While using authorship as a convenient category for referring to the coherence of Griffiths' thematic concerns and dramatic structure during this period, the article complicates notions of the television dramatist as author by arguing for the importance of visual style and showing how 'ordinary' studio form was operational in the play's political meanings.

Mapping the trickle out benefits of social and environmental enterprises: a pilot study of an East African eco business

• Objectives The objective of this paper is to propose a framework for mapping the sustainable development and poverty alleviation impacts of social and environmental enterprises in Africa. This framework is then piloted with reference to an East African Ecobusiness. • Prior Work This paper is based on data collected as part of a wider research project examining social and environmental enterprises across the 19 countries of Southern and Eastern Africa. In total, the sustainable development and poverty alleviation impacts of 20 in-depth case studies in 4 countries are being examined. • Approach Data was collected using in-depth interviews with multiple stakeholders associated with the case study business. Secondary materials were also analysed and a quantitative survey of customers undertaken. • Results In addition to their impacts on the environment, African eco businesses can also have substantial social, economic and wider poverty alleviation impacts. This paper maps the impacts of a case study East African ecobusiness, as part of developing a social and environmental enterprise impact framework for Africa and the wider developing world. In our case study, positive and negative impacts are identified, while questions are raised in relation to tradeoffs between social and environmental objectives and temporal dimensions of impact. The usefulness of existing frameworks for understanding the social, environmental and development impacts of these kinds of organisations are also considered. • Implications This paper outlines the necessity of building an African-centric impact map to capture the multi-level poverty alleviation and sustainable development impacts of social and environmental enterprise activity in developing world environments. The framework proposed also offers guidance to businesses operating in Africa about the factors that might be considered as part of their wider social and environmental responsibilities. • Value Assessing the impact of social and environmental enterprises, especially as a route to development within low income countries, is receiving increasing attention in academia and beyond. This paper presents a useful contribution to the scarce literature on social and environmental enterprises in Africa.

Tackling regional climate change by leaf albedo bio-geoengineering

The likelihood that continuing greenhouse-gas emissions will lead to an unmanageable degree of climate change [1] has stimulated the search for planetary-scale technological solutions for reducing global warming [2] (“geoengineering”), typically characterized by the necessity for costly new infrastructures and industries [3]. We suggest that the existing global infrastructure associated with arable agriculture can help, given that crop plants exert an important influence over the climatic energy budget 4 and 5 because of differences in their albedo (solar reflectivity) compared to soils and to natural vegetation [6]. Specifically, we propose a “bio-geoengineering” approach to mitigate surface warming, in which crop varieties having specific leaf glossiness and/or canopy morphological traits are specifically chosen to maximize solar reflectivity. We quantify this by modifying the canopy albedo of vegetation in prescribed cropland areas in a global-climate model, and thereby estimate the near-term potential for bio-geoengineering to be a summertime cooling of more than 1°C throughout much of central North America and midlatitude Eurasia, equivalent to seasonally offsetting approximately one-fifth of regional warming due to doubling of atmospheric CO2[7]. Ultimately, genetic modification of plant leaf waxes or canopy structure could achieve greater temperature reductions, although better characterization of existing intraspecies variability is needed first.

Evaluation of Earth system models using modern and palaeo-observations: the state-of-the-art

Earth system models are increasing in complexity and incorporating more processes than their predecessors, making them important tools for studying the global carbon cycle. However, their coupled behaviour has only recently been examined in any detail, and has yielded a very wide range of outcomes, with coupled climate-carbon cycle models that represent land-use change simulating total land carbon stores by 2100 that vary by as much as 600 Pg C given the same emissions scenario. This large uncertainty is associated with differences in how key processes are simulated in different models, and illustrates the necessity of determining which models are most realistic using rigorous model evaluation methodologies. Here we assess the state-of-the-art with respect to evaluation of Earth system models, with a particular emphasis on the simulation of the carbon cycle and associated biospheric processes. We examine some of the new advances and remaining uncertainties relating to (i) modern and palaeo data and (ii) metrics for evaluation, and discuss a range of strategies, such as the inclusion of pre-calibration, combined process- and system-level evaluation, and the use of emergent constraints, that can contribute towards the development of more robust evaluation schemes. An increasingly data-rich environment offers more opportunities for model evaluation, but it is also a challenge, as more knowledge about data uncertainties is required in order to determine robust evaluation methodologies that move the field of ESM evaluation from "beauty contest" toward the development of useful constraints on model behaviour.

The role of horizontal resolution in simulating drivers of the global hydrological cycle

The role of atmospheric general circulation model (AGCM) horizontal resolution in representing the global energy budget and hydrological cycle is assessed, with the aim of improving the understanding of model uncertainties in simulating the hydrological cycle. We use two AGCMs from the UK Met Office Hadley Centre: HadGEM1-A at resolutions ranging from 270 to 60 km, and HadGEM3-A ranging from 135 to 25 km. The models exhibit a stable hydrological cycle, although too intense compared to reanalyses and observations. This over-intensity is explained by excess surface shortwave radiation, a common error in general circulation models (GCMs). This result is insensitive to resolution. However, as resolution is increased, precipitation decreases over the ocean and increases over the land. This is associated with an increase in atmospheric moisture transport from ocean to land, which changes the partitioning of moisture fluxes that contribute to precipitation over land from less local to more non-local moisture sources. The results start to converge at 60-km resolution, which underlines the excessive reliance of the mean hydrological cycle on physical parametrization (local unresolved processes) versus model dynamics (large-scale resolved processes) in coarser HadGEM1 and HadGEM3 GCMs. This finding may be valid for other GCMs, showing the necessity to analyze other chains of GCMs that may become available in the future with such a range of horizontal resolutions. Our finding supports the hypothesis that heterogeneity in model parametrization is one of the underlying causes of model disagreement in the Coupled Model Intercomparison Project (CMIP) exercises.

Polar cap patch segmentation of the tongue of ionization in the morning convection cell

Two types of poleward moving plasma concentration enhancements (PMPCEs) were observed during a sequence of pulsed reconnection events, both in the morning convection cell: Type L (low density) was associated with a cusp flow channel and seems likely to have been produced by ionization associated with particle precipitation, while Type H (high density) appeared to originate from the segmentation of the tongue of ionization by the processes which produced the Type L events. As a result, the Type L and Type H PMPCEs were interspersed, producing a complex density structure which underlines the importance of cusp flow channels as a mechanism for segmenting and structuring electron density in the cusp and shows the necessity of differentiating between at least two classes of electron density patches.