ALBERT

Description: We examine a distributed detection problem in a wireless sensor network, where sensor nodes collaborate to detect a Gaussian signal with an unknown change of power, i.e., a scale parameter. Due to power/bandwidth constraints, we consider the case where each sensor quantizes its observation into a binary digit. The binary data are then transmitted through error-prone wireless links to a fusion center, where a generalized likelihood ratio test (GLRT) detector is employed to perform a global decision. We study the design of a binary quantizer based on an asymptotic analysis of the GLRT. Interestingly, the quantization threshold of the quantizer is independent of the unknown scale parameter. Numerical results are included to illustrate the performance of the proposed quantizer and GLRT in binary symmetric channels (BSCs).

Description: More and more hybrid electric vehicles are driven since they offer such advantages as energy savings and better active safety performance. Hybrid vehicles have two or more power driving systems and frequently switch working condition, so controlling stability is very important. In this work, a two-stage Kalman algorithm method is used to fuse data in hybrid vehicle stability testing. First, the RT3102 navigation system and Dewetron system are introduced. Second, a modeling of data fusion is proposed based on the Kalman filter. Then, this modeling is simulated and tested on a sample vehicle, using Carsim and Simulink software to test the results. The results showed the merits of this modeling.

Description: Background: With the introduction and implementation of a variety of government programs and policies to encourage adoption of electronic medical records (EMRs), EMRs are being increasingly adopted in North America. We sought to evaluate the completeness of a variety of EMR fields to determine if family physicians were comprehensively using their EMRs and the suitability of use of the data for secondary purposes in Ontario, Canada. Methods: We examined EMR data from a convenience sample of family physicians distributed throughout Ontario within the Electronic Medical Record Administrative data Linked Database (EMRALD) as extracted in the summer of 2012. We identified all physicians with at least one year of EMR use. Measures were developed and rates of physician documentation of clinical encounters, electronic prescriptions, laboratory tests, blood pressure and weight, referrals, consultation letters, and all fields in the cumulative patient profile were calculated as a function of physician and patient time since starting on the EMR. Results: Of the 167 physicians with at least one year of EMR use, we identified 186,237 patients. Overall, the fields with the highest level of completeness were for visit documentations and prescriptions (〉70 %). Improvements were observed with increasing trends of completeness overtime for almost all EMR fields according to increasing physician time on EMR. Assessment of the influence of patient time on EMR demonstrated an increasing likelihood of the population of EMR fields overtime, with the largest improvements occurring between the first and second years. Conclusions: All of the data fields examined appear to be reasonably complete within the first year of adoption with the biggest increase occurring the first to second year. Using all of the basic functions of the EMR appears to be occurring in the current environment of EMR adoption in Ontario. Thus the data appears to be suitable for secondary use.

Description: Background: Recognising the limitations of a paper-based approach to documenting vital sign observations and responding to national clinical guidelines, we have explored the use of an electronic solution that could improve the quality and safety of patient care. We have developed a system for recording vital sign observations at the bedside, automatically calculating an Early Warning Score, and saving data such that it is accessible to all relevant clinicians within a hospital trust. We have studied current clinical practice of using paper observation charts, and attempted to streamline the process. We describe our user-focussed design process, and present the key design decisions prior to describing the system in greater detail. Results: The system has been deployed in three pilot clinical areas over a period of 9 months. During this time, vital sign observations were recorded electronically using our system. Analysis of the number of observations recorded (21,316 observations) and the number of active users (111 users) confirmed that the system is being used for routine clinical observations. Feedback from clinical end-users was collected to assess user acceptance of the system. This resulted in a System Usability Scale score of 77.8, indicating high user acceptability. Conclusions: Our system has been successfully piloted, and is in the process of full implementation throughout adult inpatient clinical areas in the Oxford University Hospitals. Whilst our results demonstrate qualitative acceptance of the system, its quantitative effect on clinical care is yet to be evaluated.

Description: Currently deep learning has made great breakthroughs in visual and speech processing, mainly because it draws lessons from the hierarchical mode that brain deals with images and speech. In the field of NLP, a topic model is one of the important ways for modeling documents. Topic models are built on a generative model that clearly does not match the way humans write. In this paper, we propose Event Model, which is unsupervised and based on the language processing mechanism of neurolinguistics, to model documents. In Event Model, documents are descriptions of concrete or abstract events seen, heard, or sensed by people and words are objects in the events. Event Model has two stages: word learning and dimensionality reduction. Word learning is to learn semantics of words based on deep learning. Dimensionality reduction is the process that representing a document as a low dimensional vector by a linear mode that is completely different from topic models. Event Model achieves state-of-the-art results on document retrieval tasks.

Description: Background: According to the World Health Organization 130–150 million (according to WHO) of people globally are chronically infected with hepatitis C virus. The virus is responsible for chronic hepatitis that ultimately may cause liver cirrhosis and death. The disease is progressive, however antiviral treatment may slow down or stop its development. Therefore, it is important to estimate the severity of liver fibrosis for diagnostic, therapeutic and prognostic purposes.Liver biopsy provides a high accuracy diagnosis, however it is painful and invasive procedure. Recently, we witness an outburst of non-invasive tests (biological and physical ones) aiming to define severity of liver fibrosis, but commonly used FibroTest®, according to an independent research, in some cases may have accuracy lower than 50 %. In this paper a data mining and classification technique is proposed to determine the stage of liver fibrosis using easily accessible laboratory data. Methods: Research was carried out on archival records of routine laboratory blood tests (morphology, coagulation, biochemistry, protein electrophoresis) and histopathology records of liver biopsy as a reference value. As a result, the granular model was proposed, that contains a series of intervals representing influence of separate blood attributes on liver fibrosis stage. The model determines final diagnosis for a patient using aggregation method and voting procedure. The proposed solution is robust to missing or corrupted data. Results: The results were obtained on data from 290 patients with hepatitis C virus collected over 6 years. The model has been validated using training and test data. The overall accuracy of the solution is equal to 67.9 %. The intermediate liver fibrosis stages are hard to distinguish, due to effectiveness of biopsy itself. Additionally, the method was verified against dataset obtained from 365 patients with liver disease of various etiologies. The model proved to be robust to new data. What is worth mentioning, the error rate in misclassification of the first stage and the last stage is below 6.5 % for all analyzed datasets. Conclusions: The proposed system supports the physician and defines the stage of liver fibrosis in chronic hepatitis C. The biggest advantage of the solution is a human-centric approach using intervals, which can be verified by a specialist, before giving the final decision. Moreover, it is robust to missing data. The system can be used as a powerful support tool for diagnosis in real treatment.

Description: Background: Health decision-making requires evidence from high-quality data. As one example, the Discharge Abstract Database (DAD) compiles data from the majority of Canadian hospitals to form one of the most comprehensive and highly regarded administrative health databases available for health research, internationally. However, despite the success of this and other administrative health data resources, little is known about their history or the factors that have led to their success. The purpose of this paper is to provide an historical overview of Canadian administrative health data for health research to contribute to the institutional memory of this field. Methods: We conducted a qualitative content analysis of approximately 20 key sources to construct an historical narrative of administrative health data in Canada. Specifically, we searched for content related to key events, individuals, challenges, and successes in this field over time. Results: In Canada, administrative health data for health research has developed in tangent with provincial research centres. Interestingly, the lessons learned from this history align with the original recommendations of the 1964 Royal Commission on Health Services: (1) standardization, and (2) centralization of data resources, that is (3) facilitated through governmental financial support. Conclusions: The overview history provided here illustrates the need for longstanding partnerships between government and academia, for classification, terminology and standardization are time-consuming and ever-evolving processes. This paper will be of interest to those who work with administrative health data, and also for countries that are looking to build or improve upon their use of administrative health data for decision-making.

Description: Community detection in a complex network is an important problem of much interest in recent years. In general, a community detection algorithm chooses an objective function and captures the communities of the network by optimizing the objective function, and then, one uses various heuristics to solve the optimization problem to extract the interesting communities for the user. In this article, we demonstrate the procedure to transform a graph into points of a metric space and develop the methods of community detection with the help of a metric defined for a pair of points. We have also studied and analyzed the community structure of the network therein. The results obtained with our approach are very competitive with most of the well-known algorithms in the literature, and this is justified over the large collection of datasets. On the other hand, it can be observed that time taken by our algorithm is quite less compared to other methods and justifies the theoretical findings.

Description: A three-step iterative method with fifth-order convergence as a new modification of Newton’s method was presented. This method is for finding multiple roots of nonlinear equation with unknown multiplicity m whose multiplicity m is the highest multiplicity. Its order of convergence is analyzed and proved. Results for some numerical examples show the efficiency of the new method.

Description: Background: There is general consensus that appropriate development and use of information and communication technologies (ICT) are crucial in the delivery of effective primary care (PC). Several countries are defining policies to support and promote a structural change of the health care system through the introduction of ICT. This study analyses the state of development of basic ICT in PC systems of 31 European countries with the aim to describe the extent of, and main purposes for, computer use by General Practitioners (GPs) across Europe. Additionally, trends over time have been analysed. Methods: Descriptive statistical analysis was performed on data from the QUALICOPC (Quality and Costs of Primary Care in Europe) survey, to describe the geographic differences in the general use of computer, and in specific computerized clinical functions for different health-related purposes such as prescribing, medication checking, generating health records and research for medical information on the Internet. Results: While all the countries have achieved a near-universal adoption of a computer in their primary care practices, with only a few countries near or under the boundary of 90 %, the computerisation of primary care clinical functions presents a wide variability of adoption within and among countries and, in several cases (such as in the southern and central-eastern Europe), a large room for improvement. Conclusions: At European level, more efforts could be done to support southern and central-eastern Europe in closing the gap in adoption and use of ICT in PC. In particular, more attention seems to be need on the current usages of the computer in PC, by focusing policies and actions on the improvement of the appropriate usages that can impact on quality and costs of PC and can facilitate an interconnected health care system. However, policies and investments seem necessary but not sufficient to achieve these goals. Organizational, behavioural and also networking aspects should be taken in consideration.

Description: Background: Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. Our study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention. Methods: The study was conducted in Chakaria, a remote rural area in south-eastern Bangladesh during April–May 2013. Twelve village doctors were selected purposively from a pool of 55 village doctors who participated in the mobile health (mHealth) intervention. In depth interviews were conducted to collect data. The data were manually analysed using themes that emerged.ResultThe village doctors talked about both business benefits (access to formal doctors, getting support for decision making, and being entitled to call trained doctors) and personal benefits (both financial and non-financial). Some of the major barriers mentioned were technical problems related to accessing the call centre, charging consultation fees, and unfamiliarity with the call centre physicians. Conclusion: Village doctors saw many benefits to having a business relationship with the trained doctors that the mHealth intervention provided. mHealth through call centres has the potential to ensure consultation services to populations through existing informal healthcare providers in settings with a shortage of qualified healthcare providers.

Description: Background: Choosing the most appropriate family physician (FP) for the individual, plays a fundamental role in primary care. The aim of this study is to determine the selection criteria for the patients in choosing their family doctors and priority ranking of these criteria by using the multi-criteria decision-making method of the Analytic Hierarchy Process (AHP) model. Methods: The study was planned and conducted in two phases. In the first phase, factors affecting the patients’ decisions were revealed with a qualitative research. In the next phase, the priorities of FP selection criteria were determined by using AHP model. Criteria were compared in pairs. 96 patient were asked to fill the information forms which contains comparison scores in the Family Health Centres. Results: According to the analysis of focus group discussions FP selection criteria were congregated in to five groups: Individual Characteristics, Patient-Doctor relationship, Professional characteristics, the Setting, and Ethical Characteristics.For each of the 96 participants, comparison matrixes were formed based on the scores of their information forms. Of these, models of only 5 (5.2 %) of the participants were consistent, in other words, they have been able to score consistent ranking. The consistency ratios (CR) were found to be smaller than 0.10. Therefore the comparison matrix of this new model, which was formed based on the medians of scores only given by these 5 participants, was consistent (CR = 0.06 

Description: In this paper, we present three improvements to a three-point third order variant of Newton’s method derived from the Simpson rule. The first one is a fifth order method using the same number of functional evaluations as the third order method, the second one is a four-point 10th order method and the last one is a five-point 20th order method. In terms of computational point of view, our methods require four evaluations (one function and three first derivatives) to get fifth order, five evaluations (two functions and three derivatives) to get 10th order and six evaluations (three functions and three derivatives) to get 20th order. Hence, these methods have efficiency indexes of 1.495, 1.585 and 1.648, respectively which are better than the efficiency index of 1.316 of the third order method. We test the methods through some numerical experiments which show that the 20th order method is very efficient.

Description: Robust small target detection of low signal-to-noise ratio (SNR) is very important in infrared search and track applications for self-defense or attacks. Due to the complex background, current algorithms have some unsolved issues with false alarm rate. In order to reduce the false alarm rate, an infrared small target detection algorithm based on saliency detection and support vector machine was proposed. Firstly, we detect salient regions that may contain targets with phase spectrum Fourier transform (PFT) approach. Then, target recognition was performed in the salient regions. Experimental results show the proposed algorithm has ideal robustness and efficiency for real infrared small target detection applications.

Description: In dynamic propagation environments, beamforming algorithms may suffer from strong interference, steering vector mismatches, a low convergence speed and a high computational complexity. Reduced-rank signal processing techniques provide a way to address the problems mentioned above. This paper presents a low-complexity robust data-dependent dimensionality reduction based on an iterative optimization with steering vector perturbation (IOVP) algorithm for reduced-rank beamforming and steering vector estimation. The proposed robust optimization procedure jointly adjusts the parameters of a rank reduction matrix and an adaptive beamformer. The optimized rank reduction matrix projects the received signal vector onto a subspace with lower dimension. The beamformer/steering vector optimization is then performed in a reduced dimension subspace. We devise efficient stochastic gradient and recursive least-squares algorithms for implementing the proposed robust IOVP design. The proposed robust IOVP beamforming algorithms result in a faster convergence speed and an improved performance. Simulation results show that the proposed IOVP algorithms outperform some existing full-rank and reduced-rank algorithms with a comparable complexity.

Description: Recently, wireless sensor networks (WSNs) have drawn great interest due to their outstanding monitoring and management potential in medical, environmental and industrial applications. Most of the applications that employ WSNs demand all of the sensor nodes to run on a common time scale, a requirement that highlights the importance of clock synchronization. The clock synchronization problem in WSNs is inherently related to parameter estimation. The accuracy of clock synchronization algorithms depends essentially on the statistical properties of the parameter estimation algorithms. Recently, studies dedicated to the estimation of synchronization parameters, such as clock offset and skew, have begun to emerge in the literature. The aim of this article is to provide an overview of the state-of-the-art clock synchronization algorithms for WSNs from a statistical signal processing point of view. This article focuses on describing the key features of the class of clock synchronization algorithms that exploit the traditional two-way message (signal) exchange mechanism. Upon introducing the two-way message exchange mechanism, the main clock offset estimation algorithms for pairwise synchronization of sensor nodes are first reviewed, and their performance is compared. The class of fully-distributed clock offset estimation algorithms for network-wide synchronization is then surveyed. The paper concludes with a list of open research problems pertaining to clock synchronization of WSNs.

Description: Background: Non-adherence to Antiretroviral Treatment (ART) is strongly associated with virologic rebound and drug resistance. Studies have shown that the most frequently mentioned reason for missing ART doses is the forgetfulness of patients to take their medications on time. Therefore using communication devices as reminder tools, for example alarms, pagers, text messages and telephone calls could improve adherence to ART. The aim of this study is to measure access to cellphones, willingness to receive text message medication reminders and to identify associated factors of ART patients at the University of Gondar Hospital, in North West Ethiopia. Methods: An institution based cross sectional quantitative study was conducted among 423 patients on ART during April 2014. Data were collected using structured interviewer-administered questionnaires. Data entry and analysis were done using Epi-Info version 7 and SPSS version 20 respectively. Descriptive statistics and multivariable logistic regression analysis were used to describe the characteristic of the sample and identify factors associated with the willingness to receive text message medication reminders. Results: A total of 415 (98 % response rate) respondents participated in the interview. The majority of respondents 316 (76.1 %) owned a cellphone, and 161(50.9 %) were willing to receive text message medication reminders. Positively associated factors to the willingness were the following: Younger age group (AOR = 5.18, 95 % CI: [1.69, 15.94]), having secondary or higher education (AOR = 4.61, 95 % CI: [1.33, 16.01]), using internet (AOR = 3.94, 95 % CI: [1.67, 9.31]), not disclosing HIV status to anyone other than HCP (Health Care Provider) (AOR = 3.03, 95 % CI: [1.20, 7.61]), availability of radio in dwelling (AOR = 2.74 95 % CI: [1.27, 5.88]), not answering unknown calls (AOR = 2.67, 95 % CI: [1.34, 5.32]), use of cellphone alarm as medication reminder (AOR = 2.22, 95%CI [1.09, 4.52]), and forgetting to take medications (AOR = 2.13, 95 % CI: [1.14, 3.96]). Conclusions: A high proportion of respondents have a cell phone and are willing to use it as medication reminders. Age, educational status and using internet were the main factors that are significantly associated with the willingness of patients to receive text message medication reminders.

Description: In this paper we investigate some parallel variants of Broyden’s method and, for the basic variant, we present its convergence properties. The main result is that the behavior of the considered parallel Broyden’s variants is comparable with the classical parallel Newton method, and significantly better than the parallel Cimmino method, both for linear and nonlinear cases. The considered variants are also compared with two more recently proposed parallel Broyden’s method. Some numerical experiments are presented to illustrate the advantages and limits of the proposed algorithms.

Description: Background: Prenatal screening tests for Down syndrome (DS) are routine in many developed countries and new tests are rapidly becoming available. Decisions about prenatal screening are increasingly complex with each successive test, and pregnant women need information about risks and benefits as well as clarity about their values. Decision aids (DAs) can help healthcare providers support women in this decision. Using an environmental scan, we aimed to identify publicly available DAs focusing on prenatal screening/diagnosis for Down syndrome that provide effective support for decision making. Methods: Data sources searched were the Decision Aids Library Inventory (DALI) of the Ottawa Patient Decision Aids Research Group at the Ottawa Health Research Institute; Google searches on the internet; professional organizations, academic institutions and other experts in the field; and references in existing systematic reviews on DAs. Eligible DAs targeted pregnant women, focused on prenatal screening and/or diagnosis, applied to tests for fetal abnormalities or aneuploidies, and were in French, English, Spanish or Portuguese. Pairs of reviewers independently identified eligible DAs and extracted characteristics including the presence of practical decision support tools and features to aid comprehension. They then performed quality assessment using the 16 minimum standards established by the International Patient Decision Aids Standards (IPDASi v4.0). Results: Of 543 potentially eligible DAs (512 in DALI, 27 from experts, and four on the internet), 23 were eligible and 20 were available for data extraction. DAs were developed from 1996 to 2013 in six countries (UK, USA, Canada, Australia, Sweden, and France). Five DAs were for prenatal screening, three for prenatal diagnosis and 12 for both). Eight contained values clarification methods (personal worksheets). The 20 DAs scored a median of 10/16 (range 6–15) on the 16 IPDAS minimum standards.DiscussionNone of the 20 included DAs met all 16 IPDAS minimum standards, and few included practical decision support tools or aids to comprehension. Conclusions: Our results indicate there is a need for DAs that effectively support decision making regarding prenatal testing for Down syndrome, especially in light of the recently available non-invasive prenatal screening tests.

Description: The sign least mean square with reweighted L1-norm constraint (SLMS-RL1) algorithm is an attractive sparse channel estimation method among Gaussian mixture model (GMM) based algorithms for use in impulsive noise environments. The channel sparsity can be exploited by SLMS-RL1 algorithm based on appropriate reweighted factor, which is one of key parameters to adjust the sparse constraint for SLMS-RL1 algorithm. However, to the best of the authors’ knowledge, a reweighted factor selection scheme has not been developed. This paper proposes a Monte-Carlo (MC) based reweighted factor selection method to further strengthen the performance of SLMS-RL1 algorithm. To validate the performance of SLMS-RL1 using the proposed reweighted factor, simulations results are provided to demonstrate that convergence speed can be reduced by increasing the channel sparsity, while the steady-state MSE performance only slightly changes with different GMM impulsive-noise strengths.

Description: Background: A plethora of publicly available biomedical resources do currently exist and are constantly increasing at a fast rate. In parallel, specialized repositories are been developed, indexing numerous clinical and biomedical tools. The main drawback of such repositories is the difficulty in locating appropriate resources for a clinical or biomedical decision task, especially for non-Information Technology expert users. In parallel, although NLP research in the clinical domain has been active since the 1960s, progress in the development of NLP applications has been slow and lags behind progress in the general NLP domain.The aim of the present study is to investigate the use of semantics for biomedical resources annotation with domain specific ontologies and exploit Natural Language Processing methods in empowering the non-Information Technology expert users to efficiently search for biomedical resources using natural language. Methods: A Natural Language Processing engine which can “translate” free text into targeted queries, automatically transforming a clinical research question into a request description that contains only terms of ontologies, has been implemented. The implementation is based on information extraction techniques for text in natural language, guided by integrated ontologies. Furthermore, knowledge from robust text mining methods has been incorporated to map descriptions into suitable domain ontologies in order to ensure that the biomedical resources descriptions are domain oriented and enhance the accuracy of services discovery. The framework is freely available as a web application at (http://calchas.ics.forth.gr/). Results: For our experiments, a range of clinical questions were established based on descriptions of clinical trials from the ClinicalTrials.gov registry as well as recommendations from clinicians. Domain experts manually identified the available tools in a tools repository which are suitable for addressing the clinical questions at hand, either individually or as a set of tools forming a computational pipeline. The results were compared with those obtained from an automated discovery of candidate biomedical tools. For the evaluation of the results, precision and recall measurements were used. Our results indicate that the proposed framework has a high precision and low recall, implying that the system returns essentially more relevant results than irrelevant. Conclusions: There are adequate biomedical ontologies already available, sufficiency of existing NLP tools and quality of biomedical annotation systems for the implementation of a biomedical resources discovery framework, based on the semantic annotation of resources and the use on NLP techniques. The results of the present study demonstrate the clinical utility of the application of the proposed framework which aims to bridge the gap between clinical question in natural language and efficient dynamic biomedical resources discovery.

Description: We present a local convergence analysis of an eighth order three step methodin order to approximate a locally unique solution of nonlinear equation in a Banach spacesetting. In an earlier study by Sharma and Arora (2015), the order of convergence wasshown using Taylor series expansions and hypotheses up to the fourth order derivative oreven higher of the function involved which restrict the applicability of the proposed scheme.However, only first order derivative appears in the proposed scheme. In order to overcomethis problem, we proposed the hypotheses up to only the first order derivative. In this way,we not only expand the applicability of the methods but also propose convergence domain.Finally, where earlier studies cannot be applied, a variety of concrete numerical examplesare proposed to obtain the solutions of nonlinear equations. Our study does not exhibit thistype of problem/restriction.

Description: Lung cancer continues to rank as the leading cause of cancer deaths worldwide. One of the most promising techniques for early detection of cancerous cells relies on sputum cell analysis. This was the motivation behind the design and the development of a new computer aided diagnosis (CAD) system for early detection of lung cancer based on the analysis of sputum color images. The proposed CAD system encompasses four main processing steps. First is the preprocessing step which utilizes a Bayesian classification method using histogram analysis. Then, in the second step, mean shift segmentation is applied to segment the nuclei from the cytoplasm. The third step is the feature analysis. In this step, geometric and chromatic features are extracted from the nucleus region. These features are used in the diagnostic process of the sputum images. Finally, the diagnosis is completed using an artificial neural network and support vector machine (SVM) for classifying the cells into benign or malignant. The performance of the system was analyzed based on different criteria such as sensitivity, specificity and accuracy. The evaluation was carried out using Receiver Operating Characteristic (ROC) curve. The experimental results demonstrate the efficiency of the SVM classifier over other classifiers, with 97% sensitivity and accuracy as well as a significant reduction in the number of false positive and false negative rates.

Description: Near-infrared spectroscopy (NIRS) enables the non-invasive measurement of changes in hemodynamics and oxygenation in tissue. Changes in light-coupling due to movement of the subject can cause movement artifacts (MAs) in the recorded signals. Several methods have been developed so far that facilitate the detection and reduction of MAs in the data. However, due to fixed parameter values (e.g., global threshold) none of these methods are perfectly suitable for long-term (i.e., hours) recordings or were not time-effective when applied to large datasets. We aimed to overcome these limitations by automation, i.e., data adaptive thresholding specifically designed for long-term measurements, and by introducing a stable long-term signal reconstruction. Our new technique (“acceleration-based movement artifact reduction algorithm”, AMARA) is based on combining two methods: the “movement artifact reduction algorithm” (MARA, Scholkmann et al. Phys. Meas. 2010, 31, 649–662), and the “accelerometer-based motion artifact removal” (ABAMAR, Virtanen et al. J. Biomed. Opt. 2011, 16, 087005). We describe AMARA in detail and report about successful validation of the algorithm using empirical NIRS data, measured over the prefrontal cortex in adolescents during sleep. In addition, we compared the performance of AMARA to that of MARA and ABAMAR based on validation data.

Description: This paper focuses on the parameter identification problem for Wiener nonlinear dynamic systems with moving average noises. In order to improve the convergence rate, the gradient-based iterative algorithm is presented by replacing the unmeasurable variables with their corresponding iterative estimates, and to compute iteratively the noise estimates based on the obtained parameter estimates. The simulation results show that the proposed algorithm can effectively estimate the parameters of Wiener systems with moving average noises.

Description: Background: Although evidence has suggested that computerized drug-drug interaction alert systems may reduce the occurrence of drug-drug interactions, the numerous reminders and alerts generated by such systems could represent an excessive burden for clinicians, resulting in a high override rate of not only unimportant, but also important alerts. Methods: We analyzed physicians’ responses to alerts of relative contraindications and contraindications for coadministration in a computerized drug-drug interaction alert system at Hokkaido University Hospital. In this system, the physician must enter a password to override an alert and continue an order. All of the drug-drug interaction alerts generated between December 2011 and November 2012 at Hokkaido University Hospital were included in this study. Results: The system generated a total of 170 alerts of relative contraindications and contraindication for coadministration; 59 (34.7 %) of the corresponding orders were cancelled after the alert was accepted, and 111 (65.3 %) were overridden. The most frequent contraindication alert was for the combination of 3-hydroxy-3-methylglutaryl–coenzyme A reductase inhibitors and fibrates. No incidents involving drug-drug interactions were reported among patients who were prescribed contraindicated drug pairs after an override. Conclusions: Although computerized drug-drug interaction alert systems that require password overrides appear useful for promoting medication safety, having to enter passwords to override alerts may represent an excessive burden for the prescribing physician. Therefore, both patient safety and physicians’ workloads should be taken into consideration in future designs of computerized drug-drug interaction alert systems.

Description: Background: When new pharmaceutical products appear on the market, physicians need to know whether they are likely to be useful in their practices. Physicians currently obtain most of their information about the market release and properties of new drugs from pharmaceutical industry representatives. However, the official information contained in the summary of product characteristics (SPCs) and evaluation reports from health agencies, provide a more complete view of the potential value of new drugs, although they can be long and difficult to read. The main objective of this work was to design a prototype computer program to facilitate the objective appraisal of the potential value of a new pharmaceutical product by physicians. This prototype is based on the modeling of pharmaceutical innovations described in a previous paper. Methods: The interface was designed to allow physicians to develop a rapid understanding of the value of a new drug for their practices. We selected five new pharmaceutical products, to illustrate the function of this prototype. We considered only the texts supplied by national or international drug agencies at the time of market release. The perceived usability of the prototype was evaluated qualitatively, except for the System Usability Scale (SUS) score evaluation, by 10 physicians differing in age and medical background. Results: The display is based on the various axes of the conceptual model of pharmaceutical innovations. The user can select three levels of detail when consulting this information (highly synthetic, synthetic and detailed). Tables provide a comparison of the properties of the new pharmaceutical product with those of existing drugs, if available for the same indication, in terms of efficacy, safety and ease of use.The interface was highly appreciated by evaluators, who found it easy to understand and suggested no other additions of important, internationally valid information. The mean System Usability Scale score for the 10 physicians was 82, corresponding to a “good” user interface. Conclusions: This work led us to propose the selection, grouping, and mode of presentation for various types of knowledge on pharmaceutical innovations in a way that was appreciated by evaluators. It provides physicians with readily accessible objective information about new drugs.

Description: In this paper, the dynamical behavior of different optimal iterative schemes for solving nonlinear equations with increasing order, is studied. The tendency of the complexity of the Julia set is analyzed and referred to the fractal dimension. In fact, this fractal dimension can be shown to be a powerful tool to compare iterative schemes that estimate the solution of a nonlinear equation. Based on the box-counting algorithm, several iterative derivative-free methods of different convergence orders are compared.

Description: Background: Clinical trials apply standards approved by regulatory agencies for Electronic Data Capture (EDC). Operational Data Model (ODM) from Clinical Data Interchange Standards Consortium (CDISC) is commonly used. Electronic Health Record (EHR) systems for patient care predominantly apply HL7 standards, specifically Clinical Document Architecture (CDA). In recent years more and more patient data is processed in electronic form. Results: An open source reference implementation was designed and implemented to convert forms between ODM and CDA format. There are limitations of this conversion method due to different scope and design of ODM and CDA. Specifically, CDA has a multi-level hierarchical structure and CDA nodes can contain both XML values and XML attributes. Conclusions: Automated transformation of ODM files to CDA and vice versa is technically feasible in principle.

Description: Background: An academic, community medicine partnership was established to build a phenotype-to-outcome model targeting chronic pain. This model will be used to drive clinical decision support for pain medicine in the community setting. The first step in this effort is an examination of the electronic health records (EHR) from clinics that treat chronic pain. The biopsychosocial components provided by both patients and care providers must be of sufficient scope to populate the spectrum of patient types, treatment modalities, and possible outcomes. Methods: The patient health records from a large Midwest pain medicine practice (Michigan Pain Consultants, PC) contains physician notes, administrative codes, and patient-reported outcomes (PRO) on over 30,000 patients during the study period spanning 2010 to mid-2014. The PRO consists of a regularly administered Pain Health Assessment (PHA), a biopsychosocial, demographic, and symptomology questionnaire containing 163 items, which is completed approximately every six months with a compliance rate of over 95 %. The biopsychosocial items (74 items with Likert scales of 0–10) were examined by exploratory factor analysis and descriptive statistics to determine the number of independent constructs available for phenotypes and outcomes. Pain outcomes were examined both in the aggregate and the mean of longitudinal changes in each patient. Results: Exploratory factor analysis of the intake PHA revealed 15 orthogonal factors representing pain levels; physical, social, and emotional functions; the effects of pain on these functions; vitality and health; and measures of outcomes and satisfaction. Seven items were independent of the factors, offering unique information. As an exemplar of outcomes from the follow-up PHAs, patients reported approximately 60 % relief in their pain. When examined in the aggregate, patients showed both a decrease in pain levels and an increase in coping skills with an increased number of visits. When examined individually, 80-85 % of patients presenting with the highest pain levels reported improvement by approximately two points on an 11-point pain scale. Conclusions: We conclude that the data available in a community practice can be a rich source of biopsychosocial information relevant to the phenotypes of chronic pain. It is anticipated that phenotype linkages to best treatments and outcomes can be constructed from this set of records.

Description: Health information is increasingly being digitally stored and exchanged. The public is regularly collecting and storing health-related data on their own electronic devices and in the cloud. Diabetes prevention...

Description: Electronic medical records (EMR) offer a major potential for secondary use of data for research which can improve the safety, quality and efficiency of healthcare. They also enable the measurement of disease b...

Description: Clustering is a fundamental task in data mining. Affinity propagation clustering (APC) is an effective and efficient clustering technique that has been applied in various domains. APC iteratively propagates information between affinity samples, updates the responsibility matrix and availability matrix, and employs these matrices to choose cluster centers (or exemplars) of respective clusters. However, since it mainly uses negative Euclidean distance between exemplars and samples as the similarity between them, it is difficult to identify clusters with complex structure. Therefore, the performance of APC deteriorates on samples distributed with complex structure. To mitigate this problem, we propose an improved APC based on a path-based similarity (APC-PS). APC-PS firstly utilizes negative Euclidean distance to find exemplars of clusters. Then, it employs the path-based similarity to measure the similarity between exemplars and samples, and to explore the underlying structure of clusters. Next, it assigns non-exemplar samples to their respective clusters via that similarity. Our empirical study on synthetic and UCI datasets shows that the proposed APC-PS significantly outperforms original APC and other related approaches.

Description: Graph-based semi-supervised classification uses a graph to capture the relationship between samples and exploits label propagation techniques on the graph to predict the labels of unlabeled samples. However, it is difficult to construct a graph that faithfully describes the relationship between high-dimensional samples. Recently, low-rank representation has been introduced to construct a graph, which can preserve the global structure of high-dimensional samples and help to train accurate transductive classifiers. In this paper, we take advantage of low-rank representation for graph construction and propose an inductive semi-supervised classifier called Semi-Supervised Classification based on Low-Rank Representation (SSC-LRR). SSC-LRR first utilizes a linearized alternating direction method with adaptive penalty to compute the coefficient matrix of low-rank representation of samples. Then, the coefficient matrix is adopted to define a graph. Finally, SSC-LRR incorporates this graph into a graph-based semi-supervised linear classifier to classify unlabeled samples. Experiments are conducted on four widely used facial datasets to validate the effectiveness of the proposed SSC-LRR and the results demonstrate that SSC-LRR achieves higher accuracy than other related methods.

Description: This research proposes a two-stage user-based collaborative filtering process using an artificial immune system for the prediction of student grades, along with a filter for professor ratings in the course recommendation for college students. We test for cosine similarity and Karl Pearson (KP) correlation in affinity calculations for clustering and prediction. This research uses student information and professor information datasets of Yuan Ze University from the years 2005–2009 for the purpose of testing and training. The mean average error and confusion matrix analysis form the testing parameters. A minimum professor rating was tested to check the results, and observed that the recommendation systems herein provide highly accurate results for students with higher mean grades.

Description: Epileptic seizure is a serious health problem in the world and there is a huge population suffering from it every year. If an algorithm could automatically detect seizures and deliver the patient therapy or no...

Description: Learning deep representations of clinical events based on their distributions in electronic health records has been shown to allow for subsequent training of higher-performing predictive models compared to the...

Description: Glands are vital structures found throughout the human body and their structure and function are affected by many diseases. The ability to segment and detect glands among other types of tissues is important fo...

Description: People want to live independently, but too often disabilities or advanced age robs them of the ability to do the necessary activities of daily living (ADLs). Finding relationships between electromyograms measu...

Description: Cancer is a disease characterized as an uncontrolled growth of abnormal cells that invades neighboring tissues and destroys them. Lung cancer is the primary cause of cancer-related deaths in the world, and it ...

Description: Healthcare researchers often use multiple healthcare survey instruments to examine a particular patient symptom. The use of multiple instruments can pose some interesting research questions, such as whether th...

Description: This paper is concerned with the application of computational intelligence techniques to the conceptual design and development of a large-scale floating settlement. The settlement in question is a design for the area of Urla, which is a rural touristic region located on the west coast of Turkey, near the metropolis of Izmir. The problem at hand includes both engineering and architectural aspects that need to be addressed in a comprehensive manner. We thus adapt the view as a multi-objective constrained real-parameter optimization problem. Specifically, we consider three objectives, which are conflicting. The first one aims at maximizing accessibility of urban functions such as housing and public spaces, as well as special functions, such as a marina for yachts and a yacht club. The second one aims at ensuring the wind protection of the general areas of the settlement, by adequately placing them in between neighboring land masses. The third one aims at maximizing visibility of the settlement from external observation points, so as to maximize the exposure of the settlement. To address this complex multi-objective optimization problem and identify lucrative alternative design solutions, a multi-objective harmony search algorithm (MOHS) is developed and applied in this paper. When compared to the Differential Evolution algorithm developed for the problem in the literature, we demonstrate that MOHS achieves competitive or slightly better performance in terms of hyper volume calculation, and gives promising results when the Pareto front approximation is examined.

Description: The study investigated the feasibility of conducting a future Randomised Controlled Trial (RCT) of a mobile health (mHealth) intervention for weight loss and HbA1c reduction in Type 2 Diabetes Mellitus (T2DM).

Description: A growing number of physicians are using social media as a professional platform for health communication. The purpose of this study was to understand perspectives and experiences of these “early adopter” phys...

Description: During a construction project life cycle, project costs and time estimations contribute greatly to baseline scheduling. Besides, schedule risk analysis and project control are also influenced by the above factors. Although many papers have offered estimation techniques, little attempt has been made to generate project time series data as daily progressive estimations in different project environments that could help researchers in generating general and customized formulae in further studies. This paper, however, is an attempt to introduce a new simulation approach to reflect the data regarding time series progress of the project, considering the specifications and the complexity of the project and the environment where the project is performed. Moreover, this simulator can equip project managers with estimated information, which reassures them of the execution stages of the project although they lack historical data. A case study is presented to show the usefulness of the model and its applicability in practice. In this study, singular spectrum analysis has been employed to analyze the simulated outputs, and the results are separated based on their signal and noise trends. The signal trend is used as a point-of-reference to compare the outputs of a simulation employing S-curve technique results and the formulae corresponding to earned value management, as well as the life of a given project.

Description: The volume of research published in the biomedical domain has increasingly lead to researchers focussing on specific areas of interest and connections between findings being missed. Literature based discovery ...

Description: To facilitate long-term safety surveillance of marketing drugs, many spontaneously reporting systems (SRSs) of ADR events have been established world-wide. Since the data collected by SRSs contain sensitive pe...

Description: Cardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical ...

Description: Risk prediction models have been proposed for various diseases and are being improved as new predictors are identified. A major challenge is to determine whether the newly discovered predictors improve risk pr...

Description: Despite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which compr...

Description: Nearest neighbor (NN) imputation algorithms are efficient methods to fill in missing data where each missing value on some records is replaced by a value obtained from related cases in the whole set of records...

Description: In biomedical research, data sharing and information exchange are very important for improving quality of care, accelerating discovery, and promoting the meaningful secondary use of clinical data. A big concer...

Description: The study on disease-disease association has been increasingly viewed and analyzed as a network, in which the connections between diseases are configured using the source information on interactome maps of bio...

Description: Accurately assessing pain for those who cannot make self-report of pain, such as minimally responsive or severely brain-injured patients, is challenging. In this paper, we attempted to address this challenge b...

Description: This paper discusses the parameter estimation problems of multi-input output-error autoregressive (OEAR) systems. By combining the auxiliary model identification idea and the data filtering technique, a data filtering based recursive generalized least squares (F-RGLS) identification algorithm and a data filtering based iterative least squares (F-LSI) identification algorithm are derived. Compared with the F-RGLS algorithm, the proposed F-LSI algorithm is more effective and can generate more accurate parameter estimates. The simulation results confirm this conclusion.

Description: A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem...

Description: Web-based interventions for smoking cessation available in Portuguese do not adhere to evidence-based treatment guidelines. Besides, all existing web-based interventions are built on proprietary platforms that...

Description: Despite international initiatives like Orphanet, it remains difficult to find up-to-date information about rare diseases. The aim of this study is to propose an exhaustive set of queries for PubMed based on te...

Description: The force-directed paradigm is one of the few generic approaches to drawing graphs. Since force-directed algorithms can be extended easily, they are used frequently. Most of these algorithms are, however, quite slow on large graphs, as they compute a quadratic number of forces in each iteration. We give a new algorithm that takes only O ( m + n log n ) time per iteration when laying out a graph with n vertices and m edges. Our algorithm approximates the true forces using the so-called well-separated pair decomposition. We perform experiments on a large number of graphs and show that we can strongly reduce the runtime, even on graphs with less than a hundred vertices, without a significant influence on the quality of the drawings (in terms of the number of crossings and deviation in edge lengths).

Description: In communicating chronic risks, there is increasing use of a metaphor that can be termed ‘effective-age’: the age of a ‘healthy’ person who has the same risk profile as the individual in question. Popular meas...

Description: Administrative health care data are frequently used to study disease burden and treatment outcomes in many conditions including osteoarthritis (OA). OA is a chronic condition with significant disease burden af...

Description: Mobile phone technology is utilized for better delivery of health services worldwide. In low-and-middle income countries mobile phones are now ubiquitous. Thus leveraging mHealth applications in health sector ...

Description: Sentiment analysis of online social media has attracted significant interest recently. Many studies have been performed, but most existing methods focus on either only textual content or only visual content. In this paper, we utilize deep learning models in a convolutional neural network (CNN) to analyze the sentiment in Chinese microblogs from both textual and visual content. We first train a CNN on top of pre-trained word vectors for textual sentiment analysis and employ a deep convolutional neural network (DNN) with generalized dropout for visual sentiment analysis. We then evaluate our sentiment prediction framework on a dataset collected from a famous Chinese social media network (Sina Weibo) that includes text and related images and demonstrate state-of-the-art results on this Chinese sentiment analysis benchmark.

Description: We investigate the problem of minimizing the total power consumption under the constraint of the signal-to-noise ratio (SNR) requirement for the physical layer multicasting system with large-scale antenna arrays. In contrast with existing work, we explicitly consider both the transmit power and the circuit power scaling with the number of antennas. The joint antenna selection and beamforming technique is proposed to minimize the total power consumption. The problem is a challenging one, which aims to minimize the linear combination of ℓ 0 -norm and ℓ 2 -norm. To our best knowledge, this minimization problem has not yet been well solved. A random decremental antenna selection algorithm is designed, which is further modified by an approximation of the minimal transmit power based on the asymptotic orthogonality of the channels. Then, a more efficient decremental antenna selection algorithm is proposed based on minimizing the ℓ 0 norm. Performance results show that the ℓ 0 norm minimization algorithm greatly outperforms the random selection algorithm in terms of the total power consumption and the average run time.

Description: The use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community. HF telemonitoring interventions, however, have not been tes...

Description: While, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for d...

Description: Recently manifold learning has received extensive interest in the community of pattern recognition. Despite their appealing properties, most manifold learning algorithms are not robust in practical applications. In this paper, we address this problem in the context of the Hessian locally linear embedding (HLLE) algorithm and propose a more robust method, called RHLLE, which aims to be robust against both outliers and noise in the data. Specifically, we first propose a fast outlier detection method for high-dimensional datasets. Then, we employ a local smoothing method to reduce noise. Furthermore, we reformulate the original HLLE algorithm by using the truncation function from differentiable manifolds. In the reformulated framework, we explicitly introduce a weighted global functional to further reduce the undesirable effect of outliers and noise on the embedding result. Experiments on synthetic as well as real datasets demonstrate the effectiveness of our proposed algorithm.

Description: A new orthogonal projection method for computing the minimum distance between a point and a spatial parametric curve is presented. It consists of a geometric iteration which converges faster than the existing Newton’s method, and it is insensitive to the choice of initial values. We prove that projecting a point onto a spatial parametric curve under the method is globally second-order convergence.

Description: Improving retention in prevention of mother to child transmission (PMTCT) of HIV programs is critical to optimize maternal and infant health outcomes, especially now that lifelong treatment is immediate regard...

Description: As health care becomes more complex, it becomes more important for clinicians and patients to share information. Electronic health information exchange can help address this need. To this end, all provinces an...

Description: The survival of patients with breast cancer is highly sporadic, from a few months to more than 15 years. In recent studies, the gene expression profiling of tumors has been used as a promising means of predict...

Description: Identifying subtypes of complex diseases such as cancer is the very first step toward developing highly customized therapeutics on such diseases, as their origins significantly vary even with similar physiolog...

Description: The Variome corpus, a small collection of published articles about inherited colorectal cancer, includes annotations of 11 entity types and 13 relation types related to the curation of the relationship between...

Description: Risk calculation is increasingly used in lipid management, congestive heart failure, and atrial fibrillation. The risk scores are then used for decisions about statin use, anticoagulation, and implantable defi...

Description: The utilization of routine health information systems (HIS) for surveillance of assisted partner services (aPS) for HIV in sub-Saharan is sub-optimal, in part due to poor data quality and limited use of inform...

Description: A specific Electronic Health Record (EHR) for ophthalmology was introduced in an academic center in Germany. As diagnoses coding corresponding to the International Classification of Diseases Version 10 (ICD-10...

Description: We consider the problem of estimating the measure of subsets in very large networks. A prime tool for this purpose is the Markov Chain Monte Carlo (MCMC) algorithm. This algorithm, while extremely useful in many cases, still often suffers from the drawback of very slow convergence. We show that in a special, but important case, it is possible to obtain significantly better bounds on the convergence rate. This special case is when the huge state space can be aggregated into a smaller number of clusters, in which the states behave approximately the same way (but their behavior still may not be identical). A Markov chain with this structure is called quasi-lumpable. This property allows the aggregation of states (nodes) into clusters. Our main contribution is a rigorously proved bound on the rate at which the aggregated state distribution approaches its limit in quasi-lumpable Markov chains. We also demonstrate numerically that in certain cases this can indeed lead to a significantly accelerated way of estimating the measure of subsets. The result can be a useful tool in the analysis of complex networks, whenever they have a clustering that aggregates nodes with similar (but not necessarily identical) behavior.

Description: Background: The process of creating and designing Virtual Patients for teaching students of medicine is an expensive and time-consuming task. In order to explore potential methods of mitigating these costs, our group began exploring the possibility of creating Virtual Patients based on electronic health records. This review assesses the usage of electronic health records in the creation of interactive Virtual Patients for teaching clinical decision-making. Methods: The PubMed database was accessed programmatically to find papers relating to Virtual Patients. The returned citations were classified and the relevant full text articles were reviewed to find Virtual Patient systems that used electronic health records to create learning modalities. Results: A total of n = 362 citations were found on PubMed and subsequently classified, of which n = 28 full-text articles were reviewed. Few articles used unformatted electronic health records other than patient CT or MRI scans. The use of patient data, extracted from electronic health records or otherwise, is widespread. The use of unformatted electronic health records in their raw form is less frequent. Patient data use is broad and spans several areas, such as teaching, training, 3D visualisation, and assessment. Conclusions: Virtual Patients that are based on real patient data are widespread, yet the use of unformatted electronic health records, abundant in hospital information systems, is reported less often. The majority of teaching systems use reformatted patient data gathered from electronic health records, and do not use these electronic health records directly. Furthermore, many systems were found that used patient data in the form of CT or MRI scans. Much potential research exists regarding the use of unformatted electronic health records for the creation of Virtual Patients.

Description: Background: Human resources are an important building block of the health system. During the last decade, enormous investment has gone into the information systems to manage human resources, but due to the lack of a clear vision, policy, and strategy, the results of these efforts have not been very visible. No reliable information portal captures the actual state of human resources in Pakistan's health sector. The World Health Organization (WHO) has provided technical support for the assessment of the existing system and development of a comprehensive Human Resource Information System (HRIS) in Pakistan. Methods: The questions in the WHO-HRIS Assessment tool were distributed into five thematic groups. Purposively selected (n=65) representatives from the government, private sector, and development partners participated in this cross sectional study, based on their programmatic affiliations. Results: Fifty-five percent of organizations and departments have an independent Human Resources (HR) section managed by an establishment branch and are fully equipped with functional computers. Forty-five organizations (70%) had HR rules, regulations and coordination mechanisms, yet these are not implemented. Data reporting is mainly in paper form, on prescribed forms (51%), registers (3%) or even plain papers (20%). Data analysis does not give inputs to the decision making process and dissemination of information is quite erratic. Most of the organizations had no feedback mechanism for cross checking the HR data, rendering it unreliable. Conclusion: Pakistan is lacking appropriate HRIS management. The current HRIS indeed has a multitude of problems. In the wake of 2011 reforms within the health sector, provinces are even in a greater need for planning their respective health department services and must work on the deficiencies and inefficiencies of their HRIS so that the gaps and HR needs are better aligned for reaching the 2015 UN Millennium Development Goals (MDGs) targets.

Description: Background: Decision support systems for differential diagnosis have traditionally been evaluated on the basis of criteria how sensitively and specifically they are able to identify the correct diagnosis established by expert clinicians.DiscussionThis article questions whether evaluation criteria pertaining to identifying the correct diagnosis are most appropriate or useful. Instead it advocates evaluation of decision support systems for differential diagnosis based on the criterion of maximizing value of information.SummaryThis approach quantitatively and systematically integrates several important clinical management priorities, including avoiding serious diagnostic errors of omission and avoiding harmful or expensive tests.

Description: Background: Patient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation. These systems are costly and raise the question if such a major investment pays off. We tried to answer the following questions: How do costs and revenues of an intensive care unit develop before and after introduction of a PDMS? Can higher revenues be obtained with improved PDMS documentation? Can we present cost savings attributable to the PDMS? Methods: Retrospective analysis of cost and reimbursement data of a 25 bed Intensive Care Unit at a German University Hospital, three years before (2004--2006) and three years after (2007--2009) PDMS implementation. Results: Costs and revenues increased continuously over the years. The profit of the investigated ICU was fluctuating over the years and seemingly depending on other factors as well. We found a small increase in profit in the year after the introduction of the PDMS, but not in the following years. Profit per case peaked at 1039 [euro sign] in 2007, but dropped subsequently to 639 [euro sign] per case. We found no clear evidence for cost savings after the PDMS introduction. Our cautious calculation did not consider additional labour costs for IT staff needed for system maintenance. Conclusions: The introduction of a PDMS has probably minimal or no effect on reimbursement. In our case the observed increase in profit was too small to amortize the total investment for PDMS implementation.This may add some counterweight to the literature, where expectations for tools such as the PDMS can be quite unreasonable.

Description: Background: Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority. Methods: A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop. Results: We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures. Conclusions: We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.

Description: We present a threaded parallel adaptation of a state-of-the-art maximum clique algorithm for dense, computationally challenging graphs. We show that near-linear speedups are achievable in practice and that superlinear speedups are common. We include results for several previously unsolved benchmark problems.

Description: The stable marriage (SM) problem has a wide variety of practical applications, ranging from matching resident doctors to hospitals, to matching students to schools or, more generally, to any two-sided market. In the classical formulation, n men and n women express their preferences (via a strict total order) over the members of the other sex. Solving an SM problem means finding a stable marriage where stability is an envy-free notion: no man and woman who are not married to each other would both prefer each other to their partners or to being single. We consider both the classical stable marriage problem and one of its useful variations (denoted SMTI (Stable Marriage with Ties and Incomplete lists)) where the men and women express their preferences in the form of an incomplete preference list with ties over a subset of the members of the other sex. Matchings are permitted only with people who appear in these preference lists, and we try to find a stable matching that marries as many people as possible. Whilst the SM problem is polynomial to solve, the SMTI problem is NP-hard. We propose to tackle both problems via a local search approach, which exploits properties of the problems to reduce the size of the neighborhood and to make local moves efficiently. We empirically evaluate our algorithm for SM problems by measuring its runtime behavior and its ability to sample the lattice of all possible stable marriages. We evaluate our algorithm for SMTI problems in terms of both its runtime behavior and its ability to find a maximum cardinality stable marriage. Experimental results suggest that for SM problems, the number of steps of our algorithm grows only as O(n log(n)), and that it samples very well the set of all stable marriages. It is thus a fair and efficient approach to generate stable marriages. Furthermore, our approach for SMTI problems is able to solve large problems, quickly returning stable matchings of large and often optimal size, despite the NP-hardness of this problem.

Description: Background: Quality assessment and continuous quality feedback to the staff is crucial for safety and efficiency of teleconsultation and triage. This study evaluates whether it is feasible to use an already existing telephone triage protocol to assess the appropriateness of point-of-care and time-to-treat recommendations after teleconsultations. Methods: Based on electronic patient records, we retrospectively compared the point-of-care and time-to-treat recommendations of the paediatric telephone triage protocol with the actual recommendations of trained physicians for children with abdominal pain, following a teleconsultation. Results: In 59 of 96 cases (61%) these recommendations were congruent with the paediatric telephone protocol. Discrepancies were either of organizational nature, due to factors such as local referral policies or gatekeeping insurance models, or of medical origin, such as milder than usual symptoms or clear diagnosis of a minor ailment. Conclusions: A paediatric telephone triage protocol may be applicable in healthcare systems other than the one in which it has been developed, if triage rules are adapted to match the organisational aspects of the local healthcare system.

Description: Background: Physician notes routinely recorded during patient care represent a vast and underutilized resource for human disease studies on a population scale. Their use in research is primarily limited by the need to separate confidential patient information from clinical annotations, a process that is resource-intensive when performed manually. This study seeks to create an automated method for de-identifying physician notes that does not require large amounts of private information: in addition to training a model to recognize Protected Health Information (PHI) within private physician notes, we reverse the problem and train a model to recognize non-PHI words and phrases that appear in public medical texts. Methods: Public and private medical text sources were analyzed to distinguish common medical words and phrases from Protected Health Information. Patient identifiers are generally nouns and numbers that appear infrequently in medical literature. To quantify this relationship, term frequencies and part of speech tags were compared between journal publications and physician notes. Standard medical concepts and phrases were then examined across ten medical dictionaries. Lists and rules were included from the US census database and previously published studies. In total, 28 features were used to train decision tree classifiers. Results: The model successfully recalled 98% of PHI tokens from 220 discharge summaries. Cost sensitive classification was used to weight recall over precision (98% F10 score, 76% F1 score). More than half of the false negatives were the word "of" appearing in a hospital name. All patient names, phone numbers, and home addresses were at least partially redacted. Medical concepts such as "elevated white blood cell count" were informative for de-identification. The results exceed the previously approved criteria established by four Institutional Review Boards. Conclusions: The results indicate that distributional differences between private and public medical text can be used to accurately classify PHI. The data and algorithms reported here are made freely available for evaluation and improvement.

Description: Background: As adolescents with hemophilia approach adulthood, they are expected to assume responsibility for their disease management. A bilingual (English and French) Internet-based self-management program, "Teens Taking Charge: Managing Hemophilia Online," was developed to support adolescents with hemophilia in this transition. This study explored the usability of the website and resulted in refinement of the prototype. Methods: A purposive sample (n=18; age 13--18; mean age 15.5 years) was recruited from two tertiary care centers to assess the usability of the program in English and French. Qualitative observations using a "think aloud" usability testing method and semi-structured interviews were conducted in four iterative cycles, with changes to the prototype made as necessary following each cycle. This study was approved by research ethics boards at each site. Results: Teens responded positively to the content and appearance of the website and felt that it was easy to navigate and understand. The multimedia components (videos, animations, quizzes) were felt to enrich the experience. Changes to the presentation of content and the website user-interface were made after the first, second and third cycles of testing in English. Cycle four did not result in any further changes. Conclusions: Overall, teens found the website to be easy to use. Usability testing identified end-user concerns that informed improvements to the program. Usability testing is a crucial step in the development of Internet-based self-management programs to ensure information is delivered in a manner that is accessible and understood by users.

Description: Background: Within the field of record linkage, numerous data cleaning and standardisation techniques are employed to ensure the highest quality of links. While these facilities are common in record linkage software packages and are regularly deployed across record linkage units, little work has been published demonstrating the impact of data cleaning on linkage quality. Methods: A range of cleaning techniques was applied to both a synthetically generated dataset and a large administrative dataset previously linked to a high standard. The effect of these changes on linkage quality was investigated using pairwise F-measure to determine quality. Results: Data cleaning made little difference to the overall linkage quality, with heavy cleaning leading to a decrease in quality. Further examination showed that decreases in linkage quality were due to cleaning techniques typically reducing the variability -- although correct records were now more likely to match, incorrect records were also more likely to match, and these incorrect matches outweighed the correct matches, reducing quality overall. Conclusion: Data cleaning techniques have minimal effect on linkage quality. Care should be taken during the data cleaning process.

Description: The Internet of Things (IoT) refers to the Internet-like structure of billions of interconnected constrained devices, denoted as “smart objects”. Smart objects have limited capabilities, in terms of computational power and memory, and might be battery-powered devices, thus raising the need to adopt particularly energy efficient technologies. Among the most notable challenges that building interconnected smart objects brings about, there are standardization and interoperability. The use of IP has been foreseen as the standard for interoperability for smart objects. As billions of smart objects are expected to come to life and IPv4 addresses have eventually reached depletion, IPv6 has been identified as a candidate for smart-object communication. The deployment of the IoT raises many security issues coming from (i) the very nature of smart objects, e.g., the adoption of lightweight cryptographic algorithms, in terms of processing and memory requirements; and (ii) the use of standard protocols, e.g., the need to minimize the amount of data exchanged between nodes. This paper provides a detailed overview of the security challenges related to the deployment of smart objects. Security protocols at network, transport, and application layers are discussed, together with lightweight cryptographic algorithms proposed to be used instead of conventional and demanding ones, in terms of computational resources. Security aspects, such as key distribution and security bootstrapping, and application scenarios, such as secure data aggregation and service authorization, are also discussed.

Description: Background: Algorithms to identify screening colonoscopies in administrative databases would be useful for monitoring CRC screening uptake, tracking health resource utilization, and quality assurance. Previously developed algorithms based on expert opinion were insufficiently accurate. The purpose of this study was to develop and evaluate the accuracy of model-based algorithms to identify screening colonoscopies in health administrative databases. Methods: Patients aged 50-75 were recruited from endoscopy units in Montreal, Quebec, and Calgary, Alberta. Physician billing records and hospitalization data were obtained for each patient from the provincial administrative health databases. Indication for colonoscopy was derived using Bayesian latent class analysis informed by endoscopist and patient questionnaire responses. Two modeling methods were used to fit the data, multivariate logistic regression and recursive partitioning. The accuracies of these models were assessed. Results: 689 patients from Montreal and 541 from Calgary participated (January to March 2007). The latent class model identified 554 screening exams. Multivariate logistic regression predictions yielded an area under the curve of 0.786. Recursive partitioning using the latent outcome had sensitivity and specificity of 84.5% (95% CI: 81.5-87.5) and 63.3% (95% CI: 59.7-67.0), respectively. Conclusions: Model-based algorithms using administrative data failed to identify screening colonoscopies with sufficient accuracy. Nevertheless, the approach of constructing a latent reference standard against which model-based algorithms were evaluated may be useful for validating administrative data in other contexts where there lacks a gold standard.

Description: Background: Blindness due to diabetic retinopathy (DR) is the major disability in diabetic patients. Although early management has shown to prevent vision loss, diabetic patients have a low rate of routine ophthalmologic examination. Hence, we developed and validated sparse learning models with the aim of identifying the risk of DR in diabetic patients. Methods: Health records from the Korea National Health and Nutrition Examination Surveys (KNHANES) V-1 were used. The prediction models for DR were constructed using data from 327 diabetic patients, and were validated internally on 163 patients in the KNHANES V-1. External validation was performed using 562 diabetic patients in the KNHANES V-2. The learning models, including ridge, elastic net, and LASSO, were compared to the traditional indicators of DR. Results: Considering the Bayesian information criterion, LASSO predicted DR most efficiently. In the internal and external validation, LASSO was significantly superior to the traditional indicators by calculating the area under the curve (AUC) of the receiver operating characteristic. LASSO showed an AUC of 0.81 and an accuracy of 73.6% in the internal validation, and an AUC of 0.82 and an accuracy of 75.2% in the external validation. Conclusion: The sparse learning model using LASSO was effective in analyzing the epidemiological underlying patterns of DR. This is the first study to develop a machine learning model to predict DR risk using health records. LASSO can be an excellent choice when both discriminative power and variable selection are important in the analysis of high-dimensional electronic health records.

Description: In this paper, we present a method to provide proactive assistance in text checking, based on usage relationships between words structuralized on the Web. For a given sentence, the method builds a connectionist structure of relationships between word n-grams. Such structure is then parameterized by means of an unsupervised and language agnostic optimization process. Finally, the method provides a representation of the sentence that allows emerging the least prominent usage-based relational patterns, helping to easily find badly-written and unpopular text. The study includes the problem statement and its characterization in the literature, as well as the proposed solving approach and some experimental use.

Description: Background: Paper-based Aboriginal and Torres Strait Islander health checks have promoted a preventive approach to primary care and provided data to support research at the Inala Indigenous Health Service, south-west Brisbane, Australia. Concerns about the limitations of paper-based health checks prompted us to change to a computerised system to realise potential benefits for clinical services and research capability. We describe the rationale, implementation and anticipated benefits of computerised Aboriginal and Torres Strait Islander health checks in one primary health care setting. Methods: In May 2010, the Inala Indigenous Health Service commenced a project to computerise Aboriginal and Torres Strait Islander child, adult, diabetic, and antenatal health checks. The computerised health checks were launched in September 2010 and then evaluated for staff satisfaction, research consent rate and uptake. Ethical approval for health check data to be used for research purposes was granted in December 2010. Results: Three months after the September 2010 launch date, all but two health checks (378 out of 380, 99.5%) had been completed using the computerised system. Staff gave the system a median mark of 8 out of 10 (range 5-9), where 10 represented the highest level of overall satisfaction. By September 2011, 1099 child and adult health checks, 138 annual diabetic checks and 52 of the newly introduced antenatal checks had been completed. These numbers of computerised health checks are greater than for the previous year (2010) of paper-based health checks with a risk difference of 0.07 (95% confidence interval 0.05, 0.10). Additionally, two research projects based on computerised health check data were underway. Conclusions: The Inala Indigenous Health Service has demonstrated that moving from paper-based Aboriginal and Torres Strait Islander health checks to a system using computerised health checks is feasible and can facilitate research. We expect computerised health checks will improve clinical care and continue to enable research projects using validated data, reflecting the local Aboriginal and Torres Strait Islander community's priorities.

Description: Background: With the increasing prevalence of Picture Archiving and Communication Systems (PACS) in healthcare institutions, there is a growing need to measure their success. However, there is a lack of published literature emphasizing the technical and social factors underlying a successful PACS. Methods: An updated Information Systems Success Model was utilized by radiology technologists (RTs) to evaluate the success of PACS at a large medical center in Taiwan. A survey, consisting of 109 questionnaires, was analyzed by Structural Equation Modeling. Results: Socio-technical factors (including system quality, information quality, service quality, perceived usefulness, user satisfaction, and PACS dependence) were proven to be effective measures of PACS success. Although the relationship between service quality and perceived usefulness was not significant, other proposed relationships amongst the six measurement parameters of success were all confirmed. Conclusions: Managers have an obligation to improve the attributes of PACS. At the onset of its deployment, RTs will have formed their own subjective opinions with regards to its quality (system quality, information quality, and service quality). As these personal concepts are either refuted or reinforced based on personal experiences, RTs will become either satisfied or dissatisfied with PACS, based on their perception of its usefulness or lack of usefulness. A satisfied RT may play a pivotal role in the implementation of PACS in the future.

Description: The construction of a similarity matrix is one significant step for the spectral clustering algorithm; while the Gaussian kernel function is one of the most common measures for constructing the similarity matrix. However, with a fixed scaling parameter, the similarity between two data points is not adaptive and appropriate for multi-scale datasets. In this paper, through quantitating the value of the importance for each vertex of the similarity graph, the Gaussian kernel function is scaled, and an adaptive Gaussian kernel similarity measure is proposed. Then, an adaptive spectral clustering algorithm is gotten based on the importance of shared nearest neighbors. The idea is that the greater the importance of the shared neighbors between two vertexes, the more possible it is that these two vertexes belong to the same cluster; and the importance value of the shared neighbors is obtained with an iterative method, which considers both the local structural information and the distance similarity information, so as to improve the algorithm’s performance. Experimental results on different datasets show that our spectral clustering algorithm outperforms the other spectral clustering algorithms, such as the self-tuning spectral clustering and the adaptive spectral clustering based on shared nearest neighbors in clustering accuracy on most datasets.

Description: In this paper, we propose a detection method of pulmonary nodules in X-ray computed tomography (CT) scans by use of three image filters and appearance-based k-means clustering. First, voxel values are suppressed in radial directions so as to eliminate extra regions in the volumes of interest (VOIs). Globular regions are enhanced by moment-of-inertia tensors where the voxel values in the VOIs are regarded as mass. Excessively enhanced voxels are reduced based on displacement between the VOI centers and the gravity points of the voxel values in the VOIs. Initial nodule candidates are determined by these filtering processings. False positives are reduced by, first, normalizing the directions of intensity distributions in the VOIs by rotating the VOIs based on the eigenvectors of the moment-of-inertia tensors, and then applying an appearance-based two-step k-means clustering technique to the rotated VOIs. The proposed method is applied to actual CT scans and experimental results are shown.

Description: We propose a linear time algorithm, called G2DLP, for generating 2D lattice L(n1, n2) paths, equivalent to two-item  multiset permutations, with a given number of turns. The usage of turn has three meanings: in the context of multiset permutations, it means that two consecutive elements of a permutation belong to two different items; in lattice path enumerations, it means that the path changes its direction, either from eastward to northward or from northward to eastward; in open shop scheduling, it means that we transfer a job from one type of machine to another. The strategy of G2DLP is divide-and-combine; the division is based on the enumeration results of a previous study and is achieved by aid of an integer partition algorithm and a multiset permutation algorithm; the combination is accomplished by a concatenation algorithm that constructs the paths we require. The advantage of G2DLP is twofold. First, it is optimal in the sense that it directly generates all feasible paths without visiting an infeasible one. Second, it can generate all paths in any specified order of turns, for example, a decreasing order or an increasing order. In practice, two applications, scheduling and cryptography, are discussed.

Description: Background: In this study we implemented and developed state-of-the-art machine learning (ML) and natural language processing (NLP) technologies and built a computerized algorithm for medication reconciliation. Our specific aims are: (1) to develop a computerized algorithm for medication discrepancy detection between patients’ discharge prescriptions (structured data) and medications documented in free-text clinical notes (unstructured data); and (2) to assess the performance of the algorithm on real-world medication reconciliation data. Methods: We collected clinical notes and discharge prescription lists for all 271 patients enrolled in the Complex Care Medical Home Program at Cincinnati Children’s Hospital Medical Center between 1/1/2010 and 12/31/2013. A double-annotated, gold-standard set of medication reconciliation data was created for this collection. We then developed a hybrid algorithm consisting of three processes: (1) a ML algorithm to identify medication entities from clinical notes, (2) a rule-based method to link medication names with their attributes, and (3) a NLP-based, hybrid approach to match medications with structured prescriptions in order to detect medication discrepancies. The performance was validated on the gold-standard medication reconciliation data, where precision (P), recall (R), F-value (F) and workload were assessed. Results: The hybrid algorithm achieved 95.0%/91.6%/93.3% of P/R/F on medication entity detection and 98.7%/99.4%/99.1% of P/R/F on attribute linkage. The medication matching achieved 92.4%/90.7%/91.5% (P/R/F) on identifying matched medications in the gold-standard and 88.6%/82.5%/85.5% (P/R/F) on discrepant medications. By combining all processes, the algorithm achieved 92.4%/90.7%/91.5% (P/R/F) and 71.5%/65.2%/68.2% (P/R/F) on identifying the matched and the discrepant medications, respectively. The error analysis on algorithm outputs identified challenges to be addressed in order to improve medication discrepancy detection. Conclusion: By leveraging ML and NLP technologies, an end-to-end, computerized algorithm achieves promising outcome in reconciling medications between clinical notes and discharge prescriptions.

Description: In this work we generate the numerical solutions of Burgers’ equation by applying the Crank-Nicholson method and different schemes for solving nonlinear systems, instead of using Hopf-Cole transformation to reduce Burgers’ equation into the linear heat equation. The method is analyzed on two test problems in order to check its efficiency on different kinds of initial conditions. Numerical solutions as well as exact solutions for different values of viscosity are calculated, concluding that the numerical results are very close to the exact solution.

Description: Background: Management of diabetes mellitus is complex and involves controlling multiple risk factors that may lead to complications. Given that patients provide most of their own diabetes care, patient self-management training is an important strategy for improving quality of care. Web-based interventions have the potential to bridge gaps in diabetes self-care and self-management. The objective of this study was to determine the effect of a web-based patient self-management intervention on psychological (self-efficacy, quality of life, self-care) and clinical (blood pressure, cholesterol, glycemic control, weight) outcomes. Methods: For this cohort study we used repeated-measures modelling and qualitative individual interviews. We invited patients with type 2 diabetes to use a self-management website and asked them to complete questionnaires assessing self-efficacy (primary outcome) every three weeks for nine months before and nine months after they received access to the website. We collected clinical outcomes at three-month intervals over the same period. We conducted in-depth interviews at study conclusion to explore acceptability, strengths and weaknesses, and mediators of use of the website. We analyzed the data using a qualitative descriptive approach and inductive thematic analysis. Results: Eighty-one participants (mean age 57.2?years, standard deviation 12) were included in the analysis. The self-efficacy score did not improve significantly more than expected after nine months (absolute change 0.12; 95% confidence interval ?0.028, 0.263; p?=?0.11), nor did clinical outcomes. Website usage was limited (average 0.7 logins/month). Analysis of the interviews (n?=?21) revealed four themes:1) mediators of website use; 2) patterns of website use, including role of the blog in driving site traffic; 3) feedback on website; and 4) potential mechanisms for website effect. Conclusions: A self-management website for patients with type 2 diabetes did not improve self-efficacy. Website use was limited. Although its perceived reliability, availability of a blog and emailed reminders drew people to the website, participants? struggles with type 2 diabetes, competing priorities in their lives, and website accessibility were barriers to its use. Future interventions should aim to integrate the intervention seamlessly into the daily routine of end users such that it is not seen as yet another chore.