A Data Colocation Grid Framework for Big Data Medical Image Processing: Backend Design

Science.gov (United States)

Huo, Yuankai; Parvathaneni, Prasanna; Plassard, Andrew J.; Bermudez, Camilo; Yao, Yuang; Lyu, Ilwoo; Gokhale, Aniruddha; Landman, Bennett A.

2018-01-01

When processing large medical imaging studies, adopting high performance grid computing resources rapidly becomes important. We recently presented a "medical image processing-as-a-service" grid framework that offers promise in utilizing the Apache Hadoop ecosystem and HBase for data colocation by moving computation close to medical image storage. However, the framework has not yet proven to be easy to use in a heterogeneous hardware environment. Furthermore, the system has not yet validated when considering variety of multi-level analysis in medical imaging. Our target design criteria are (1) improving the framework’s performance in a heterogeneous cluster, (2) performing population based summary statistics on large datasets, and (3) introducing a table design scheme for rapid NoSQL query. In this paper, we present a heuristic backend interface application program interface (API) design for Hadoop & HBase for Medical Image Processing (HadoopBase-MIP). The API includes: Upload, Retrieve, Remove, Load balancer (for heterogeneous cluster) and MapReduce templates. A dataset summary statistic model is discussed and implemented by MapReduce paradigm. We introduce a HBase table scheme for fast data query to better utilize the MapReduce model. Briefly, 5153 T1 images were retrieved from a university secure, shared web database and used to empirically access an in-house grid with 224 heterogeneous CPU cores. Three empirical experiments results are presented and discussed: (1) load balancer wall-time improvement of 1.5-fold compared with a framework with built-in data allocation strategy, (2) a summary statistic model is empirically verified on grid framework and is compared with the cluster when deployed with a standard Sun Grid Engine (SGE), which reduces 8-fold of wall clock time and 14-fold of resource time, and (3) the proposed HBase table scheme improves MapReduce computation with 7 fold reduction of wall time compare with a naïve scheme when datasets are relative

A decision modeling for phasor measurement unit location selection in smart grid systems

Science.gov (United States)

Lee, Seung Yup

As a key technology for enhancing the smart grid system, Phasor Measurement Unit (PMU) provides synchronized phasor measurements of voltages and currents of wide-area electric power grid. With various benefits from its application, one of the critical issues in utilizing PMUs is the optimal site selection of units. The main aim of this research is to develop a decision support system, which can be used in resource allocation task for smart grid system analysis. As an effort to suggest a robust decision model and standardize the decision modeling process, a harmonized modeling framework, which considers operational circumstances of component, is proposed in connection with a deterministic approach utilizing integer programming. With the results obtained from the optimal PMU placement problem, the advantages and potential that the harmonized modeling process possesses are assessed and discussed.

DXplain: a Web-based diagnostic decision support system for medical students.

Science.gov (United States)

London, S

1998-01-01

DXplain is a diagnostic decision support program, with a new World Wide Web interface, designed to help medical students and physicians formulate differential diagnoses based on clinical findings. It covers over 2000 diseases and 5000 clinical manifestations. DXplain suggests possible diagnoses, and provides brief descriptions of every disease in the database. Not all diseases are included, nor does DXplain take into account preexisting conditions or the chronological sequence of clinical manifestations. Despite these limitations, it is a useful educational tool, particularly for problem-based learning (PBL) cases and for students in clinical rotations, as it fills a niche not adequately covered by MEDLINE or medical texts. The system is relatively self-explanatory, requiring little or no end-user training. Medical libraries offering, or planning to offer, their users access to Web-based materials and resources may find this system a valuable addition to their electronic collections. Should it prove popular with the local users, provision of access may also establish or enhance the library's image as a partner in medical education.

Study on Behavior Value Analysis and Decision Methodology of Grid Corporations in China

Directory of Open Access Journals (Sweden)

Jiang Yuanbin

2017-01-01

Full Text Available Based on grid corporations, business environment and value characteristics in China, the article analyzes its behavior value factors, and then divides its behavior into three categories: the behavior only affecting the current Economic Value Added(EVA, the behavior affecting both the current and future EVA, and the behavior only affecting future EVA. Finally, the article studies such corporations, behavior value decision making based upon analyses and classifications above.

A Maturity Grid Assessment Tool for Environmentally Conscious Design in the Medical Device Industry

DEFF Research Database (Denmark)

Moultrie, James; Sutcliffe, Laura Francesca Rose; Maier, Anja

2016-01-01

. This intervention tool provides designers and product marketers with insights on how to improve the design of their medical devices and specifically allows consideration of the complex trade-offs between decisions that influence different life-cycle stages. Through the tool, actionable insight is created......The medical device industry is growing increasingly concerned about environmental impact of products. Whilst there are many tools aiming to support environmentally conscious design, they are typically complex to use, demand substantial data collection and are not tailored to the specific needs...... of the medical device sector. This paper reports on the development of a Maturity Grid to address this gap. This novel design tool was developed iteratively through application in five case studies. The tool captures principles of eco-design for medical devices in a simple form, designed to be used by a team...

Medical decision making

NARCIS (Netherlands)

Stiggelbout, A.M.; Vries, M. de; Scherer, L.; Keren, G.; Wu, G.

2016-01-01

This chapter presents an overview of the field of medical decision making. It distinguishes the levels of decision making seen in health-care practice and shows how research in judgment and decision making support or improve decision making. Most of the research has been done at the micro level,

Grid-based virtual clinic for medical diagnosis tutoring | Yatchou ...

African Journals Online (AJOL)

La réalisation visée est un outil collaboratif d\\'enseignement pour les médecins du terrain et les étudiants en médecine au sein d\\'une organisation virtuelle. The emerging grid-based technologies are increasingly adopted to enhance education and provide better learning services. This is characterized all over the world, ...

Semantics-based plausible reasoning to extend the knowledge coverage of medical knowledge bases for improved clinical decision support.

Science.gov (United States)

Mohammadhassanzadeh, Hossein; Van Woensel, William; Abidi, Samina Raza; Abidi, Syed Sibte Raza

2017-01-01

Capturing complete medical knowledge is challenging-often due to incomplete patient Electronic Health Records (EHR), but also because of valuable, tacit medical knowledge hidden away in physicians' experiences. To extend the coverage of incomplete medical knowledge-based systems beyond their deductive closure, and thus enhance their decision-support capabilities, we argue that innovative, multi-strategy reasoning approaches should be applied. In particular, plausible reasoning mechanisms apply patterns from human thought processes, such as generalization, similarity and interpolation, based on attributional, hierarchical, and relational knowledge. Plausible reasoning mechanisms include inductive reasoning , which generalizes the commonalities among the data to induce new rules, and analogical reasoning , which is guided by data similarities to infer new facts. By further leveraging rich, biomedical Semantic Web ontologies to represent medical knowledge, both known and tentative, we increase the accuracy and expressivity of plausible reasoning, and cope with issues such as data heterogeneity, inconsistency and interoperability. In this paper, we present a Semantic Web-based, multi-strategy reasoning approach, which integrates deductive and plausible reasoning and exploits Semantic Web technology to solve complex clinical decision support queries. We evaluated our system using a real-world medical dataset of patients with hepatitis, from which we randomly removed different percentages of data (5%, 10%, 15%, and 20%) to reflect scenarios with increasing amounts of incomplete medical knowledge. To increase the reliability of the results, we generated 5 independent datasets for each percentage of missing values, which resulted in 20 experimental datasets (in addition to the original dataset). The results show that plausibly inferred knowledge extends the coverage of the knowledge base by, on average, 2%, 7%, 12%, and 16% for datasets with, respectively, 5%, 10%, 15

Semantics-based plausible reasoning to extend the knowledge coverage of medical knowledge bases for improved clinical decision support

OpenAIRE

Mohammadhassanzadeh, Hossein; Van Woensel, William; Abidi, Samina Raza; Abidi, Syed Sibte Raza

2017-01-01

Background Capturing complete medical knowledge is challenging-often due to incomplete patient Electronic Health Records (EHR), but also because of valuable, tacit medical knowledge hidden away in physicians? experiences. To extend the coverage of incomplete medical knowledge-based systems beyond their deductive closure, and thus enhance their decision-support capabilities, we argue that innovative, multi-strategy reasoning approaches should be applied. In particular, plausible reasoning mech...

Decision tree ensembles for online operation of large smart grids

International Nuclear Information System (INIS)

Steer, Kent C.B.; Wirth, Andrew; Halgamuge, Saman K.

2012-01-01

Highlights: ► We present a new technique for the online control of large smart grids. ► We use a Decision Tree Ensemble in a Receding Horizon Controller. ► Decision Trees can approximate online optimisation approaches. ► Decision Trees can make adjustments to their output in real time. ► The new technique outperforms heuristic online optimisation approaches. - Abstract: Smart grids utilise omnidirectional data transfer to operate a network of energy resources. Associated technologies present operators with greater control over system elements and more detailed information on the system state. While these features may improve the theoretical optimal operating performance, determining the optimal operating strategy becomes more difficult. In this paper, we show how a decision tree ensemble or ‘forest’ can produce a near-optimal control strategy in real time. The approach substitutes the decision forest for the simulation–optimisation sub-routine commonly employed in receding horizon controllers. The method is demonstrated on a small and a large network, and compared to controllers employing particle swarm optimisation and evolutionary strategies. For the smaller network the proposed method performs comparably in terms of total energy usage, but delivers a greater demand deficit. On the larger network the proposed method is superior with respect to all measures. We conclude that the method is useful when the time required to evaluate possible strategies via simulation is high.

Medical image registration algorithms assesment Bronze Standard application enactment on grids using the MOTEUR workflow engine

CERN Document Server

Glatard, T; Pennec, X

2006-01-01

Medical image registration is pre-processing needed for many medical image analysis procedures. A very large number of registration algorithms are available today, but their performance is often not known and very difficult to assess due to the lack of gold standard. The Bronze Standard algorithm is a very data and compute intensive statistical approach for quantifying registration algorithms accuracy. In this paper, we describe the Bronze Standard application and we discuss the need for grids to tackle such computations on medical image databases. We demonstrate MOTEUR, a service-based workflow engine optimized for dealing with data intensive applications. MOTEUR eases the enactment of the Bronze Standard and similar applications on the EGEE production grid infrastructure. It is a generic workflow engine, based on current standards and freely available, that can be used to instrument legacy application code at low cost.

Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences.

Science.gov (United States)

Scalia, Peter; Durand, Marie-Anne; Kremer, Jan; Faber, Marjan; Elwyn, Glyn

2018-01-01

Randomized trials have shown that patient decision aids can modify users' preferred healthcare options, but research has yet to identify the attributes embedded in these tools that cause preferences to shift. The aim of this study was to investigate people's preferences as they used decision aids for 5 health decisions and, for each of the following: 1) determine if using the interactive Option Grid led to a pre-post shift in preferences; 2) determine which frequently asked questions (FAQs) led to preference shifts; 3) determine the FAQs that were rated as the most important as users compared options. Interactive Option Grid decision aids enable users to view attributes of available treatment or screening options, rate their importance, and specify their preferred options before and after decision aid use. The McNemar-Bowker paired test was used to compare stated pre-post preferences. Multinomial logistic regressions were conducted to investigate possible associations between covariates and preference shifts. Overall, 626 users completed the 5 most-used tools: 1) Amniocentesis test: yes or no? ( n = 73); 2) Angina: treatment options ( n = 88); 3) Breast cancer: surgical options ( n = 265); 4) Prostate Specific Antigen (PSA) test: yes or no? ( n = 82); 5) Statins for heart disease risk: yes or no? ( n = 118). The breast cancer, PSA, and statins Option Grid decision aids generated significant preference shifts. Generally, users shifted their preference when presented with the description of the available treatment options, and the risk associated with each option. The use of decision aids for some, but not all health decisions, was accompanied by a shift in user preferences. Users typically valued information associated with risks, and chose more risk averse options after completing the interactive tool.

A data grid for imaging-based clinical trials

Science.gov (United States)

Zhou, Zheng; Chao, Sander S.; Lee, Jasper; Liu, Brent; Documet, Jorge; Huang, H. K.

2007-03-01

Clinical trials play a crucial role in testing new drugs or devices in modern medicine. Medical imaging has also become an important tool in clinical trials because images provide a unique and fast diagnosis with visual observation and quantitative assessment. A typical imaging-based clinical trial consists of: 1) A well-defined rigorous clinical trial protocol, 2) a radiology core that has a quality control mechanism, a biostatistics component, and a server for storing and distributing data and analysis results; and 3) many field sites that generate and send image studies to the radiology core. As the number of clinical trials increases, it becomes a challenge for a radiology core servicing multiple trials to have a server robust enough to administrate and quickly distribute information to participating radiologists/clinicians worldwide. The Data Grid can satisfy the aforementioned requirements of imaging based clinical trials. In this paper, we present a Data Grid architecture for imaging-based clinical trials. A Data Grid prototype has been implemented in the Image Processing and Informatics (IPI) Laboratory at the University of Southern California to test and evaluate performance in storing trial images and analysis results for a clinical trial. The implementation methodology and evaluation protocol of the Data Grid are presented.

A multi-agent based distributed energy management scheme for smart grid applications

International Nuclear Information System (INIS)

Radhakrishnan, Bharat Menon; Srinivasan, Dipti

2016-01-01

A multi-agent system based distributed EMS (energy management system) is proposed in this paper to perform optimal energy allocation and management for grids comprising of renewables, storage and distributed generation. The reliable and efficient operation of smart grids is slackened due to the presence of intermittent renewables. As the load demand and renewables are uncertain throughout the day, an energy management system is essential to ensure grid stability and achieve reductions in operation costs and CO_2 emissions. The main objectives of the proposed algorithm is to maintain power balance in the system and to ensure long cycle life for storage units by controlling their SOC (state of charge). The proposed EMS scheme is tested and validated on a practical test system, which replicates a small-scale smart grid with a variety of distributed sources, storage devices, loads, power electronic converters, and SCADA (supervisory control and data acquisition) system. This system is also connected to the utility grid and the power exchange is controlled with the help of a battery system through a fuzzy based decision-making framework. The proposed algorithm is also extensively verified and tested using a series of sensitivity analyses and benchmarking with existing algorithms. - Highlights: • An agent-based decentralized algorithm is proposed to perform energy management. • The multi-agent system approach eliminates the possibility of single point failures. • Adaptive fuzzy systems make the decision making more reliable, flexible and robust. • The algorithm is extensively tested and validated using sensitivity and verification analyses.

Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications.

Science.gov (United States)

Holden, Richard J; Srinivas, Preethi; Campbell, Noll L; Clark, Daniel O; Bodke, Kunal S; Hong, Youngbok; Boustani, Malaz A; Ferguson, Denisha; Callahan, Christopher M

2018-03-06

Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n = 24), in-store shopper observations (n = 39), and laboratory-based simulated OTC shopping tasks (n = 21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making. Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications. A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making. This model suggests

Portrayal of medical decision making around medical interventions life-saving encounters on three medical television shows.

Science.gov (United States)

Schwei, Rebecca J; Jacobs, Elizabeth A; Wingert, Katherine; Montague, Enid

2015-07-01

Previous literature has shown that patients obtain information about the medical system from television shows. Additionally, shared decision making is regularly cited as the ideal way to make decisions during a medical encounter. Little information exists surrounding the characteristics of medical decision-making, such as who makes the decision, on medical television shows. We evaluate the characteristics of medical decisions in lifesaving encounters on medical television shows and evaluate if these characteristics were different on staged and reality television shows. We coded type of medical intervention, patient's ability to participate in decision, presence of patient advocate during decision, final decision maker, decision to use intervention, and controversy surrounding decision on three television shows. Frequencies by show were calculated and differences across the three television shows and between staged (ER) and reality ( BostonMed and Hopkins ) television shows were assessed with chi-square tests. The final data set included 37 episodes, 137 patients and 593 interventions. On ER, providers were significantly more likely to make the decision about the medical intervention without informing the patient when a patient was capable of making a decision compared to BostonMed or Hopkins (ptelevision shows we analyzed. It is possible that what patients see on television influences their expectations surrounding the decision making process and the use of medical interventions in everyday healthcare encounters.

Dutch gas distribution grid goes green: decision support tool for local biogas utilization

NARCIS (Netherlands)

Weidenaar, Teade; Hoekstra, Sipke; Wolters, Mannes

2011-01-01

A Decision Support Tool (DST) has been developed that will aid Distribution Service Operators (DSOs) in their decision making process on which investments to make in the gas distribution grid in order to facilitate the use of biogas. The DST considers both the conversion of biogas to electricity as

Dual processing model of medical decision-making

Science.gov (United States)

2012-01-01

Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical

Dual processing model of medical decision-making.

Science.gov (United States)

Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

2012-09-03

Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. We show that physician's beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker's threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the

Health-e-Child a grid platform for european paediatrics

CERN Document Server

Skaburskas, K; Shade, J; Manset, D; Revillard, J; Rios, A; Anjum, A; Branson, A; Bloodsworth, P; Hauer, T; McClatchey, R; Rogulin, D

2008-01-01

The Health-e-Child (HeC) project [1], [2] is an EC Framework Programme 6 Integrated Project that aims to develop a grid-based integrated healthcare platform for paediatrics. Using this platform biomedical informaticians will integrate heterogeneous data and perform epidemiological studies across Europe. The resulting Grid enabled biomedical information platform will be supported by robust search, optimization and matching techniques for information collected in hospitals across Europe. In particular, paediatricians will be provided with decision support, knowledge discovery and disease modelling applications that will access data in hospitals in the UK, Italy and France, integrated via the Grid. For economy of scale, reusability, extensibility, and maintainability, HeC is being developed on top of an EGEE/gLite [3] based infrastructure that provides all the common data and computation management services required by the applications. This paper discusses some of the major challenges in bio-medical data integr...

Dispositional optimism, self-framing and medical decision-making.

Science.gov (United States)

Zhao, Xu; Huang, Chunlei; Li, Xuesong; Zhao, Xin; Peng, Jiaxi

2015-03-01

Self-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N = 500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making. © 2014 International Union of Psychological Science.

[Shared medical decision making in gynaecology].

Science.gov (United States)

This, P; Panel, P

2010-02-01

When two options or more can be chosen in medical care, the final decision implies two steps: facts analysis, and patient evaluation of preferences. Shared Medical Decision-Making is a rational conceptual frame that can be used in such cases. In this paper, we describe the concept, its practical modalities, and the questions raised by its use. In gynaecology, many medical situations involve "sensitive preferences choice": for example, contraceptive choice, menorrhagia treatment, and approach of menopause. Some tools from the "Shared Medical Decision Making" concept are useful to structure medical consultations, to convey information, and to reveal patients preferences. Decision aid are used in clinical research settings, but some of them may also be easily used in usual practice, and help physicians to improve both quality and traceability of the decisional process. Copyright 2009 Elsevier Masson SAS. All rights reserved.

Decision Optimization for Power Grid Operating Conditions with High- and Low-Voltage Parallel Loops

Directory of Open Access Journals (Sweden)

Dong Yang

2017-05-01

Full Text Available With the development of higher-voltage power grids, the high- and low-voltage parallel loops are emerging, which lead to energy losses and even threaten the security and stability of power systems. The multi-infeed high-voltage direct current (HVDC configurations widely appearing in AC/DC interconnected power systems make this situation even worse. Aimed at energy saving and system security, a decision optimization method for power grid operating conditions with high- and low-voltage parallel loops is proposed in this paper. Firstly, considering hub substation distribution and power grid structure, parallel loop opening schemes are generated with GN (Girvan-Newman algorithms. Then, candidate opening schemes are preliminarily selected from all these generated schemes based on a filtering index. Finally, with the influence on power system security, stability and operation economy in consideration, an evaluation model for candidate opening schemes is founded based on analytic hierarchy process (AHP. And a fuzzy evaluation algorithm is used to find the optimal scheme. Simulation results of a New England 39-bus system and an actual power system validate the effectiveness and superiority of this proposed method.

Overcoming barriers to development of cooperative medical decision support models.

Science.gov (United States)

Hudson, Donna L; Cohen, Maurice E

2012-01-01

Attempts to automate the medical decision making process have been underway for the at least fifty years, beginning with data-based approaches that relied chiefly on statistically-based methods. Approaches expanded to include knowledge-based systems, both linear and non-linear neural networks, agent-based systems, and hybrid methods. While some of these models produced excellent results none have been used extensively in medical practice. In order to move these methods forward into practical use, a number of obstacles must be overcome, including validation of existing systems on large data sets, development of methods for including new knowledge as it becomes available, construction of a broad range of decision models, and development of non-intrusive methods that allow the physician to use these decision aids in conjunction with, not instead of, his or her own medical knowledge. None of these four requirements will come easily. A cooperative effort among researchers, including practicing MDs, is vital, particularly as more information on diseases and their contributing factors continues to expand resulting in more parameters than the human decision maker can process effectively. In this article some of the basic structures that are necessary to facilitate the use of an automated decision support system are discussed, along with potential methods for overcoming existing barriers.

Framework of Uncertainty in Medical Decision Making

DEFF Research Database (Denmark)

Austin, L; Brodersen, John; Reventlow, Susanne

Historically, medical decisions have primarily involved diagnosis and treatment of symptomatic patients. Increasingly, medical decisions concern uncertain future health states in asymptomatic people. We construct a taxonomy of five medical decision situations that encompasses these wider...... possibilities. For each, we identify potential sources of uncertainty that should be considered when assessing the degree of belief that a person has, or will have, a condition. Decision trees illustrate the normative structure of each situation. The five decision situations involve: 1) assessing...

Real-Time Pricing Decision Making for Retailer-Wholesaler in Smart Grid Based on Game Theory

Directory of Open Access Journals (Sweden)

Yeming Dai

2014-01-01

Full Text Available Real-time pricing DSM (demand side management is widely used to dynamically change or shift the electricity consumption in the smart grid. In this paper, a game decision making scheme is proposed in the smart grid with DSM. The interaction between two retailers and their wholesaler is modeled as a two-stage game model. Considering the competition between two retailers, two different game models are developed in terms of the different action order between retailers and their wholesaler. Through analyzing the equilibrium revenues of the retailers for different situations we find that although the wholesaler expects to decentralize certain management powers to the retailers, it has retained the right to change the rules of the game and frequently reneged on the promises. More specifically, the law should ensure that any change of the revenue-sharing formula must go through certain legal procedures. Imposing legal restrictions on the wholesaler’s discretionary policy suggests that the time-inconsistency problem is mitigated. Numerical simulation shows the effectiveness of proposed scheme.

Patient engagement in healthcare: pathways for effective medical decision making

Directory of Open Access Journals (Sweden)

Serena Barello

2015-04-01

Full Text Available Making patients protagonists of decisions about their care is a primacy in the 21st century medical ethics. Precisely, to favor shared treatment decisions potentially enables patients’ autonomy and self-determination, and protects patients’ rights to make decisions about their own future care. To fully accomplish this goal, medicine should take into account the complexity of the healthcare decision making processes: patients may experience dilemmas when having to take decisions that not only concern their patient role/identity but also involve the psychosocial impact of treatments on their overall life quality. A deeper understanding of the patients’ expected role in the decision making process across their illness journey may favor the optimal implementation of this practice into the day-to-day medical agenda. In this paper, authors discuss the value of assuming the Patient Health Engagement Model to sustain successful pathways for effective medical decision making throughout the patient’s illness course. This model and its relational implication for the clinical encounter might be the base for an innovative “patient-doctor relational agenda” able to sustain an “engagement-sensitive” medical decision making.

Utility-based Reinforcement Learning for Reactive Grids

OpenAIRE

Perez , Julien; Germain-Renaud , Cécile; Kégl , Balázs; Loomis , C.

2008-01-01

International audience; Large scale production grids are an important case for autonomic computing. They follow a mutualization paradigm: decision-making (human or automatic) is distributed and largely independent, and, at the same time, it must implement the highlevel goals of the grid management. This paper deals with the scheduling problem with two partially conflicting goals: fairshare and Quality of Service (QoS). Fair sharing is a wellknown issue motivated by return on investment for pa...

Improving Grid Resilience through Informed Decision-making (IGRID)

Energy Technology Data Exchange (ETDEWEB)

Burnham, Laurie [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Power Systems Research; Stamber, Kevin L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Systems Research, Analysis and Applications; Jeffers, Robert Fredric [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Resilience and Regulatory Effects; Stevens-Adams, Susan Marie [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Human Factors; Verzi, Stephen Joseph [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Systems Research, Analysis and Applications; Galiardi, Meghan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Systems Research, Analysis and Applications; Haass, Michael Joseph [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Cognitive Systems; Cauthen, Katherine Regina [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Systems Research, Analysis and Applications

2016-09-01

The transformation of the distribution grid from a centralized to decentralized architecture, with bi-directional power and data flows, is made possible by a surge in network intelligence and grid automation. While changes are largely beneficial, the interface between grid operator and automated technologies is not well understood, nor are the benefits and risks of automation. Quantifying and understanding the latter is an important facet of grid resilience that needs to be fully investigated. The work described in this document represents the first empirical study aimed at identifying and mitigating the vulnerabilities posed by automation for a grid that for the foreseeable future will remain a human-in-the-loop critical infrastructure. Our scenario-based methodology enabled us to conduct a series of experimental studies to identify causal relationships between grid-operator performance and automated technologies and to collect measurements of human performance as a function of automation. Our findings, though preliminary, suggest there are predictive patterns in the interplay between human operators and automation, patterns that can inform the rollout of distribution automation and the hiring and training of operators, and contribute in multiple and significant ways to the field of grid resilience.

Dual processing model of medical decision-making

Directory of Open Access Journals (Sweden)

Djulbegovic Benjamin

2012-09-01

Full Text Available Abstract Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I and/or an analytical, deliberative (system II processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to

Emerging medical informatics with case-based reasoning for aiding clinical decision in multi-agent system.

Science.gov (United States)

Shen, Ying; Colloc, Joël; Jacquet-Andrieu, Armelle; Lei, Kai

2015-08-01

This research aims to depict the methodological steps and tools about the combined operation of case-based reasoning (CBR) and multi-agent system (MAS) to expose the ontological application in the field of clinical decision support. The multi-agent architecture works for the consideration of the whole cycle of clinical decision-making adaptable to many medical aspects such as the diagnosis, prognosis, treatment, therapeutic monitoring of gastric cancer. In the multi-agent architecture, the ontological agent type employs the domain knowledge to ease the extraction of similar clinical cases and provide treatment suggestions to patients and physicians. Ontological agent is used for the extension of domain hierarchy and the interpretation of input requests. Case-based reasoning memorizes and restores experience data for solving similar problems, with the help of matching approach and defined interfaces of ontologies. A typical case is developed to illustrate the implementation of the knowledge acquisition and restitution of medical experts. Copyright © 2015 Elsevier Inc. All rights reserved.

Grid-based modeling for land use planning and environmental resource mapping.

Energy Technology Data Exchange (ETDEWEB)

Kuiper, J. A.

1999-08-04

Geographic Information System (GIS) technology is used by land managers and natural resource planners for examining resource distribution and conducting project planning, often by visually interpreting spatial data representing environmental or regulatory variables. Frequently, many variables influence the decision-making process, and modeling can improve results with even a small investment of time and effort. Presented are several grid-based GIS modeling projects, including: (1) land use optimization under environmental and regulatory constraints; (2) identification of suitable wetland mitigation sites; and (3) predictive mapping of prehistoric cultural resource sites. As different as the applications are, each follows a similar process of problem conceptualization, implementation of a practical grid-based GIS model, and evaluation of results.

Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science.

Science.gov (United States)

Kim, Hyejin; Song, Mi-Kyung

2018-01-01

Adults who lack decision-making capacity and a surrogate ("unbefriended" adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals. This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature. Six electronic databases were searched using 4 keywords: "unbefriended," "unrepresented patients," "adult orphans," and "incapacitated patients without surrogates." After screening, the final sample included 10 data-based articles for synthesis. Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings varied; and (4) professional guidelines and laws to address the issues related to this population were inconsistent. There have been no studies regarding the quality of medical decision-making and its outcomes for this population or societal impact. Extremely limited empirical data exist on unbefriended adults to develop strategies to improve how medical decisions are made for this population. There is an urgent need for research to examine the quality of medical decision-making and its outcomes for this vulnerable population.

Decision making about pre-medication to children.

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Proczkowska-Björklund, M; Runeson, I; Gustafsson, P A; Svedin, C G

2008-11-01

Inviting the child to participate in medical decisions regarding common medical procedures might influence the child's behaviour during the procedures. We wanted to study nurse decision-making communication regarding pre-medication before ear, nose and throat (ENT) surgery. In total, 102 children (3-6 years) signed for ENT surgery were video-filmed during the pre-medication process. The nurse decision-making communication was identified, transcribed and grouped in six main categories dependent on the level of participation (self-determination, compromise, negotiation, questioning, information, lack of communication). Associations between child factors (age, gender, verbal communication and non-verbal communication) and different nurse decision-making communication were studied. Associations between the decision-making communication and verbal hesitation and/or the child's compliance in taking pre-medication were also studied. Totally, information was the most frequently used category of decision making communication followed by negotiation and questioning. To the children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more compromise, negotiation and gave less information to children with less compliance. No specific type of nurse decision-making communication was associated with verbal hesitation. The most important predictors for verbal hesitation were none or hesitant eye contact with nurse (OR = 4.5) and placement nearby or in parent's lap (OR = 4.7). Predictors for less compliance in taking pre-medication were verbal hesitation from the child (OR = 22.7) and children who did not give any verbal answer to nurse initial questions (OR = 5.5). Decision-making communication could not predict the child's compliance during pre-medication. Although negotiation, questioning and self-determination communication were associated with more unwillingness to take pre-medication

Dual processing model of medical decision-making

OpenAIRE

Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

2012-01-01

Abstract Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administe...

A Stackelberg Game Approach for Energy Outage-Aware Power Distribution of an Off-Grid Base Station over Multiple Retailers

Directory of Open Access Journals (Sweden)

Seung Hyun Jeon

2018-03-01

Full Text Available This paper investigates the problem of power distribution for an off-grid base station (BS that operates sustainably without an electrical grid. We consider that multiple retailers with heterogeneous renewable energy sources (RESs compete to maximize their revenues by individually setting the unit power price. Energy outages (EOs, which cause the power supply to fall below that which is sufficient for ensuring the traffic arrival rate required for the off-grid BS, critically affect the users’ service quality. To minimize EOs and operational expenditure (OPEX, the off-grid BS manages the power supply by reacting to the retailers’ pricing decisions. We analyze the economic benefits of power distribution to the off-grid BS from the perspective of the retailers’ pricing competition, by designing a hierarchical decision-making scheme as a multi-leader single-follower Stackelberg game. We derive a closed form expression for the optimal behavior of the off-grid BS and retailers, based on well-designed utility functions. Finally, numerical results demonstrate the proposed solution with its practical convergence time.

Cognitive-emotional decision making (CEDM): a framework of patient medical decision making.

Science.gov (United States)

Power, Tara E; Swartzman, Leora C; Robinson, John W

2011-05-01

Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhal's (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

An Extended Design of the "Grid-Enabled SEE++ System" Based on Globus Toolkit 4 and gLite Conference

CERN Document Server

Schreiner, W.; Buchberger, M.; Kaltofen, T.

2006-01-01

"Grid-Enabled SEE++" based on the SEE++ software system for the biomechanical 3D simulation of the human eye and its muscles. SEE++ simulates the common eye muscle surgery techniques in a graphic interactive way that is familiar to an experienced surgeon. The goal of "Grid-Enabled SEE++" is to adapt and to extend SEE++ in several steps and to develop an efficient grid-based tool for "Evidence Based Medicine", which supports the surgeons in choosing optimal surgery techniques for the treatments of different syndromes of strabismus. In our previous work, we combined the SEE++ software with the Globus (pre-Web Service) middleware and developed a parallel version of the simulation of the "Hess-Lancaster test" (typical medical examination). By this, we demonstrated how a noticeable speedup can be achieved in SEE++ by the exploitation of the computational power of the Grid. Furthermore, we reported the prototype implementation of a medical database component for "Grid-Enabled SEE++". Finally, we designed a so calle...

Framing effect debiasing in medical decision making.

Science.gov (United States)

Almashat, Sammy; Ayotte, Brian; Edelstein, Barry; Margrett, Jennifer

2008-04-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts. The present study investigated the effects of a debiasing procedure designed to prevent the framing effect for young adults who made decisions based on hypothetical medical decision-making vignettes. The debiasing technique involved participants listing advantages and disadvantages of each treatment prior to making a choice. One hundred and two undergraduate students read a set of three medical treatment vignettes that presented information in terms of different outcome probabilities under either debiasing or control conditions. The framing effect was demonstrated by the control group in two of the three vignettes. The debiasing group successfully avoided the framing effect for both of these vignettes. These results further support previous findings of the framing effect as well as an effective debiasing technique. This study improved upon previous framing debiasing studies by including a control group and personal medical scenarios, as well as demonstrating debiasing in a framing condition in which the framing effect was demonstrated without a debiasing procedure. The findings suggest a relatively simple manipulation may circumvent the use of decision-making heuristics in patients.

QoS Differential Scheduling in Cognitive-Radio-Based Smart Grid Networks: An Adaptive Dynamic Programming Approach.

Science.gov (United States)

Yu, Rong; Zhong, Weifeng; Xie, Shengli; Zhang, Yan; Zhang, Yun

2016-02-01

As the next-generation power grid, smart grid will be integrated with a variety of novel communication technologies to support the explosive data traffic and the diverse requirements of quality of service (QoS). Cognitive radio (CR), which has the favorable ability to improve the spectrum utilization, provides an efficient and reliable solution for smart grid communications networks. In this paper, we study the QoS differential scheduling problem in the CR-based smart grid communications networks. The scheduler is responsible for managing the spectrum resources and arranging the data transmissions of smart grid users (SGUs). To guarantee the differential QoS, the SGUs are assigned to have different priorities according to their roles and their current situations in the smart grid. Based on the QoS-aware priority policy, the scheduler adjusts the channels allocation to minimize the transmission delay of SGUs. The entire transmission scheduling problem is formulated as a semi-Markov decision process and solved by the methodology of adaptive dynamic programming. A heuristic dynamic programming (HDP) architecture is established for the scheduling problem. By the online network training, the HDP can learn from the activities of primary users and SGUs, and adjust the scheduling decision to achieve the purpose of transmission delay minimization. Simulation results illustrate that the proposed priority policy ensures the low transmission delay of high priority SGUs. In addition, the emergency data transmission delay is also reduced to a significantly low level, guaranteeing the differential QoS in smart grid.

Health-e-Child: a grid platform for european paediatrics

International Nuclear Information System (INIS)

Skaburskas, K; Estrella, F; Shade, J; Manset, D; Revillard, J; Rios, A; Anjum, A; Branson, A; Bloodsworth, P; Hauer, T; McClatchey, R; Rogulin, D

2008-01-01

The Health-e-Child (HeC) project [1], [2] is an EC Framework Programme 6 Integrated Project that aims to develop a grid-based integrated healthcare platform for paediatrics. Using this platform biomedical informaticians will integrate heterogeneous data and perform epidemiological studies across Europe. The resulting Grid enabled biomedical information platform will be supported by robust search, optimization and matching techniques for information collected in hospitals across Europe. In particular, paediatricians will be provided with decision support, knowledge discovery and disease modelling applications that will access data in hospitals in the UK, Italy and France, integrated via the Grid. For economy of scale, reusability, extensibility, and maintainability, HeC is being developed on top of an EGEE/gLite [3] based infrastructure that provides all the common data and computation management services required by the applications. This paper discusses some of the major challenges in bio-medical data integration and indicates how these will be resolved in the HeC system. HeC is presented as an example of how computer science (and, in particular Grid infrastructures) originating from high energy physics can be adapted for use by biomedical informaticians to deliver tangible real-world benefits

Mapping Perceptions of Lupus Medication Decision-Making Facilitators: The Importance of Patient Context.

Science.gov (United States)

Qu, Haiyan; Shewchuk, Richard M; Alarcón, Graciela; Fraenkel, Liana; Leong, Amye; Dall'Era, Maria; Yazdany, Jinoos; Singh, Jasvinder A

2016-12-01

Numerous factors can impede or facilitate patients' medication decision-making and adherence to physicians' recommendations. Little is known about how patients and physicians jointly view issues that affect the decision-making process. Our objective was to derive an empirical framework of patient-identified facilitators to lupus medication decision-making from key stakeholders (including 15 physicians, 5 patients/patient advocates, and 8 medical professionals) using a patient-centered cognitive mapping approach. We used nominal group patient panels to identify facilitators to lupus treatment decision-making. Stakeholders independently sorted the identified facilitators (n = 98) based on their similarities and rated the importance of each facilitator in patient decision-making. Data were analyzed using multidimensional scaling and hierarchical cluster analysis. A cognitive map was derived that represents an empirical framework of facilitators for lupus treatment decisions from multiple stakeholders' perspectives. The facilitator clusters were 1) hope for a normal/healthy life, 2) understand benefits and effectiveness of taking medications, 3) desire to minimize side effects, 4) medication-related data, 5) medication effectiveness for "me," 6) family focus, 7) confidence in physician, 8) medication research, 9) reassurance about medication, and 10) medication economics. Consideration of how different stakeholders perceive the relative importance of lupus medication decision-making clusters is an important step toward improving patient-physician communication and effective shared decision-making. The empirically derived framework of medication decision-making facilitators can be used as a guide to develop a lupus decision aid that focuses on improving physician-patient communication. © 2016, American College of Rheumatology.

Assessing survivability to support power grid investment decisions

International Nuclear Information System (INIS)

Koziolek, Anne; Avritzer, Alberto; Suresh, Sindhu; Menasché, Daniel S.; Diniz, Morganna; Souza e Silva, Edmundo de; Leão, Rosa M.; Trivedi, Kishor; Happe, Lucia

2016-01-01

The reliability of power grids has been subject of study for the past few decades. Traditionally, detailed models are used to assess how the system behaves after failures. Such models, based on power flow analysis and detailed simulations, yield accurate characterizations of the system under study. However, they fall short on scalability. In this paper, we propose an efficient and scalable approach to assess the survivability of power systems. Our approach takes into account the phased-recovery of the system after a failure occurs. The proposed phased-recovery model yields metrics such as the expected accumulated energy not supplied between failure and full recovery. Leveraging the predictive power of the model, we use it as part of an optimization framework to assist in investment decisions. Given a budget and an initial circuit to be upgraded, we propose heuristics to sample the solution space in a principled way accounting for survivability-related metrics. We have evaluated the feasibility of this approach by applying it to the design of a benchmark distribution automation circuit. Our empirical results indicate that the combination of survivability and power flow analysis can provide meaningful investment decision support for power systems engineers. - Highlights: • We propose metrics and models for scalable survivability analysis of power systems. • The survivability model captures the system phased-recovery, from failure to repair. • The survivability model is used as a building block of an optimization framework. • Heuristics assist in investment options accounting for survivability-related metrics.

Intelligent Decision-Making System with Green Pervasive Computing for Renewable Energy Business in Electricity Markets on Smart Grid

Directory of Open Access Journals (Sweden)

Park JongHyuk

2009-01-01

Full Text Available This paper is about the intelligent decision-making system for the smart grid based electricity market which requires distributed decision making on the competitive environments composed of many players and components. It is very important to consider the renewable energy and emission problem which are expected to be monitored by wireless communication networks. It is very difficult to predict renewable energy outputs and emission prices over time horizon, so it could be helpful to catch up those data on real time basis using many different kinds of communication infrastructures. On this backgrounds this paper provides an algorithm to make an optimal decision considering above factors.

The MammoGrid Project Grids Architecture

CERN Document Server

McClatchey, Richard; Hauer, Tamas; Estrella, Florida; Saiz, Pablo; Rogulin, Dmitri; Buncic, Predrag; Clatchey, Richard Mc; Buncic, Predrag; Manset, David; Hauer, Tamas; Estrella, Florida; Saiz, Pablo; Rogulin, Dmitri

2003-01-01

The aim of the recently EU-funded MammoGrid project is, in the light of emerging Grid technology, to develop a European-wide database of mammograms that will be used to develop a set of important healthcare applications and investigate the potential of this Grid to support effective co-working between healthcare professionals throughout the EU. The MammoGrid consortium intends to use a Grid model to enable distributed computing that spans national borders. This Grid infrastructure will be used for deploying novel algorithms as software directly developed or enhanced within the project. Using the MammoGrid clinicians will be able to harness the use of massive amounts of medical image data to perform epidemiological studies, advanced image processing, radiographic education and ultimately, tele-diagnosis over communities of medical "virtual organisations". This is achieved through the use of Grid-compliant services [1] for managing (versions of) massively distributed files of mammograms, for handling the distri...

Grid Transmission Expansion Planning Model Based on Grid Vulnerability

Science.gov (United States)

Tang, Quan; Wang, Xi; Li, Ting; Zhang, Quanming; Zhang, Hongli; Li, Huaqiang

2018-03-01

Based on grid vulnerability and uniformity theory, proposed global network structure and state vulnerability factor model used to measure different grid models. established a multi-objective power grid planning model which considering the global power network vulnerability, economy and grid security constraint. Using improved chaos crossover and mutation genetic algorithm to optimize the optimal plan. For the problem of multi-objective optimization, dimension is not uniform, the weight is not easy given. Using principal component analysis (PCA) method to comprehensive assessment of the population every generation, make the results more objective and credible assessment. the feasibility and effectiveness of the proposed model are validated by simulation results of Garver-6 bus system and Garver-18 bus.

Family involvement in medical decision-making: Perceptions of nursing and psychology students.

Science.gov (United States)

Itzhaki, Michal; Hildesheimer, Galya; Barnoy, Sivia; Katz, Michael

2016-05-01

Family members often rely on health care professionals to guide and support them through the decision-making process. Although family involvement in medical decisions should be included in the preservice curriculum for the health care professions, perceptions of students in caring professions on family involvement in medical decision-making have not yet been examined. To examine the perceptions of nursing and psychology students on family involvement in medical decision-making for seriously ill patients. A descriptive cross-sectional design was used. First year undergraduate nursing and psychology students studying for their Bachelor of Arts degree were recruited. Perceptions were assessed with a questionnaire constructed based on the Multi-Attribute Utility Theory (MAUT), which examines decision-maker preferences. The questionnaire consisted of two parts referring to the respondent once as the patient and then as the family caregiver. Questionnaires were completed by 116 nursing students and 156 psychology students. Most were of the opinion that family involvement in decision-making is appropriate, especially when the patient is incapable of making decisions. Nursing students were more inclined than psychology students to think that financial, emotional, and value-based considerations should be part of the family's involvement in decision-making. Both groups of students perceived the emotional consideration as most acceptable, whereas the financial consideration was considered the least acceptable. Nursing and psychology students perceive family involvement in medical decision-making as appropriate. In order to train students to support families in the process of decision-making, further research should examine Shared Decision-Making (SDM) programs, which involve patient and clinician collaboration in health care decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

IMPRESS: medical location-aware decision making during emergencies

Science.gov (United States)

Gkotsis, I.; Eftychidis, G.; Leventakis, G.; Mountzouris, M.; Diagourtas, D.; Kostaridis, A.; Hedel, R.; Olunczek, A.; Hahmann, S.

2017-09-01

Emergency situations and mass casualties involve several agencies and public authorities, which need to gather data from the incident scene and exchange geo-referenced information to provide fast and accurate first aid to the people in need. Tracking patients on their way to the hospitals can prove critical in taking lifesaving decisions. Increased and continuous flow of information combined by vital signs and geographic location of emergency victims can greatly reduce the response time of the medical emergency chain and improve the efficiency of disaster medicine activity. Recent advances in mobile positioning systems and telecommunications are providing the technology needed for the development of location-aware medical applications. IMPRESS is an advanced ICT platform based on adequate technologies for developing location-aware medical response during emergencies. The system incorporates mobile and fixed components that collect field data from diverse sources, support medical location and situation-based services and share information on the patient's transport from the field to the hospitals. In IMPRESS platform tracking of victims, ambulances and emergency services vehicles is integrated with medical, traffic and crisis management information into a common operational picture. The Incident Management component of the system manages operational resources together with patient tracking data that contain vital sign values and patient's status evolution. Thus, it can prioritize emergency transport decisions, based on medical and location-aware information. The solution combines positioning and information gathered and owned by various public services involved in MCIs or large-scale disasters. IMPRESS solution, were validated in field and table top exercises in cooperation with emergency services and hospitals.

Family interests and medical decisions for children.

Science.gov (United States)

Baines, Paul

2017-10-01

Medical decisions for children are usually justified by the claim that they are in a child's best interests. More recently, following criticisms of the best interests standard, some advocate that the family's interests should influence medical decisions for children, although what is meant by family interests is often not made clear. I argue that at least two senses of family interests may be discerned. There is a 'weak' sense (as the amalgamated interests of family members) of family interests and a 'strong' sense (that the family itself has interests over and above the interests of individuals). I contend that there are problems with both approaches in making medical decisions for children but that the weak sense is more plausible. Despite this, I argue that claims for family interests are not helpful in making medical decisions for children. © 2017 John Wiley & Sons Ltd.

Patient decision-making: medical ethics and mediation.

OpenAIRE

Craig, Y J

1996-01-01

A review of medical ethics literature relating to the importance of the participation of patients in decision-making introduces the role of rights-based mediation as a voluntary process now being developed innovatively in America. This is discussed in relation to the theory of communicative ethics and moral personhood. References are then made to the work of medical ethics committees and the role of mediation within these. Finally it is suggested that mediation is part of an eirenic ethic alr...

On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid.

Science.gov (United States)

Elwyn, Glyn; Rasmussen, Julie; Kinsey, Katharine; Firth, Jill; Marrin, Katy; Edwards, Adrian; Wood, Fiona

2018-02-01

Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use. Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids. We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients. In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice. After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways. © 2016 John Wiley & Sons, Ltd.

The attitude-behavior discrepancy in medical decision making.

Science.gov (United States)

He, Fei; Li, Dongdong; Cao, Rong; Zeng, Juli; Guan, Hao

2014-12-01

In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions. This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description. A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behavior\\attitude to risky plan\\attitude to conservative plan (3). A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P framing of a description has an impact on medical decision-making.

Research and design of smart grid monitoring control via terminal based on iOS system

Science.gov (United States)

Fu, Wei; Gong, Li; Chen, Heli; Pan, Guangji

2017-06-01

Aiming at a series of problems existing in current smart grid monitoring Control Terminal, such as high costs, poor portability, simple monitoring system, poor software extensions, low system reliability when transmitting information, single man-machine interface, poor security, etc., smart grid remote monitoring system based on the iOS system has been designed. The system interacts with smart grid server so that it can acquire grid data through WiFi/3G/4G networks, and monitor each grid line running status, as well as power plant equipment operating conditions. When it occurs an exception in the power plant, incident information can be sent to the user iOS terminal equipment timely, which will provide troubleshooting information to help the grid staff to make the right decisions in a timely manner, to avoid further accidents. Field tests have shown the system realizes the integrated grid monitoring functions, low maintenance cost, friendly interface, high security and reliability, and it possesses certain applicable value.

The emergency patient's participation in medical decision-making.

Science.gov (United States)

Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

2016-09-01

The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy.

Science.gov (United States)

Blumenthal-Barby, J S; Krieger, Heather

2015-05-01

The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria. Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion. Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making. Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients. © The Author(s) 2014.

A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study

Science.gov (United States)

Damschroder, Laura J; Fetters, Michael D; Zikmund-Fisher, Brian J; Crabtree, Benjamin F; Hudson, Shawna V; Ruffin IV, Mack T; Fucinari, Juliana; Kang, Minji; Taichman, L Susan; Creswell, John W

2018-01-01

Background Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling. Objective The overall goal of the MiHealth, MiChoice project is to design and implement a theory-driven, Web-based tool that incorporates the US MEC (provider-level intervention) within the vehicle of a contraceptive decision tool for women with chronic medical conditions (patient-level intervention) in community-based primary care settings (practice-level intervention). This will be a 3-phase study that includes a predesign phase, a design phase, and a testing phase in a randomized controlled trial. This study protocol describes phase 1 and aim 1, which is to determine patient-, provider-, and practice-level factors that are relevant to the design and implementation of the contraceptive decision tool. Methods This is a mixed methods implementation study. To customize the delivery of the US MEC in the decision tool, we selected high-priority constructs from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to drive data collection and analysis at the practice and provider level, respectively. A conceptual model that incorporates constructs from the transtheoretical model and the health beliefs model undergirds patient-level data collection and analysis and will inform customization of the decision tool for this population. We will recruit 6 community-based primary care practices and conduct quantitative surveys and semistructured qualitative

[Kairos. Decision-making in medical ethics].

Science.gov (United States)

Jousset, David

2014-06-01

This paper assesses the decision making patterns in medical ethics: the formalized pattern of decision science, the meditative pattern of an art of judgement and lastly the still-to-be-elaborated pattern of kairology or sense of the right time. The ethical decision is to be thought out in the conditions of medical action while resorting to the philosophical concepts that shed light on the issue. And it is precisely where medicine and philosophy of human action meet that the Greek notion of kairos, or "propitious moment", evokes the critical point where decision has to do with what is vital. Reflection shows that this kairos can be thought out outside the sacrificial pattern (deciding comes down to killing a possibility) by understanding the opportune moment as a sign of ethical action, as the condition for the formation of the subject (making a decision) and finally as a new relationship to time, including in the context of medical urgency. Thus with an approach to clinical ethics centred on the relation to the individual, the focus is less on the probabilistic knowledge of the decidable than on the meaning of the decision, and the undecidable comes to be accepted as an infinite dimension going beyond the limits of our acts, which makes the contingency and the grandeur of human responsibility.

A Novel Grid Impedance Estimation Technique based on Adaptive Virtual Resistance Control Loop Applied to Distributed Generation Inverters

DEFF Research Database (Denmark)

Ghzaiel, Walid; Jebali-Ben Ghorbal, Manel; Slama-Belkhodja, Ilhem

2013-01-01

and to take the decision of either keep the DG connected, or disconnect it from the utility grid. The proposed method is based on a fast and easy grid fault detection method. A virtual damping resistance is used to drive the system to the resonance in order to extract the grid impedance parameters, both...... the power quality and even damage some sensitive loads connected at the point of the common coupling (PCC). This paper presents detection-estimation method of the grid impedance variation. This estimation tehnique aims to improve the dynamic of the distributed generation (DG) interfacing inverter control...

Naturalistic Decision Making in Power Grid Operations: Implications for Dispatcher Training and Usability Testing

Energy Technology Data Exchange (ETDEWEB)

Greitzer, Frank L.; Podmore, Robin

2008-11-17

The focus of the present study is on improved training approaches to accelerate learning and improved methods for analyzing effectiveness of tools within a high-fidelity power grid simulated environment. A theory-based model has been developed to document and understand the mental processes that an expert power system operator uses when making critical decisions. The theoretical foundation for the method is based on the concepts of situation awareness, the methods of cognitive task analysis, and the naturalistic decision making (NDM) approach of Recognition Primed Decision Making. The method has been systematically explored and refined as part of a capability demonstration of a high-fidelity real-time power system simulator under normal and emergency conditions. To examine NDM processes, we analyzed transcripts of operator-to-operator conversations during the simulated scenario to reveal and assess NDM-based performance criteria. The results of the analysis indicate that the proposed framework can be used constructively to map or assess the Situation Awareness Level of the operators at each point in the scenario. We can also identify the mental models and mental simulations that the operators employ at different points in the scenario. This report documents the method, describes elements of the model, and provides appendices that document the simulation scenario and the associated mental models used by operators in the scenario.

MrGrid: a portable grid based molecular replacement pipeline.

Directory of Open Access Journals (Sweden)

Jason W Schmidberger

Full Text Available BACKGROUND: The crystallographic determination of protein structures can be computationally demanding and for difficult cases can benefit from user-friendly interfaces to high-performance computing resources. Molecular replacement (MR is a popular protein crystallographic technique that exploits the structural similarity between proteins that share some sequence similarity. But the need to trial permutations of search models, space group symmetries and other parameters makes MR time- and labour-intensive. However, MR calculations are embarrassingly parallel and thus ideally suited to distributed computing. In order to address this problem we have developed MrGrid, web-based software that allows multiple MR calculations to be executed across a grid of networked computers, allowing high-throughput MR. METHODOLOGY/PRINCIPAL FINDINGS: MrGrid is a portable web based application written in Java/JSP and Ruby, and taking advantage of Apple Xgrid technology. Designed to interface with a user defined Xgrid resource the package manages the distribution of multiple MR runs to the available nodes on the Xgrid. We evaluated MrGrid using 10 different protein test cases on a network of 13 computers, and achieved an average speed up factor of 5.69. CONCLUSIONS: MrGrid enables the user to retrieve and manage the results of tens to hundreds of MR calculations quickly and via a single web interface, as well as broadening the range of strategies that can be attempted. This high-throughput approach allows parameter sweeps to be performed in parallel, improving the chances of MR success.

Influence of framing on medical decision making

OpenAIRE

Feng, Jun; Gong, Jingjing; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei; Zhang, Yan

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience.

Influence of framing on medical decision making.

Science.gov (United States)

Gong, Jingjing; Zhang, Yan; Feng, Jun; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience.

Medical futility in children's nursing: making end-of-life decisions.

Science.gov (United States)

Brien, Irene O; Duffy, Anita; Shea, Ellen O

Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of 'parental autonomy' and 'the child's best interests' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children's nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children's nursing.

Medical futility in children's nursing: making end-of-life decisions.

LENUS (Irish Health Repository)

Brien, Irene O

2012-02-01

Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

Research and Application of Auxiliary Optimization Technology of Power Grid Accident Processing Based on the Mode of Regulation and Control Integration

Directory of Open Access Journals (Sweden)

Cui Houzhen

2015-01-01

Full Text Available Accident processing is the most important link of the scheduling of daily monitoring. The improvement of intelligent level is of great significance for improving the efficiency of accident processing scheduling, shortening the time of accident processing and preventing further deterioration of accidents. According to features of accident processing scheduling, this paper puts forward an integrated framework of aid decision-making of online accident processing based on large power grid, and carries out a study from five aspects, namely integrated information support platform, risk perception in advance, online fault diagnosis, aid decision-making afterwards and visual display, so as to conduct real-time tracking on operating state of power grid, eliminate potential safety hazards of power grid and upgrade power grid from “manual analysis” scheduling to “intelligent analysis” scheduling.

A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study.

Science.gov (United States)

Wu, Justine P; Damschroder, Laura J; Fetters, Michael D; Zikmund-Fisher, Brian J; Crabtree, Benjamin F; Hudson, Shawna V; Ruffin, Mack T; Fucinari, Juliana; Kang, Minji; Taichman, L Susan; Creswell, John W

2018-04-18

Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling. The overall goal of the MiHealth, MiChoice project is to design and implement a theory-driven, Web-based tool that incorporates the US MEC (provider-level intervention) within the vehicle of a contraceptive decision tool for women with chronic medical conditions (patient-level intervention) in community-based primary care settings (practice-level intervention). This will be a 3-phase study that includes a predesign phase, a design phase, and a testing phase in a randomized controlled trial. This study protocol describes phase 1 and aim 1, which is to determine patient-, provider-, and practice-level factors that are relevant to the design and implementation of the contraceptive decision tool. This is a mixed methods implementation study. To customize the delivery of the US MEC in the decision tool, we selected high-priority constructs from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to drive data collection and analysis at the practice and provider level, respectively. A conceptual model that incorporates constructs from the transtheoretical model and the health beliefs model undergirds patient-level data collection and analysis and will inform customization of the decision tool for this population. We will recruit 6 community-based primary care practices and conduct quantitative surveys and semistructured qualitative interviews with women who

Influence of framing on medical decision making

Science.gov (United States)

Gong, Jingjing; Zhang, Yan; Feng, Jun; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience. PMID:27034630

General Practitioners’ Decisions about Discontinuation of Medication

DEFF Research Database (Denmark)

Nixon, Michael Simon; Vendelø, Morten Thanning

2016-01-01

insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de......Purpose – The purpose of this paper is to investigate how general practitioners’ (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach – In total, 24 GPs were interviewed, three practices were observed and documents were...... a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value – The analysis offers new...

A study to enhance medical students’ professional decision-making, using teaching interventions on common medications

Directory of Open Access Journals (Sweden)

Jane Wilcock

2015-06-01

Full Text Available Aim: To create sustained improvements in medical students’ critical thinking skills through short teaching interventions in pharmacology. Method: The ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination. Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed. Results: Students enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies. Conclusion: Short teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training.

A study to enhance medical students’ professional decision-making, using teaching interventions on common medications

Science.gov (United States)

Wilcock, Jane; Strivens, Janet

2015-01-01

Aim To create sustained improvements in medical students’ critical thinking skills through short teaching interventions in pharmacology. Method The ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination). Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group) was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed. Results Students enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies. Conclusion Short teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training. PMID:26051556

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation.

Science.gov (United States)

Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade; Liu, Chien-Tsai

2018-01-19

A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan. This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. A CDS engine was developed that can download patients' up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians' responses to handling the alerts for each encounter. The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When

Ecosystem Based Business Model of Smart Grid

OpenAIRE

Lundgaard, Morten Raahauge; Ma, Zheng; Jørgensen, Bo Nørregaard

2015-01-01

This paper tries to investigate the ecosystem based business model in a smart grid infrastructure and the potential of value capture in the highly complex macro infrastructure such as smart grid. This paper proposes an alternative perspective to study the smart grid business ecosystem to support the infrastructural challenges, such as the interoperability of business components for smart grid. So far little research has explored the business ecosystem in the smart grid concept. The study on t...

Framework for Modeling High-Impact, Low-Frequency Power Grid Events to Support Risk-Informed Decisions

Energy Technology Data Exchange (ETDEWEB)

Veeramany, Arun; Unwin, Stephen D.; Coles, Garill A.; Dagle, Jeffery E.; Millard, W. David; Yao, Juan; Glantz, Clifford S.; Gourisetti, Sri Nikhil Gup

2015-12-03

Natural and man-made hazardous events resulting in loss of grid infrastructure assets challenge the electric power grid’s security and resilience. However, the planning and allocation of appropriate contingency resources for such events requires an understanding of their likelihood and the extent of their potential impact. Where these events are of low likelihood, a risk-informed perspective on planning can be problematic as there exists an insufficient statistical basis to directly estimate the probabilities and consequences of their occurrence. Since risk-informed decisions rely on such knowledge, a basis for modeling the risk associated with high-impact low frequency events (HILFs) is essential. Insights from such a model can inform where resources are most rationally and effectively expended. The present effort is focused on development of a HILF risk assessment framework. Such a framework is intended to provide the conceptual and overarching technical basis for the development of HILF risk models that can inform decision makers across numerous stakeholder sectors. The North American Electric Reliability Corporation (NERC) 2014 Standard TPL-001-4 considers severe events for transmission reliability planning, but does not address events of such severity that they have the potential to fail a substantial fraction of grid assets over a region, such as geomagnetic disturbances (GMD), extreme seismic events, and coordinated cyber-physical attacks. These are beyond current planning guidelines. As noted, the risks associated with such events cannot be statistically estimated based on historic experience; however, there does exist a stable of risk modeling techniques for rare events that have proven of value across a wide range of engineering application domains. There is an active and growing interest in evaluating the value of risk management techniques in the State transmission planning and emergency response communities, some of this interest in the context of

An analysis of medical decision making

International Nuclear Information System (INIS)

Lusted, L.B.

1977-01-01

Medical decision-making studies continue to focus on two questions: How do physicians make decisions and how should physicians make decisions. Researchers pursuing the first question emphasize human cognitive processes and the programming of symbol systems to model the observed human behaviour. Those researchers concentrating on the second question assume that there is a standard of performance against which physicians' decisions can be judged, and to help the physician improve his performance an array of tools is proposed. These tools include decision trees, Bayesian analysis, decision matrices, receiver operating characteristic (ROC) analysis, and cost-benefit considerations including utility measures. Both questions must be answered in an ethical context where ethics and decision analysis are intertwined. (author)

Research on the Method of Urban Waterlogging Flood Routing Based on Hexagonal Grid

Directory of Open Access Journals (Sweden)

LAI Guangling

2016-12-01

Full Text Available An evolution of the urban waterlogging flood routing was studied in this paper based on the method of hexagonal grid modeling. Using the method of discrete grid, established an urban geometry model on account of the regular multi-scale discrete grid. With the fusion of 3D topographic survey data and 2D building vector data, formed a regular network model of surface. This model took multi special block into account, such as urban terrain and buildings. On this basis, a method of reverse flow deduction was proposed, which was an inverse computation from the state of flood to the evolution process. That is, based on the water depth of flood, made use of the connectivity with the outfall to calculate the range of water logging, and then implemented the urban waterlogging flood simulation deduction. The test indicated that, this method can implement the evolution of urban waterlogging scenario deduction effectively. And the correlational research could provide scientific basis for urban disaster prevention and emergency decision-making.

Data Decision and Drug Therapy Based on Non-Small Cell Lung Cancer in a Big Data Medical System in Developing Countries

Directory of Open Access Journals (Sweden)

Jia Wu

2018-05-01

Full Text Available In many developing or underdeveloped countries, limited medical resources and large populations may affect the survival of mankind. The research for the medical information system and recommendation of effective treatment methods may improve diagnosis and drug therapy for patients in developing or underdeveloped countries. In this study, we built a system model for the drug therapy, relevance parameter analysis, and data decision making in non-small cell lung cancer. Based on the probability analysis and status decision, the optimized therapeutic schedule can be calculated and selected, and then effective drug therapy methods can be determined to improve relevance parameters. Statistical analysis of clinical data proves that the model of the probability analysis and decision making can provide fast and accurate clinical data.

The normalization heuristic: an untested hypothesis that may misguide medical decisions.

Science.gov (United States)

Aberegg, Scott K; O'Brien, James M

2009-06-01

Medical practice is increasingly informed by the evidence from randomized controlled trials. When such evidence is not available, clinical hypotheses based on pathophysiological reasoning and common sense guide clinical decision making. One commonly utilized general clinical hypothesis is the assumption that normalizing abnormal laboratory values and physiological parameters will lead to improved patient outcomes. We refer to the general use of this clinical hypothesis to guide medical therapeutics as the "normalization heuristic". In this paper, we operationally define this heuristic and discuss its limitations as a rule of thumb for clinical decision making. We review historical and contemporaneous examples of normalization practices as empirical evidence for the normalization heuristic and to highlight its frailty as a guide for clinical decision making.

[The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].

Science.gov (United States)

Su, Szu-Huei; Wu, Li-Min

2018-04-01

The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.

AQUAGRID: The subsurface hydrology Grid service of the Sardinian regional Grid infrastructure

International Nuclear Information System (INIS)

Lecca, G.; Murgia, F.; Maggi, P.; Perias, A.

2007-01-01

AQUAGRID is the subsurface hydrology service of the Sardinian regional Grid infrastructure, designed to deliver complex environmental applications via a user-friendly Web portal. The service is oriented towards the needs of water professionals providing them a flexible and powerful tool to solve water resources management problems and aid decision between different remediation options for contaminated soil and groundwater. In this paper, the AQUAGRID application concept and the enabling technologies are illustrated. The heart of the service is the CODESA-3D hydrogeological model to simulate complex and large groundwater flow and contaminant transport problems. The relevant experience gained from the porting of the CODESA-3D application on the EGEE infrastructure, via the GILDA test bed (https://gilda.ct.infn.it), has contributed to the service prototype. AQUAGRID is built on top of compute-Grid technologies by means of the EnginFrame Grid portal. The portal enables the interaction with the underlying Grid infrastructure and manages the computational requirements of the whole application system. Data management, distribution and visualization mechanisms are based on the tools provided by the DatacroSSing Decision Support System (http://datacrossing.crs4.it). The DSS, built on top of the SRB data-Grid middleware, is based on Web-GIS and relational database technologies. The resulting production environment allows the end-user to visualize and interact with the results of the performed analyses, using graphs, annotated maps and 3D objects. Such a set of graphical widgets increases enormously the number of AQUAGRID potential users because it does not require any specific expertise of the physical model and technological background to be understood. (Author)

[Judicial framework for medical decision-making concerning minors].

Science.gov (United States)

Sirvent, N; Bérard, E

2010-02-01

One aim of the law promulgated in France on March 4, 2002 concerning patients' rights and the quality of the health care system was to reconsider the bases of the physician-patient relationship. The new legal framework recommends establishment of a true dialogue between the two protagonists, and it assigns decisional priority to the patient rather than to the physician or third parties. In the case of minors, the principle of parental authority requires that the physician consults the holders of this authority before making any medical decision. However, the law of March 4, 2002 also reinforced the participation of minors in medical decisions concerning them. The lawmaker explicitly envisaged the possibility of overruling the principle of parental authority. This new "balance of power" obliges the physician to inform the minor of his or her medical condition in a manner appropriate to the child's degree of maturity. The minor may even put forward the principle of medical secrecy to prevent the sharing of information with his or her parents. This new "autonomy" of minors gives rise to at least two reservations: i) the difficulty involved in assessment of a minor's degree of discernment; ii) the minor's vulnerability with respect to his or her entourage. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

Minors' rights in medical decision making.

Science.gov (United States)

Hickey, Kathryn

2007-01-01

In the past, minors were not considered legally capable of making medical decisions and were viewed as incompetent because of their age. The authority to consent or refuse treatment for a minor remained with a parent or guardian. This parental authority was derived from the constitutional right to privacy regarding family matters, common law rule, and a general presumption that parents or guardians will act in the best interest of their incompetent child. However, over the years, the courts have gradually recognized that children younger than 18 years who show maturity and competence deserve a voice in determining their course of medical treatment. This article will explore the rights and interests of minors, parents, and the state in medical decision making and will address implications for nursing administrators and leaders.

Modeling and Grid impedance Variation Analysis of Parallel Connected Grid Connected Inverter based on Impedance Based Harmonic Analysis

DEFF Research Database (Denmark)

Kwon, JunBum; Wang, Xiongfei; Bak, Claus Leth

2014-01-01

This paper addresses the harmonic compensation error problem existing with parallel connected inverter in the same grid interface conditions by means of impedance-based analysis and modeling. Unlike the single grid connected inverter, it is found that multiple parallel connected inverters and grid...... impedance can make influence to each other if they each have a harmonic compensation function. The analysis method proposed in this paper is based on the relationship between the overall output impedance and input impedance of parallel connected inverter, where controller gain design method, which can...

Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

Science.gov (United States)

Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

2015-07-01

To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Shared decision making and medication management in the recovery process.

Science.gov (United States)

Deegan, Patricia E; Drake, Robert E

2006-11-01

Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

Science.gov (United States)

da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

2005-01-01

This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment.

Ecosystem Based Business Model of Smart Grid

DEFF Research Database (Denmark)

Lundgaard, Morten Raahauge; Ma, Zheng; Jørgensen, Bo Nørregaard

2015-01-01

This paper tries to investigate the ecosystem based business model in a smart grid infrastructure and the potential of value capture in the highly complex macro infrastructure such as smart grid. This paper proposes an alternative perspective to study the smart grid business ecosystem to support...... the infrastructural challenges, such as the interoperability of business components for smart grid. So far little research has explored the business ecosystem in the smart grid concept. The study on the smart grid with the theory of business ecosystem may open opportunities to understand market catalysts. This study...... contributes an understanding of business ecosystem applicable for smart grid. Smart grid infrastructure is an intricate business ecosystem, which have several intentions to deliver the value proposition and what it should be. The findings help to identify and capture value from markets....

The limits of parental responsibility regarding medical treatment decisions.

Science.gov (United States)

Woolley, Sarah L

2011-11-01

Parental responsibility (PR) was a concept introduced by the Children Act (CA) 1989 which aimed to replace the outdated notion of parental rights and duties which regarded children as parental possessions. Section 3(1) CA 1989 defines PR as 'all the rights, duties, powers, responsibilities and authority which by law a parent of a child has in relation to the child'. In exercising PR, individuals may make medical treatment decisions on children's behalf. Medical decision-making is one area of law where both children and the state can intercede and limit parental decision-making. Competent children can consent to treatment and the state can interfere if parental decisions are not seemingly in the child's 'best interests'. This article examines the concept, and limitations, of PR in relation to medical treatment decision-making.

Feature combination analysis in smart grid based using SOM for Sudan national grid

Science.gov (United States)

Bohari, Z. H.; Yusof, M. A. M.; Jali, M. H.; Sulaima, M. F.; Nasir, M. N. M.

2015-12-01

In the investigation of power grid security, the cascading failure in multicontingency situations has been a test because of its topological unpredictability and computational expense. Both system investigations and burden positioning routines have their limits. In this project, in view of sorting toward Self Organizing Maps (SOM), incorporated methodology consolidating spatial feature (distance)-based grouping with electrical attributes (load) to evaluate the vulnerability and cascading impact of various part sets in the force lattice. Utilizing the grouping result from SOM, sets of overwhelming stacked beginning victimized people to perform assault conspires and asses the consequent falling impact of their failures, and this SOM-based approach viably distinguishes the more powerless sets of substations than those from the conventional burden positioning and other bunching strategies. The robustness of power grids is a central topic in the design of the so called "smart grid". In this paper, to analyze the measures of importance of the nodes in a power grid under cascading failure. With these efforts, we can distinguish the most vulnerable nodes and protect them, improving the safety of the power grid. Also we can measure if a structure is proper for power grids.

Health Care Professional Factors Influencing Shared Medical Decision Making in Korea

Directory of Open Access Journals (Sweden)

Kae-Hwa Jo

2015-11-01

Full Text Available Till date, the medical decision-making process in Korea has followed the paternalist model, relying on the instructions of physicians. However, in recent years, shared decision making at the end-of-life between physicians and nurses is now emphasized in Korea. The purpose of this study was conducted to explore how health care professionals’ characteristics, attitude toward dignified dying, and moral sensitivity affect their shared medical decision making. The design was descriptive survey. This study was undertaken in two university hospitals in two metropolitan cities, South Korea. The participants were 344 nurses and 80 physicians who work at university hospitals selected by convenience sampling method. Data were collected from January 10 through March 20, 2014 using the Dignified Dying Scale, Moral Sensitivity Scale, and Shared Medical Decision-Making Scale. Shared medical decision making, attitude toward dignified dying, moral sensitivity, age, and working experience had a significant correlation with each other. The factors affecting shared medical decision making of Korean health care professionals were moral sensitivity and attitude toward dignified dying. These variables explained 22.4% of the shared medical decision making. Moral sensitivity and a positive attitude toward dignified dying should be promoted among health care professionals as a part of an educational program for shared medical decision making.

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

Science.gov (United States)

Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

2009-01-01

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

IEEE NSS 2008 Short Course: How to use the Grid for Physics and Medical Applications

CERN Document Server

Moscicki, J T; Lechner, A

2008-01-01

This course is intended to introduce the Grid technology to scientists and engineers with no experience in this field. Participants will gain practical skills on how to quickly make use of distributed computing resources for their applications. The class begins will an introduction to the Grid technology and an overview of existing Grid applications. A case study will show the details of a real medical Geant 4 simulation running on the Grid. Hands-on exercises will give practical experience with using the application oriented tools such as Ganga (http://cern.ch/ganga) and DIANE (http://cern.ch/diane) to support solving scientific problems. The participants will have an opportunity to get involved into using the Grid beyond the scope of the course and get further support for their applications.

Context-Aware Usage-Based Grid Authorization Framework

Institute of Scientific and Technical Information of China (English)

CUI Yongquan; HONG Fan; FU Cai

2006-01-01

Due to inherent heterogeneity, multi-domain characteristic and highly dynamic nature, authorization is a critical concern in grid computing. This paper proposes a general authorization and access control architecture, grid usage control (GUCON), for grid computing. It's based on the next generation access control mechanism usage control (UCON) model. The GUCON Framework dynamic grants and adapts permission to the subject based on a set of contextual information collected from the system environments; while retaining the authorization by evaluating access requests based on subject attributes, object attributes and requests. In general, GUCON model provides very flexible approaches to adapt the dynamically security request. GUCON model is being implemented in our experiment prototype.

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

Science.gov (United States)

Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

2016-01-01

The contribution of patients' non-medical characteristics to individual physicians' decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non-medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. In the final sample of patients' records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. The design of the study made it difficult to draw definite cause-and-effect conclusions. The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients

Important medical decisions: Using brief motivational interviewing to enhance patients' autonomous decision-making.

Science.gov (United States)

Pantalon, Michael V; Sledge, William H; Bauer, Stephen F; Brodsky, Beth; Giannandrea, Stephanie; Kay, Jerald; Lazar, Susan G; Mellman, Lisa A; Offenkrantz, William C; Oldham, John; Plakun, Eric M; Rockland, Lawrence H

2013-03-01

The use of motivational interviewing (MI) when the goals of patient and physician are not aligned is examined. A clinical example is presented of a patient who, partly due to anxiety and fear, wants to opt out of further evaluation of his hematuria while the physician believes that the patient must follow up on the finding of hematuria. As patients struggle in making decisions about their medical care, physician interactions can become strained and medical care may become compromised. Physicians sometimes rely on their authority within the doctor-patient relationship to assist patients in making decisions. These methods may be ineffective when there is a conflict in motivations or goals, such as with patient ambivalence and resistance. Furthermore, the values of patient autonomy may conflict with the values of beneficence. A patient simulation exercise is used to demonstrate the value of MI in addressing the motivations of a medical patient when autonomy is difficult to realize because of a high level of resistance to change due to fear. The salience of MI in supporting the value of patient autonomy without giving up the value of beneficence is discussed by providing a method of evaluating the patient's best interests by psychotherapeutically addressing his anxious, fear-based ambivalence.

Braving difficult choices alone: children's and adolescents' medical decision making.

Directory of Open Access Journals (Sweden)

Azzurra Ruggeri

Full Text Available OBJECTIVE: What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. METHODS: Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1 own informed choice; (2 informed parents' choice to amputate; (3 informed parents' choice to continue a treatment; and (4 uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. RESULTS: Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. CONCLUSIONS: Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.

Braving difficult choices alone: children's and adolescents' medical decision making.

Science.gov (United States)

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.

Braving Difficult Choices Alone: Children's and Adolescents' Medical Decision Making

Science.gov (United States)

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

Objective What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Methods Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Results Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Conclusions Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process. PMID:25084274

Risk-Based Two-Stage Stochastic Optimization Problem of Micro-Grid Operation with Renewables and Incentive-Based Demand Response Programs

Directory of Open Access Journals (Sweden)

Pouria Sheikhahmadi

2018-03-01

Full Text Available The operation problem of a micro-grid (MG in grid-connected mode is an optimization one in which the main objective of the MG operator (MGO is to minimize the operation cost with optimal scheduling of resources and optimal trading energy with the main grid. The MGO can use incentive-based demand response programs (DRPs to pay an incentive to the consumers to change their demands in the peak hours. Moreover, the MGO forecasts the output power of renewable energy resources (RERs and models their uncertainties in its problem. In this paper, the operation problem of an MGO is modeled as a risk-based two-stage stochastic optimization problem. To model the uncertainties of RERs, two-stage stochastic programming is considered and conditional value at risk (CVaR index is used to manage the MGO’s risk-level. Moreover, the non-linear economic models of incentive-based DRPs are used by the MGO to change the peak load. The numerical studies are done to investigate the effect of incentive-based DRPs on the operation problem of the MGO. Moreover, to show the effect of the risk-averse parameter on MGO decisions, a sensitivity analysis is carried out.

Validating evidence based decision making in health care

DEFF Research Database (Denmark)

Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak

Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register o...... are highly influenced by the geographical placement of surgeons. Therfore, decisions to use mesh are boundedly rationality, rather than rational.......Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register...... of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...

Heuristics: foundations for a novel approach to medical decision making.

Science.gov (United States)

Bodemer, Nicolai; Hanoch, Yaniv; Katsikopoulos, Konstantinos V

2015-03-01

Medical decision-making is a complex process that often takes place during uncertainty, that is, when knowledge, time, and resources are limited. How can we ensure good decisions? We present research on heuristics-simple rules of thumb-and discuss how medical decision-making can benefit from these tools. We challenge the common view that heuristics are only second-best solutions by showing that they can be more accurate, faster, and easier to apply in comparison to more complex strategies. Using the example of fast-and-frugal decision trees, we illustrate how heuristics can be studied and implemented in the medical context. Finally, we suggest how a heuristic-friendly culture supports the study and application of heuristics as complementary strategies to existing decision rules.

Do continuing medical education articles foster shared decision making?

Science.gov (United States)

Labrecque, Michel; Lafortune, Valérie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Légaré, France

2010-01-01

Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based information on benefits and harms of available treatment and/or preventive options that are deemed essential for shared decision making (SDM) to occur in clinical practice. Articles were selected from 5 medical journals that publish CME articles and are provided free of charge to primary-care physicians of the Province of Quebec, Canada. Two individuals independently scored each article with the use of a 10-item checklist based on the International Patient Decision Aid Standards. In case of discrepancy, the item score was established by team consensus. Scores were added to produce a total article score ranging from 0 (no item present) to 10 (all items present). Thirty articles (6 articles per journal) were selected. Total article scores ranged from 1 to 9, with a mean (+/- SD) of 3.1 +/- 2.0 (95% confidence interval 2.8-4.3). Health conditions and treatment options were the items most frequently discussed in the articles; next came treatment benefits. Possible harms, the use of the same denominators for benefits and harms, and methods to facilitate the communication of benefits and harms to patients were almost never described. No significant differences between journals were observed. The CME articles evaluated did not include the evidence-based information necessary to foster SDM in clinical practice. Peer-reviewed and non-peer-reviewed medical journals should require CME articles to include this type of information.

[Value-based cancer care. From traditional evidence-based decision making to balanced decision making within frameworks of shared values].

Science.gov (United States)

Palazzo, Salvatore; Filice, Aldo; Mastroianni, Candida; Biamonte, Rosalbino; Conforti, Serafino; Liguori, Virginia; Turano, Salvatore; De Simone, Rosanna; Rovito, Antonio; Manfredi, Caterina; Minardi, Stefano; Vilardo, Emmanuelle; Loizzo, Monica; Oriolo, Carmela

2016-04-01

Clinical decision making in oncology is based so far on the evidence of efficacy from high-quality clinical research. Data collection and analysis from experimental studies provide valuable insight into response rates and progression-free or overall survival. Data processing generates valuable information for medical professionals involved in cancer patient care, enabling them to make objective and unbiased choices. The increased attention of many scientific associations toward a more rational resource consumption in clinical decision making is mirrored in the Choosing Wisely campaign against the overuse or misuse of exams and procedures of little or no benefit for the patient. This cultural movement has been actively promoting care solutions based on the concept of "value". As a result, the value-based decision-making process for cancer care should not be dissociated from economic sustainability and from ethics of the affordability, also given the growing average cost of the most recent cancer drugs. In support of this orientation, the National Comprehensive Cancer Network (NCCN) has developed innovative and "complex" guidelines based on values, defined as "evidence blocks", with the aim of assisting the medical community in making overall sustainable choices.

Multiple Attribute Decision Making Based Relay Vehicle Selection for Electric Vehicle Communication

Directory of Open Access Journals (Sweden)

Zhao Qiang

2015-01-01

Full Text Available Large-scale electric vehicle integration into power grid and charging randomly will cause serious impacts on the normal operation of power grid. Therefore, it is necessary to control the charging behavior of electric vehicle, while information transmission for electric vehicle is significant. Due to the highly mobile characteristics of vehicle, transferring information to power grid directly might be inaccessible. Relay vehicle (RV can be used for supporting multi-hop connection between SV and power grid. This paper proposes a multiple attribute decision making (MADM-based RV selection algorithm, which considers multiple attribute, including data transfer rate, delay, route duration. It takes the characteristics of electric vehicle communication into account, which can provide protection for the communication services of electric vehicle charging and discharging. Numerical results demonstrate that compared to previous algorithm, the proposed algorithm offer better performance in terms of throughput, transmission delay.

Formulation of Low Peclet Number Based Grid Expansion Factor for the Solution of the Convection Diffusion Equation

Directory of Open Access Journals (Sweden)

A. Abdullah

2018-04-01

Full Text Available Convection-diffusion problems, due to its fundamental nature, are found in various science and engineering applications. In this research, the importance of the relationship between grid structure and flow parameters in such problems is emphasized. In particular, we propose a systematic technique in the selection of the grid expansion factor based on its logarithmic relationship with low Peclet number. Such linear mathematical connection between the two non-dimensional parameters serves as a guideline for more structured decision-making and improves the heuristic process in the determination of the computational domain grid for the numerical solution of convection-diffusion equations especially in the prediction of the concentration of the scalar. Results confirm the effectiveness of the new approach.

Uncertainties in real-world decisions on medical technologies.

Science.gov (United States)

Lu, C Y

2014-08-01

Patients, clinicians, payers and policy makers face substantial uncertainties in their respective healthcare decisions as they attempt to achieve maximum value, or the greatest level of benefit possible at a given cost. Uncertainties largely come from incomplete information at the time that decisions must be made. This is true in all areas of medicine because evidence from clinical trials is often incongruent with real-world patient care. This article highlights key uncertainties around the (comparative) benefits and harms of medical technologies. Initiatives and strategies such as comparative effectiveness research and coverage with evidence development may help to generate reliable and relevant evidence for decisions on coverage and treatment. These efforts could result in better decisions that improve patient outcomes and better use of scarce medical resources. © 2014 John Wiley & Sons Ltd.

Grid Architecture 2

Energy Technology Data Exchange (ETDEWEB)

Taft, Jeffrey D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2016-01-01

The report describes work done on Grid Architecture under the auspices of the Department of Electricity Office of Electricity Delivery and Reliability in 2015. As described in the first Grid Architecture report, the primary purpose of this work is to provide stakeholder insight about grid issues so as to enable superior decision making on their part. Doing this requires the creation of various work products, including oft-times complex diagrams, analyses, and explanations. This report provides architectural insights into several important grid topics and also describes work done to advance the science of Grid Architecture as well.

GENECODIS-Grid: An online grid-based tool to predict functional information in gene lists

International Nuclear Information System (INIS)

Nogales, R.; Mejia, E.; Vicente, C.; Montes, E.; Delgado, A.; Perez Griffo, F. J.; Tirado, F.; Pascual-Montano, A.

2007-01-01

In this work we introduce GeneCodis-Grid, a grid-based alternative to a bioinformatics tool named Genecodis that integrates different sources of biological information to search for biological features (annotations) that frequently co-occur in a set of genes and rank them by statistical significance. GeneCodis-Grid is a web-based application that takes advantage of two independent grid networks and a computer cluster managed by a meta-scheduler and a web server that host the application. The mining of concurrent biological annotations provides significant information for the functional analysis of gene list obtained by high throughput experiments in biology. Due to the large popularity of this tool, that has registered more than 13000 visits since its publication in January 2007, there is a strong need to facilitate users from different sites to access the system simultaneously. In addition, the complexity of some of the statistical tests used in this approach has made this technique a good candidate for its implementation in a Grid opportunistic environment. (Author)

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities

OpenAIRE

Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed u...

Making reasonable decisions: a qualitative study of medical decision making in the care of patients with a clinically significant haemoglobin disorder.

Science.gov (United States)

Crowther, Helen J; Kerridge, Ian

2015-10-01

Therapies utilized in patients with clinically significant haemoglobin disorders appear to vary between clinicians and units. This study aimed to investigate the processes of evidence implementation and medical decision making in the care of such patients in NSW, Australia. Using semi-structured interviews, 11 haematologists discussed their medical decision-making processes with particular attention paid to the use of published evidence. Transcripts were thematically analysed by a single investigator on a line-by-line basis. Decision making surrounding the care of patients with significant haemoglobin disorders varied and was deeply contextual. Three main determinants of clinical decision making were identified - factors relating to the patient and to their illness, factors specific to the clinician and the institution in which they were practising and factors related to the notion of evidence and to utility and role of evidence-based medicine in clinical practice. Clinicians pay considerable attention to medical decision making and evidence incorporation and attempt to tailor these to particular patient contexts. However, the patient context is often inferred and when discordant with the clinician's own contexture can lead to discomfort with decision recommendations. Clinicians strive to improve comfort through the use of experience and trustworthy evidence. © 2015 John Wiley & Sons, Ltd.

Feasibility of web-based decision aids in neurological patients

NARCIS (Netherlands)

van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

2010-01-01

Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting.

Science.gov (United States)

Martelli, Nicolas; Hansen, Paul; van den Brink, Hélène; Boudard, Aurélie; Cordonnier, Anne-Laure; Devaux, Capucine; Pineau, Judith; Prognon, Patrice; Borget, Isabelle

2016-02-01

At the hospital level, decisions about purchasing new and oftentimes expensive medical devices must take into account multiple criteria simultaneously. Multi-criteria decision analysis (MCDA) is increasingly used for health technology assessment (HTA). One of the most successful hospital-based HTA approaches is mini-HTA, of which a notable example is the Matrix4value model. To develop a funding decision-support tool combining MCDA and mini-HTA, based on Matrix4value, suitable for medical devices for individual patient use in French university hospitals - known as the IDA tool, short for 'innovative device assessment'. Criteria for assessing medical devices were identified from a literature review and a survey of 18 French university hospitals. Weights for the criteria, representing their relative importance, were derived from a survey of 25 members of a medical devices committee using an elicitation technique involving pairwise comparisons. As a test of its usefulness, the IDA tool was applied to two new drug-eluting beads (DEBs) for transcatheter arterial chemoembolization. The IDA tool comprises five criteria and weights for each of two over-arching categories: risk and value. The tool revealed that the two new DEBs conferred no additional value relative to DEBs currently available. Feedback from participating decision-makers about the IDA tool was very positive. The tool could help to promote a more structured and transparent approach to HTA decision-making in French university hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

Court decisions on medical malpractice.

Science.gov (United States)

Knaak, Jan-Paul; Parzeller, Markus

2014-11-01

Recent studies on court cases dealing with medical malpractice are few and far between. This retrospective study, therefore, undertakes an analysis of medical malpractice lawsuits brought before regional courts in two judicial districts of the federal state of Hesse. Over a 5-year period (2006-2010), 232 court decisions on medical malpractice taken by the regional courts (Landgericht) of Kassel and Marburg were evaluated according to medical discipline, diagnosis, therapy, relevant level of care, charge of neglect of duty by the claimant party, outcome of the lawsuit, and further criteria. With certain overlaps, the disciplines most frequently confronted with claims of medical malpractice were accident surgery and orthopedics (30.2%; n = 70), dentistry (16.4%; n = 38), surgery (12.1%; n = 28), and gynecology and obstetrics (7.8%; n = 18), followed by the remaining medical disciplines (38.8%; n = 90). Malpractice allegations were brought against the practice-based sector in 35.8 % (n = 83) of cases, the hospital-based sector in 63.3% (n = 147) of cases, and other sectors in 0.9% (n = 2) of cases. The allegation grounds included false administration of treatment (67.2%; n = 156), false indication of treatment (37.1%; n = 86), false diagnosis (31.5%; n = 73), and/or organizational negligence (13.8%; n = 32). A breach of duty to inform was given as grounds for the claim in 38.8% (n = 90) of cases. A significant majority of 65.6% (n = 152) of cases ended in a court settlement. Of the cases, 18.9% (n = 44) were concluded by claim withdrawal, 11.2% (n = 26) by claim dismissal and 2.6% (n = 6) by criminal sentence. Of the cases, 1.7% (n = 4) were for purposes of securing evidence. Although there was no conclusive evidence of malpractice, two thirds of the cases ended in a court settlement. On the one hand, this outcome reduces the burden on the courts, but on the other, it can in the long term give

Adaptive Micro-Grid Operation Based on IEC 61850

Directory of Open Access Journals (Sweden)

Wei Deng

2015-05-01

Full Text Available Automatically identifying the new equipment after its integration and adjusting operation strategy to realize “plug and play” functionality are becoming essential for micro-grid operations. In order to improve and perfect the micro-grid “plug and play” function with the increased amount of equipment with different information protocols and more diverse system applications, this paper presents a solution for adaptive micro-grid operation based on IEC 61850, and proposes the design and specific implementation methods of micro-grid “plug and play” function and system operation mode conversion in detail, by using the established IEC 61850 information model of a micro-grid. Actual operation tests based on the developed IED and micro-grid test platform are performed to verify the feasibility and validity of the proposed solution. The tests results show that the solution can automatically identify the IEC 61850 information model of equipment after its integration, intelligently adjust the operation strategies to adapt to new system states and achieves a reliable system operation mode conversion.

Detecting New Evidences for Evidence-Based Medical Guidelines with Journal Filtering

NARCIS (Netherlands)

Hu, Qing; Huang, Zisheng; ten Teije, Annette; van Harmelen, Frank; Riaño, David; Lenz, Richard; Reichert, Manfred

2017-01-01

Evidence-based medical guidelines are systematically developed recommendations with the aim to assist practitioner and patients decisions regarding appropriate health care for specific clinical circumstances, and are based on evidence described in medical research papers. Evidence-based medical

Beyond Bioethics: A Child Rights-Based Approach to Complex Medical Decision-Making.

Science.gov (United States)

Wade, Katherine; Melamed, Irene; Goldhagen, Jeffrey

2016-01-01

This analysis adopts a child rights approach-based on the principles, standards, and norms of child rights and the U.N. Convention on the Rights of the Child (CRC)-to explore how decisions could be made with regard to treatment of a severely impaired infant (Baby G). While a child rights approach does not provide neat answers to ethically complex issues, it does provide a framework for decision-making in which the infant is viewed as an independent rights-holder. The state has obligations to develop the capacity of those who make decisions for infants in such situations to meet their obligations to respect, protect, and fulfill their rights as delineated in the CRC. Furthermore, a child rights approach requires procedural clarity and transparency in decision-making processes. As all rights in the CRC are interdependent and indivisible, all must be considered in the process of ethical decision-making, and the reasons for decisions must be delineated by reference to how these rights were considered. It is also important that decisions that are made in this context be monitored and reviewed to ensure consistency. A rights-based framework ensures decision-making is child-centered and that there are transparent criteria and legitimate procedures for making decisions regarding the child's most basic human right: the right to life, survival, and development.

A comparative analysis of dynamic grids vs. virtual grids using the A3pviGrid framework.

Science.gov (United States)

Shankaranarayanan, Avinas; Amaldas, Christine

2010-11-01

With the proliferation of Quad/Multi-core micro-processors in mainstream platforms such as desktops and workstations; a large number of unused CPU cycles can be utilized for running virtual machines (VMs) as dynamic nodes in distributed environments. Grid services and its service oriented business broker now termed cloud computing could deploy image based virtualization platforms enabling agent based resource management and dynamic fault management. In this paper we present an efficient way of utilizing heterogeneous virtual machines on idle desktops as an environment for consumption of high performance grid services. Spurious and exponential increases in the size of the datasets are constant concerns in medical and pharmaceutical industries due to the constant discovery and publication of large sequence databases. Traditional algorithms are not modeled at handing large data sizes under sudden and dynamic changes in the execution environment as previously discussed. This research was undertaken to compare our previous results with running the same test dataset with that of a virtual Grid platform using virtual machines (Virtualization). The implemented architecture, A3pviGrid utilizes game theoretic optimization and agent based team formation (Coalition) algorithms to improve upon scalability with respect to team formation. Due to the dynamic nature of distributed systems (as discussed in our previous work) all interactions were made local within a team transparently. This paper is a proof of concept of an experimental mini-Grid test-bed compared to running the platform on local virtual machines on a local test cluster. This was done to give every agent its own execution platform enabling anonymity and better control of the dynamic environmental parameters. We also analyze performance and scalability of Blast in a multiple virtual node setup and present our findings. This paper is an extension of our previous research on improving the BLAST application framework

GridWise Standards Mapping Overview

Energy Technology Data Exchange (ETDEWEB)

Bosquet, Mia L.

2004-04-01

''GridWise'' is a concept of how advanced communications, information and controls technology can transform the nation's energy system--across the spectrum of large scale, central generation to common consumer appliances and equipment--into a collaborative network, rich in the exchange of decision making information and an abundance of market-based opportunities (Widergren and Bosquet 2003) accompanying the electric transmission and distribution system fully into the information and telecommunication age. This report summarizes a broad review of standards efforts which are related to GridWise--those which could ultimately contribute significantly to advancements toward the GridWise vision, or those which represent today's current technological basis upon which this vision must build.

Decision support tool for Virtual Power Players: Hybrid Particle Swarm Optimization applied to Day-ahead Vehicle-To-Grid Scheduling

DEFF Research Database (Denmark)

Soares, João; Valle, Zita; Morais, Hugo

2013-01-01

This paper presents a decision support Tool methodology to help virtual power players (VPPs) in the Smart Grid (SGs) context to solve the day-ahead energy ressource scheduling considering the intensive use of Distributed Generation (DG) and Vehicle-To-Grid (V2G). The main focus is the application...... of a new hybrid method combing a particle swarm approach and a deterministic technique based on mixedinteger linear programming (MILP) to solve the day-ahead scheduling minimizing total operation costs from the aggregator point of view. A realistic mathematical formulation, considering the electric network...... constraints and V2G charging and discharging efficiencies is presented. Full AC power flow calculation is included in the hybrid method to allow taking into account the network constraints. A case study with a 33-bus distribution network and 1800 V2G resources is used to illustrate the performance...

Development and validation of a musculoskeletal physical examination decision-making test for medical students.

Science.gov (United States)

Bishop, Julie Y; Awan, Hisham M; Rowley, David M; Nagel, Rollin W

2013-01-01

Despite a renewed emphasis among educators, musculoskeletal education is still lacking in medical school and residency training programs. We created a musculoskeletal multiple-choice physical examination decision-making test to assess competency and physical examination knowledge of our trainees. We developed a 20-question test in musculoskeletal physical examination decision-making test with content that most medical students and orthopedic residents should know. All questions were reviewed by ratings of US orthopedic chairmen. It was administered to postgraduate year 2 to 5 orthopedic residents and 2 groups of medical students: 1 group immediately after their 3-week musculoskeletal course and the other 1 year after the musculoskeletal course completion. We hypothesized that residents would score highest, medical students 1 year post-musculoskeletal training lowest, and students immediately post-musculoskeletal training midrange. We administered an established cognitive knowledge test to compare student knowledge base as we expected the scores to correlate. Academic medical center in the Midwestern United States. Orthopedic residents, chairmen, and medical students. Fifty-four orthopedic chairmen (54 of 110 or 49%) responded to our survey, rating a mean overall question importance of 7.12 (0 = Not Important; 5 = Important; 10 = Very Important). Mean physical examination decision-making scores were 89% for residents, 77% for immediate post-musculoskeletal trained medical students, and 59% 1 year post-musculoskeletal trained medical students (F = 42.07, pphysical examination decision-making test was found to be internally consistent (Kuder-Richardson Formula 20 = 0.69). The musculoskeletal cognitive knowledge test was 78% for immediate post-musculoskeletal trained students and 71% for the 1 year post-musculoskeletal trained students. The student physical examination and cognitive knowledge scores were correlated (r = 0.54, pphysical examination decision-making test

Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial.

Science.gov (United States)

Elwyn, Glyn; Pickles, Tim; Edwards, Adrian; Kinsey, Katharine; Brain, Kate; Newcombe, Robert G; Firth, Jill; Marrin, Katy; Nye, Alan; Wood, Fiona

2016-04-01

To evaluate whether introducing tools, specifically designed for use in clinical encounters, namely Option Grids, into a clinical practice setting leads to higher levels of shared decision making. A stepped wedge trial design where 6 physiotherapists at an interface clinic in Oldham, UK, were sequentially instructed in how to use an Option Grid for osteoarthritis of the knee. Patients with suspected or confirmed osteoarthritis of the knee were recruited, six per clinician prior to instruction, and six per clinician afterwards. We measured shared decision making, patient knowledge, and readiness to decide. A total of 72 patients were recruited; 36 were allocated to the intervention group. There was an 8.4 point (95% CI 4.4 to 12.2) increase in the Observer OPTION score (range 0-100) in the intervention group. The mean gain in knowledge was 0.9 points (score range 0-5, 95% CI, 0.3 to 1.5). There was no increase in encounter duration. Shared decision making increased when clinicians used the knee osteoarthritis Option Grid. Tools designed to support collaboration and deliberation about treatment options lead to increased levels of shared decision making. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Factors influencing US medical students' decision to pursue surgery.

Science.gov (United States)

Schmidt, Lauren E; Cooper, Clairice A; Guo, Weidun Alan

2016-06-01

Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career. Copyright © 2016 Elsevier Inc. All rights reserved.

A novel approach to optimize workflow in grid-based teleradiology applications.

Science.gov (United States)

Yılmaz, Ayhan Ozan; Baykal, Nazife

2016-01-01

This study proposes an infrastructure with a reporting workflow optimization algorithm (RWOA) in order to interconnect facilities, reporting units and radiologists on a single access interface, to increase the efficiency of the reporting process by decreasing the medical report turnaround time and to increase the quality of medical reports by determining the optimum match between the inspection and radiologist in terms of subspecialty, workload and response time. Workflow centric network architecture with an enhanced caching, querying and retrieving mechanism is implemented by seamlessly integrating Grid Agent and Grid Manager to conventional digital radiology systems. The inspection and radiologist attributes are modelled using a hierarchical ontology structure. Attribute preferences rated by radiologists and technical experts are formed into reciprocal matrixes and weights for entities are calculated utilizing Analytic Hierarchy Process (AHP). The assignment alternatives are processed by relation-based semantic matching (RBSM) and Integer Linear Programming (ILP). The results are evaluated based on both real case applications and simulated process data in terms of subspecialty, response time and workload success rates. Results obtained using simulated data are compared with the outcomes obtained by applying Round Robin, Shortest Queue and Random distribution policies. The proposed algorithm is also applied to a real case teleradiology application process data where medical reporting workflow was performed based on manual assignments by the chief radiologist for 6225 inspections. RBSM gives the highest subspecialty success rate and integrating ILP with RBSM ratings as RWOA provides a better response time and workload distribution success rate. RWOA based image delivery also prevents bandwidth, storage or hardware related stuck and latencies. When compared with a real case teleradiology application where inspection assignments were performed manually, the proposed

PSO-Based Smart Grid Application for Sizing and Optimization of Hybrid Renewable Energy Systems.

Science.gov (United States)

Mohamed, Mohamed A; Eltamaly, Ali M; Alolah, Abdulrahman I

2016-01-01

This paper introduces an optimal sizing algorithm for a hybrid renewable energy system using smart grid load management application based on the available generation. This algorithm aims to maximize the system energy production and meet the load demand with minimum cost and highest reliability. This system is formed by photovoltaic array, wind turbines, storage batteries, and diesel generator as a backup source of energy. Demand profile shaping as one of the smart grid applications is introduced in this paper using load shifting-based load priority. Particle swarm optimization is used in this algorithm to determine the optimum size of the system components. The results obtained from this algorithm are compared with those from the iterative optimization technique to assess the adequacy of the proposed algorithm. The study in this paper is performed in some of the remote areas in Saudi Arabia and can be expanded to any similar regions around the world. Numerous valuable results are extracted from this study that could help researchers and decision makers.

Patients' participation in decision-making in the medical field

DEFF Research Database (Denmark)

Glasdam, Stinne; Oeye, Christine; Thrysøe, Lars

2015-01-01

is going to happen in his life. Both professionals and patients have an underlying, tacit preconception that every medical treatment is better than no treatment. Patients do not always want to be a ‘customer’ in the healthcare system; they want to be a patient, consulting an expert for help and advice......, which creates resistance to the some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal frame and medical logic. The decision-making competence in relation to the choice of treatment is placed away...

Performance Evaluation of the Machine Learning Algorithms Used in Inference Mechanism of a Medical Decision Support System

Directory of Open Access Journals (Sweden)

Mert Bal

2014-01-01

Full Text Available The importance of the decision support systems is increasingly supporting the decision making process in cases of uncertainty and the lack of information and they are widely used in various fields like engineering, finance, medicine, and so forth, Medical decision support systems help the healthcare personnel to select optimal method during the treatment of the patients. Decision support systems are intelligent software systems that support decision makers on their decisions. The design of decision support systems consists of four main subjects called inference mechanism, knowledge-base, explanation module, and active memory. Inference mechanism constitutes the basis of decision support systems. There are various methods that can be used in these mechanisms approaches. Some of these methods are decision trees, artificial neural networks, statistical methods, rule-based methods, and so forth. In decision support systems, those methods can be used separately or a hybrid system, and also combination of those methods. In this study, synthetic data with 10, 100, 1000, and 2000 records have been produced to reflect the probabilities on the ALARM network. The accuracy of 11 machine learning methods for the inference mechanism of medical decision support system is compared on various data sets.

Performance evaluation of the machine learning algorithms used in inference mechanism of a medical decision support system.

Science.gov (United States)

Bal, Mert; Amasyali, M Fatih; Sever, Hayri; Kose, Guven; Demirhan, Ayse

2014-01-01

The importance of the decision support systems is increasingly supporting the decision making process in cases of uncertainty and the lack of information and they are widely used in various fields like engineering, finance, medicine, and so forth, Medical decision support systems help the healthcare personnel to select optimal method during the treatment of the patients. Decision support systems are intelligent software systems that support decision makers on their decisions. The design of decision support systems consists of four main subjects called inference mechanism, knowledge-base, explanation module, and active memory. Inference mechanism constitutes the basis of decision support systems. There are various methods that can be used in these mechanisms approaches. Some of these methods are decision trees, artificial neural networks, statistical methods, rule-based methods, and so forth. In decision support systems, those methods can be used separately or a hybrid system, and also combination of those methods. In this study, synthetic data with 10, 100, 1000, and 2000 records have been produced to reflect the probabilities on the ALARM network. The accuracy of 11 machine learning methods for the inference mechanism of medical decision support system is compared on various data sets.

MINDS - Medical Information Network Decision Support System

National Research Council Canada - National Science Library

Armenian, H. K

2008-01-01

.... The increase in and complexity of medical data at various levels of resolution has increased the need for system level advancements in clinical decision support systems that provide computer-aided...

Real-Time Pricing-Based Scheduling Strategy in Smart Grids: A Hierarchical Game Approach

Directory of Open Access Journals (Sweden)

Jie Yang

2014-01-01

Full Text Available This paper proposes a scheduling strategy based on real-time pricing in smart grids. A hierarchical game is employed to analyze the decision-making process of generators and consumers. We prove the existence and uniqueness of Nash equilibrium and utilize a backward induction method to obtain the generation and consumption strategies. Then, we propose two dynamic algorithms for the generators and consumers to search for the equilibrium in a distributed fashion. Simulation results demonstrate that the proposed scheduling strategy can match supply with demand and shift load away from peak time.

Dynamically Authorized Role-Based Access Control for Grid Applications

Institute of Scientific and Technical Information of China (English)

YAO Hanbing; HU Heping; LU Zhengding; LI Ruixuan

2006-01-01

Grid computing is concerned with the sharing and coordinated use of diverse resources in distributed "virtual organizations". The heterogeneous, dynamic and multi-domain nature of these environments makes challenging security issues that demand new technical approaches. Despite the recent advances in access control approaches applicable to Grid computing, there remain issues that impede the development of effective access control models for Grid applications. Among them there are the lack of context-based models for access control, and reliance on identity or capability-based access control schemes. An access control scheme that resolve these issues is presented, and a dynamically authorized role-based access control (D-RBAC) model extending the RBAC with context constraints is proposed. The D-RABC mechanisms dynamically grant permissions to users based on a set of contextual information collected from the system and user's environments, while retaining the advantages of RBAC model. The implementation architecture of D-RBAC for the Grid application is also described.

Improved delayed signal cancellation-based SRF-PLL for unbalanced grid

DEFF Research Database (Denmark)

Messo, Tuomas; Sihvo, Jussi; Yang, Dongsheng

2017-01-01

Problems with power quality in the grid have gained a lot of attention recently due to rapid increase in the amount of grid-connected power converters. The converter should produce sinusoidal currents also during abnormal conditions, such as unbalanced grid voltages. Several methods, like...... the delayed signal cancellation-based method (DSC), have been proposed to alleviate the detrimental effect of unbalance. This paper proposes an improvement to a delayed signal cancellation based synchronization algorithm for unbalanced grids. The proposed PLL structure employs only half of the delay required...

Grid portal-based data management for lattice QCD data

Energy Technology Data Exchange (ETDEWEB)

Andronico, G. [Istituto Nazionale di Fisica Nucleare, Sezione di Catania, via S. Sofia 64, 95123 Catania (Italy)]. E-mail: giuseppe.andronico@ct.infn.it; Barbera, R. [Istituto Nazionale di Fisica Nucleare, Sezione di Catania, via S. Sofia 64, 95123 Catania (Italy); Dipartimento di Fisica e Astronomia dell' Universita di Catania, via S. Sofia 64, 95123 Catania (Italy); Falzone, A. [NICE SRL, via Marchesi di Roero 1, 14020 Cortanze (Italy)

2004-11-21

We describe here a case of the European Union DataGrid Project data management services by a Lattice Quantum ChromoDynamics (LQCD) application to share the large amount of configurations generated and based on a solution developed from the International Lattice Data Grid Project using a XML dialect called QCDML. In order to allow the user to store, search and browse the lattice configurations described by QCDML in an uniform and transparent way, we have exploited the functionalities of the GENIUS Grid portal, jointly developed by INFN and NICE srl in the context of the Italian INFN Grid and EU DataGrid Projects.

Grid portal-based data management for lattice QCD data

International Nuclear Information System (INIS)

Andronico, G.; Barbera, R.; Falzone, A.

2004-01-01

We describe here a case of the European Union DataGrid Project data management services by a Lattice Quantum ChromoDynamics (LQCD) application to share the large amount of configurations generated and based on a solution developed from the International Lattice Data Grid Project using a XML dialect called QCDML. In order to allow the user to store, search and browse the lattice configurations described by QCDML in an uniform and transparent way, we have exploited the functionalities of the GENIUS Grid portal, jointly developed by INFN and NICE srl in the context of the Italian INFN Grid and EU DataGrid Projects

Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: a qualitative study.

Science.gov (United States)

Katz, Jeffrey N; Lyons, Nancy; Wolff, Lisa S; Silverman, Jodie; Emrani, Parastu; Holt, Holly L; Corbett, Kelly L; Escalante, Agustin; Losina, Elena

2011-04-21

Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics.

Medical students, clinical preventive services, and shared decision-making.

Science.gov (United States)

Keefe, Carole W; Thompson, Margaret E; Noel, Mary Margaret

2002-11-01

Improving access to preventive care requires addressing patient, provider, and systems barriers. Patients often lack knowledge or are skeptical about the importance of prevention. Physicians feel that they have too little time, are not trained to deliver preventive services, and are concerned about the effectiveness of prevention. We have implemented an educational module in the required family practice clerkship (1) to enhance medical student learning about common clinical preventive services and (2) to teach students how to inform and involve patients in shared decision making about those services. Students are asked to examine available evidence-based information for preventive screening services. They are encouraged to look at the recommendations of various organizations and use such resources as reports from the U.S. Preventive Services Task Force to determine recommendations they want to be knowledgeable about in talking with their patients. For learning shared decision making, students are trained to use a model adapted from Braddock and colleagues(1) to discuss specific screening services and to engage patients in the process of making informed decisions about what is best for their own health. The shared decision making is presented and modeled by faculty, discussed in small groups, and students practice using Web-based cases and simulations. The students are evaluated using formative and summative performance-based assessments as they interact with simulated patients about (1) screening for high blood cholesterol and other lipid abnormalities, (2) screening for colorectal cancer, (3) screening for prostate cancer, and (4) screening for breast cancer. The final student evaluation is a ten-minute, videotaped discussion with a simulated patient about screening for colorectal cancer that is graded against a checklist that focuses primarily on the elements of shared decision making. Our medical students appear quite willing to accept shared decision making as

Grist: Grid-based Data Mining for Astronomy

Science.gov (United States)

Jacob, J. C.; Katz, D. S.; Miller, C. D.; Walia, H.; Williams, R. D.; Djorgovski, S. G.; Graham, M. J.; Mahabal, A. A.; Babu, G. J.; vanden Berk, D. E.; Nichol, R.

2005-12-01

The Grist project is developing a grid-technology based system as a research environment for astronomy with massive and complex datasets. This knowledge extraction system will consist of a library of distributed grid services controlled by a workflow system, compliant with standards emerging from the grid computing, web services, and virtual observatory communities. This new technology is being used to find high redshift quasars, study peculiar variable objects, search for transients in real time, and fit SDSS QSO spectra to measure black hole masses. Grist services are also a component of the ``hyperatlas'' project to serve high-resolution multi-wavelength imagery over the Internet. In support of these science and outreach objectives, the Grist framework will provide the enabling fabric to tie together distributed grid services in the areas of data access, federation, mining, subsetting, source extraction, image mosaicking, statistics, and visualization.

Grist : grid-based data mining for astronomy

Science.gov (United States)

Jacob, Joseph C.; Katz, Daniel S.; Miller, Craig D.; Walia, Harshpreet; Williams, Roy; Djorgovski, S. George; Graham, Matthew J.; Mahabal, Ashish; Babu, Jogesh; Berk, Daniel E. Vanden;

Preparing for smart grid technologies: A behavioral decision research approach to understanding consumer expectations about smart meters

International Nuclear Information System (INIS)

Krishnamurti, Tamar; Schwartz, Daniel; Davis, Alexander; Fischhoff, Baruch; Bruine de Bruin, Wändi; Lave, Lester; Wang, Jack

2012-01-01

With the enactment of the 2009 American Recovery and Reinvestment Act, U.S. President Obama made a public commitment to a new approach to energy production and transmission in the United States. It features installing smart meters and related technologies in residential homes, as part of transforming the current electrical grid into a “smart grid.” Realizing this transformation requires consumers to accept these new technologies and take advantage of the opportunities that they create. We use methods from behavioral decision research to understand consumer beliefs about smart meters, including in-depth mental models interviews and a follow-up survey with a sample of potential smart meter customers of a major U.S. mid-Atlantic electricity utility. In both the surveys and the interviews, most respondents reported wanting smart meters. However, these preferences were often based on erroneous beliefs regarding their purpose and function. Respondents confused smart meters with in-home displays and other enabling technologies, while expecting to realize immediate savings. They also perceived risks, including less control over their electricity usage, violations of their privacy, and increased costs. We discuss the policy implications of our results. - Highlights: ► We outline normative risks and benefits of smart meters from scientific literature. ► We examine consumer perceptions of smart meters via interviews and surveys. ► Smart meter desire stems from consumer misconceptions about purpose and function. ► Appropriate communications may prevent consumer protests against the smart grid.

Shared decision making for psychiatric medication management: beyond the micro-social.

Science.gov (United States)

Morant, Nicola; Kaminskiy, Emma; Ramon, Shulamit

2016-10-01

Mental health care has lagged behind other health-care domains in developing and applying shared decision making (SDM) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self-management and recovery-oriented practice, and growing policy-level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. This conceptual review argues that several aspects of mental health care that differ from other health-care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM. It is therefore problematic to uncritically import models of SDM developed in other health-care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro-social focus of a medical consultation. Contextualizing specific medication-related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM. A broad conceptualization of decision making for psychiatric medication that moves beyond the micro-social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Research on the comparison of extension mechanism of cellular automaton based on hexagon grid and rectangular grid

Science.gov (United States)

Zhai, Xiaofang; Zhu, Xinyan; Xiao, Zhifeng; Weng, Jie

2009-10-01

Historically, cellular automata (CA) is a discrete dynamical mathematical structure defined on spatial grid. Research on cellular automata system (CAS) has focused on rule sets and initial condition and has not discussed its adjacency. Thus, the main focus of our study is the effect of adjacency on CA behavior. This paper is to compare rectangular grids with hexagonal grids on their characteristics, strengths and weaknesses. They have great influence on modeling effects and other applications including the role of nearest neighborhood in experimental design. Our researches present that rectangular and hexagonal grids have different characteristics. They are adapted to distinct aspects, and the regular rectangular or square grid is used more often than the hexagonal grid. But their relative merits have not been widely discussed. The rectangular grid is generally preferred because of its symmetry, especially in orthogonal co-ordinate system and the frequent use of raster from Geographic Information System (GIS). However, in terms of complex terrain, uncertain and multidirectional region, we have preferred hexagonal grids and methods to facilitate and simplify the problem. Hexagonal grids can overcome directional warp and have some unique characteristics. For example, hexagonal grids have a simpler and more symmetric nearest neighborhood, which avoids the ambiguities of the rectangular grids. Movement paths or connectivity, the most compact arrangement of pixels, make hexagonal appear great dominance in the process of modeling and analysis. The selection of an appropriate grid should be based on the requirements and objectives of the application. We use rectangular and hexagonal grids respectively for developing city model. At the same time we make use of remote sensing images and acquire 2002 and 2005 land state of Wuhan. On the base of city land state in 2002, we make use of CA to simulate reasonable form of city in 2005. Hereby, these results provide a proof of

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

Science.gov (United States)

Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

Science.gov (United States)

Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

2015-12-01

Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

GRID-BASED EXPLORATION OF COSMOLOGICAL PARAMETER SPACE WITH SNAKE

International Nuclear Information System (INIS)

Mikkelsen, K.; Næss, S. K.; Eriksen, H. K.

2013-01-01

We present a fully parallelized grid-based parameter estimation algorithm for investigating multidimensional likelihoods called Snake, and apply it to cosmological parameter estimation. The basic idea is to map out the likelihood grid-cell by grid-cell according to decreasing likelihood, and stop when a certain threshold has been reached. This approach improves vastly on the 'curse of dimensionality' problem plaguing standard grid-based parameter estimation simply by disregarding grid cells with negligible likelihood. The main advantages of this method compared to standard Metropolis-Hastings Markov Chain Monte Carlo methods include (1) trivial extraction of arbitrary conditional distributions; (2) direct access to Bayesian evidences; (3) better sampling of the tails of the distribution; and (4) nearly perfect parallelization scaling. The main disadvantage is, as in the case of brute-force grid-based evaluation, a dependency on the number of parameters, N par . One of the main goals of the present paper is to determine how large N par can be, while still maintaining reasonable computational efficiency; we find that N par = 12 is well within the capabilities of the method. The performance of the code is tested by comparing cosmological parameters estimated using Snake and the WMAP-7 data with those obtained using CosmoMC, the current standard code in the field. We find fully consistent results, with similar computational expenses, but shorter wall time due to the perfect parallelization scheme

Differences in simulated doctor and patient medical decision making: a construal level perspective.

Science.gov (United States)

Peng, Jiaxi; He, Fei; Zhang, Yan; Liu, Quanhui; Miao, Danmin; Xiao, Wei

2013-01-01

Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. This study investigated the characteristics of and differences in doctor-patient medical decision making on the basis of construal level theory. A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, pframing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, pframe (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59). Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation.

Attitudes to infant feeding decision-making--a mixed-methods study of Australian medical students and GP registrars.

Science.gov (United States)

Brodribb, Wendy; Fallon, Tony; Jackson, Claire; Hegney, Desley

2010-03-01

Breastfeeding is an important public health issue. While medical practitioners can have a significant impact on breastfeeding initiation and duration, there are few studies investigating their views regarding women's infant feeding decisions. This mixed-methods study employed qualitative (focus groups and interviews) and quantitative (questionnaire) data collection techniques to investigate the attitudes and views of Australian medical students and GP registrars about infant feeding decision-making. Three approaches to infant feeding decisions were evident: 'the moral choice' (women were expected to breastfeed); 'the free choice' (doctors should not influence a woman's decision); and 'the equal choice' (the outcome of the decision was unimportant). Participants were uncertain about differences between artificial-feeding and breastfeeding outcomes, and there was some concern that advising a mother to breastfeed may lead to maternal feelings of guilt and failure. These findings, the first in an Australian setting, provide a foundation on which to base further educational interventions for medical practitioners.

Lessons learned by (from?) an economist working in medical decision making.

Science.gov (United States)

Wakker, Peter P

2008-01-01

This article is a personal account of the author's experiences as an economist working in medical decision making. He discusses the differences between economic decision theory and medical decision making and gives examples of the mutual benefits resulting from interactions. In particular, he discusses the pros and cons of different methods for measuring quality of life (or, as economists would call it, utility), including the standard gamble, the time tradeoff, and the healthy-years equivalent methods.

Seminal Quality Prediction Using Clustering-Based Decision Forests

Directory of Open Access Journals (Sweden)

Hong Wang

2014-08-01

Full Text Available Prediction of seminal quality with statistical learning tools is an emerging methodology in decision support systems in biomedical engineering and is very useful in early diagnosis of seminal patients and selection of semen donors candidates. However, as is common in medical diagnosis, seminal quality prediction faces the class imbalance problem. In this paper, we propose a novel supervised ensemble learning approach, namely Clustering-Based Decision Forests, to tackle unbalanced class learning problem in seminal quality prediction. Experiment results on real fertility diagnosis dataset have shown that Clustering-Based Decision Forests outperforms decision tree, Support Vector Machines, random forests, multilayer perceptron neural networks and logistic regression by a noticeable margin. Clustering-Based Decision Forests can also be used to evaluate variables’ importance and the top five important factors that may affect semen concentration obtained in this study are age, serious trauma, sitting time, the season when the semen sample is produced, and high fevers in the last year. The findings could be helpful in explaining seminal concentration problems in infertile males or pre-screening semen donor candidates.

Task-and-role-based access-control model for computational grid

Institute of Scientific and Technical Information of China (English)

LONG Tao; HONG Fan; WU Chi; SUN Ling-li

2007-01-01

Access control in a grid environment is a challenging issue because the heterogeneous nature and independent administration of geographically dispersed resources in grid require access control to use fine-grained policies. We established a task-and-role-based access-control model for computational grid (CG-TRBAC model), integrating the concepts of role-based access control (RBAC) and task-based access control (TBAC). In this model, condition restrictions are defined and concepts specifically tailored to Workflow Management System are simplified or omitted so that role assignment and security administration fit computational grid better than traditional models; permissions are mutable with the task status and system variables, and can be dynamically controlled. The CG-TRBAC model is proved flexible and extendible. It can implement different control policies. It embodies the security principle of least privilege and executes active dynamic authorization. A task attribute can be extended to satisfy different requirements in a real grid system.

OGC and Grid Interoperability in enviroGRIDS Project

Science.gov (United States)

Gorgan, Dorian; Rodila, Denisa; Bacu, Victor; Giuliani, Gregory; Ray, Nicolas

2010-05-01

the OGC Web service protocols, the advantages offered by the Grid technology - such as providing a secure interoperability between the distributed geospatial resource -and the issues introduced by the integration of distributed geospatial data in a secure environment: data and service discovery, management, access and computation. enviroGRIDS project proposes a new architecture which allows a flexible and scalable approach for integrating the geospatial domain represented by the OGC Web services with the Grid domain represented by the gLite middleware. The parallelism offered by the Grid technology is discussed and explored at the data level, management level and computation level. The analysis is carried out for OGC Web service interoperability in general but specific details are emphasized for Web Map Service (WMS), Web Feature Service (WFS), Web Coverage Service (WCS), Web Processing Service (WPS) and Catalog Service for Web (CSW). Issues regarding the mapping and the interoperability between the OGC and the Grid standards and protocols are analyzed as they are the base in solving the communication problems between the two environments: grid and geospatial. The presetation mainly highlights how the Grid environment and Grid applications capabilities can be extended and utilized in geospatial interoperability. Interoperability between geospatial and Grid infrastructures provides features such as the specific geospatial complex functionality and the high power computation and security of the Grid, high spatial model resolution and geographical area covering, flexible combination and interoperability of the geographical models. According with the Service Oriented Architecture concepts and requirements of interoperability between geospatial and Grid infrastructures each of the main functionality is visible from enviroGRIDS Portal and consequently, by the end user applications such as Decision Maker/Citizen oriented Applications. The enviroGRIDS portal is the single way

Near-Body Grid Adaption for Overset Grids

Science.gov (United States)

Buning, Pieter G.; Pulliam, Thomas H.

2016-01-01

A solution adaption capability for curvilinear near-body grids has been implemented in the OVERFLOW overset grid computational fluid dynamics code. The approach follows closely that used for the Cartesian off-body grids, but inserts refined grids in the computational space of original near-body grids. Refined curvilinear grids are generated using parametric cubic interpolation, with one-sided biasing based on curvature and stretching ratio of the original grid. Sensor functions, grid marking, and solution interpolation tasks are implemented in the same fashion as for off-body grids. A goal-oriented procedure, based on largest error first, is included for controlling growth rate and maximum size of the adapted grid system. The adaption process is almost entirely parallelized using MPI, resulting in a capability suitable for viscous, moving body simulations. Two- and three-dimensional examples are presented.

ONE SIZE FITS ALL? ON PATIENT AUTONOMY, MEDICAL DECISION-MAKING, AND THE IMPACT OF CULTURE.

Science.gov (United States)

Gilbar, Roy; Miola, José

2015-01-01

While both medical law and medical ethics have developed in a way that has sought to prioritise patient autonomy, it is less clear whether it has done so in a way that enhances the self-determination of patients from non-western backgrounds. In this article, we consider the desire of some patients from non-western backgrounds for family involvement in decision-making and argue that this desire is not catered for effectively in either medical law or medical ethics. We examine an alternative approach based on relational autonomy that might serve both to allow such patients to exercise their self-determination while still allowing them to include family members in the decision-making process. © The Author 2014. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Fast and accurate grid representations for atom-based docking with partner flexibility.

Science.gov (United States)

de Vries, Sjoerd J; Zacharias, Martin

2017-06-30

Macromolecular docking methods can broadly be divided into geometric and atom-based methods. Geometric methods use fast algorithms that operate on simplified, grid-like molecular representations, while atom-based methods are more realistic and flexible, but far less efficient. Here, a hybrid approach of grid-based and atom-based docking is presented, combining precalculated grid potentials with neighbor lists for fast and accurate calculation of atom-based intermolecular energies and forces. The grid representation is compatible with simultaneous multibody docking and can tolerate considerable protein flexibility. When implemented in our docking method ATTRACT, grid-based docking was found to be ∼35x faster. With the OPLSX forcefield instead of the ATTRACT coarse-grained forcefield, the average speed improvement was >100x. Grid-based representations may allow atom-based docking methods to explore large conformational spaces with many degrees of freedom, such as multiple macromolecules including flexibility. This increases the domain of biological problems to which docking methods can be applied. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

PSO-Based Smart Grid Application for Sizing and Optimization of Hybrid Renewable Energy Systems

Science.gov (United States)

Mohamed, Mohamed A.; Eltamaly, Ali M.; Alolah, Abdulrahman I.

2016-01-01

This paper introduces an optimal sizing algorithm for a hybrid renewable energy system using smart grid load management application based on the available generation. This algorithm aims to maximize the system energy production and meet the load demand with minimum cost and highest reliability. This system is formed by photovoltaic array, wind turbines, storage batteries, and diesel generator as a backup source of energy. Demand profile shaping as one of the smart grid applications is introduced in this paper using load shifting-based load priority. Particle swarm optimization is used in this algorithm to determine the optimum size of the system components. The results obtained from this algorithm are compared with those from the iterative optimization technique to assess the adequacy of the proposed algorithm. The study in this paper is performed in some of the remote areas in Saudi Arabia and can be expanded to any similar regions around the world. Numerous valuable results are extracted from this study that could help researchers and decision makers. PMID:27513000

Grid-based electronic structure calculations: The tensor decomposition approach

Energy Technology Data Exchange (ETDEWEB)

Rakhuba, M.V., E-mail: rakhuba.m@gmail.com [Skolkovo Institute of Science and Technology, Novaya St. 100, 143025 Skolkovo, Moscow Region (Russian Federation); Oseledets, I.V., E-mail: i.oseledets@skoltech.ru [Skolkovo Institute of Science and Technology, Novaya St. 100, 143025 Skolkovo, Moscow Region (Russian Federation); Institute of Numerical Mathematics, Russian Academy of Sciences, Gubkina St. 8, 119333 Moscow (Russian Federation)

2016-05-01

We present a fully grid-based approach for solving Hartree–Fock and all-electron Kohn–Sham equations based on low-rank approximation of three-dimensional electron orbitals. Due to the low-rank structure the total complexity of the algorithm depends linearly with respect to the one-dimensional grid size. Linear complexity allows for the usage of fine grids, e.g. 8192{sup 3} and, thus, cheap extrapolation procedure. We test the proposed approach on closed-shell atoms up to the argon, several molecules and clusters of hydrogen atoms. All tests show systematical convergence with the required accuracy.

Community-based participatory research and user-centered design in a diabetes medication information and decision tool.

Science.gov (United States)

Henderson, Vida A; Barr, Kathryn L; An, Lawrence C; Guajardo, Claudia; Newhouse, William; Mase, Rebecca; Heisler, Michele

2013-01-01

Together, community-based participatory research (CBPR), user-centered design (UCD), and health information technology (HIT) offer promising approaches to improve health disparities in low-resource settings. This article describes the application of CBPR and UCD principles to the development of iDecide/Decido, an interactive, tailored, web-based diabetes medication education and decision support tool delivered by community health workers (CHWs) to African American and Latino participants with diabetes in Southwest and Eastside Detroit. The decision aid is offered in English or Spanish and is delivered on an iPad in participants' homes. The overlapping principles of CBPR and UCD used to develop iDecide/Decido include a user-focused or community approach, equitable academic and community partnership in all study phases, an iterative development process that relies on input from all stakeholders, and a program experience that is specified, adapted, and implemented with the target community. Collaboration between community members, researchers, and developers is especially evident in the program's design concept, animations, pictographs, issue cards, goal setting, tailoring, and additional CHW tools. The principles of CBPR and UCD can be successfully applied in developing health information tools that are easy to use and understand, interactive, and target health disparities.

Medical decision-making in children and adolescents: developmental and neuroscientific aspects.

Science.gov (United States)

Grootens-Wiegers, Petronella; Hein, Irma M; van den Broek, Jos M; de Vries, Martine C

2017-05-08

Various international laws and guidelines stress the importance of respecting the developing autonomy of children and involving minors in decision-making regarding treatment and research participation. However, no universal agreement exists as to at what age minors should be deemed decision-making competent. Minors of the same age may show different levels of maturity. In addition, patients deemed rational conversation-partners as a child can suddenly become noncompliant as an adolescent. Age, context and development all play a role in decision-making competence. In this article we adopt a perspective on competence that specifically focuses on the impact of brain development on the child's decision-making process. We believe that the discussion on decision-making competence of minors can greatly benefit from a multidisciplinary approach. We adopted such an approach in order to contribute to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills and abilities that need to be sufficiently developed to support the capacity. Based on this approach it can be concluded that at the age of 12 children can have the capacity to be decision-making competent. However, this age coincides with the onset of adolescence. Early development of the brain's reward system combined with late development of the control system diminishes decision-making competence in adolescents in specific contexts. We conclude that even adolescents possessing capacities required for decision-making, may need support of facilitating environmental factors

Differences in Simulated Doctor and Patient Medical Decision Making: A Construal Level Perspective

Science.gov (United States)

Zhang, Yan; Liu, Quanhui; Miao, Danmin; Xiao, Wei

2013-01-01

Background Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. Objective This study investigated the characteristics of and differences in doctor–patient medical decision making on the basis of construal level theory. Methods A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. Results Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, peffect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, peffect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59). Conclusion Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation. PMID:24244445

Differences in simulated doctor and patient medical decision making: a construal level perspective.

Directory of Open Access Journals (Sweden)

Jiaxi Peng

Full Text Available BACKGROUND: Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. OBJECTIVE: This study investigated the characteristics of and differences in doctor-patient medical decision making on the basis of construal level theory. METHODS: A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. RESULTS: Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011. Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, p<.001. The effect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35; however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, p<.001. The effect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005 and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07 but nonsignificant in the negative frame (F2, 404 = .29, p = 59. CONCLUSION: Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation.

The CrossGrid project

International Nuclear Information System (INIS)

Kunze, M.

2003-01-01

There are many large-scale problems that require new approaches to computing, such as earth observation, environmental management, biomedicine, industrial and scientific modeling. The CrossGrid project addresses realistic problems in medicine, environmental protection, flood prediction, and physics analysis and is oriented towards specific end-users: Medical doctors, who could obtain new tools to help them to obtain correct diagnoses and to guide them during operations; industries, that could be advised on the best timing for some critical operations involving risk of pollution; flood crisis teams, that could predict the risk of a flood on the basis of historical records and actual hydrological and meteorological data; physicists, who could optimize the analysis of massive volumes of data distributed across countries and continents. Corresponding applications will be based on Grid technology and could be complex and difficult to use: the CrossGrid project aims at developing several tools that will make the Grid more friendly for average users. Portals for specific applications will be designed, that should allow for easy connection to the Grid, create a customized work environment, and provide users with all necessary information to get their job done

GRID-BASED EXPLORATION OF COSMOLOGICAL PARAMETER SPACE WITH SNAKE

Energy Technology Data Exchange (ETDEWEB)

Mikkelsen, K.; Næss, S. K.; Eriksen, H. K., E-mail: kristin.mikkelsen@astro.uio.no [Institute of Theoretical Astrophysics, University of Oslo, P.O. Box 1029, Blindern, NO-0315 Oslo (Norway)

2013-11-10

We present a fully parallelized grid-based parameter estimation algorithm for investigating multidimensional likelihoods called Snake, and apply it to cosmological parameter estimation. The basic idea is to map out the likelihood grid-cell by grid-cell according to decreasing likelihood, and stop when a certain threshold has been reached. This approach improves vastly on the 'curse of dimensionality' problem plaguing standard grid-based parameter estimation simply by disregarding grid cells with negligible likelihood. The main advantages of this method compared to standard Metropolis-Hastings Markov Chain Monte Carlo methods include (1) trivial extraction of arbitrary conditional distributions; (2) direct access to Bayesian evidences; (3) better sampling of the tails of the distribution; and (4) nearly perfect parallelization scaling. The main disadvantage is, as in the case of brute-force grid-based evaluation, a dependency on the number of parameters, N{sub par}. One of the main goals of the present paper is to determine how large N{sub par} can be, while still maintaining reasonable computational efficiency; we find that N{sub par} = 12 is well within the capabilities of the method. The performance of the code is tested by comparing cosmological parameters estimated using Snake and the WMAP-7 data with those obtained using CosmoMC, the current standard code in the field. We find fully consistent results, with similar computational expenses, but shorter wall time due to the perfect parallelization scheme.

Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

Directory of Open Access Journals (Sweden)

Abbasali Ebrahimian

2014-01-01

Full Text Available Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1 patient’s condition’ and (2 the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation.

Wind Farm Grid Integration Using VSC Based HVDC Transmission - An Overview

DEFF Research Database (Denmark)

Chaudhary, Sanjay Kumar; Teodorescu, Remus; Rodriguez, Pedro

2008-01-01

The paper gives an overview of HVAC and HVDC connection of wind farm to the grid, with an emphasis on Voltage Source Converter (VSC)-based HVDC for large wind farms requiring long distance cable connection. Flexible control capabilities of a VSC-based HVDC system enables smooth integration of wind...... farm into the power grid network while meeting the Grid Code Requirements (GCR). Operation of a wind farm with VSC-based HVDC connection is described....

Effectively marketing prepaid medical care with decision support systems.

Science.gov (United States)

Forgionne, G A

1991-01-01

The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches.

Effect of training problem-solving skill on decision-making and critical thinking of personnel at medical emergencies

Science.gov (United States)

Heidari, Mohammad; Shahbazi, Sara

2016-01-01

Background: The aim of this study was to determine the effect of problem-solving training on decision-making skill and critical thinking in emergency medical personnel. Materials and Methods: This study is an experimental study that performed in 95 emergency medical personnel in two groups of control (48) and experimental (47). Then, a short problem-solving course based on 8 sessions of 2 h during the term, was performed for the experimental group. Of data gathering was used demographic and researcher made decision-making and California critical thinking skills questionnaires. Data were analyzed using SPSS software. Results: The finding revealed that decision-making and critical thinking score in emergency medical personnel are low and problem-solving course, positively affected the personnel’ decision-making skill and critical thinking after the educational program (P problem-solving in various emergency medicine domains such as education, research, and management, is recommended. PMID:28149823

State-space-based harmonic stability analysis for paralleled grid-connected inverters

DEFF Research Database (Denmark)

Wang, Yanbo; Wang, Xiongfei; Chen, Zhe

2016-01-01

This paper addresses a state-space-based harmonic stability analysis of paralleled grid-connected inverters system. A small signal model of individual inverter is developed, where LCL filter, the equivalent delay of control system, and current controller are modeled. Then, the overall small signal...... model of paralleled grid-connected inverters is built. Finally, the state space-based stability analysis approach is developed to explain the harmonic resonance phenomenon. The eigenvalue traces associated with time delay and coupled grid impedance are obtained, which accounts for how the unstable...... inverter produces the harmonic resonance and leads to the instability of whole paralleled system. The proposed approach reveals the contributions of the grid impedance as well as the coupled effect on other grid-connected inverters under different grid conditions. Simulation and experimental results...

Wind power integration in island-based smart grid projects : A comparative study between Jeju Smart Grid Test-bed and Smart Grid Gotland

OpenAIRE

Piehl, Hampus

2014-01-01

Smart grids seem to be the solution to use energy from renewable and intermittent energy sources in an efficient manner. There are many research projects around the world and two of them are Jeju Smart Grid Test-bed and Smart Grid Gotland. They have in common that they are both island-based projects and connected to the Powergrid on the mainland by HVDC-link. The purpose of this thesis is to compare the two projects and find out what challenges and strategies they have related to wind power i...

Protocol-based care: the standardisation of decision-making?

Science.gov (United States)

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as

Frequency scanning-based stability analysis method for grid-connected inverter system

DEFF Research Database (Denmark)

Wang, Yanbo; Wang, Xiongfei; Blaabjerg, Frede

2017-01-01

This paper proposes a frequency scanning-based impedance analysis for stability assessment of grid-connected inverter system, which is able to perform stability assessment without using system mathematical models and inherit the superior feature of impedance-based stability criterion with conside......This paper proposes a frequency scanning-based impedance analysis for stability assessment of grid-connected inverter system, which is able to perform stability assessment without using system mathematical models and inherit the superior feature of impedance-based stability criterion...... with consideration of the inverter nonlinearities. Small current disturbance is injected into grid-connected inverter system in a particular frequency range, and the impedance is computed according to the harmonic-frequency response using Fourier analysis, and then the stability is predicted on the basis...... of the impedance stability criterion. The stability issues of grid-connected inverters with grid-current feedback and the converter-current feedback are addressed using the proposed method. The results obtained from simulation and experiments validate the effectiveness of the method. The frequency scanning...

From the grid to the smart grid, topologically

Science.gov (United States)

Pagani, Giuliano Andrea; Aiello, Marco

2016-05-01

In its more visionary acceptation, the smart grid is a model of energy management in which the users are engaged in producing energy as well as consuming it, while having information systems fully aware of the energy demand-response of the network and of dynamically varying prices. A natural question is then: to make the smart grid a reality will the distribution grid have to be upgraded? We assume a positive answer to the question and we consider the lower layers of medium and low voltage to be the most affected by the change. In our previous work, we analyzed samples of the Dutch distribution grid (Pagani and Aiello, 2011) and we considered possible evolutions of these using synthetic topologies modeled after studies of complex systems in other technological domains (Pagani and Aiello, 2014). In this paper, we take an extra important step by defining a methodology for evolving any existing physical power grid to a good smart grid model, thus laying the foundations for a decision support system for utilities and governmental organizations. In doing so, we consider several possible evolution strategies and apply them to the Dutch distribution grid. We show how increasing connectivity is beneficial in realizing more efficient and reliable networks. Our proposal is topological in nature, enhanced with economic considerations of the costs of such evolutions in terms of cabling expenses and economic benefits of evolving the grid.

Reinforcement Learning Based Novel Adaptive Learning Framework for Smart Grid Prediction

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Tian Li

2017-01-01

Full Text Available Smart grid is a potential infrastructure to supply electricity demand for end users in a safe and reliable manner. With the rapid increase of the share of renewable energy and controllable loads in smart grid, the operation uncertainty of smart grid has increased briskly during recent years. The forecast is responsible for the safety and economic operation of the smart grid. However, most existing forecast methods cannot account for the smart grid due to the disabilities to adapt to the varying operational conditions. In this paper, reinforcement learning is firstly exploited to develop an online learning framework for the smart grid. With the capability of multitime scale resolution, wavelet neural network has been adopted in the online learning framework to yield reinforcement learning and wavelet neural network (RLWNN based adaptive learning scheme. The simulations on two typical prediction problems in smart grid, including wind power prediction and load forecast, validate the effectiveness and the scalability of the proposed RLWNN based learning framework and algorithm.

AVQS: Attack Route-Based Vulnerability Quantification Scheme for Smart Grid

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Jongbin Ko

2014-01-01

Full Text Available A smart grid is a large, consolidated electrical grid system that includes heterogeneous networks and systems. Based on the data, a smart grid system has a potential security threat in its network connectivity. To solve this problem, we develop and apply a novel scheme to measure the vulnerability in a smart grid domain. Vulnerability quantification can be the first step in security analysis because it can help prioritize the security problems. However, existing vulnerability quantification schemes are not suitable for smart grid because they do not consider network vulnerabilities. We propose a novel attack route-based vulnerability quantification scheme using a network vulnerability score and an end-to-end security score, depending on the specific smart grid network environment to calculate the vulnerability score for a particular attack route. To evaluate the proposed approach, we derive several attack scenarios from the advanced metering infrastructure domain. The experimental results of the proposed approach and the existing common vulnerability scoring system clearly show that we need to consider network connectivity for more optimized vulnerability quantification.

AVQS: attack route-based vulnerability quantification scheme for smart grid.

Science.gov (United States)

Ko, Jongbin; Lim, Hyunwoo; Lee, Seokjun; Shon, Taeshik

2014-01-01

A smart grid is a large, consolidated electrical grid system that includes heterogeneous networks and systems. Based on the data, a smart grid system has a potential security threat in its network connectivity. To solve this problem, we develop and apply a novel scheme to measure the vulnerability in a smart grid domain. Vulnerability quantification can be the first step in security analysis because it can help prioritize the security problems. However, existing vulnerability quantification schemes are not suitable for smart grid because they do not consider network vulnerabilities. We propose a novel attack route-based vulnerability quantification scheme using a network vulnerability score and an end-to-end security score, depending on the specific smart grid network environment to calculate the vulnerability score for a particular attack route. To evaluate the proposed approach, we derive several attack scenarios from the advanced metering infrastructure domain. The experimental results of the proposed approach and the existing common vulnerability scoring system clearly show that we need to consider network connectivity for more optimized vulnerability quantification.

Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.

Science.gov (United States)

Stein, Bradley D; Kogan, Jane N; Mihalyo, Mark J; Schuster, James; Deegan, Patricia E; Sorbero, Mark J; Drake, Robert E

2013-04-01

Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.

Evidence-based decision making in health care settings: from theory to practice.

Science.gov (United States)

Kohn, Melanie Kazman; Berta, Whitney; Langley, Ann; Davis, David

2011-01-01

The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: A study protocol

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Gagnon Marie-Pierre

2011-01-01

Full Text Available Abstract Background In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale. Methods/design This descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+. Discussion Barriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared

Schwarz-Christoffel Conformal Mapping based Grid Generation for Global Oceanic Circulation Models

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Xu, Shiming

2015-04-01

We propose new grid generation algorithms for global ocean general circulation models (OGCMs). Contrary to conventional, analytical forms based dipolar or tripolar grids, the new algorithm are based on Schwarz-Christoffel (SC) conformal mapping with prescribed boundary information. While dealing with the conventional grid design problem of pole relocation, it also addresses more advanced issues of computational efficiency and the new requirements on OGCM grids arisen from the recent trend of high-resolution and multi-scale modeling. The proposed grid generation algorithm could potentially achieve the alignment of grid lines to coastlines, enhanced spatial resolution in coastal regions, and easier computational load balance. Since the generated grids are still orthogonal curvilinear, they can be readily 10 utilized in existing Bryan-Cox-Semtner type ocean models. The proposed methodology can also be applied to the grid generation task for regional ocean modeling when complex land-ocean distribution is present.

BIG: a Grid Portal for Biomedical Data and Images

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Giovanni Aloisio

2004-06-01

Full Text Available Modern management of biomedical systems involves the use of many distributed resources, such as high performance computational resources to analyze biomedical data, mass storage systems to store them, medical instruments (microscopes, tomographs, etc., advanced visualization and rendering tools. Grids offer the computational power, security and availability needed by such novel applications. This paper presents BIG (Biomedical Imaging Grid, a Web-based Grid portal for management of biomedical information (data and images in a distributed environment. BIG is an interactive environment that deals with complex user's requests, regarding the acquisition of biomedical data, the "processing" and "delivering" of biomedical images, using the power and security of Computational Grids.

Generating Big Data Sets from Knowledge-based Decision Support Systems to Pursue Value-based Healthcare

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Arturo González-Ferrer

2018-03-01

Full Text Available Talking about Big Data in healthcare we usually refer to how to use data collected from current electronic medical records, either structured or unstructured, to answer clinically relevant questions. This operation is typically carried out by means of analytics tools (e.g. machine learning or by extracting relevant data from patient summaries through natural language processing techniques. From other perspective of research in medical informatics, powerful initiatives have emerged to help physicians taking decisions, in both diagnostics and therapeutics, built from the existing medical evidence (i.e. knowledge-based decision support systems. Much of the problems these tools have shown, when used in real clinical settings, are related to their implementation and deployment, more than failing in its support, but, technology is slowly overcoming interoperability and integration issues. Beyond the point-of-care decision support these tools can provide, the data generated when using them, even in controlled trials, could be used to further analyze facts that are traditionally ignored in the current clinical practice. In this paper, we reflect on the technologies available to make the leap and how they could help driving healthcare organizations shifting to a value-based healthcare philosophy.

Towards meaningful medication-related clinical decision support: recommendations for an initial implementation.

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Phansalkar, S; Wright, A; Kuperman, G J; Vaida, A J; Bobb, A M; Jenders, R A; Payne, T H; Halamka, J; Bloomrosen, M; Bates, D W

2011-01-01

Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings.

dSPACE based adaptive neuro-fuzzy controller of grid interactive inverter

International Nuclear Information System (INIS)

Altin, Necmi; Sefa, İbrahim

2012-01-01

Highlights: ► We propose a dSPACE based neuro-fuzzy controlled grid interactive inverter. ► The membership functions and rule base of fuzzy logic controller by using ANFIS. ► A LCL output filter is designed. ► A high performance controller is designed. - Abstract: In this study, design, simulation and implementation of a dSPACE based grid interactive voltage source inverter are proposed. This inverter has adaptive neuro-fuzzy controller and capable of importing electrical energy, generated from renewable energy sources such as the wind, the solar and the fuel cells to the grid. A line frequency transformer and a LCL filter are used at the output of the grid interactive inverter which is designed as current controlled to decrease the susceptibility to phase errors. Membership functions and rule base of the fuzzy logic controller, which control the inverter output current, are determined by using artificial neural networks. Both simulation and experimental results show that, the grid interactive inverter operates synchronously with the grid. The inverter output current which is imported to the grid is in sinusoidal waveform and the harmonic level of it meets the international standards (4.3 < 5.0%). In addition, simulation and experimental results of the neuro-fuzzy and the PI controlled inverter are given together and compared in detail. Simulation and experimental results show that the proposed inverter has faster response to the reference variations and lower steady state error than PI controller.

Medical decision making tools: Bayesian analysis and ROC analysis

International Nuclear Information System (INIS)

Lee, Byung Do

2006-01-01

During the diagnostic process of the various oral and maxillofacial lesions, we should consider the following: 'When should we order diagnostic tests? What tests should be ordered? How should we interpret the results clinically? And how should we use this frequently imperfect information to make optimal medical decision?' For the clinicians to make proper judgement, several decision making tools are suggested. This article discusses the concept of the diagnostic accuracy (sensitivity and specificity values) with several decision making tools such as decision matrix, ROC analysis and Bayesian analysis. The article also explain the introductory concept of ORAD program

[Shared decision-making in medical practice--patient-centred communication skills].

Science.gov (United States)

van Staveren, Remke

2011-01-01

Most patients (70%) want to participate actively in important healthcare decisions, the rest (30%) prefer the doctor to make the decision for them. Shared decision-making provides more patient satisfaction, a better quality of life and contributes to a better doctor-patient relationship. Patients making their own decision generally make a well considered and medically sensible choice. In shared decision-making the doctor asks many open questions, gives and requests much information, asks if the patient wishes to participate in the decision-making and explicitly takes into account patient circumstances and preferences. Shared decision-making should remain an individual choice and should not become a new dogma.

Patient decision making in the face of conflicting medication information

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Emily Elstad

2012-08-01

Full Text Available When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative, and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources.

General practitioners' decisions about discontinuation of medication: an explorative study.

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Nixon, Michael Simon; Vendelø, Morten Thanning

2016-06-20

Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience.

Controller for a small induction-generator based wind-turbine

Energy Technology Data Exchange (ETDEWEB)

Ahshan, R.; Iqbal, M.T.; Mann, George K.I. [Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John' s, Newfoundland (Canada)

2008-04-15

Design of a low-cost micro-controller for a small induction-generator based grid-connected wind-turbine is presented in this paper. The controller senses the parameters of the wind-turbine generator and the grid, and makes decisions about grid connection and disconnection. Low-cost instrumentation circuitry has been developed to measure the generator and grid parameters. Based on the measurement of voltage and frequency of the wind-turbine generator and the grid side, a control decision is taken to connect the system to the grid. The controller makes decision to disconnect the system from the grid based on the power flow measurement between the wind turbine and the grid. The power flow between wind turbine and the grid depends upon the availability of the wind. The prototype controller has been developed based on a micro-controller PIC16F877 and has been tested in the laboratory. (author)

Grid Databases for Shared Image Analysis in the MammoGrid Project

CERN Document Server

Amendolia, S R; Hauer, T; Manset, D; McClatchey, R; Odeh, M; Reading, T; Rogulin, D; Schottlander, D; Solomonides, T

2004-01-01

The MammoGrid project aims to prove that Grid infrastructures can be used for collaborative clinical analysis of database-resident but geographically distributed medical images. This requires: a) the provision of a clinician-facing front-end workstation and b) the ability to service real-world clinician queries across a distributed and federated database. The MammoGrid project will prove the viability of the Grid by harnessing its power to enable radiologists from geographically dispersed hospitals to share standardized mammograms, to compare diagnoses (with and without computer aided detection of tumours) and to perform sophisticated epidemiological studies across national boundaries. This paper outlines the approach taken in MammoGrid to seamlessly connect radiologist workstations across a Grid using an "information infrastructure" and a DICOM-compliant object model residing in multiple distributed data stores in Italy and the UK

Culture and medical decision making : Patient perspectives in Japan and the U.S

NARCIS (Netherlands)

Alden, D.; Friend, J.; Lee, A.Y.; de Vries, Marieke; Osawa, R.; Chen, Q.

2015-01-01

Objective: Two studies identified core value influences on medical decision-making processes across and within cultures. Methods: In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents

Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

Directory of Open Access Journals (Sweden)

Karpa Kelly

2011-10-01

Full Text Available Abstract Background Consumer use of herbal and natural products (H/NP is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants (n = 532 in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7% on the first survey and 87 of 535 (16.3% clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81% indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and time-consuming formal H/NP curricula. Yet, it will be challenging to make providers aware of such resources.

Hybrid method based on embedded coupled simulation of vortex particles in grid based solution

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Kornev, Nikolai

2017-09-01

The paper presents a novel hybrid approach developed to improve the resolution of concentrated vortices in computational fluid mechanics. The method is based on combination of a grid based and the grid free computational vortex (CVM) methods. The large scale flow structures are simulated on the grid whereas the concentrated structures are modeled using CVM. Due to this combination the advantages of both methods are strengthened whereas the disadvantages are diminished. The procedure of the separation of small concentrated vortices from the large scale ones is based on LES filtering idea. The flow dynamics is governed by two coupled transport equations taking two-way interaction between large and fine structures into account. The fine structures are mapped back to the grid if their size grows due to diffusion. Algorithmic aspects of the hybrid method are discussed. Advantages of the new approach are illustrated on some simple two dimensional canonical flows containing concentrated vortices.

Agent based approach for engineering and control of micro-grids

International Nuclear Information System (INIS)

Basso, Gillian

2013-01-01

Energy management is, nowadays, a subject of uttermost importance. Indeed, we are facing growing concerns such as petroleum reserve depletion, earth global warming or power quality (e.g. avoiding blackouts during peak times). Smart grids is an attempt to solve such problems, by adding to power grids bidirectional communications and ICT capabilities in order to provide an intelligent autonomic management for the grid. This thesis focuses on the management of micro-grids thanks to multi-agent systems (MAS). Micro-grids are low-power networks, composed of small and decentralized energy producers (possibly renewable) and consumers. These networks can be connected to the main grid or islanded, this make them more complex. Due to their complexity and their geographical distribution, smart grids and micro-grids can not be easily managed by a centralized system. Distributed artificial intelligences especially MAS appear to be a solution to resolve problems related to smart grids. Firstly we defined an approach implementing feedback loops. These feedback loops exist in complex systems which can be defined with several abstraction levels. Two levels are interacting. The micro-level contains a set of agents owning behaviours that can be combined. The result of the combination impact the state of the system. The macro-level processes these influences to define a new state of the system which will impact the agents behaviours at the micro-level. This feedback loop separates behaviours on several levels. This approach is used to defined a demand and supply matching problem in micro-grid. This problem afford to manage a set of goals which currently are independently processed. Finally, an application is developed using MAS that ensures grid stability thanks to storage systems. This application was thought to be integrated to the approach detailed above. Secondly, a grid simulator id developed. This simulator allows dynamic control of devices. It is based on three main principles

ADDIS: A decision support system for evidence-based medicine

NARCIS (Netherlands)

G. van Valkenhoef (Gert); T. Tervonen (Tommi); T. Zwinkels (Tijs); B. de Brock (Bert); H.L. Hillege (Hans)

2013-01-01

textabstractClinical trials are the main source of information for the efficacy and safety evaluation of medical treatments. Although they are of pivotal importance in evidence-based medicine, there is a lack of usable information systems providing data-analysis and decision support capabilities for

Evolutionary strategy to develop learning-based decision systems. Application to breast cancer and liver fibrosis stadialization.

Science.gov (United States)

Gorunescu, Florin; Belciug, Smaranda

2014-06-01

The purpose of this paper is twofold: first, to propose an evolutionary-based method for building a decision model and, second, to assess and validate the model's performance using five different real-world medical datasets (breast cancer and liver fibrosis) by comparing it with state-of-the-art machine learning techniques. The evolutionary-inspired approach has been used to develop the learning-based decision model in the following manner: the hybridization of algorithms has been considered as "crossover", while the development of new variants which can be thought of as "mutation". An appropriate hierarchy of the component algorithms was established based on a statistically built fitness measure. A synergetic decision-making process, based on a weighted voting system, involved the collaboration between the selected algorithms in making the final decision. Well-established statistical performance measures and comparison tests have been extensively used to design and implement the model. Finally, the proposed method has been tested on five medical datasets, out of which four publicly available, and contrasted with state-of-the-art techniques, showing its efficiency in supporting the medical decision-making process. Copyright © 2014 Elsevier Inc. All rights reserved.

Cognitive schema and naturalistic decision making in evidence-based practices.

Science.gov (United States)

Falzer, Paul R

2004-04-01

A recent article in this journal proposed a naturalistic approach to decision making that overcomes problems intrinsic to classical decision theory. The approach emphasizes cognitive and multi-level processes, the development of expert reasoning, and the role of decision support in individual and organizational decision making. The current paper builds on this effort by suggesting a naturalistic, multi-level, theory that can facilitate the dissemination of evidence-based practices (EBPs). The paper presents "Image Theory," a theory that has been extensively investigated in other disciplines, but has yet to be utilized in medical decision research. It is suggested that its rich, empirically tested, distinctions among kinds of cognitive and organizational processes and types of decisions and tasks make Image Theory especially valuable in describing impediments to implementing EBPs. The paper discusses how naturalistic theory can assist clinicians, administrators, researchers, and policy makers in achieving a balance between evidence-based medicine and patient-centered practice.

Recovery and resilience after a nuclear power plant disaster: a medical decision model for managing an effective, timely, and balanced response.

Science.gov (United States)

Coleman, C Norman; Blumenthal, Daniel J; Casto, Charles A; Alfant, Michael; Simon, Steven L; Remick, Alan L; Gepford, Heather J; Bowman, Thomas; Telfer, Jana L; Blumenthal, Pamela M; Noska, Michael A

2013-04-01

Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents.

Grid connection rules for electric cars integrated as virtual power plant in smart grids

DEFF Research Database (Denmark)

Leban, Krisztina Monika; Ritchie, Ewen; Thøgersen, Paul Bach

2013-01-01

This paper reviews the situation of V2G and proposes a solution involving a consolidating fleet manager, and a decision making process for the individual V2G electric car owner. A grid connection routine for electric vehicles is proposed. The algorithm dealing with decisions to be taken in foreseen...

A Realistic Digital Deteriorating Patient to Foster Emergency Decision-Making Skills in Medical Students

DEFF Research Database (Denmark)

Blanchard, Emmanuel G.; Wiseman, Jeffrey; Naismith, Laura

2012-01-01

and effective in improving student decision making, DPA is difficult to carry out since it requires students and medical instructors, all busy people, to be available at the same time and location. The present paper describes the “Digital” Deteriorating Patient Activity (DDPA), an agent-based tutoring system...

Medical decision-making capacity in patients with malignant glioma.

Science.gov (United States)

Triebel, Kristen L; Martin, Roy C; Nabors, Louis B; Marson, Daniel C

2009-12-15

Patients with malignant glioma (MG) must make ongoing medical treatment decisions concerning a progressive disease that erodes cognition. We prospectively assessed medical decision-making capacity (MDC) in patients with MG using a standardized psychometric instrument. Participants were 22 healthy controls and 26 patients with histologically verified MG. Group performance was compared on the Capacity to Consent to Treatment Instrument (CCTI), a psychometric measure of MDC incorporating 4 standards (choice, understanding, reasoning, and appreciation), and on neuropsychological and demographic variables. Capacity outcomes (capable, marginally capable, or incapable) on the CCTI standards were identified for the MG group. Within the MG group, scores on demographic, clinical, and neuropsychological variables were correlated with scores on each CCTI standard, and significant bivariate correlates were subsequently entered into exploratory stepwise regression analyses to identify multivariate cognitive predictors of the CCTI standards. Patients with MG performed significantly below controls on consent standards of understanding and reasoning, and showed a trend on appreciation. Relative to controls, more than 50% of the patients with MG demonstrated capacity compromise (marginally capable or incapable outcomes) in MDC. In the MG group, cognitive measures of verbal acquisition/recall and, to a lesser extent, semantic fluency predicted performance on the appreciation, reasoning, and understanding standards. Karnofsky score was also associated with CCTI performance. Soon after diagnosis, patients with malignant glioma (MG) have impaired capacity to make treatment decisions relative to controls. Medical decision-making capacity (MDC) impairment in MG seems to be primarily related to the effects of short-term verbal memory deficits. Ongoing assessment of MDC in patients with MG is strongly recommended.

[End-of-life care and end-of-life medical decisions: the ITAELD study].

Science.gov (United States)

Miccinesi, Guido; Puliti, Donella; Paci, Eugenio

2011-01-01

To describe the attitudes towards end of life care and the practice of end-of-life medical decisions with possible life-shortening effect among Italian physicians. Cross sectional study (last death among the assisted patients in the last 12 months was considered). In the year 2007, 5,710 GPs and 8,950 hospital physicians were invited all over Italy to participate in the ITAELDstudy through anonymous mail questionnaire. Proportion of agreement with statements on end-of-life care issues. Proportion of deaths with an end-of-life medical decision. The response rate was 19.2%. The 65% of respondents agreed with the duty to respect any non-treatment request of the competent patient, the 55% agreed with the same duty in case of advanced directives, the 39% in case of proxy's request. The 53% of respondents agreed with the ethical acceptability of active euthanasia in selected cases. Among 1,850 deaths the 57.7% did not receive any end-of-life medical decision. For a further 21.0% no decision was possible, being sudden and unexpected deaths. In the remaining 21.3% at least one end-of-life medical decision was reported: 0.8% was classified as physician assisted death, 20.5% as non-treatment decision. Among all deceased the 19.6% were reported to have been deeply sedated. Being favourable to the use of opioids in terminal patients was associated to non-treatment decisions with possible but non-intentional life shortening effect; agreeing with the duty to fully respect any actual non-treatment request of the competent patient was associated to end-of life medical decisions with intentional life-shortening effect (adjusted OR>10 in both cases). The life stance and ethical beliefs of physicians determine their behaviour at the end of life wherever specific statements of law are lacking. Therefore education and debate are needed on these issues.

Clinical Assistant Diagnosis for Electronic Medical Record Based on Convolutional Neural Network.

Science.gov (United States)

Yang, Zhongliang; Huang, Yongfeng; Jiang, Yiran; Sun, Yuxi; Zhang, Yu-Jin; Luo, Pengcheng

2018-04-20

Automatically extracting useful information from electronic medical records along with conducting disease diagnoses is a promising task for both clinical decision support(CDS) and neural language processing(NLP). Most of the existing systems are based on artificially constructed knowledge bases, and then auxiliary diagnosis is done by rule matching. In this study, we present a clinical intelligent decision approach based on Convolutional Neural Networks(CNN), which can automatically extract high-level semantic information of electronic medical records and then perform automatic diagnosis without artificial construction of rules or knowledge bases. We use collected 18,590 copies of the real-world clinical electronic medical records to train and test the proposed model. Experimental results show that the proposed model can achieve 98.67% accuracy and 96.02% recall, which strongly supports that using convolutional neural network to automatically learn high-level semantic features of electronic medical records and then conduct assist diagnosis is feasible and effective.

The framing effect in medical decision-making: a review of the literature.

Science.gov (United States)

Gong, Jingjing; Zhang, Yan; Yang, Zheng; Huang, Yonghua; Feng, Jun; Zhang, Weiwei

2013-01-01

The framing effect, identified by Tversky and Kahneman, is one of the most striking cognitive biases, in which people react differently to a particular choice depending whether it is presented as a loss or as a gain. Numerous studies have subsequently demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision-making. Compared to daily decisions, medical decisions are of low frequency but of paramount importance. The framing effect is a well-documented bias in a variety of studies, but research is inconsistent regarding whether and how variables influence framing effects in medical decision-making. To clarify the discrepancy in the previous literature, published literature in the English language concerning the framing effect was retrieved using electronic and bibliographic searches. Two reviewers examined each article for inclusion and evaluated the articles' methodological quality. The framing effect in medical decision-making was reviewed in these papers. No studies identified an influence of framing information upon compliance with health recommendations, and different studies demonstrate different orientations of the framing effect. Because so many variables influence the presence or absence of the framing effect, the unexplained heterogeneity between studies suggests the possibility of a framing effect under specific conditions. Further research is needed to determine why the framing effect is induced and how it can be precluded.

Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing.

Science.gov (United States)

Tsalatsanis, Athanasios; Hozo, Iztok; Kumar, Ambuj; Djulbegovic, Benjamin

2015-01-01

Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing.

Directory of Open Access Journals (Sweden)

Athanasios Tsalatsanis

Full Text Available Dual Processing Theories (DPT assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive and type 2 (deliberative. Based on DPT we have derived a Dual Processing Model (DPM to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

Soil Erosion Estimation Using Grid-based Computation

Directory of Open Access Journals (Sweden)

Josef Vlasák

2005-06-01

Full Text Available Soil erosion estimation is an important part of a land consolidation process. Universal soil loss equation (USLE was presented by Wischmeier and Smith. USLE computation uses several factors, namely R – rainfall factor, K – soil erodability, L – slope length factor, S – slope gradient factor, C – cropping management factor, and P – erosion control management factor. L and S factors are usually combined to one LS factor – Topographic factor. The single factors are determined from several sources, such as DTM (Digital Terrain Model, BPEJ – soil type map, aerial and satellite images, etc. A conventional approach to the USLE computation, which is widely used in the Czech Republic, is based on the selection of characteristic profiles for which all above-mentioned factors must be determined. The result (G – annual soil loss of such computation is then applied for a whole area (slope of interest. Another approach to the USLE computation uses grids as a main data-structure. A prerequisite for a grid-based USLE computation is that each of the above-mentioned factors exists as a separate grid layer. The crucial step in this computation is a selection of appropriate grid resolution (grid cell size. A large cell size can cause an undesirable precision degradation. Too small cell size can noticeably slow down the whole computation. Provided that the cell size is derived from the source’s precision, the appropriate cell size for the Czech Republic varies from 30m to 50m. In some cases, especially when new surveying was done, grid computations can be performed with higher accuracy, i.e. with a smaller grid cell size. In such case, we have proposed a new method using the two-step computation. The first step computation uses a bigger cell size and is designed to identify higher erosion spots. The second step then uses a smaller cell size but it make the computation only the area identified in the previous step. This decomposition allows a

Managing Complexity: Exploring Decision Making on Medication by Young Adults with ADHD.

Science.gov (United States)

Druedahl, Louise C; Kälvemark Sporrong, Sofia

2018-04-19

Attention-deficit hyperactivity disorder (ADHD) causes difficulties with hyperactivity, impulsivity and inattention. Treatment of ADHD includes both medication and non-pharmacological options. Knowledge of treatment preferences by young adults with ADHD is sparse. The objective of this study was to explore the beliefs and experiences of young adults with ADHD related to their medication treatment decisions. Data were collected in Denmark in 2016 through a focus group and individual in-depth interviews. Conventional content analysis was used. Ten young adults with ADHD (22-to 29-year-old) participated. Three major themes were identified: (1) the patient’s right to choose concerning ADHD medicine; (2) the patient’s decision of whether or not to treat ADHD with medication; and (3) factors affecting the patient’s decision on whether to take ADHD medication or not. The latter theme contained 15 factors, which were distributed across three levels: individual, between-individuals, and societal. The dominant factors were increasing quality of life and improving oneself e.g., improving social skills. For counselling at the pharmacy and by prescribers, it is important to be aware of the different factors that affect young adult patients’ decisions on whether to take ADHD medication or not. This knowledge will aid to understand reasons for non-adherence and to determine appropriate treatment for the individual patient.

Real Time Load Optimisation of Cable Based Transmission Grids

DEFF Research Database (Denmark)

Olsen, Rasmus Schmidt; Holbøll, Joachim; Guðmundsdottir, Unnur Stella

2011-01-01

Energinet.dk has launched an investigation of dynamic current ratings of cable based transmission grids, where both internal and external parameters are variables. The first topic was to investigate state of the art within calculating the current carrying capacity (ampacity or loadability......) of cables embedded in larger cable systems. Some recently published research has been concerned with dynamic loadability, but such researches are based on many assumptions. It is shown in the paper, that only limited research has been concerned with larger cable grids, and no remarkable work could been...

MICROARRAY IMAGE GRIDDING USING GRID LINE REFINEMENT TECHNIQUE

Directory of Open Access Journals (Sweden)

V.G. Biju

2015-05-01

Full Text Available An important stage in microarray image analysis is gridding. Microarray image gridding is done to locate sub arrays in a microarray image and find co-ordinates of spots within each sub array. For accurate identification of spots, most of the proposed gridding methods require human intervention. In this paper a fully automatic gridding method which enhances spot intensity in the preprocessing step as per a histogram based threshold method is used. The gridding step finds co-ordinates of spots from horizontal and vertical profile of the image. To correct errors due to the grid line placement, a grid line refinement technique is proposed. The algorithm is applied on different image databases and results are compared based on spot detection accuracy and time. An average spot detection accuracy of 95.06% depicts the proposed method’s flexibility and accuracy in finding the spot co-ordinates for different database images.

The development of the CoRE-Values framework as an aid to ethical decision-making.

Science.gov (United States)

Manson, Helen M

2012-01-01

Ethical analysis frameworks can help to identify the ethical dimensions to clinical care and provide a method for justifying clinical decisions. Published frameworks, however, have some limitations to easy, practical use. The aim was to identify a comprehensive yet easy-to-use framework that clarifies ethical decision-making, suitable for use by medical learners and clinical educators. A literature search identified published frameworks that define the components of ethical clinical decision-making. On this basis, a new framework, the 'CoRE-Values Compass and Grid' was constructed. This was formally evaluated during a medical school interprofessional teaching session. For 88% of 228 medical and nursing students, the new framework was easy to understand; 85% reported it as easy to use. The framework improved awareness of the ethical dimensions to a clinical scenario for 97% of students and the ability to systematically identify ethical aspects for 83%. Students and instructors reported that the framework helped to link ethics theory with clinical practice. The framework was described as a useful educational tool by 85% of students and 95% of instructors. The 'CoRE-Values Compass and Grid' is a new framework, shown to aid the systematic identification and consideration of ethical aspects to clinical cases.

The more the merrier: grid based modelling of Kepler dwarfs with 5-dimensional stellar grids

Directory of Open Access Journals (Sweden)

Serenelli Aldo

2017-01-01

Full Text Available We present preliminary results of our grid based modelling (GBM of the dwarf/subgiant sample of stars observed with Kepler including global asteroseismic parameters. GBM analysis in this work is based on a large grid of stellar models that is characterized by five independent parameters: model mass and age, initial metallicity (Zini, initial helium (Yini, and mixing length parameter (αMLT. Using this grid relaxes assumptions used in all previous GBM work where the initial composition is determined by a single parameter and that αMLT is fixed to a solar-calibrated value. The new grid allows us to study, for example, the impact of different galactic chemical enrichment models on the determination of stellar parameters such as mass radius and age. Also, it allows to include new results from stellar atmosphere models on αMLT in the GBM analysis in a simple manner. Alternatively, it can be tested if global asteroseismology is a useful tool to constraint our ignorance on quantities such as Yini and αMLT. Initial findings show that mass determination is robust with respect to freedom in the latter quantities, with a 4.4% maximum deviation for extreme assumptions regarding prior information on Yini – Zini relations and aMLT. On the other hand, tests carried out so far seem to indicate that global seismology does not have much power to constrain Yini – Zni relations of αMLT values without resourcing to additional information.

Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: a qualitative study.

Science.gov (United States)

Sale, Joanna E M; Gignac, Monique A; Hawker, Gillian; Frankel, Lucy; Beaton, Dorcas; Bogoch, Earl; Elliot-Gibson, Victoria

2011-05-09

Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. 21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients

Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: A qualitative study

Directory of Open Access Journals (Sweden)

Hawker Gillian

2011-05-01

Full Text Available Abstract Background Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. Methods A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. Results 21 patients (6 males, 15 females aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication. These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication. These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Conclusions Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care

The impact of mass media health communication on health decision-making and medical advice-seeking behavior of u.s. Hispanic population.

Science.gov (United States)

De Jesus, Maria

2013-01-01

Mass media health communication has enormous potential to drastically alter how health-related information is disseminated and obtained by different populations. However, there is little evidence regarding the influence of media channels on health decision-making and medical advice-seeking behaviors among the Hispanic population. The Pew 2007 Hispanic Healthcare Survey was used to test the hypothesis that the amount of mass media health communication (i.e., quantity of media-based health information received) is more likely to influence Hispanic adults' health decision-making and medical advice-seeking behavior compared to health literacy and language proficiency variables. Results indicated that quantity of media-based health information is positively associated with health decision-making and medical advice-seeking behavior above and beyond the influence of health literacy and English and Spanish language proficiency. In a context where physician-patient dynamics are increasingly shifting from a passive patient role model to a more active patient role model, media-based health information can serve as an influential cue to action, prompting Hispanic individuals to make certain health-related decisions and to seek more health advice and information from a health provider. Study implications are discussed.

Disturbance estimator based predictive current control of grid-connected inverters

OpenAIRE

Al-Khafaji, Ahmed Samawi Ghthwan

2013-01-01

ABSTRACT: The work presented in my thesis considers one of the modern discrete-time control approaches based on digital signal processing methods, that have been developed to improve the performance control of grid-connected three-phase inverters. Disturbance estimator based predictive current control of grid-connected inverters is proposed. For inverter modeling with respect to the design of current controllers, we choose the d-q synchronous reference frame to make it easier to understand an...

Relationship of depression and anxiety to cancer patients' medical decision-making.

Science.gov (United States)

Petersen, Suni; Schwartz, Robert C; Sherman-Slate, Elisabeth; Frost, Hanna; Straub, Jamie L; Damjanov, Nevena

2003-10-01

The purpose of this study was to examine the relation of depression and anxiety to cancer patients' medical decision-making. Participants were 79 rural and urban cancer patients undergoing chemotherapy. The four decisional styles of the Decisional Processing Model were the independent variables. Dependent variables were anxiety and depression, measured by Spielberger's State-Trait Anxiety and the Center for Disease Control Depression Scale, respectively. Consistent with the Decisional Processing Model, analysis suggested that patients make medical decisions by information seeking, information processing, advice following, or ruminating. Decisional style did not vary according to type or stage of cancer, prognosis, time elapsed since initial diagnosis, or whether cancer was initial or recurrent. Decisional style did not systematically vary with depression and anxiety suggesting how a person makes decisions is a stable personality trait. Thus, decision-making may follow a cognitive schema. It is likely that patients' decisional styles help to manage anxiety and depression when confronted with life-threatening illness. Implications for informed consent and patients' involvement in decision-making are discussed.

Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

Science.gov (United States)

2011-01-01

Background Consumer use of herbal and natural products (H/NP) is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants) (n = 532) in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7%) on the first survey and 87 of 535 (16.3%) clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81%) indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P < 0.0001), boosted their knowledge of H/NP (p < 0.0001), and increased their confidence in providing accurate H/NP answers to patients and colleagues (P < 0.0001). Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and

Grid-friendly wind power systems based on the synchronverter technology

International Nuclear Information System (INIS)

Zhong, Qing-Chang; Ma, Zhenyu; Ming, Wen-Long; Konstantopoulos, George C.

2015-01-01

Highlights: • A grid-friendly wind power system that uses the synchronverter technology is proposed. • Both the rotor-side and the grid-side converters act as synchronverters. • The complete generator–motor–generator system improves the performance under grid faults. • Real-time digital simulation results verify the effectiveness of the proposed method. - Abstract: Back-to-back PWM converters are becoming a realistic alternative to conventional converters in high-power wind power applications. In this paper, a control strategy based on the synchronverter technology is proposed for back-to-back PWM converters. Both converters are run as synchronverters, which are mathematically equivalent to the conventional synchronous generators. The rotor-side converter is responsible for maintaining the DC link voltage and the grid-side converter is responsible for the maximum power point tracking (MPPT). As the two converters are operated using the synchronverter technology, the formed wind power system becomes more friendly to the grid. Extensive real-time digital simulation results are presented to verify the effectiveness of the proposed method under normal operation and grid-fault scenarios

The extended RBAC model based on grid computing

Institute of Scientific and Technical Information of China (English)

CHEN Jian-gang; WANG Ru-chuan; WANG Hai-yan

2006-01-01

This article proposes the extended role-based access control (RBAC) model for solving dynamic and multidomain problems in grid computing, The formulated description of the model has been provided. The introduction of context and the mapping relations of context-to-role and context-to-permission help the model adapt to dynamic property in grid environment.The multidomain role inheritance relation by the authorization agent service realizes the multidomain authorization amongst the autonomy domain. A function has been proposed for solving the role inheritance conflict during the establishment of the multidomain role inheritance relation.

Decision based on big data research for non-small cell lung cancer in medical artificial system in developing country.

Science.gov (United States)

Wu, Jia; Tan, Yanlin; Chen, Zhigang; Zhao, Ming

2018-06-01

Non-small cell lung cancer (NSCLC) is a high risk cancer and is usually scanned by PET-CT for testing, predicting and then give the treatment methods. However, in the actual hospital system, at least 640 images must be generated for each patient through PET-CT scanning. Especially in developing countries, a huge number of patients in NSCLC are attended by doctors. Artificial system can predict and make decision rapidly. According to explore and research artificial medical system, the selection of artificial observations also can result in low work efficiency for doctors. In this study, data information of 2,789,675 patients in three hospitals in China are collected, compiled, and used as the research basis; these data are obtained through image acquisition and diagnostic parameter machine decision-making method on the basis of the machine diagnosis and medical system design model of adjuvant therapy. By combining image and diagnostic parameters, the machine decision diagnosis auxiliary algorithm is established. Experimental result shows that the accuracy has reached 77% in NSCLC. Copyright © 2018 Elsevier B.V. All rights reserved.

An inexact two-stage stochastic robust programming for residential micro-grid management-based on random demand

International Nuclear Information System (INIS)

Ji, L.; Niu, D.X.; Huang, G.H.

2014-01-01

In this paper a stochastic robust optimization problem of residential micro-grid energy management is presented. Combined cooling, heating and electricity technology (CCHP) is introduced to satisfy various energy demands. Two-stage programming is utilized to find the optimal installed capacity investment and operation control of CCHP (combined cooling heating and power). Moreover, interval programming and robust stochastic optimization methods are exploited to gain interval robust solutions under different robustness levels which are feasible for uncertain data. The obtained results can help micro-grid managers minimizing the investment and operation cost with lower system failure risk when facing fluctuant energy market and uncertain technology parameters. The different robustness levels reflect the risk preference of micro-grid manager. The proposed approach is applied to residential area energy management in North China. Detailed computational results under different robustness level are presented and analyzed for providing investment decision and operation strategies. - Highlights: • An inexact two-stage stochastic robust programming model for CCHP management. • The energy market and technical parameters uncertainties were considered. • Investment decision, operation cost, and system safety were analyzed. • Uncertainties expressed as discrete intervals and probability distributions

Smart Energy Management and Control for Fuel Cell Based Micro-Grid Connected Neighborhoods

Energy Technology Data Exchange (ETDEWEB)

Dr. Mohammad S. Alam

2006-03-15

Fuel cell power generation promises to be an efficient, pollution-free, reliable power source in both large scale and small scale, remote applications. DOE formed the Solid State Energy Conversion Alliance with the intention of breaking one of the last barriers remaining for cost effective fuel cell power generation. The Alliance’s goal is to produce a core solid-state fuel cell module at a cost of no more than $400 per kilowatt and ready for commercial application by 2010. With their inherently high, 60-70% conversion efficiencies, significantly reduced carbon dioxide emissions, and negligible emissions of other pollutants, fuel cells will be the obvious choice for a broad variety of commercial and residential applications when their cost effectiveness is improved. In a research program funded by the Department of Energy, the research team has been investigating smart fuel cell-operated residential micro-grid communities. This research has focused on using smart control systems in conjunction with fuel cell power plants, with the goal to reduce energy consumption, reduce demand peaks and still meet the energy requirements of any household in a micro-grid community environment. In Phases I and II, a SEMaC was developed and extended to a micro-grid community. In addition, an optimal configuration was determined for a single fuel cell power plant supplying power to a ten-home micro-grid community. In Phase III, the plan is to expand this work to fuel cell based micro-grid connected neighborhoods (mini-grid). The economic implications of hydrogen cogeneration will be investigated. These efforts are consistent with DOE’s mission to decentralize domestic electric power generation and to accelerate the onset of the hydrogen economy. A major challenge facing the routine implementation and use of a fuel cell based mini-grid is the varying electrical demand of the individual micro-grids, and, therefore, analyzing these issues is vital. Efforts are needed to determine

SQoS based Planning using 4-regular Grid for Optical Fiber Metworks

DEFF Research Database (Denmark)

Riaz, Muhammad Tahir; Pedersen, Jens Myrup; Madsen, Ole Brun

optical fiber based network infrastructures. In the first step of SQoS based planning, this paper describes how 4-regular Grid structures can be implemented in the physical level of optical fiber network infrastructures. A systematic approach for implementing the Grid structure is presented. We used...

SQoS based Planning using 4-regular Grid for Optical Fiber Networks

DEFF Research Database (Denmark)

Riaz, Muhammad Tahir; Pedersen, Jens Myrup; Madsen, Ole Brun

2005-01-01

optical fiber based network infrastructures. In the first step of SQoS based planning, this paper describes how 4-regular Grid structures can be implemented in the physical level of optical fiber network infrastructures. A systematic approach for implementing the Grid structure is presented. We used...

Surveying End-of-Life Medical Decisions in France: Evaluation of an Innovative Mixed-Mode Data Collection Strategy.

Science.gov (United States)

Legleye, Stephane; Pennec, Sophie; Monnier, Alain; Stephan, Amandine; Brouard, Nicolas; Bilsen, Johan; Cohen, Joachim

2016-02-18

Monitoring medical decisions at the end of life has become an important issue in many societies. Built on previous European experiences, the survey and project Fin de Vie en France ("End of Life in France," or EOLF) was conducted in 2010 to provide an overview of medical end-of-life decisions in France. To describe the methodology of EOLF and evaluate the effects of design innovations on data quality. EOLF used a mixed-mode data collection strategy (paper and Internet) along with follow-up campaigns that employed various contact modes (paper and telephone), all of which were gathered from various institutions (research team, hospital, and medical authorities at the regional level). A telephone nonresponse survey was also used. Through descriptive statistics and multivariate logistic regressions, these innovations were assessed in terms of their effects on the response rate, quality of the sample, and differences between Web-based and paper questionnaires. The participation rate was 40.0% (n=5217). The respondent sample was very close to the sampling frame. The Web-based questionnaires represented only 26.8% of the questionnaires, and the Web-based secured procedure led to limitations in data management. The follow-up campaigns had a strong effect on participation, especially for paper questionnaires. With higher participation rates (63.21% and 63.74%), the telephone follow-up and nonresponse surveys showed that only a very low proportion of physicians refused to participate because of the topic or the absence of financial incentive. A multivariate analysis showed that physicians who answered on the Internet reported less medication to hasten death, and that they more often took no medical decisions in the end-of-life process. Varying contact modes is a useful strategy. Using a mixed-mode design is interesting, but selection and measurement effects must be studied further in this sensitive field.

Development of an evidence-based decision pathway for vestibular schwannoma treatment options.

Science.gov (United States)

Linkov, Faina; Valappil, Benita; McAfee, Jacob; Goughnour, Sharon L; Hildrew, Douglas M; McCall, Andrew A; Linkov, Igor; Hirsch, Barry; Snyderman, Carl

To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways. Copyright © 2016 Elsevier Inc. All rights reserved.

Efficient identification of opportunities for Distributed Generation based on Smart Grid Technology

DEFF Research Database (Denmark)

Mutule, Anna; Obushevs, Artjoms; Lvov, Aleksandr

2013-01-01

The paper presents the main goals and achievements of the Smart Grids ERA-NET project named “Efficient identification of opportunities for Distributed Generation based on Smart Grid Technology (SmartGen)” during the second stage of project implementation. A description of Smart Grid Technology (S......) models developed within the framework of the project is given. The performed study cases where the SGT-models were implemented to analyze the impact of the electrical grid are discussed....

Metrics for Assessment of Smart Grid Data Integrity Attacks

Energy Technology Data Exchange (ETDEWEB)

Annarita Giani; Miles McQueen; Russell Bent; Kameshwar Poolla; Mark Hinrichs

2012-07-01

There is an emerging consensus that the nation’s electricity grid is vulnerable to cyber attacks. This vulnerability arises from the increasing reliance on using remote measurements, transmitting them over legacy data networks to system operators who make critical decisions based on available data. Data integrity attacks are a class of cyber attacks that involve a compromise of information that is processed by the grid operator. This information can include meter readings of injected power at remote generators, power flows on transmission lines, and relay states. These data integrity attacks have consequences only when the system operator responds to compromised data by redispatching generation under normal or contingency protocols. These consequences include (a) financial losses from sub-optimal economic dispatch to service loads, (b) robustness/resiliency losses from placing the grid at operating points that are at greater risk from contingencies, and (c) systemic losses resulting from cascading failures induced by poor operational choices. This paper is focused on understanding the connections between grid operational procedures and cyber attacks. We first offer two examples to illustrate how data integrity attacks can cause economic and physical damage by misleading operators into taking inappropriate decisions. We then focus on unobservable data integrity attacks involving power meter data. These are coordinated attacks where the compromised data are consistent with the physics of power flow, and are therefore passed by any bad data detection algorithm. We develop metrics to assess the economic impact of these attacks under re-dispatch decisions using optimal power flow methods. These metrics can be use to prioritize the adoption of appropriate countermeasures including PMU placement, encryption, hardware upgrades, and advance attack detection algorithms.

Knowledge Management for Wireless Grid Operation Centers

OpenAIRE

Bordetsky, Alex; Dolk, Daniel

2002-01-01

Proceedings of the 35th Hawaii International Conference on System Sciences - 2002 Our objective is to develop generalized principles for grid operations centers that can be applied to specific domains. We focus on the domain of wireless telecommunications NOCs (WNOCs) as a starting point in this process. To address this problem, we focus specifically on the knowledge requirements for service-based decision support within wireless telecommunications. We use a Mission...

A methodology toward manufacturing grid-based virtual enterprise operation platform

Science.gov (United States)

Tan, Wenan; Xu, Yicheng; Xu, Wei; Xu, Lida; Zhao, Xianhua; Wang, Li; Fu, Liuliu

2010-08-01

Virtual enterprises (VEs) have become one of main types of organisations in the manufacturing sector through which the consortium companies organise their manufacturing activities. To be competitive, a VE relies on the complementary core competences among members through resource sharing and agile manufacturing capacity. Manufacturing grid (M-Grid) is a platform in which the production resources can be shared. In this article, an M-Grid-based VE operation platform (MGVEOP) is presented as it enables the sharing of production resources among geographically distributed enterprises. The performance management system of the MGVEOP is based on the balanced scorecard and has the capacity of self-learning. The study shows that a MGVEOP can make a semi-automated process possible for a VE, and the proposed MGVEOP is efficient and agile.

Deploying web-based visual exploration tools on the grid

Energy Technology Data Exchange (ETDEWEB)

Jankun-Kelly, T.J.; Kreylos, Oliver; Shalf, John; Ma, Kwan-Liu; Hamann, Bernd; Joy, Kenneth; Bethel, E. Wes

2002-02-01

We discuss a web-based portal for the exploration, encapsulation, and dissemination of visualization results over the Grid. This portal integrates three components: an interface client for structured visualization exploration, a visualization web application to manage the generation and capture of the visualization results, and a centralized portal application server to access and manage grid resources. We demonstrate the usefulness of the developed system using an example for Adaptive Mesh Refinement (AMR) data visualization.

Application of epidemic algorithms for smart grids control

International Nuclear Information System (INIS)

Krkoleva, Aleksandra

2012-01-01

Smart Grids are a new concept for electricity networks development, aiming to provide economically efficient and sustainable power system by integrating effectively the actions and needs of the network users. The thesis addresses the Smart Grids concept, with emphasis on the control strategies developed on the basis of epidemic algorithms, more specifically, gossip algorithms. The thesis is developed around three Smart grid aspects: the changed role of consumers in terms of taking part in providing services within Smart Grids; the possibilities to implement decentralized control strategies based on distributed algorithms; and information exchange and benefits emerging from implementation of information and communication technologies. More specifically, the thesis presents a novel approach for providing ancillary services by implementing gossip algorithms. In a decentralized manner, by exchange of information between the consumers and by making decisions on local level, based on the received information and local parameters, the group achieves its global objective, i. e. providing ancillary services. The thesis presents an overview of the Smart Grids control strategies with emphasises on new strategies developed for the most promising Smart Grids concepts, as Micro grids and Virtual power plants. The thesis also presents the characteristics of epidemic algorithms and possibilities for their implementation in Smart Grids. Based on the research on epidemic algorithms, two applications have been developed. These applications are the main outcome of the research. The first application enables consumers, represented by their commercial aggregators, to participate in load reduction and consequently, to participate in balancing market or reduce the balancing costs of the group. In this context, the gossip algorithms are used for aggregator's message dissemination for load reduction and households and small commercial and industrial consumers to participate in maintaining

Medical decision making in symptoms of type 2 diabetes mellitus in general practice

Science.gov (United States)

de Cruppé, W.; von dem Knesebeck, O.; Gerstenberger, E.; Link, C.; Marceau, L.; Siegrist, J.; Geraedts, M.; McKinlay, J.

2013-01-01

Background Patient and physician attributes influence medical decisions as non-medical factors. The current study examines the influence of patient age and gender and physicians' gender and years of clinical experience on medical decision making in patients with undiagnosed diabetes type 2. Method A factorial experiment was conducted to estimate the influence of patient and physician attributes. An identical physician patient encounter with a patient presenting with diabetes symptoms was videotaped with varying patient attributes. Professional actors played the “patients”. A sample of 64 randomly chosen and stratified (gender and years of experience) primary care physicians was interviewed about the presented videos. Results Results show few significant differences in diagnostic decisions: Younger patients were asked more frequently about psychosocial problems while with older patients a cancer diagnosis was more often taken into consideration. Female physicians made an earlier second appointment date compared to male physicians. Physicians with more years of professional experience considered more often diabetes as the diagnosis than physicians with less experience. Conclusion Medical decision making in patients with diabetes type 2 is only marginally influenced by patients' and physicians' characteristics under study. PMID:21332034

Rule-based decision making model

International Nuclear Information System (INIS)

Sirola, Miki

1998-01-01

A rule-based decision making model is designed in G2 environment. A theoretical and methodological frame for the model is composed and motivated. The rule-based decision making model is based on object-oriented modelling, knowledge engineering and decision theory. The idea of safety objective tree is utilized. Advanced rule-based methodologies are applied. A general decision making model 'decision element' is constructed. The strategy planning of the decision element is based on e.g. value theory and utility theory. A hypothetical process model is built to give input data for the decision element. The basic principle of the object model in decision making is division in tasks. Probability models are used in characterizing component availabilities. Bayes' theorem is used to recalculate the probability figures when new information is got. The model includes simple learning features to save the solution path. A decision analytic interpretation is given to the decision making process. (author)

Operation Performance Evaluation of Power Grid Enterprise Using a Hybrid BWM-TOPSIS Method

Directory of Open Access Journals (Sweden)

Peipei You

2017-12-01

Full Text Available Electricity market reform is in progress in China, and the operational performance of power grid enterprises are vital for its healthy and sustainable development in the current electricity market environment. In this paper, a hybrid multi-criteria decision-making (MCDM framework for operational performance evaluation of a power grid enterprise is proposed from the perspective of sustainability. The latest MCDM method, namely the best-worst method (BWM was employed to determine the weights of all criteria, and the technique for order preference by similarity to an ideal solution (TOPSIS was applied to rank the operation performance of a power grid enterprise. The evaluation index system was built based on the concept of sustainability, which includes three criteria (namely economy, society, and environment and seven sub-criteria. Four power grid enterprises were selected to perform the empirical analysis, and the results indicate that power grid enterprise A1 has the best operation performance. The proposed hybrid BWM-TOPSIS-based framework for operation performance evaluation of a power grid enterprise is effective and practical.

OPNET/Simulink Based Testbed for Disturbance Detection in the Smart Grid

Energy Technology Data Exchange (ETDEWEB)

Sadi, Mohammad A. H. [University of Memphis; Dasgupta, Dipankar [ORNL; Ali, Mohammad Hassan [University of Memphis; Abercrombie, Robert K [ORNL

2015-01-01

The important backbone of the smart grid is the cyber/information infrastructure, which is primarily used to communicate with different grid components. A smart grid is a complex cyber physical system containing a numerous and variety number of sources, devices, controllers and loads. Therefore, the smart grid is vulnerable to grid related disturbances. For such dynamic system, disturbance and intrusion detection is a paramount issue. This paper presents a Simulink and Opnet based co-simulated platform to carry out a cyber-intrusion in cyber network for modern power systems and the smart grid. The IEEE 30 bus power system model is used to demonstrate the effectiveness of the simulated testbed. The experiments were performed by disturbing the circuit breakers reclosing time through a cyber-attack. Different disturbance situations in the considered test system are considered and the results indicate the effectiveness of the proposed co-simulated scheme.

Mini-Grids for the Base of the Pyramid Market: A Critical Review

Directory of Open Access Journals (Sweden)

Subhes C. Bhattacharyya

2018-04-01

Full Text Available The lack of access to electricity of more than 1.1 billion people around the world remains a major developmental challenge and Goal 7 of the Sustainable Development Goals (SDG as well as Sustainable Energy for All (SE4ALL have set a target of universal electrification by 2030. Various studies have identified mini-grid-based electrification as a possible solution. There is a growing body of literature available now that has explored the feasibility, practical application and policy interventions required to support mini-grids. Through a review of available literature, this paper explores whether mini-grids can be a solution for the base of the pyramid (BoP market and the challenges faced in deploying mini-grids in such markets. Interventions to support the mini-grid deployment are also discussed. The paper finds that the mini-grids are targeting the BoP market but the business is not attractive in profitability terms and requires financial support. Lack of regulatory clarity and non-coordinated policies affect the financial viability of projects, which requires careful support. Mini-grid electrification has hardly been embedded in rural development agenda and hence they have not contributed significantly to livelihood generation. Careful realignment of policies, regulatory frameworks and support systems can better support mini-grid deployment in developing countries.

Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

Science.gov (United States)

Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

2016-05-01

Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.

Attitudes towards informed consent, confidentiality, and substitute treatment decisions in southern African medical students: a case study from Zimbabwe.

Science.gov (United States)

Hipshman, L

1999-08-01

This study explored the attitudes of biomedical science students (medical students) in a non-Western setting towards three medical ethics concepts that are based on fundamental Western culture ethical principles. A dichotomous (agree/disagree) response questionnaire was constructed using Western ethnocentric culture (WEC) based perspectives of informed consent, confidentiality, and substitute decision-making. Hypothesized WEC-Biased responses were assigned to the questionnaire's questions or propositions. A number of useful responses (169) were obtained from a large, cross-sectional, convenience sample of the MBChB students at the University of Zimbabwe Medical School. Statistical analysis described the differences in response patterns between the student's responses compared to the hypothesized WEC-Biased response. The effect of the nine independent variables on selected dependent variables (responses to certain questionnaire questions) was analyzed by stepwise logistic regression. Students concurred with the hypothesized WEC-Biased responses for two-thirds of the questionnaire items. This agreement included support for the role of legal advocacy in the substitute decision-making process. The students disagreed with the hypothesized WEC-Biased responses in several important medical ethics aspects. Most notably, the students indicated that persons with mental dysfunctions, as a class, were properly considered incompetent to make treatment decisions. None of the studied independent variables was often associated with students' responses, but training year was more frequently implicated than either ethnicity or gender. In order to develop internationally and culturally relevant medical ethics standards, non-Western perspectives ought to be acknowledged and incorporated. Two main areas for further efforts include: curriculum development in ethics reasoning and related clinical (medico-legal) decision-making processes that would be relevant to medical students from

Agent-based Decentralization of Applications in Distributed Smart Grid Systems

DEFF Research Database (Denmark)

Kienesberger, Georg; Xypolytou, Evangelia; Marchgraber, Jurgen

2015-01-01

systems (DMACS) and aims to give an overview on the different requirements and challenges on the way from current centralized control systems to DMACS. Therefore, different ICT scenarios and MAS topologies are employed to discuss the decentralization of three exemplary smart grid applications: voltage......Smart grid technology promises to prepare today’s power systems for the challenges of the future by extensive integration of information and communication technology (ICT). One key aspect is the control paradigm which will have to be shifted from completely centralized control systems to more...... dezentralized concepts in order to adapt to the distributed nature of smart grids. Multi-agent systems (MAS) are a very promising approach for designing distributed, decentralized systems, naturally also in the field of smart grids. This work introduces the notion of decentralized multi-agent-based control...

AMP: a science-driven web-based application for the TeraGrid

Science.gov (United States)

Woitaszek, M.; Metcalfe, T.; Shorrock, I.

The Asteroseismic Modeling Portal (AMP) provides a web-based interface for astronomers to run and view simulations that derive the properties of Sun-like stars from observations of their pulsation frequencies. In this paper, we describe the architecture and implementation of AMP, highlighting the lightweight design principles and tools used to produce a functional fully-custom web-based science application in less than a year. Targeted as a TeraGrid science gateway, AMP's architecture and implementation are intended to simplify its orchestration of TeraGrid computational resources. AMP's web-based interface was developed as a traditional standalone database-backed web application using the Python-based Django web development framework, allowing us to leverage the Django framework's capabilities while cleanly separating the user interface development from the grid interface development. We have found this combination of tools flexible and effective for rapid gateway development and deployment.

Design of decision support interventions for medication prescribing.

Science.gov (United States)

Horsky, Jan; Phansalkar, Shobha; Desai, Amrita; Bell, Douglas; Middleton, Blackford

2013-06-01

Describe optimal design attributes of clinical decision support (CDS) interventions for medication prescribing, emphasizing perceptual, cognitive and functional characteristics that improve human-computer interaction (HCI) and patient safety. Findings from published reports on success, failures and lessons learned during implementation of CDS systems were reviewed and interpreted with regard to HCI and software usability principles. We then formulated design recommendations for CDS alerts that would reduce unnecessary workflow interruptions and allow clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort. Excessive alerting that tends to distract clinicians rather than provide effective CDS can be reduced by designing only high severity alerts as interruptive dialog boxes and less severe warnings without explicit response requirement, by curating system knowledge bases to suppress warnings with low clinical utility and by integrating contextual patient data into the decision logic. Recommended design principles include parsimonious and consistent use of color and language, minimalist approach to the layout of information and controls, the use of font attributes to convey hierarchy and visual prominence of important data over supporting information, the inclusion of relevant patient data in the context of the alert and allowing clinicians to respond with one or two clicks. Although HCI and usability principles are well established and robust, CDS and EHR system interfaces rarely conform to the best known design conventions and are seldom conceived and designed well enough to be truly versatile and dependable tools. These relatively novel interventions still require careful monitoring, research and analysis of its track record to mature. Clarity and specificity of alert content and optimal perceptual and cognitive attributes, for example, are essential for providing effective decision support to clinicians

Single-Phase LLCL-Filter-based Grid-Tied Inverter with Low-Pass Filter Based Capacitor Current Feedback Active damper

DEFF Research Database (Denmark)

Liu, Yuan; Wu, Weimin; Li, Yun

2016-01-01

The capacitor-current-feedback active damping method is attractive for high-order-filter-based high power grid-tied inverter when the grid impedance varies within a wide range. In order to improve the system control bandwidth and attenuate the high order grid background harmonics by using the quasi....... In this paper, a low pass filter is proposed to be inserted in the capacitor current feedback loop op LLCL-filter based grid-tied inverter together with a digital proportional and differential compensator. The detailed theoretical analysis is given. For verification, simulations on a 2kW/220V/10kHz LLCL...

The GridSite Web/Grid security system

International Nuclear Information System (INIS)

McNab, Andrew; Li Yibiao

2010-01-01

We present an overview of the current status of the GridSite toolkit, describing the security model for interactive and programmatic uses introduced in the last year. We discuss our experiences of implementing these internal changes and how they and previous rounds of improvements have been prompted by requirements from users and wider security trends in Grids (such as CSRF). Finally, we explain how these have improved the user experience of GridSite-based websites, and wider implications for portals and similar web/grid sites.

Software-Based Challenges of Developing the Future Distribution Grid

Energy Technology Data Exchange (ETDEWEB)

Stewart, Emma; Kiliccote, Sila; McParland, Charles

2014-06-01

distribution grid modeling, and measured data sources are a key missing element . Modeling tools need to be calibrated based on measured grid data to validate their output in varied conditions such as high renewables penetration and rapidly changing topology. In addition, establishing a standardized data modeling format would enable users to transfer data among tools to take advantage of different analysis features. ?

Decision conflict and regret among surrogate decision makers in the medical intensive care unit.

Science.gov (United States)

Miller, Jesse J; Morris, Peter; Files, D Clark; Gower, Emily; Young, Michael

2016-04-01

Family members of critically ill patients in the intensive care unit face significant morbidity. It may be the decision-making process that plays a significant role in the psychological morbidity associated with being a surrogate in the ICU. We hypothesize that family members facing end-of-life decisions will have more decisional conflict and decisional regret than those facing non-end-of-life decisions. We enrolled a sample of adult patients and their surrogates in a tertiary care, academic medical intensive care unit. We queried the surrogates regarding decisions they had made on behalf of the patient and assessed decision conflict. We then contacted the family member again to assess decision regret. Forty (95%) of 42 surrogates were able to identify at least 1 decision they had made on behalf of the patient. End-of-life decisions (defined as do not resuscitate [DNR]/do not intubate [DNI] or continuation of life support) accounted for 19 of 40 decisions (47.5%). Overall, the average Decision Conflict Scale (DCS) score was 21.9 of 100 (range 0-100, with 0 being little decisional conflict and 100 being great decisional conflict). The average DCS score for families facing end-of-life decisions was 25.5 compared with 18.7 for all other decisions. Those facing end-of-life decisions scored higher on the uncertainty subscale (subset of DCS questions that indicates level of certainty regarding decision) with a mean score of 43.4 compared with all other decisions with a mean score of 27.0. Overall, very few surrogates experienced decisional regret with an average DRS score of 13.4 of 100. Nearly all surrogates enrolled were faced with decision-making responsibilities on behalf of his or her critically ill family member. In our small pilot study, we found more decisional conflict in those surrogates facing end-of-life decisions, specifically on the subset of questions dealing with uncertainty. Surrogates report low levels of decisional regret. Copyright © 2015 Elsevier

Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making.

Science.gov (United States)

van der Horst, Nick; Backx, Fjg; Goedhart, Edwin A; Huisstede, Bionka Ma

2017-11-01

There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify RTP consultation and responsibilities after hamstring injury. The study used the Delphi procedure. The results of a systematic review were used as a starting point for the Delphi procedure. Fifty-eight experts in the field of hamstring injury management selected by 28 FIFA Medical Centres of Excellence worldwide participated. Each Delphi round consisted of a questionnaire, an analysis and an anonymised feedback report. After four Delphi rounds, with more than 83% response for each round, consensus was achieved that RTP should be defined as 'the moment a player has received criteria-based medical clearance and is mentally ready for full availability for match selection and/or full training'. The experts reached consensus on the following criteria to support the RTP decision: medical staff clearance, absence of pain on palpation, absence of pain during strength and flexibility testing, absence of pain during/after functional testing, similar hamstring flexibility, performance on field testing, and psychological readiness. It was also agreed that RTP decisions should be based on shared decision-making, primarily via consultation with the athlete, sports physician, physiotherapist, fitness trainer and team coach. The consensus regarding aspects of RTP should provide clarity and facilitate the assessment of when RTP is appropriate after hamstring injury, so as to avoid or reduce the risk of injury recurrence because of a premature RTP. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

An Analysis of Delay-based and Integrator-based Sequence Detectors for Grid-Connected Converters

DEFF Research Database (Denmark)

Khazraj, Hesam; Silva, Filipe Miguel Faria da; Bak, Claus Leth

2017-01-01

-signal cancellation operators are the main members of the delay-based sequence detectors. The aim of this paper is to provide a theoretical and experimental comparative study between integrator and delay based sequence detectors. The theoretical analysis is conducted based on the small-signal modelling......Detecting and separating positive and negative sequence components of the grid voltage or current is of vital importance in the control of grid-connected power converters, HVDC systems, etc. To this end, several techniques have been proposed in recent years. These techniques can be broadly...... classified into two main classes: The integrator-based techniques and Delay-based techniques. The complex-coefficient filter-based technique, dual second-order generalized integrator-based method, multiple reference frame approach are the main members of the integrator-based sequence detector and the delay...

Ethnic bias and clinical decision-making among New Zealand medical students: an observational study.

Science.gov (United States)

Harris, Ricci; Cormack, Donna; Stanley, James; Curtis, Elana; Jones, Rhys; Lacey, Cameron

2018-01-23

Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making. All final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression. Three hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses. NZ medical students demonstrated ethnic bias, although

Adolescent and parental perceptions of medical decision-making in Hong Kong.

Science.gov (United States)

Hui, Edwin

2011-11-01

To investigate whether Chinese adolescents in Hong Kong share similar perceptions with their Western counterparts regarding their capacity for autonomous decision-making, and secondarily whether Chinese parents underestimate their adolescent children's desire and capacity for autonomous decision-making. 'Healthy Adolescents' and their parents were recruited from four local secondary schools, and 'Sick Adolescents' and their parents from the pediatric wards and outpatient clinics. Their perceptions of adolescents' understanding of illnesses and treatments, maturity in judgment, risk-taking, openness to divergent opinions, pressure from parents and doctors, submission to parental authority and preference for autonomy in medical decision-making are surveyed by a 50-item questionnaire on a five-point Likert scale. Findings indicate that Chinese adolescents aged 14-16 perceive themselves to possess the necessary cognitive abilities and maturity in judgment to be autonomous decision-makers like their Western counterparts. Paradoxically, although they hesitate to assert their autonomy, they are also unwilling to surrender that autonomy to their parents even under coercion or intimidation. Parents tend to underestimate their adolescents' preferences for making autonomous decisions and overestimate the importance of parental authority in decision-making. '14-and-above' Chinese adolescents in Hong Kong perceive themselves as capable of autonomous decision-making in medically-related matters, but hesitate to assert their autonomy, probably because of the Confucian values of parental authority and filial piety that are deeply embedded in the local culture. © 2010 Blackwell Publishing Ltd.

caGrid 1.0: a Grid enterprise architecture for cancer research.

Science.gov (United States)

Oster, Scott; Langella, Stephen; Hastings, Shannon; Ervin, David; Madduri, Ravi; Kurc, Tahsin; Siebenlist, Frank; Covitz, Peter; Shanbhag, Krishnakant; Foster, Ian; Saltz, Joel

2007-10-11

caGrid is the core Grid architecture of the NCI-sponsored cancer Biomedical Informatics Grid (caBIG) program. The current release, caGrid version 1.0, is developed as the production Grid software infrastructure of caBIG. Based on feedback from adopters of the previous version (caGrid 0.5), it has been significantly enhanced with new features and improvements to existing components. This paper presents an overview of caGrid 1.0, its main components, and enhancements over caGrid 0.5.

Feminist ethics and menopause: autonomy and decision-making in primary medical care.

Science.gov (United States)

Murtagh, Madeleine J; Hepworth, Julie

2003-04-01

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Primary care specialty career choice among Canadian medical students: Understanding the factors that influence their decisions.

Science.gov (United States)

Osborn, Heather Ann; Glicksman, Jordan T; Brandt, Michael G; Doyle, Philip C; Fung, Kevin

2017-02-01

To identify which factors influence medical students' decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Ontario medical school. An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). The main factors that influenced participants' decision to choose a career in primary care or pediatrics, and the main factors that influenced participants' decision to choose a career in a non-front-line specialty. A total of 323 participants were included in this study. Factors that significantly influenced participants' career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [ P = .005], acceptable on-call demands [ P = .012], and lifestyle flexibility [ P = .006]); a robust physician-patient relationship (ability to promote individual health promotion [ P = .014] and the opportunity to form long-term relationships [ P  < .001], provide comprehensive care [ P = .001], and treat patients and their families [ P = .006]); and duration of residency program ( P = .001). The career-related factors that significantly influenced participants' decision to choose a non-front-line specialty were as follows: becoming an expert ( P  < .001), maintaining a focused scope of practice ( P  < .001), having a procedure-focused practice ( P = .001), seeing immediate results from one's actions ( P  < .001), potentially earning a high income ( P  < .001), and having a perceived status among colleagues ( P  < .001). In this study, 8 factors were found to positively influence medical students' career choice in family medicine and pediatrics, and 6 factors influenced the decision to choose a career in a non-front-line specialty. Medical students can be

Disrupted latent decision processes in medication-free pediatric OCD patients.

Science.gov (United States)

Erhan, Ceyla; Bulut, Gresa Çarkaxhiu; Gökçe, Sebla; Ozbas, Duru; Turkakin, Esin; Dursun, Onur Burak; Yazgan, Yanki; Balcı, Fuat

2017-01-01

Decision-making in Obsessive Compulsive Disorder has typically been investigated in the adult population. Computational approaches have recently started to get integrated into these studies. However, decision-making research in pediatric OCD populations is scarce. We investigated latent decision processes in 21 medication-free pediatric OCD patients and 23 healthy control participants. We hypothesized that OCD patients would be more cautious and less efficient in evidence accumulation than controls in a two alternative forced choice (2AFC) task. Pediatric OCD patients were less efficient than controls in accumulating perceptual evidence and showed a tendency to be more cautious. In comparison to post-correct decisions, OCD patients increased decision thresholds after erroneous decisions, whereas healthy controls decreased decision thresholds. These changes were coupled with weaker evidence accumulation after errors in both groups. The small sample size limited the power of the study. Our results demonstrate poorer decision-making performance in pediatric OCD patients at the level of latent processes, specifically in terms of evidence accumulation. Copyright © 2016 Elsevier B.V. All rights reserved.

Learning to improve medical decision making from imbalanced data without a priori cost.

Science.gov (United States)

Wan, Xiang; Liu, Jiming; Cheung, William K; Tong, Tiejun

2014-12-05

In a medical data set, data are commonly composed of a minority (positive or abnormal) group and a majority (negative or normal) group and the cost of misclassifying a minority sample as a majority sample is highly expensive. This is the so-called imbalanced classification problem. The traditional classification functions can be seriously affected by the skewed class distribution in the data. To deal with this problem, people often use a priori cost to adjust the learning process in the pursuit of optimal classification function. However, this priori cost is often unknown and hard to estimate in medical decision making. In this paper, we propose a new learning method, named RankCost, to classify imbalanced medical data without using a priori cost. Instead of focusing on improving the class-prediction accuracy, RankCost is to maximize the difference between the minority class and the majority class by using a scoring function, which translates the imbalanced classification problem into a partial ranking problem. The scoring function is learned via a non-parametric boosting algorithm. We compare RankCost to several representative approaches on four medical data sets varying in size, imbalanced ratio, and dimension. The experimental results demonstrate that unlike the currently available methods that often perform unevenly with different priori costs, RankCost shows comparable performance in a consistent manner. It is a challenging task to learn an effective classification model based on imbalanced data in medical data analysis. The traditional approaches often use a priori cost to adjust the learning of the classification function. This work presents a novel approach, namely RankCost, for learning from medical imbalanced data sets without using a priori cost. The experimental results indicate that RankCost performs very well in imbalanced data classification and can be a useful method in real-world applications of medical decision making.

Development of a Cartesian grid based CFD solver (CARBS)

International Nuclear Information System (INIS)

Vaidya, A.M.; Maheshwari, N.K.; Vijayan, P.K.

2013-12-01

Formulation for 3D transient incompressible CFD solver is developed. The solution of variable property, laminar/turbulent, steady/unsteady, single/multi specie, incompressible with heat transfer in complex geometry will be obtained. The formulation can handle a flow system in which any number of arbitrarily shaped solid and fluid regions are present. The solver is based on the use of Cartesian grids. A method is proposed to handle complex shaped objects and boundaries on Cartesian grids. Implementation of multi-material, different types of boundary conditions, thermo physical properties is also considered. The proposed method is validated by solving two test cases. 1 st test case is that of lid driven flow in inclined cavity. 2 nd test case is the flow over cylinder. The 1 st test case involved steady internal flow subjected to WALL boundaries. The 2 nd test case involved unsteady external flow subjected to INLET, OUTLET and FREE-SLIP boundary types. In both the test cases, non-orthogonal geometry was involved. It was found that, under such a wide conditions, the Cartesian grid based code was found to give results which were matching well with benchmark data. Convergence characteristics are excellent. In all cases, the mass residue was converged to 1E-8. Based on this, development of 3D general purpose code based on the proposed approach can be taken up. (author)

Informatics Solutions for Prosumers connected to Smart Grids

Directory of Open Access Journals (Sweden)

Simona Vasilica OPREA

2015-03-01

Full Text Available This paper gives a brief overview about electricity consumption optimization based on consumption profiles of electricity prosumers that are connected to smart grids. The main object of this approach is identification of informatics solutions for electricity consumption optimization in order to decrease electricity bill. In this way, larger scale integration of renewable energy sources is allowed therefore entire society will gain benefits. This paper describes the main objectives of such informatics system and stages for its implementation. The system will analyze the specific profile and behavior of each electricity consumer or prosumer, automatically assist him to make right decisions and offer optimal advice for usage of controllable and non-controllable appliances. It will serve, based on big data transfer from electricity consumers or prosumers, as a powerful tool for grid operators that will be able to better plan their resources.

Intelligence system based classification approach for medical disease diagnosis

Science.gov (United States)

Sagir, Abdu Masanawa; Sathasivam, Saratha

2017-08-01

The prediction of breast cancer in women who have no signs or symptoms of the disease as well as survivability after undergone certain surgery has been a challenging problem for medical researchers. The decision about presence or absence of diseases depends on the physician's intuition, experience and skill for comparing current indicators with previous one than on knowledge rich data hidden in a database. This measure is a very crucial and challenging task. The goal is to predict patient condition by using an adaptive neuro fuzzy inference system (ANFIS) pre-processed by grid partitioning. To achieve an accurate diagnosis at this complex stage of symptom analysis, the physician may need efficient diagnosis system. A framework describes methodology for designing and evaluation of classification performances of two discrete ANFIS systems of hybrid learning algorithms least square estimates with Modified Levenberg-Marquardt and Gradient descent algorithms that can be used by physicians to accelerate diagnosis process. The proposed method's performance was evaluated based on training and test datasets with mammographic mass and Haberman's survival Datasets obtained from benchmarked datasets of University of California at Irvine's (UCI) machine learning repository. The robustness of the performance measuring total accuracy, sensitivity and specificity is examined. In comparison, the proposed method achieves superior performance when compared to conventional ANFIS based gradient descent algorithm and some related existing methods. The software used for the implementation is MATLAB R2014a (version 8.3) and executed in PC Intel Pentium IV E7400 processor with 2.80 GHz speed and 2.0 GB of RAM.

Critical factors in career decision making for women medical graduates.

Science.gov (United States)

Lawrence, Joanna; Poole, Phillippa; Diener, Scott

2003-04-01

Within the next 30 years there will be equal numbers of women and men in the medical workforce. Indications are that women are increasing their participation in specialties other than general practice, although at a slower rate than their participation in the workforce as a whole. To inform those involved in training and employment of medical women, this study investigated the influencing factors in career decision making for female medical graduates. A total of 305 women medical graduates from the University of Auckland responded to a mail survey (73% response rate) which examined influences on decision making, in both qualitative and quantitative ways, as part of a larger survey. Most women were satisfied with their careers. The principal component analysis of the influencing factors identified four distinct factors important in career choice - interest, flexibility, women friendliness and job security, although the first two of these were rated more highly than the others. Barriers to full participation by medical women in training and employment need to be systematically examined and removed. This is not only to allow women themselves to reach their full potential, but for workforce and socio-economic reasons. Initiatives that allow and value more flexible training and work practices, particularly through the years of child raising, are necessary for women and the health care workforce at large.

CEOS contributions to informing energy management and policy decision making using space-based Earth observations

International Nuclear Information System (INIS)

Eckman, Richard S.; Stackhouse, Paul W.

2012-01-01

Earth observations are playing an increasingly significant role in informing decision making in the energy sector. In renewable energy applications, space-based observations now routinely augment sparse ground-based observations used as input for renewable energy resource assessment applications. As one of the nine Group on Earth Observations (GEO) societal benefit areas, the enhancement of management and policy decision making in the energy sector is receiving attention in activities conducted by the Committee on Earth Observation Satellites (CEOS). CEOS has become the “space arm” for the implementation of the Global Earth Observation System of Systems (GEOSS) vision. It is directly supporting the space-based, near-term tasks articulated in the GEO three-year work plan. This paper describes a coordinated program of demonstration projects conducted by CEOS member agencies and partners to utilize Earth observations to enhance energy management end-user decision support systems. We discuss the importance of engagement with stakeholders and understanding their decision support needs in successfully increasing the uptake of Earth observation products for societal benefit. Several case studies are presented, demonstrating the importance of providing data sets in formats and units familiar and immediately usable by decision makers. These projects show the utility of Earth observations to enhance renewable energy resource assessment in the developing world, forecast space weather impacts on the power grid, and improve energy efficiency in the built environment.

CEOS Contributions to Informing Energy Management and Policy Decision Making Using Space-Based Earth Observations

Science.gov (United States)

Eckman, Richard S.

2009-01-01

Earth observations are playing an increasingly significant role in informing decision making in the energy sector. In renewable energy applications, space-based observations now routinely augment sparse ground-based observations used as input for renewable energy resource assessment applications. As one of the nine Group on Earth Observations (GEO) societal benefit areas, the enhancement of management and policy decision making in the energy sector is receiving attention in activities conducted by the Committee on Earth Observation Satellites (CEOS). CEOS has become the "space arm" for the implementation of the Global Earth Observation System of Systems (GEOSS) vision. It is directly supporting the space-based, near-term tasks articulated in the GEO three-year work plan. This paper describes a coordinated program of demonstration projects conducted by CEOS member agencies and partners to utilize Earth observations to enhance energy management end-user decision support systems. I discuss the importance of engagement with stakeholders and understanding their decision support needs in successfully increasing the uptake of Earth observation products for societal benefit. Several case studies are presented, demonstrating the importance of providing data sets in formats and units familiar and immediately usable by decision makers. These projects show the utility of Earth observations to enhance renewable energy resource assessment in the developing world, forecast space-weather impacts on the power grid, and improve energy efficiency in the built environment.

The Geographic Information Grid System Based on Mobile Agent

Institute of Scientific and Technical Information of China (English)

无

2006-01-01

We analyze the deficiencies of current application systems, and discuss the key requirements of distributed Geographic Information service (GIS). We construct the distributed GIS on grid platform. Considering the flexibility and efficiency, we integrate the mobile agent technology into the system. We propose a new prototype system, the Geographic Information Grid System (GIGS) based on mobile agent. This system has flexible services and high performance, and improves the sharing of distributed resources. The service strategy of the system and the examples are also presented.

Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making.

Science.gov (United States)

Sokol, Randi G; Shaughnessy, Allen F

2018-01-01

Continuing medical information courses have been criticized for not promoting behavior change among their participants. For behavior change to occur, participants often need to consciously reject previous ideas and transform their way of thinking. Transformational learning is a process that cultivates deep emotional responses and can lead to cognitive and behavioral change in learners, potentially facilitating rich learning experiences and expediting knowledge translation. We explored participants' experiences at a 2-day conference designed to support transformative learning as they encounter new concepts within Information Mastery, which challenge their previous frameworks around the topic of medical decision making. Using the lens of transformative learning theory, we asked: how does Information Mastery qualitatively promote perspective transformation and hence behavior change? We used a hermeneutic phenomenologic approach to capture the lived experience of 12 current and nine previous attendees of the "Information Mastery" course through individual interviews, focus groups, and observation. Data were thematically analyzed. Both prevoius and current conference attendees described how the delivery of new concepts about medical decision making evoked strong emotional responses, facilitated personal transformation, and propelled expedited behavior change around epistemological, moral, and information management themes, resulting in a newfound sense of self-efficacy, confidence, and ownership in their ability to make medical decisions. When the topic area holds the potential to foster a qualitative reframing of learners' guiding paradigms and worldviews, attention should be paid to supporting learners' personalized meaning-making process through transformative learning opportunities to promote translation into practice.

Justice and care: decision making by medical school student promotions committees.

Science.gov (United States)

Green, Emily P; Gruppuso, Philip A

2017-06-01

The function of medical school entities that determine student advancement or dismissal has gone largely unexplored. The decision making of 'academic progress' or student promotions committees is examined using a theoretical framework contrasting ethics of justice and care, with roots in the moral development work of theorists Kohlberg and Gilligan. To ascertain promotions committee members' conceptualisation of the role of their committee, ethical orientations used in member decision making, and student characteristics most influential in that decision making. An electronic survey was distributed to voting members of promotions committees at 143 accredited allopathic medical schools in the USA. Descriptive statistics were calculated and data were analysed by gender, role, institution type and class size. Respondents included 241 voting members of promotions committees at 55 medical schools. Respondents endorsed various promotions committee roles, including acting in the best interest of learners' future patients and graduating highly qualified learners. Implementing policy was assigned lower importance. The overall pattern of responses did not indicate a predominant orientation toward an ethic of justice or care. Respondents indicated that committees have discretion to take individual student characteristics into consideration during deliberations, and that they do so in practice. Among the student characteristics with the greatest influence on decision making, professionalism and academic performance were paramount. Eighty-five per cent of participants indicated that they received no training. Promotions committee members do not regard orientations of justice and care as being mutually exclusive and endorse an array of statements regarding the committee's purpose that may conflict with one another. The considerable variance in the influence of student characteristics and the general absence of committee member training indicate a need for clear delineation of the

Grid impedance estimation based hybrid islanding detection method for AC microgrids

DEFF Research Database (Denmark)

Ghzaiel, Walid; Jebali-Ben Ghorbal, Manel; Slama-Belkhodja, Ilhem

2017-01-01

This paper focuses on a hybrid islanding detection algorithm for parallel-inverters-based microgrids. The proposed algorithm is implemented on the unit ensuring the control of the intelligent bypass switch connecting or disconnecting the microgrid from the utility. This method employs a grid...... to avoid interactions with other units. The selected inverter will be the one closest to the controllable distributed generation system or to a healthy grid side in case of meshed microgrid with multiple-grid connections. The detection algorithm is applied to quickly detect the resonance phenomena, so...

Improving mobile robot localization: grid-based approach

Science.gov (United States)

Yan, Junchi

2012-02-01

Autonomous mobile robots have been widely studied not only as advanced facilities for industrial and daily life automation, but also as a testbed in robotics competitions for extending the frontier of current artificial intelligence. In many of such contests, the robot is supposed to navigate on the ground with a grid layout. Based on this observation, we present a localization error correction method by exploring the geometric feature of the tile patterns. On top of the classical inertia-based positioning, our approach employs three fiber-optic sensors that are assembled under the bottom of the robot, presenting an equilateral triangle layout. The sensor apparatus, together with the proposed supporting algorithm, are designed to detect a line's direction (vertical or horizontal) by monitoring the grid crossing events. As a result, the line coordinate information can be fused to rectify the cumulative localization deviation from inertia positioning. The proposed method is analyzed theoretically in terms of its error bound and also has been implemented and tested on a customary developed two-wheel autonomous mobile robot.

Enhanced Requirements for Assessment in a Competency-Based, Time-Variable Medical Education System.

Science.gov (United States)

Gruppen, Larry D; Ten Cate, Olle; Lingard, Lorelei A; Teunissen, Pim W; Kogan, Jennifer R

2018-03-01

Competency-based, time-variable medical education has reshaped the perceptions and practices of teachers, curriculum designers, faculty developers, clinician educators, and program administrators. This increasingly popular approach highlights the fact that learning among different individuals varies in duration, foundation, and goal. Time variability places particular demands on the assessment data that are so necessary for making decisions about learner progress. These decisions may be formative (e.g., feedback for improvement) or summative (e.g., decisions about advancing a student). This article identifies challenges to collecting assessment data and to making assessment decisions in a time-variable system. These challenges include managing assessment data, defining and making valid assessment decisions, innovating in assessment, and modeling the considerable complexity of assessment in real-world settings and richly interconnected social systems. There are hopeful signs of creativity in assessment both from researchers and practitioners, but the transition from a traditional to a competency-based medical education system will likely continue to create much controversy and offer opportunities for originality and innovation in assessment.

Cognitive decision modelling of emotion-based learning impairment in schizophrenia: the role of awareness.

Science.gov (United States)

Cella, Matteo; Dymond, Simon; Cooper, Andrew; Turnbull, Oliver H

2012-03-30

Individuals with schizophrenia often lack insight or awareness. Resulting impairment has been observed in various cognitive domains and, recently, linked to problems in emotion-based learning. The Iowa Gambling Task (IGT) has been used to assess emotion-based decision-making in patients with schizophrenia, but results have been inconclusive. The current study further investigates emotion-based decision-making in schizophrenia by elucidating the unique contribution of awareness. Twenty-five patients with schizophrenia and 24 healthy controls were assessed with a modified version of the IGT recording awareness at regular intervals. Symptom assessment, medication and medical history were recorded for the clinical group. Patients with schizophrenia underperformed on the IGT compared to controls. Subjective awareness levels were significantly lower in the schizophrenia group and were associated with hallucination severity. Cognitive decision modelling further indicated that patients with schizophrenia had impaired attention to losses, compared to controls. This parameter was positively correlated with awareness. We also found that positive symptoms altered awareness levels and suggest that this disruption may contribute to sub-optimal decision-making. Overall, a lack of awareness may be an important aspect in understanding impaired social cognitive functioning and emotion-based learning observed in schizophrenia. Copyright © 2011 Elsevier Ltd. All rights reserved.

Do adapted vignettes improve medical decision-making capacity for individuals with Alzheimer's disease?

Science.gov (United States)

Thalén, Liv; Heimann Mühlenbock, Katarina; Almkvist, Ove; Eriksdotter, Maria; Sundström, Erik; Tallberg, Ing-Mari

2017-12-01

Medical decision-making capacity (MDC) is known to decline in individuals with Alzheimer's disease (AD). The vignette method uses hypothetical information as a prerequisite for measuring the capacity to make well-informed decisions to clinical trials. Our aim was to investigate if adapted vignettes can help individuals with mild AD to assimilate information, make decisions and express them in an understandable way, compared to corresponding decisions based on linguistically more demanding vignettes, as measured by the Swedish Linguistic Instrument for Medical Decision-making (LIMD). Two vignettes from LIMD were altered linguistically with the aim to facilitate understanding for individuals with AD. An experimental within-subject design was used to study the influence on MDC of readability (original/adapted vignettes) and content (two different clinical trials). We included 24 patients with mild AD in this prospective study, which read all four vignettes along with a few other tests. This allowed us to investigate the association between MDC and cognitive function. Adapted vignettes did not yield significant differences regarding MDC as compared with original vignettes using a two-way repeated measures analysis of variance. A difference was found between the two clinical trials where LIMD score was significantly higher for Kidney disease than hypertension vignettes. Our results indicate that adapted vignettes may not improve MDC for individuals with mild AD. MDC was affected by which clinical trial the vignettes regarded, which implies that other factors affecting MDC need to be investigated, like length of text and vocabulary used. © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Grid-based Simulation of Industrial Thin Film Production

NARCIS (Netherlands)

Krzhizhanovskaya, V.V.; Sloot, P.M.A.; Gorbachev, Y.E.

2005-01-01

In this article, the authors introduce a Grid-based virtual reactor, a High Level Architecture (HLA)-supported problem-solving environment that allows for detailed numerical study of industrial thin-film production in plasma-enhanced chemical vapor deposition (PECVD) reactors. They briefly describe

Factors influencing a nurse's decision to question medication administration in a neonatal clinical care unit.

Science.gov (United States)

Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee

2016-09-01

The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to

A comparison of web-based versus print-based decision AIDS for prostate cancer screening: participants' evaluation and utilization.

Science.gov (United States)

Tomko, Catherine; Davis, Kimberly M; Luta, George; Krist, Alexander H; Woolf, Steven H; Taylor, Kathryn L

2015-01-01

Patient decision aids facilitate informed decision making for medical tests and procedures that have uncertain benefits. To describe participants' evaluation and utilization of print-based and web-based prostate cancer screening decision aids that were found to improve decisional outcomes in a prior randomized controlled trial. Men completed brief telephone interviews at baseline, one month, and 13 months post-randomization. Participants were primary care patients, 45-70 years old, who received the print-based (N = 628) or web-based decision aid (N = 625) and completed the follow-up assessments. We assessed men's baseline preference for web-based or print-based materials, time spent using the decision aids, comprehension of the overall message, and ratings of the content. Decision aid use was self-reported by 64.3 % (web) and 81.8 % (print) of participants. Significant predictors of decision aid use were race (white vs. non-white, OR = 2.43, 95 % CI: 1.77, 3.35), higher education (OR = 1.68, 95 % CI: 1.06, 2.70) and trial arm (print vs. web, OR = 2.78, 95 % CI: 2.03, 3.83). Multivariable analyses indicated that web-arm participants were more likely to use the website when they preferred web-based materials (OR: 1.91, CI: 1.17, 3.12), whereas use of the print materials was not significantly impacted by a preference for print-based materials (OR: 0.69, CI: 0.38, 1.25). Comprehension of the decision aid message (i.e., screening is an individual decision) did not significantly differ between arms in adjusted analyses (print: 61.9 % and web: 68.2 %, p = 0.42). Decision aid use was independently influenced by race, education, and the decision aid medium, findings consistent with the 'digital divide.' These results suggest that when it is not possible to provide this age cohort with their preferred decision aid medium, print materials will be more highly used than web-based materials. Although there are many advantages to web-based decision aids, providing an option for

Hierarchical Controlled Grid-Connected Microgrid based on a Novel Autonomous Current Sharing Controller

DEFF Research Database (Denmark)

Guan, Yajuan; Quintero, Juan Carlos Vasquez; Guerrero, Josep M.

2015-01-01

In this paper, a hierarchical control system based on a novel autonomous current sharing controller for grid-connected microgrids (MGs) is presented. A three-level hierarchical control system is implemented to guarantee the power sharing performance among voltage controlled parallel inverters......, while providing the required active and reactive power to the utility grid. A communication link is used to transmit the control signal from the tertiary and secondary control levels to the primary control. Simulation results from a MG based on two grid-connected parallel inverters are shown in order...

Grid based calibration of SWAT hydrological models

Directory of Open Access Journals (Sweden)

D. Gorgan

2012-07-01

Full Text Available The calibration and execution of large hydrological models, such as SWAT (soil and water assessment tool, developed for large areas, high resolution, and huge input data, need not only quite a long execution time but also high computation resources. SWAT hydrological model supports studies and predictions of the impact of land management practices on water, sediment, and agricultural chemical yields in complex watersheds. The paper presents the gSWAT application as a web practical solution for environmental specialists to calibrate extensive hydrological models and to run scenarios, by hiding the complex control of processes and heterogeneous resources across the grid based high computation infrastructure. The paper highlights the basic functionalities of the gSWAT platform, and the features of the graphical user interface. The presentation is concerned with the development of working sessions, interactive control of calibration, direct and basic editing of parameters, process monitoring, and graphical and interactive visualization of the results. The experiments performed on different SWAT models and the obtained results argue the benefits brought by the grid parallel and distributed environment as a solution for the processing platform. All the instances of SWAT models used in the reported experiments have been developed through the enviroGRIDS project, targeting the Black Sea catchment area.

Racial, gender, and socioeconomic status bias in senior medical student clinical decision-making: a national survey.

Science.gov (United States)

Williams, Robert L; Romney, Crystal; Kano, Miria; Wright, Randy; Skipper, Betty; Getrich, Christina M; Sussman, Andrew L; Zyzanski, Stephen J

2015-06-01

Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. The study included senior medical students. We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p = .03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p socioeconomic status, geographic variations, and the influence of interactions between patient race and gender on student recommendations.

Medical decision support and medical informatics education: roots, methods and applications in czechoslovakia and the czech republic.

Science.gov (United States)

Zvárová, Jana

2013-01-01

The paper describes the history of medical informatics in Czechoslovakia and the Czech Republic. It focuses on the topics of medical informatics education and decision support methods and systems. Several conferences held in Czechoslovakia and in the Czech Republic organized in cooperation with IMIA or EFMI are described. Support of European Union and Czech agencies in several European and national projects focused on medical informatics topics highly contributed to medical informatics development in Czechoslovakia and the Czech Republic and to the establishment of the European Center for Medical Informatics, Statistics and Epidemiology as the joint workplace of Charles University in Prague and Academy of Sciences of the Czech Republic in 1994.

Developing a Philippine Cancer Grid. Part 1: Building a Prototype for a Data Retrieval System for Breast Cancer Research Using Medical Ontologies

Science.gov (United States)

Coronel, Andrei D.; Saldana, Rafael P.

Cancer is a leading cause of morbidity and mortality in the Philippines. Developed within the context of a Philippine Cancer Grid, the present study used web development technologies such as PHP, MySQL, and Apache server to build a prototype data retrieval system for breast cancer research that incorporates medical ontologies from the Unified Medical Language System (UMLS).

Adaptation of Powerline Communications-Based Smart Metering Deployments to the Requirements of Smart Grids

Directory of Open Access Journals (Sweden)

Alberto Sendin

2015-11-01

Full Text Available Powerline communications (PLC-based smart meter deployments are now a reality in many regions of the world. Although PLC elements are generally incorporated in smart meters and data concentrators, the underlying PLC network allows the integration of other smart grid services directly over it. The remote control capabilities that automation programs need and are today deployed over their medium voltage (MV grid, can be extended to the low voltage (LV grid through these existing PLC networks. This paper demonstrates the capabilities of narrowband high data rate (NB HDR PLC technologies deployed over LV grids for smart metering purposes to support internet protocol internet protocol (IP communications in the LV grid. The paper demonstrates these possibilities with the presentation of the simulation and laboratory results of IP communications over international telecommunication union: ITU-T G.9904 PLC technology, and the definition of a PLC Network Management System based on a simple network management protocol (SNMP management information base (MIB definition and applicable use cases.

The Knowledge Base Interface for Parametric Grid Information

International Nuclear Information System (INIS)

Hipp, James R.; Simons, Randall W.; Young, Chris J.

1999-01-01

The parametric grid capability of the Knowledge Base (KBase) provides an efficient robust way to store and access interpolatable information that is needed to monitor the Comprehensive Nuclear Test Ban Treaty. To meet both the accuracy and performance requirements of operational monitoring systems, we use an approach which combines the error estimation of kriging with the speed and robustness of Natural Neighbor Interpolation. The method involves three basic steps: data preparation, data storage, and data access. In past presentations we have discussed in detail the first step. In this paper we focus on the latter two, describing in detail the type of information which must be stored and the interface used to retrieve parametric grid data from the Knowledge Base. Once data have been properly prepared, the information (tessellation and associated value surfaces) needed to support the interface functionality, can be entered into the KBase. The primary types of parametric grid data that must be stored include (1) generic header information; (2) base model, station, and phase names and associated ID's used to construct surface identifiers; (3) surface accounting information; (4) tessellation accounting information; (5) mesh data for each tessellation; (6) correction data defined for each surface at each node of the surfaces owning tessellation (7) mesh refinement calculation set-up and flag information; and (8) kriging calculation set-up and flag information. The eight data components not only represent the results of the data preparation process but also include all required input information for several population tools that would enable the complete regeneration of the data results if that should be necessary

Synchronization method for grid integrated battery storage systems during asymmetrical grid faults

Directory of Open Access Journals (Sweden)

Popadić Bane

2017-01-01

Full Text Available This paper aims at presenting a robust and reliable synchronization method for battery storage systems during asymmetrical grid faults. For this purpose, a Matlab/Simulink based model for testing of the power electronic interface between the grid and the battery storage systems has been developed. The synchronization method proposed in the paper is based on the proportional integral resonant controller with the delay signal cancellation. The validity of the synchronization method has been verified using the advanced laboratory station for the control of grid connected distributed energy sources. The proposed synchronization method has eliminated unfavourable components from the estimated grid angular frequency, leading to the more accurate and reliable tracking of the grid voltage vector positive sequence during both the normal operation and the operation during asymmetrical grid faults. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III 042004: Integrated and Interdisciplinary Research entitled: Smart Electricity Distribution Grids Based on Distribution Management System and Distributed Generation

Enhancing adaptive sparse grid approximations and improving refinement strategies using adjoint-based a posteriori error estimates

Science.gov (United States)

Jakeman, J. D.; Wildey, T.

2015-01-01

In this paper we present an algorithm for adaptive sparse grid approximations of quantities of interest computed from discretized partial differential equations. We use adjoint-based a posteriori error estimates of the physical discretization error and the interpolation error in the sparse grid to enhance the sparse grid approximation and to drive adaptivity of the sparse grid. Utilizing these error estimates provides significantly more accurate functional values for random samples of the sparse grid approximation. We also demonstrate that alternative refinement strategies based upon a posteriori error estimates can lead to further increases in accuracy in the approximation over traditional hierarchical surplus based strategies. Throughout this paper we also provide and test a framework for balancing the physical discretization error with the stochastic interpolation error of the enhanced sparse grid approximation.

Enhancing adaptive sparse grid approximations and improving refinement strategies using adjoint-based a posteriori error estimates

International Nuclear Information System (INIS)

Jakeman, J.D.; Wildey, T.

2015-01-01

In this paper we present an algorithm for adaptive sparse grid approximations of quantities of interest computed from discretized partial differential equations. We use adjoint-based a posteriori error estimates of the physical discretization error and the interpolation error in the sparse grid to enhance the sparse grid approximation and to drive adaptivity of the sparse grid. Utilizing these error estimates provides significantly more accurate functional values for random samples of the sparse grid approximation. We also demonstrate that alternative refinement strategies based upon a posteriori error estimates can lead to further increases in accuracy in the approximation over traditional hierarchical surplus based strategies. Throughout this paper we also provide and test a framework for balancing the physical discretization error with the stochastic interpolation error of the enhanced sparse grid approximation

Control strategy based on SPWM switching patterns for grid connected photovoltaic inverter

Science.gov (United States)

Hassaine, L.; Mraoui, A.

2017-02-01

Generally, for lower installation of photovoltaic systems connected to the grid, pulse width modulation (PWM) is a widely used technique for controlling the voltage source inverters injects currents into the grid. The current injected must be sinusoidal with reduced harmonic distortion. In this paper, a digital implementation of a control strategy based on PWM switching patterns for an inverter for photovoltaic system connected to the grid is presented. This strategy synchronize a sinusoidal inverter output current with a grid voltage The digital implementation of the proposed PWM switching pattern when is compared with the conventional one exhibit the advantage: Simplicity, reduction of the memory requirements and power calculation for the control

A virtual laboratory for medical image analysis

NARCIS (Netherlands)

Olabarriaga, Sílvia D.; Glatard, Tristan; de Boer, Piter T.

2010-01-01

This paper presents the design, implementation, and usage of a virtual laboratory for medical image analysis. It is fully based on the Dutch grid, which is part of the Enabling Grids for E-sciencE (EGEE) production infrastructure and driven by the gLite middleware. The adopted service-oriented

An Efficient Topology-Based Algorithm for Transient Analysis of Power Grid

KAUST Repository

Yang, Lan

2015-08-10

In the design flow of integrated circuits, chip-level verification is an important step that sanity checks the performance is as expected. Power grid verification is one of the most expensive and time-consuming steps of chip-level verification, due to its extremely large size. Efficient power grid analysis technology is highly demanded as it saves computing resources and enables faster iteration. In this paper, a topology-base power grid transient analysis algorithm is proposed. Nodal analysis is adopted to analyze the topology which is mathematically equivalent to iteratively solving a positive semi-definite linear equation. The convergence of the method is proved.

Power Grid Construction Project Portfolio Optimization Based on Bi-level programming model

Science.gov (United States)

Zhao, Erdong; Li, Shangqi

2017-08-01

As the main body of power grid operation, county-level power supply enterprises undertake an important emission to guarantee the security of power grid operation and safeguard social power using order. The optimization of grid construction projects has been a key issue of power supply capacity and service level of grid enterprises. According to the actual situation of power grid construction project optimization of county-level power enterprises, on the basis of qualitative analysis of the projects, this paper builds a Bi-level programming model based on quantitative analysis. The upper layer of the model is the target restriction of the optimal portfolio; the lower layer of the model is enterprises’ financial restrictions on the size of the enterprise project portfolio. Finally, using a real example to illustrate operation proceeding and the optimization result of the model. Through qualitative analysis and quantitative analysis, the bi-level programming model improves the accuracy and normative standardization of power grid enterprises projects.

Medical Service Corps: Junior Officer and Recent Retiree Stay/Leave Decisions

National Research Council Canada - National Science Library

Shepherd, Lillian

2001-01-01

.... Since few studies have been conducted on turnover intent in officers within the Navy Medical Department, previous studies, theories, and influencers on stay/leave decisions in Department of Defense...

Can shared decision-making reduce medical malpractice litigation? A systematic review.

Science.gov (United States)

Durand, Marie-Anne; Moulton, Benjamin; Cockle, Elizabeth; Mann, Mala; Elwyn, Glyn

2015-04-18

To explore the likely influence and impact of shared decision-making on medical malpractice litigation and patients' intentions to initiate litigation. We included all observational, interventional and qualitative studies published in all languages, which assessed the effect or likely influence of shared decision-making or shared decision-making interventions on medical malpractice litigation or on patients' intentions to litigate. The following databases were searched from inception until January 2014: CINAHL, Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, HMIC, Lexis library, MEDLINE, NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge. We also hand searched reference lists of included studies and contacted experts in the field. Downs & Black quality assessment checklist, the Critical Appraisal Skill Programme qualitative tool, and the Critical Appraisal Guidelines for single case study research were used to assess the quality of included studies. 6562 records were screened and 19 articles were retrieved for full-text review. Five studies wee included in the review. Due to the number and heterogeneity of included studies, we conducted a narrative synthesis adapted from the ESRC guidance for narrative synthesis. Four themes emerged. The analysis confirms the absence of empirical data necessary to determine whether or not shared decision-making promoted in the clinical encounter can reduce litigation. Three out of five included studies provide retrospective and simulated data suggesting that ignoring or failing to diagnose patient preferences, particularly when no effort has been made to inform and support understanding of possible harms and benefits, puts clinicians at a higher risk of litigation. Simulated scenarios suggest that documenting the use of decision support interventions in patients' notes could offer some level of medico-legal protection. Our analysis also indicated that a sizeable

Why decision support systems are important for medical education.

Science.gov (United States)

Konstantinidis, Stathis Th; Bamidis, Panagiotis D

2016-03-01

During the last decades, the inclusion of digital tools in health education has rapidly lead to a continuously enlarging digital era. All the online interactions between learners and tutors, the description, creation, reuse and sharing of educational digital resources and the interlinkage between them in conjunction with cheap storage technology has led to an enormous amount of educational data. Medical education is a unique type of education due to accuracy of information needed, continuous changing competences required and alternative methods of education used. Nowadays medical education standards provide the ground for organising the educational data and the paradata. Analysis of such education data through education data mining techniques is in its infancy, but decision support systems (DSSs) for medical education need further research. To the best of our knowledge, there is a gap and a clear need for identifying the challenges for DSSs in medical education in the era of medical education standards. Thus, in this Letter the role and the attributes of such a DSS for medical education are delineated and the challenges and vision for future actions are identified.

The Erasmus Computing Grid - Building a Super-Computer Virtually for Free at the Erasmus Medical Center and the Hogeschool Rotterdam

NARCIS (Netherlands)

T.A. Knoch (Tobias); L.V. de Zeeuw (Luc)

2006-01-01

textabstractThe Set-Up of the 20 Teraflop Erasmus Computing Grid: To meet the enormous computational needs of live- science research as well as clinical diagnostics and treatment the Hogeschool Rotterdam and the Erasmus Medical Center are currently setting up one of the largest desktop

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Human Space Flight Missions

Science.gov (United States)

Kerstman, Eric L.; Minard, Charles; FreiredeCarvalho, Mary H.; Walton, Marlei E.; Myers, Jerry G., Jr.; Saile, Lynn G.; Lopez, Vilma; Butler, Douglas J.; Johnson-Throop, Kathy A.

2011-01-01

This slide presentation reviews the Integrated Medical Model (IMM) and its use as a risk assessment and decision support tool for human space flight missions. The IMM is an integrated, quantified, evidence-based decision support tool useful to NASA crew health and mission planners. It is intended to assist in optimizing crew health, safety and mission success within the constraints of the space flight environment for in-flight operations. It uses ISS data to assist in planning for the Exploration Program and it is not intended to assist in post flight research. The IMM was used to update Probability Risk Assessment (PRA) for the purpose of updating forecasts for the conditions requiring evacuation (EVAC) or Loss of Crew Life (LOC) for the ISS. The IMM validation approach includes comparison with actual events and involves both qualitative and quantitaive approaches. The results of these comparisons are reviewed. Another use of the IMM is to optimize the medical kits taking into consideration the specific mission and the crew profile. An example of the use of the IMM to optimize the medical kits is reviewed.

Applications of decision theory to test-based decision making

NARCIS (Netherlands)

van der Linden, Willem J.

1987-01-01

The use of Bayesian decision theory to solve problems in test-based decision making is discussed. Four basic decision problems are distinguished: (1) selection; (2) mastery; (3) placement; and (4) classification, the situation where each treatment has its own criterion. Each type of decision can be

The eGo grid model: An open-source and open-data based synthetic medium-voltage grid model for distribution power supply systems

Science.gov (United States)

Amme, J.; Pleßmann, G.; Bühler, J.; Hülk, L.; Kötter, E.; Schwaegerl, P.

2018-02-01

The increasing integration of renewable energy into the electricity supply system creates new challenges for distribution grids. The planning and operation of distribution systems requires appropriate grid models that consider the heterogeneity of existing grids. In this paper, we describe a novel method to generate synthetic medium-voltage (MV) grids, which we applied in our DIstribution Network GeneratOr (DINGO). DINGO is open-source software and uses freely available data. Medium-voltage grid topologies are synthesized based on location and electricity demand in defined demand areas. For this purpose, we use GIS data containing demand areas with high-resolution spatial data on physical properties, land use, energy, and demography. The grid topology is treated as a capacitated vehicle routing problem (CVRP) combined with a local search metaheuristics. We also consider the current planning principles for MV distribution networks, paying special attention to line congestion and voltage limit violations. In the modelling process, we included power flow calculations for validation. The resulting grid model datasets contain 3608 synthetic MV grids in high resolution, covering all of Germany and taking local characteristics into account. We compared the modelled networks with real network data. In terms of number of transformers and total cable length, we conclude that the method presented in this paper generates realistic grids that could be used to implement a cost-optimised electrical energy system.

Operation of an InGrid based X-ray detector at the CAST experiment

Science.gov (United States)

Krieger, Christoph; Desch, Klaus; Kaminski, Jochen; Lupberger, Michael

2018-02-01

The CERN Axion Solar Telescope (CAST) is searching for axions and other particles which could be candidates for DarkMatter and even Dark Energy. These particles could be produced in the Sun and detected by a conversion into soft X-ray photons inside a strong magnetic field. In order to increase the sensitivity for physics beyond the Standard Model, detectors with a threshold below 1 keV as well as efficient background rejection methods are required to compensate for low energies and weak couplings resulting in very low detection rates. Those criteria are fulfilled by a detector utilizing the combination of a pixelized readout chip with an integrated Micromegas stage. These InGrid (Integrated Grid) devices can be build by photolithographic postprocessing techniques, resulting in a close to perfect match of grid and pixels facilitating the detection of single electrons on the chip surface. The high spatial resolution allows for energy determination by simple electron counting as well as for an event-shape based analysis as background rejection method. Tests at an X-ray generator revealed the energy threshold of an InGrid based X-ray detector to be well below the carbon Kα line at 277 eV. After the successful demonstration of the detectors key features, the detector was mounted at one of CAST's four detector stations behind an X-ray telescope in 2014. After several months of successful operation without any detector related interruptions, the InGrid based X-ray detector continues data taking at CAST in 2015. During operation at the experiment, background rates in the order of 10-5 keV-1 cm-2 s-1 have been achieved by application of a likelihood based method discriminating the non-photon background originating mostly from cosmic rays. For continued operation in 2016, an upgraded InGrid based detector is to be installed among other improvements including decoupling and sampling of the signal induced on the grid as well as a veto scintillator to further lower the

Design of Energy Storage Management System Based on FPGA in Micro-Grid

Science.gov (United States)

Liang, Yafeng; Wang, Yanping; Han, Dexiao

2018-01-01

Energy storage system is the core to maintain the stable operation of smart micro-grid. Aiming at the existing problems of the energy storage management system in the micro-grid such as Low fault tolerance, easy to cause fluctuations in micro-grid, a new intelligent battery management system based on field programmable gate array is proposed : taking advantage of FPGA to combine the battery management system with the intelligent micro-grid control strategy. Finally, aiming at the problem that during estimation of battery charge State by neural network, initialization of weights and thresholds are not accurate leading to large errors in prediction results, the genetic algorithm is proposed to optimize the neural network method, and the experimental simulation is carried out. The experimental results show that the algorithm has high precision and provides guarantee for the stable operation of micro-grid.

Development and verification of remote research environment based on 'Fusion research grid'

International Nuclear Information System (INIS)

Iba, Katsuyuki; Ozeki, Takahisa; Totsuka, Toshiyuki; Suzuki, Yoshio; Oshima, Takayuki; Sakata, Shinya; Sato, Minoru; Suzuki, Mitsuhiro; Hamamatsu, Kiyotaka; Kiyono, Kimihiro

2008-01-01

'Fusion research grid' is a concept that unites scientists and let them collaborate effectively against their difference in time zone and location in a nuclear fusion research. Fundamental technologies of 'Fusion research grid' have been developed at JAEA in the VizGrid project under the e-Japan project at the Ministry of Education, Culture, Sports, Science and Technology (MEXT). We are conscious of needs to create new systems that assist researchers with their research activities because remote collaborations have been increasing in international projects. Therefore we have developed prototype remote research environments for experiments, diagnostics, analyses and communications based on 'Fusion research grid'. All users can access these environments from anywhere because 'Fusion research grid' does not require a closed network like Super SINET to maintain security. The prototype systems were verified in experiments at JT-60U and their availability was confirmed

Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

Science.gov (United States)

Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

2016-06-01

Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital-based

‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

Science.gov (United States)

Durand, Marie-Anne; Alam, Shama; Grande, Stuart W; Elwyn, Glyn

2016-01-01

Objective Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. Design Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). Setting Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. Participants In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. Intervention The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). Outcome measures We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. Results After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. Conclusions and relevance Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast

Micro-grid platform based on NODE.JS architecture, implemented in electrical network instrumentation

Science.gov (United States)

Duque, M.; Cando, E.; Aguinaga, A.; Llulluna, F.; Jara, N.; Moreno, T.

2016-05-01

In this document, I propose a theory about the impact of systems based on microgrids in non-industrialized countries that have the goal to improve energy exploitation through alternatives methods of a clean and renewable energy generation and the creation of the app to manage the behavior of the micro-grids based on the NodeJS, Django and IOJS technologies. The micro-grids allow the optimal way to manage energy flow by electric injection directly in electric network small urban's cells in a low cost and available way. In difference from conventional systems, micro-grids can communicate between them to carry energy to places that have higher demand in accurate moments. This system does not require energy storage, so, costs are lower than conventional systems like fuel cells, solar panels or else; even though micro-grids are independent systems, they are not isolated. The impact that this analysis will generate, is the improvement of the electrical network without having greater control than an intelligent network (SMART-GRID); this leads to move to a 20% increase in energy use in a specified network; that suggest there are others sources of energy generation; but for today's needs, we need to standardize methods and remain in place to support all future technologies and the best option are the Smart Grids and Micro-Grids.

Modernizing Distribution System Restoration to Achieve Grid Resiliency Against Extreme Weather Events: An Integrated Solution

Energy Technology Data Exchange (ETDEWEB)

Chen, Chen; Wang, Jianhui; Ton, Dan

2017-07-07

Recent severe power outages caused by extreme weather hazards have highlighted the importance and urgency of improving the resilience of the electric power grid. As the distribution grids still remain vulnerable to natural disasters, the power industry has focused on methods of restoring distribution systems after disasters in an effective and quick manner. The current distribution system restoration practice for utilities is mainly based on predetermined priorities and tends to be inefficient and suboptimal, and the lack of situational awareness after the hazard significantly delays the restoration process. As a result, customers may experience an extended blackout, which causes large economic loss. On the other hand, the emerging advanced devices and technologies enabled through grid modernization efforts have the potential to improve the distribution system restoration strategy. However, utilizing these resources to aid the utilities in better distribution system restoration decision-making in response to extreme weather events is a challenging task. Therefore, this paper proposes an integrated solution: a distribution system restoration decision support tool designed by leveraging resources developed for grid modernization. We first review the current distribution restoration practice and discuss why it is inadequate in response to extreme weather events. Then we describe how the grid modernization efforts could benefit distribution system restoration, and we propose an integrated solution in the form of a decision support tool to achieve the goal. The advantages of the solution include improving situational awareness of the system damage status and facilitating survivability for customers. The paper provides a comprehensive review of how the existing methodologies in the literature could be leveraged to achieve the key advantages. The benefits of the developed system restoration decision support tool include the optimal and efficient allocation of repair crews

Simulation-Based Approach for Studying the Balancing of Local Smart Grids with Electric Vehicle Batteries

Directory of Open Access Journals (Sweden)

Juhani Latvakoski

2015-07-01

Full Text Available Modern society is facing great challenges due to pollution and increased carbon dioxide (CO2 emissions. As part of solving these challenges, the use of renewable energy sources and electric vehicles (EVs is rapidly increasing. However, increased dynamics have triggered problems in balancing energy supply and consumption demand in the power systems. The resulting uncertainty and unpredictability of energy production, consumption, and management of peak loads has caused an increase in costs for energy market actors. Therefore, the means for studying the balancing of local smart grids with EVs is a starting point for this paper. The main contribution is a simulation-based approach which was developed to enable the study of the balancing of local distribution grids with EV batteries in a cost-efficient manner. The simulation-based approach is applied to enable the execution of a distributed system with the simulation of a local distribution grid, including a number of charging stations and EVs. A simulation system has been constructed to support the simulation-based approach. The evaluation has been carried out by executing the scenario related to balancing local distribution grids with EV batteries in a step-by-step manner. The evaluation results indicate that the simulation-based approach is able to facilitate the evaluation of smart grid– and EV-related communication protocols, control algorithms for charging, and functionalities of local distribution grids as part of a complex, critical cyber-physical system. In addition, the simulation system is able to incorporate advanced methods for monitoring, controlling, tracking, and modeling behavior. The simulation model of the local distribution grid can be executed with the smart control of charging and discharging powers of the EVs according to the load situation in the local distribution grid. The resulting simulation system can be applied to the study of balancing local smart grids with EV

Croatia's rural areas - renewable energy based electricity generation for isolated grids

Directory of Open Access Journals (Sweden)

Protic Sonja Maria

2014-01-01

Full Text Available Several Western Balkan states face the consequences of the Yugoslavian war, which left hometowns with dilapidated electricity grid connections, a high average age of power plant capacities and low integration of renewable energy sources, grid bottlenecks and a lack of competition. In order to supply all households with electricity, UNDP Croatia did a research on decentralized supply systems based on renewable energy sources. Decentralized supply systems offer cheaper electricity connections and provide faster support to rural development. This paper proposes a developed methodology to financially compare isolated grid solutions that primarily use renewable energies to an extension of the public electricity network to small regions in Croatia. Isolated grid supply proves to be very often a preferable option. Furthermore, it points out the lack of a reliable evaluation of non-monetizable aspects and promotes a new interdisciplinary approach.

Camera Coverage Estimation Based on Multistage Grid Subdivision

Directory of Open Access Journals (Sweden)

Meizhen Wang

2017-04-01

Full Text Available Visual coverage is one of the most important quality indexes for depicting the usability of an individual camera or camera network. It is the basis for camera network deployment, placement, coverage-enhancement, planning, etc. Precision and efficiency are critical influences on applications, especially those involving several cameras. This paper proposes a new method to efficiently estimate superior camera coverage. First, the geographic area that is covered by the camera and its minimum bounding rectangle (MBR without considering obstacles is computed using the camera parameters. Second, the MBR is divided into grids using the initial grid size. The status of the four corners of each grid is estimated by a line of sight (LOS algorithm. If the camera, considering obstacles, covers a corner, the status is represented by 1, otherwise by 0. Consequently, the status of a grid can be represented by a code that is a combination of 0s or 1s. If the code is not homogeneous (not four 0s or four 1s, the grid will be divided into four sub-grids until the sub-grids are divided into a specific maximum level or their codes are homogeneous. Finally, after performing the process above, total camera coverage is estimated according to the size and status of all grids. Experimental results illustrate that the proposed method’s accuracy is determined by the method that divided the coverage area into the smallest grids at the maximum level, while its efficacy is closer to the method that divided the coverage area into the initial grids. It considers both efficiency and accuracy. The initial grid size and maximum level are two critical influences on the proposed method, which can be determined by weighing efficiency and accuracy.

The surveillance error grid.

Science.gov (United States)

Klonoff, David C; Lias, Courtney; Vigersky, Robert; Clarke, William; Parkes, Joan Lee; Sacks, David B; Kirkman, M Sue; Kovatchev, Boris

2014-07-01

Currently used error grids for assessing clinical accuracy of blood glucose monitors are based on out-of-date medical practices. Error grids have not been widely embraced by regulatory agencies for clearance of monitors, but this type of tool could be useful for surveillance of the performance of cleared products. Diabetes Technology Society together with representatives from the Food and Drug Administration, the American Diabetes Association, the Endocrine Society, and the Association for the Advancement of Medical Instrumentation, and representatives of academia, industry, and government, have developed a new error grid, called the surveillance error grid (SEG) as a tool to assess the degree of clinical risk from inaccurate blood glucose (BG) monitors. A total of 206 diabetes clinicians were surveyed about the clinical risk of errors of measured BG levels by a monitor. The impact of such errors on 4 patient scenarios was surveyed. Each monitor/reference data pair was scored and color-coded on a graph per its average risk rating. Using modeled data representative of the accuracy of contemporary meters, the relationships between clinical risk and monitor error were calculated for the Clarke error grid (CEG), Parkes error grid (PEG), and SEG. SEG action boundaries were consistent across scenarios, regardless of whether the patient was type 1 or type 2 or using insulin or not. No significant differences were noted between responses of adult/pediatric or 4 types of clinicians. Although small specific differences in risk boundaries between US and non-US clinicians were noted, the panel felt they did not justify separate grids for these 2 types of clinicians. The data points of the SEG were classified in 15 zones according to their assigned level of risk, which allowed for comparisons with the classic CEG and PEG. Modeled glucose monitor data with realistic self-monitoring of blood glucose errors derived from meter testing experiments plotted on the SEG when compared to

Geospatial Information Service System Based on GeoSOT Grid & Encoding

Directory of Open Access Journals (Sweden)

LI Shizhong

2016-12-01

Full Text Available With the rapid development of the space and earth observation technology, it is important to establish a multi-source, multi-scale and unified cross-platform reference for global data. In practice, the production and maintenance of geospatial data are scattered in different units, and the standard of the data grid varies between departments and systems. All these bring out the disunity of standards among different historical periods or orgnizations. Aiming at geospatial information security library for the national high resolution earth observation, there are some demands for global display, associated retrieval and template applications and other integrated services for geospatial data. Based on GeoSOT grid and encoding theory system, "geospatial information security library information of globally unified grid encoding management" data subdivision organization solutions have been proposed; system-level analyses, researches and designs have been carried out. The experimental results show that the data organization and management method based on GeoSOT can significantly improve the overall efficiency of the geospatial information security service system.

Grid-based platform for training in Earth Observation

Science.gov (United States)

Petcu, Dana; Zaharie, Daniela; Panica, Silviu; Frincu, Marc; Neagul, Marian; Gorgan, Dorian; Stefanut, Teodor

2010-05-01

GiSHEO platform [1] providing on-demand services for training and high education in Earth Observation is developed, in the frame of an ESA funded project through its PECS programme, to respond to the needs of powerful education resources in remote sensing field. It intends to be a Grid-based platform of which potential for experimentation and extensibility are the key benefits compared with a desktop software solution. Near-real time applications requiring simultaneous multiple short-time-response data-intensive tasks, as in the case of a short time training event, are the ones that are proved to be ideal for this platform. The platform is based on Globus Toolkit 4 facilities for security and process management, and on the clusters of four academic institutions involved in the project. The authorization uses a VOMS service. The main public services are the followings: the EO processing services (represented through special WSRF-type services); the workflow service exposing a particular workflow engine; the data indexing and discovery service for accessing the data management mechanisms; the processing services, a collection allowing easy access to the processing platform. The WSRF-type services for basic satellite image processing are reusing free image processing tools, OpenCV and GDAL. New algorithms and workflows were develop to tackle with challenging problems like detecting the underground remains of old fortifications, walls or houses. More details can be found in [2]. Composed services can be specified through workflows and are easy to be deployed. The workflow engine, OSyRIS (Orchestration System using a Rule based Inference Solution), is based on DROOLS, and a new rule-based workflow language, SILK (SImple Language for worKflow), has been built. Workflow creation in SILK can be done with or without a visual designing tools. The basics of SILK are the tasks and relations (rules) between them. It is similar with the SCUFL language, but not relying on XML in

Project Scheduling Heuristics-Based Standard PSO for Task-Resource Assignment in Heterogeneous Grid

OpenAIRE

Chen, Ruey-Maw; Wang, Chuin-Mu

2011-01-01

The task scheduling problem has been widely studied for assigning resources to tasks in heterogeneous grid environment. Effective task scheduling is an important issue for the performance of grid computing. Meanwhile, the task scheduling problem is an NP-complete problem. Hence, this investigation introduces a named “standard“ particle swarm optimization (PSO) metaheuristic approach to efficiently solve the task scheduling problems in grid. Meanwhile, two promising heuristics based on multimo...

Intelligent Control of Micro Grid: A Big Data-Based Control Center

Science.gov (United States)

Liu, Lu; Wang, Yanping; Liu, Li; Wang, Zhiseng

2018-01-01

In this paper, a structure of micro grid system with big data-based control center is introduced. Energy data from distributed generation, storage and load are analized through the control center, and from the results new trends will be predicted and applied as a feedback to optimize the control. Therefore, each step proceeded in micro grid can be adjusted and orgnized in a form of comprehensive management. A framework of real-time data collection, data processing and data analysis will be proposed by employing big data technology. Consequently, a integrated distributed generation and a optimized energy storage and transmission process can be implemented in the micro grid system.

A roadmap for caGrid, an enterprise Grid architecture for biomedical research.

Science.gov (United States)

Saltz, Joel; Hastings, Shannon; Langella, Stephen; Oster, Scott; Kurc, Tahsin; Payne, Philip; Ferreira, Renato; Plale, Beth; Goble, Carole; Ervin, David; Sharma, Ashish; Pan, Tony; Permar, Justin; Brezany, Peter; Siebenlist, Frank; Madduri, Ravi; Foster, Ian; Shanbhag, Krishnakant; Mead, Charlie; Chue Hong, Neil

2008-01-01

caGrid is a middleware system which combines the Grid computing, the service oriented architecture, and the model driven architecture paradigms to support development of interoperable data and analytical resources and federation of such resources in a Grid environment. The functionality provided by caGrid is an essential and integral component of the cancer Biomedical Informatics Grid (caBIG) program. This program is established by the National Cancer Institute as a nationwide effort to develop enabling informatics technologies for collaborative, multi-institutional biomedical research with the overarching goal of accelerating translational cancer research. Although the main application domain for caGrid is cancer research, the infrastructure provides a generic framework that can be employed in other biomedical research and healthcare domains. The development of caGrid is an ongoing effort, adding new functionality and improvements based on feedback and use cases from the community. This paper provides an overview of potential future architecture and tooling directions and areas of improvement for caGrid and caGrid-like systems. This summary is based on discussions at a roadmap workshop held in February with participants from biomedical research, Grid computing, and high performance computing communities.

Asymmetrical Grid Fault Ride-Through Strategy of Three-phase Grid-connected Inverter Considering Network Impedance Impact in Low Voltage Grid

DEFF Research Database (Denmark)

Guo, Xiaoqiang; Zhang, Xue; Wang, Baocheng

2014-01-01

This letter presents a new control strategy of threephase grid-connected inverter for the positive sequence voltage recovery and negative sequence voltage reduction under asymmetrical grid faults. Unlike the conventional control strategy based on an assumption that the network impedance is mainly...... of the proposed solution for the flexible voltage support in a low-voltage grid, where thenetwork impedance is mainly resistive.......This letter presents a new control strategy of threephase grid-connected inverter for the positive sequence voltage recovery and negative sequence voltage reduction under asymmetrical grid faults. Unlike the conventional control strategy based on an assumption that the network impedance is mainly...... inductive, the proposed control strategy is more flexible and effective by considering the network impedance impact, which is of great importance for the high penetration of grid-connected renewable energy systems into low-voltage grids. The experimental tests are carried out to validate the effectiveness...

Photovoltaic Grid-Connected Modeling and Characterization Based on Experimental Results.

Science.gov (United States)

Humada, Ali M; Hojabri, Mojgan; Sulaiman, Mohd Herwan Bin; Hamada, Hussein M; Ahmed, Mushtaq N

2016-01-01

A grid-connected photovoltaic (PV) system operates under fluctuated weather condition has been modeled and characterized based on specific test bed. A mathematical model of a small-scale PV system has been developed mainly for residential usage, and the potential results have been simulated. The proposed PV model based on three PV parameters, which are the photocurrent, IL, the reverse diode saturation current, Io, the ideality factor of diode, n. Accuracy of the proposed model and its parameters evaluated based on different benchmarks. The results showed that the proposed model fitting the experimental results with high accuracy compare to the other models, as well as the I-V characteristic curve. The results of this study can be considered valuable in terms of the installation of a grid-connected PV system in fluctuated climatic conditions.

Combining Market-Based Control with Distribution Grid Constraints when Coordinating Electric Vehicle Charging

Directory of Open Access Journals (Sweden)

Geert Deconinck

2015-12-01

Full Text Available The charging of electric vehicles (EVs impacts the distribution grid, and its cost depends on the price of electricity when charging. An aggregator that is responsible for a large fleet of EVs can use a market-based control algorithm to coordinate the charging of these vehicles, in order to minimize the costs. In such an optimization, the operational parameters of the distribution grid, to which the EVs are connected, are not considered. This can lead to violations of the technical constraints of the grid (e.g., under-voltage, phase unbalances; for example, because many vehicles start charging simultaneously when the price is low. An optimization that simultaneously takes the economic and technical aspects into account is complex, because it has to combine time-driven control at the market level with event-driven control at the operational level. Different case studies investigate under which circumstances the market-based control, which coordinates EV charging, conflicts with the operational constraints of the distribution grid. Especially in weak grids, phase unbalance and voltage issues arise with a high share of EVs. A low-level voltage droop controller at the charging point of the EV can be used to avoid many grid constraint violations, by reducing the charge power if the local voltage is too low. While this action implies a deviation from the cost-optimal operating point, it is shown that this has a very limited impact on the business case of an aggregator, and is able to comply with the technical distribution grid constraints, even in weak distribution grids with many EVs.

Medical Decision-Making Among Elderly People in Long Term Care.

Science.gov (United States)

Tymchuk, Alexander J.; And Others

1988-01-01

Presented informed consent information on high and low risk medical procedures to elderly persons in long term care facility in standard, simplified, or storybook format. Comprehension was significantly better for simplified and storybook formats. Ratings of decision-making ability approximated comprehension test results. Comprehension test…

[Cost-conscious medical decisions. Normative guidance within the conflicting demands of ethics and economics].

Science.gov (United States)

Marckmann, G; In der Schmitten, J

2014-05-01

Under the current conditions in the health care system, physicians inevitably have to take responsibility for the cost dimension of their decisions on the level of single cases. This article, therefore, discusses the question how physicians can integrate cost considerations into their clinical decisions at the microlevel in a medically rational and ethically justified way. We propose a four-step model for "ethical cost-consciousness": (1) forego ineffective interventions as required by good evidence-based medicine, (2) respect individual patient preferences, (3) minimize the diagnostic and therapeutic effort to achieve a certain treatment goal, and (4) forego expensive interventions that have only a small or unlikely (net) benefit for the patient. Steps 1-3 are ethically justified by the principles of beneficence, nonmaleficence, and respect for autonomy, step 4 by the principles of justice. For decisions on step 4, explicit cost-conscious guidelines should be developed locally or regionally. Following the four-step model can contribute to ethically defensible, cost-conscious decision-making at the microlevel. In addition, physicians' rationing decisions should meet basic standards of procedural fairness. Regular cost-case discussions and clinical ethics consultation should be available as decision support. Implementing step 4, however, requires first of all a clear political legitimation with the corresponding legal framework.

Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists.

Science.gov (United States)

Bruins, Marjan J; Ruijs, Gijs J H M; Wolfhagen, Maurice J H M; Bloembergen, Peter; Aarts, Jos E C M

2011-03-30

Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making. © 2011 Bruins et al; licensee BioMed Central Ltd.

Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

Directory of Open Access Journals (Sweden)

Bloembergen Peter

2011-03-01

Full Text Available Abstract Background Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. Methods In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Results Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Conclusions Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making.

An adaptive multi-agent-based approach to smart grids control and optimization

Energy Technology Data Exchange (ETDEWEB)

Carvalho, Marco [Florida Institute of Technology, Melbourne, FL (United States); Perez, Carlos; Granados, Adrian [Institute for Human and Machine Cognition, Ocala, FL (United States)

2012-03-15

In this paper, we describe a reinforcement learning-based approach to power management in smart grids. The scenarios we consider are smart grid settings where renewable power sources (e.g. Photovoltaic panels) have unpredictable variations in power output due, for example, to weather or cloud transient effects. Our approach builds on a multi-agent system (MAS)-based infrastructure for the monitoring and coordination of smart grid environments with renewable power sources and configurable energy storage devices (battery banks). Software agents are responsible for tracking and reporting power flow variations at different points in the grid, and to optimally coordinate the engagement of battery banks (i.e. charge/idle/discharge modes) to maintain energy requirements to end-users. Agents are able to share information and coordinate control actions through a parallel communications infrastructure, and are also capable of learning, from experience, how to improve their response strategies for different operational conditions. In this paper we describe our approach and address some of the challenges associated with the communications infrastructure for distributed coordination. We also present some preliminary results of our first simulations using the GridLAB-D simulation environment, created by the US Department of Energy (DoE) at Pacific Northwest National Laboratory (PNNL). (orig.)

Decision optimization of case-based computer-aided decision systems using genetic algorithms with application to mammography

International Nuclear Information System (INIS)

Mazurowski, Maciej A; Habas, Piotr A; Zurada, Jacek M; Tourassi, Georgia D

2008-01-01

This paper presents an optimization framework for improving case-based computer-aided decision (CB-CAD) systems. The underlying hypothesis of the study is that each example in the knowledge database of a medical decision support system has different importance in the decision making process. A new decision algorithm incorporating an importance weight for each example is proposed to account for these differences. The search for the best set of importance weights is defined as an optimization problem and a genetic algorithm is employed to solve it. The optimization process is tailored to maximize the system's performance according to clinically relevant evaluation criteria. The study was performed using a CAD system developed for the classification of regions of interests (ROIs) in mammograms as depicting masses or normal tissue. The system was constructed and evaluated using a dataset of ROIs extracted from the Digital Database for Screening Mammography (DDSM). Experimental results show that, according to receiver operator characteristic (ROC) analysis, the proposed method significantly improves the overall performance of the CAD system as well as its average specificity for high breast mass detection rates

Observability and Decision Support for Supervision of Distributed Power System Control

DEFF Research Database (Denmark)

Pertl, Michael

in NorthernCalifornia. Two possible applications of the model are presented: peak reduction compared to uncontrolled charging, and an energy arbitrage scenario. Overall, it is shown that a combination of classical and innovative approaches can contribute to improved situation awareness of control room...... operational information, relevant to the current grid condition, need to be developed. This dissertation covers three areas where specific challenges for improved observability and decision support in future control rooms are addressed: Classical large power system stability issues, innovative data......-network-based approach for real-time voltage estimation in active distribution grids, and a modeling approach to harness the flexibility of an aggregation of electric vehicles. For improved monitoring and maintaining power system stability, a decision support tool for transient stability preventive control, based...

Risk aversion in medical decision making: a survey

OpenAIRE

Liliana Chicaíza; Mario García; Giancarlo Romano

2011-01-01

This article surveys the literature on risk aversion in medical decision making. The search covered Econlit, Jstor Science Direct and Springer Link since 1985. The results are classified in three topics: Risk aversion in the frameworks of Expected Utility and Rank Dependent Expected Utility theories, and the methodologies for measuring risk aversion and its applications to clinical situations from the points of view of economics and psychology. It was found that, despite conceptual and method...

Wireless Sensor Network Based Smart Grid Communications: Cyber Attacks, Intrusion Detection System and Topology Control

Directory of Open Access Journals (Sweden)

Lipi Chhaya

2017-01-01

Full Text Available The existing power grid is going through a massive transformation. Smart grid technology is a radical approach for improvisation in prevailing power grid. Integration of electrical and communication infrastructure is inevitable for the deployment of Smart grid network. Smart grid technology is characterized by full duplex communication, automatic metering infrastructure, renewable energy integration, distribution automation and complete monitoring and control of entire power grid. Wireless sensor networks (WSNs are small micro electrical mechanical systems that are deployed to collect and communicate the data from surroundings. WSNs can be used for monitoring and control of smart grid assets. Security of wireless sensor based communication network is a major concern for researchers and developers. The limited processing capabilities of wireless sensor networks make them more vulnerable to cyber-attacks. The countermeasures against cyber-attacks must be less complex with an ability to offer confidentiality, data readiness and integrity. The address oriented design and development approach for usual communication network requires a paradigm shift to design data oriented WSN architecture. WSN security is an inevitable part of smart grid cyber security. This paper is expected to serve as a comprehensive assessment and analysis of communication standards, cyber security issues and solutions for WSN based smart grid infrastructure.

High density grids

Energy Technology Data Exchange (ETDEWEB)

Cohen, Aina E.; Baxter, Elizabeth L.

2018-01-16

An X-ray data collection grid device is provided that includes a magnetic base that is compatible with robotic sample mounting systems used at synchrotron beamlines, a grid element fixedly attached to the magnetic base, where the grid element includes at least one sealable sample window disposed through a planar synchrotron-compatible material, where the planar synchrotron-compatible material includes at least one automated X-ray positioning and fluid handling robot fiducial mark.

Completing the third person's perspective on patients' involvement in medical decision-making: approaching the full picture.

Science.gov (United States)

Kasper, Jürgen; Hoffmann, Frauke; Heesen, Christoph; Köpke, Sascha; Geiger, Friedemann

2012-01-01

Shared decision making is based on the idea of cooperation and partnership between patients and doctors. In this concept both parties may initiate and perform specific decision-making steps. However, the common observation-based instruments focus solely on doctors' behaviour. Content and quality of information provided to involve patients in medical decisions are hardly considered in evaluation of SDM. This study investigates the advantages of a revised observer inventory taking into account these aspects. Based on the OPTION scale, a more comprehensive observation-based inventory was developed, additionally considering both the patient-sided indicators for patient involvement and the criteria of evidence-based patient information. The inventory comprises three scales (doctor, patient, doctor-patient dyad) and 15 indicators each. Rater training and re-analyses of 76 consultations previously analysed using the OPTION scale were conducted. Convergent validities were calculated between the observer-based scales and the patients' ratings on the Shared Decision Making Questionnaire, the Decisional Conflict Scale and the Control Preference Scale. Interrater reliabilities of the revised scales were high (r=.87 to .74) and even higher when only the dyadic perspective was coded (.86). The revised inventory provided additional information on the involvement taking place. No substantive correlations were found between observation-based and patients' subjective judgments. The observers' perspective on patient involvement needs to consider patient activities. Inconsistencies of patients' and observers' judgements concerning patient participation need further investigation. Copyright © 2012. Published by Elsevier GmbH.

GSIMF: a web service based software and database management system for the next generation grids

International Nuclear Information System (INIS)

Wang, N; Ananthan, B; Gieraltowski, G; May, E; Vaniachine, A

2008-01-01

To process the vast amount of data from high energy physics experiments, physicists rely on Computational and Data Grids; yet, the distribution, installation, and updating of a myriad of different versions of different programs over the Grid environment is complicated, time-consuming, and error-prone. Our Grid Software Installation Management Framework (GSIMF) is a set of Grid Services that has been developed for managing versioned and interdependent software applications and file-based databases over the Grid infrastructure. This set of Grid services provide a mechanism to install software packages on distributed Grid computing elements, thus automating the software and database installation management process on behalf of the users. This enables users to remotely install programs and tap into the computing power provided by Grids

Mini-grid based off-grid electrification to enhance electricity access in developing countries: What policies may be required?

International Nuclear Information System (INIS)

Bhattacharyya, Subhes C.; Palit, Debajit

2016-01-01

With 1.2 billion people still lacking electricity access by 2013, electricity access remains a major global challenge. Although mini-grid based electrification has received attention in recent times, their full exploitation requires policy support covering a range of areas. Distilling the experience from a five year research project, OASYS South Asia, this paper presents the summary of research findings and shares the experience from four demonstration activities. It suggests that cost-effective universal electricity service remains a challenge and reaching the universal electrification target by 2030 will remain a challenge for the less developed countries. The financial, organisational and governance weaknesses hinder successful implementation of projects in many countries. The paper then provides 10 policy recommendations to promote mini-grids as a complementary route to grid extension to promote electricity access for successful outcomes. - Highlights: •The academic and action research activities undertaken through OASYS South Asia Project are reported. •Evidence produced through a multi-dimensional participatory framework supplemented by four demonstration projects. •Funding and regulatory challenges militate against universal electrification objectives by 2030. •Innovative business approaches linking local mini-grids and livelihood opportunities exist. •Enabling policies are suggested to exploit such options.

Value-Based Reimbursement: Impact of Curtailing Physician Autonomy in Medical Decision Making.

Science.gov (United States)

Gupta, Dipti; Karst, Ingolf; Mendelson, Ellen B

2016-02-01

In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.

Copula-based modeling of stochastic wind power in Europe and implications for the Swiss power grid

International Nuclear Information System (INIS)

Hagspiel, Simeon; Papaemannouil, Antonis; Schmid, Matthias; Andersson, Göran

2012-01-01

Highlights: ► We model stochastic wind power using copula theory. ► Stochastic wind power is integrated in a European system adequacy evaluation. ► The Swiss power grid is put at risk by further integrating wind power in Europe. ► System elements located at or close to Swiss borders are affected the most. ► A criticality indicator allows prioritizing expansion plans on a probabilistic basis. -- Abstract: Large scale integration of wind energy poses new challenges to the European power system due to its stochastic nature and often remote location. In this paper a multivariate uncertainty analysis problem is formulated for the integration of stochastic wind energy in the European grid. By applying copula theory a synthetic set of data is generated from scarce wind speed reanalysis data in order to achieve the increased sample size for the subsequent Monte Carlo simulation. In the presented case study, European wind power samples are generated from the modeled stochastic process. Under the precondition of a modeled perfect market environment, wind power impacts dispatch decisions and therefore leads to alterations in power balances. Stochastic power balances are implemented in a detailed model of the European electricity network, based on the generated samples. Finally, a Monte Carlo method is used to determine power flows and contingencies in the system. An indicator is elaborated in order to analyze risk of overloading and to prioritize necessary grid reinforcements. Implications for the Swiss power grid are investigated in detail, revealing that the current system is significantly put at risk in certain areas by the further integration of wind power in Europe. It is the first time that the results of a probabilistic model for wind energy are further deployed within a power system analysis of the interconnected European grid. The method presented in this paper allows to account for stochastic wind energy in a load flow analysis and to evaluate

A Stationary Reference Frame Grid Synchronization System for Three-Phase Grid-Connected Power Converters Under Adverse Grid Conditions

DEFF Research Database (Denmark)

Rodríguez, P.; Luna, A.; Muñoz-Aguilar, R. S.

2012-01-01

synchronization method for three-phase three-wire networks, namely dual second-order generalized integrator (SOGI) frequency-locked loop. The method is based on two adaptive filters, implemented by using a SOGI on the stationary αβ reference frame, and it is able to perform an excellent estimation......Grid synchronization algorithms are of great importance in the control of grid-connected power converters, as fast and accurate detection of the grid voltage parameters is crucial in order to implement stable control strategies under generic grid conditions. This paper presents a new grid...

Optimal Control of Micro Grid Operation Mode Seamless Switching Based on Radau Allocation Method

Science.gov (United States)

Chen, Xiaomin; Wang, Gang

2017-05-01

The seamless switching process of micro grid operation mode directly affects the safety and stability of its operation. According to the switching process from island mode to grid-connected mode of micro grid, we establish a dynamic optimization model based on two grid-connected inverters. We use Radau allocation method to discretize the model, and use Newton iteration method to obtain the optimal solution. Finally, we implement the optimization mode in MATLAB and get the optimal control trajectory of the inverters.

Interior point algorithm-based power flow optimisation of a combined AC and DC multi-terminal grid

Directory of Open Access Journals (Sweden)

Farhan Beg

2015-01-01

Full Text Available The high cost of power electronic equipment, lower reliability and poor power handling capacity of the semiconductor devices had stalled the deployment of systems based on DC (multi-terminal direct current system (MTDC networks. The introduction of voltage source converters (VSCs for transmission has renewed the interest in the development of large interconnected grids based on both alternate current (AC and DC transmission networks. Such a grid platform also realises the added advantage of integrating the renewable energy sources into the grid. Thus a grid based on DC MTDC network is a possible solution to improve energy security and check the increasing supply demand gap. An optimal power solution for combined AC and DC grids obtained by the solution of the interior point algorithm is proposed in this study. Multi-terminal HVDC grids lie at the heart of various suggested transmission capacity increases. A significant difference is observed when MTDC grids are solved for power flows in place of conventional AC grids. This study deals with the power flow problem of a combined MTDC and an AC grid. The AC side is modelled with the full power flow equations and the VSCs are modelled using a connecting line, two generators and an AC node. The VSC and the DC losses are also considered. The optimisation focuses on several different goals. Three different scenarios are presented in an arbitrary grid network with ten AC nodes and five converter stations.

Evaluation of RxNorm for Medication Clinical Decision Support.

Science.gov (United States)

Freimuth, Robert R; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G

2014-01-01

We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS.

Modular Multilevel Converters Based Variable Speed Wind Turbines for Grid Faults

DEFF Research Database (Denmark)

Deng, Fujin; Liu, Dong; Wang, Yanbo

2016-01-01

in the dc-link of the power converter to improve system performance, but also ensure the grid-side current balancing to increase the generated power of the wind turbine under the unbalanced grid fault, in comparison with the conventional VSWT based on BTB three-level NPC converters. The simulation studies......The modular multilevel converter (MMC) becomes attractive in the medium- and high-power application with high modularity. In this paper, the MMC is proposed to be applied in the variable speed wind turbine (VSWT) based on the full-scale back-to-back (BTB) power converter, where the generator...

Paediatricians' decision making about prescribing stimulant medications for children with attention-deficit/hyperactivity disorder.

Science.gov (United States)

Chow, S-J; Sciberras, E; Gillam, L H; Green, J; Efron, D

2014-05-01

Attention-deficit/hyperactivity disorder (ADHD) is now the most common reason for a child to present to a paediatrician in Australia. Stimulant medications are commonly prescribed for children with ADHD, to reduce symptoms and improve function. In this study we investigated the factors that influence paediatricians' decisions about prescribing stimulant medications. In-depth, semi-structured interviews were conducted with paediatricians (n = 13) who were purposively recruited so as to sample a broad demographic of paediatricians working in diverse clinical settings. Paediatricians were recruited from public outpatient and private paediatrician clinics in Victoria, Australia. The interviews were audio-recorded and transcribed verbatim for thematic analysis. Paediatricians also completed a questionnaire describing their demographic and practice characteristics. Our findings showed that the decision to prescribe is a dynamic process involving two key domains: (1) weighing up clinical factors; and (2) interacting with parents and the patient along the journey to prescribing. Five themes relating to this process emerged from data analysis: comprehensive assessments that include history, examination and information from others; influencing factors such as functional impairment and social inclusion; previous success; facilitating parental understanding including addressing myths and parental confusion; and decision-making model. Paediatricians' decisions to prescribe stimulant medications are influenced by multiple factors that operate concurrently and interdependently. Paediatricians do not make decisions about prescribing in isolation; rather, they actively involve parents, teachers and patients, to arrive at a collective, well-informed decision. © 2013 John Wiley & Sons Ltd.

Grid regulation services for energy storage devices based on grid frequency

Energy Technology Data Exchange (ETDEWEB)

Pratt, Richard M.; Hammerstrom, Donald J.; Kintner-Meyer, Michael C. W.; Tuffner, Francis K.

2017-09-05

Disclosed herein are representative embodiments of methods, apparatus, and systems for charging and discharging an energy storage device connected to an electrical power distribution system. In one exemplary embodiment, a controller monitors electrical characteristics of an electrical power distribution system and provides an output to a bi-directional charger causing the charger to charge or discharge an energy storage device (e.g., a battery in a plug-in hybrid electric vehicle (PHEV)). The controller can help stabilize the electrical power distribution system by increasing the charging rate when there is excess power in the electrical power distribution system (e.g., when the frequency of an AC power grid exceeds an average value), or by discharging power from the energy storage device to stabilize the grid when there is a shortage of power in the electrical power distribution system (e.g., when the frequency of an AC power grid is below an average value).

Grid regulation services for energy storage devices based on grid frequency

Science.gov (United States)

Pratt, Richard M; Hammerstrom, Donald J; Kintner-Meyer, Michael C.W.; Tuffner, Francis K

2013-07-02

Disclosed herein are representative embodiments of methods, apparatus, and systems for charging and discharging an energy storage device connected to an electrical power distribution system. In one exemplary embodiment, a controller monitors electrical characteristics of an electrical power distribution system and provides an output to a bi-directional charger causing the charger to charge or discharge an energy storage device (e.g., a battery in a plug-in hybrid electric vehicle (PHEV)). The controller can help stabilize the electrical power distribution system by increasing the charging rate when there is excess power in the electrical power distribution system (e.g., when the frequency of an AC power grid exceeds an average value), or by discharging power from the energy storage device to stabilize the grid when there is a shortage of power in the electrical power distribution system (e.g., when the frequency of an AC power grid is below an average value).

Bayesian grid matching

DEFF Research Database (Denmark)

Hartelius, Karsten; Carstensen, Jens Michael

2003-01-01

A method for locating distorted grid structures in images is presented. The method is based on the theories of template matching and Bayesian image restoration. The grid is modeled as a deformable template. Prior knowledge of the grid is described through a Markov random field (MRF) model which r...

A web-based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial and process evaluation.

Science.gov (United States)

van der Krieke, Lian; Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

2013-10-07

Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical

Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? : A cross-sectional survey

OpenAIRE

Ekdahl, Anne W; Andersson, Lars; Wiréhn, Ann-Britt; Friedrichsen, Maria

2011-01-01

Abstract Background Medical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the role elderly people with co-morbidities wish to assume and actually had with regard to information and participation in medical decision making during their last stay in hospita...

The biometric-based module of smart grid system

Science.gov (United States)

Engel, E.; Kovalev, I. V.; Ermoshkina, A.

2015-10-01

Within Smart Grid concept the flexible biometric-based module base on Principal Component Analysis (PCA) and selective Neural Network is developed. The formation of the selective Neural Network the biometric-based module uses the method which includes three main stages: preliminary processing of the image, face localization and face recognition. Experiments on the Yale face database show that (i) selective Neural Network exhibits promising classification capability for face detection, recognition problems; and (ii) the proposed biometric-based module achieves near real-time face detection, recognition speed and the competitive performance, as compared to some existing subspaces-based methods.

Degenerate Quadtree Latitude/Longitude Grid Based on WGS-84 Ellipsoidal Facet

Directory of Open Access Journals (Sweden)

HU Bailin

2016-12-01

Full Text Available For the needs of digital earth development and solving many global problems, a new discrete global grid system-DQLLG (degenerate quadtree latitude/longitude grid was put forward, which was based on WGS-84 ellipsoidal facet. The hierarchical subdivision method, characteristics and grid column/row coordinate system were detailed. The Latitude/Longitude coordinate, area and side length of multi-resolution meshes on different subdivision levels were calculated. Then the changes of mesh areas and side lengths were analyzed and compared that with spherical DQLLG. The research indicates that the DQLLG had many excellent features:uniformity, hierarchy, consistency of direction, extensive data compatibility and so on. It has certain practicality for Global GIS in the future.

Simulation based virtual learning environment in medical genetics counseling

DEFF Research Database (Denmark)

Makransky, Guido; Bonde, Mads T.; Wulff, Julie S. G.

2016-01-01

BACKGROUND: Simulation based learning environments are designed to improve the quality of medical education by allowing students to interact with patients, diagnostic laboratory procedures, and patient data in a virtual environment. However, few studies have evaluated whether simulation based...... the perceived relevance of medical educational activities. The results suggest that simulations can help future generations of doctors transfer new understanding of disease mechanisms gained in virtual laboratory settings into everyday clinical practice....... learning environments increase students' knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making. METHODS: An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major...

Towards Agent-Based Model Specification in Smart Grid: A Cognitive Agent-based Computing Approach

OpenAIRE

Akram, Waseem; Niazi, Muaz A.; Iantovics, Laszlo Barna

2017-01-01

A smart grid can be considered as a complex network where each node represents a generation unit or a consumer. Whereas links can be used to represent transmission lines. One way to study complex systems is by using the agent-based modeling (ABM) paradigm. An ABM is a way of representing a complex system of autonomous agents interacting with each other. Previously, a number of studies have been presented in the smart grid domain making use of the ABM paradigm. However, to the best of our know...

"It Was the Best Decision of My Life": a thematic content analysis of former medical tourists' patient testimonials.

Science.gov (United States)

Hohm, Carly; Snyder, Jeremy

2015-01-22

Medical tourism is international travel with the intention of receiving medical care. Medical tourists travel for many reasons, including cost savings, limited domestic access to specific treatments, and interest in accessing unproven interventions. Medical tourism poses new health and safety risks to patients, including dangers associated with travel following surgery, difficulty assessing the quality of care abroad, and complications in continuity of care. Online resources are important to the decision-making of potential medical tourists and the websites of medical tourism facilitation companies (companies that may or may not be affiliated with a clinic abroad and help patients plan their travel) are an important source of online information for these individuals. These websites fail to address the risks associated with medical tourism, which can undermine the informed decision-making of potential medical tourists. Less is known about patient testimonials on these websites, which can be a particularly powerful influence on decision-making. A thematic content analysis was conducted of patient testimonials hosted on the YouTube channels of four medical tourism facilitation companies. Five videos per company were viewed. The content of these videos was analyzed and themes identified and counted for each video. Ten main themes were identified. These themes were then grouped into three main categories: facilitator characteristics (e.g., mentions of the facilitator by name, reference to the price of the treatment or to cost savings); service characteristics (e.g., the quality and availability of the surgeon, the quality and friendliness of the support staff); and referrals (e.g., referrals to other potential medical tourists). These testimonials were found either not to mention risks associated with medical tourism or to claim that these risks can be effectively managed through the use of the facilitation company. The failure fully to address the risks of medical

Photovoltaic Grid-Connected Modeling and Characterization Based on Experimental Results

Science.gov (United States)

Humada, Ali M.; Hojabri, Mojgan; Sulaiman, Mohd Herwan Bin; Hamada, Hussein M.; Ahmed, Mushtaq N.

2016-01-01

A grid-connected photovoltaic (PV) system operates under fluctuated weather condition has been modeled and characterized based on specific test bed. A mathematical model of a small-scale PV system has been developed mainly for residential usage, and the potential results have been simulated. The proposed PV model based on three PV parameters, which are the photocurrent, IL, the reverse diode saturation current, Io, the ideality factor of diode, n. Accuracy of the proposed model and its parameters evaluated based on different benchmarks. The results showed that the proposed model fitting the experimental results with high accuracy compare to the other models, as well as the I-V characteristic curve. The results of this study can be considered valuable in terms of the installation of a grid-connected PV system in fluctuated climatic conditions. PMID:27035575

OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records.

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Chen, Jonathan H; Podchiyska, Tanya; Altman, Russ B

2016-03-01

To answer a "grand challenge" in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com's product recommender. EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender's ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10(-10)) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10(-16)). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from "correct" ones. Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. "interesting" suggestions). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government

Social support plays a role in the attitude that people have towards taking an active role in medical decision-making.

Science.gov (United States)

Brabers, Anne E M; de Jong, Judith D; Groenewegen, Peter P; van Dijk, Liset

2016-09-21

There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be argued that a patient's social context has to be taken into account as well, because social norms and resources affect behaviour. This study aims to examine the role of social resources, in the form of the availability of informational and emotional support, on the attitude towards taking an active role in medical decision-making. A questionnaire was sent to members of the Dutch Health Care Consumer Panel (response 70 %; n = 1300) in June 2013. A regression model was then used to estimate the relation between medical and lay informational support and emotional support and the attitude towards taking an active role in medical decision-making. Availability of emotional support is positively related to the attitude towards taking an active role in medical decision-making only in people with a low level of education, not in persons with a middle and high level of education. The latter have a more positive attitude towards taking an active role in medical decision-making, irrespective of the level of emotional support available. People with better access to medical informational support have a more positive attitude towards taking an active role in medical decision-making; but no significant association was found for lay informational support. This study shows that social resources are associated with the attitude towards taking an active role in medical decision-making. Strategies aimed at increasing patient involvement have to address this.

FDTD parallel computational analysis of grid-type scattering filter characteristics for medical X-ray image diagnosis

International Nuclear Information System (INIS)

Takahashi, Koichi; Miyazaki, Yasumitsu; Goto, Nobuo

2007-01-01

X-ray diagnosis depends on the intensity of transmitted and scattered waves in X-ray propagation in biomedical media. X-ray is scattered and absorbed by tissues, such as fat, bone and internal organs. However, image processing for medical diagnosis, based on the scattering and absorption characteristics of these tissues in X-ray spectrum is not so much studied. To obtain precise information of tissues in a living body, the accurate characteristics of scattering and absorption are required. In this paper, X-ray scattering and absorption in biomedical media are studied using 2-dimensional finite difference time domain (FDTD) method. In FDTD method, the size of analysis space is very limited by the performance of available computers. To overcome this limitation, parallel and successive FDTD method is introduced. As a result of computer simulation, the amplitude of transmitted and scattered waves are presented numerically. The fundamental filtering characteristics of grid-type filter are also shown numerically. (author)

Elliptic Curve Cryptography-Based Authentication with Identity Protection for Smart Grids.

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Liping Zhang

Full Text Available In a smart grid, the power service provider enables the expected power generation amount to be measured according to current power consumption, thus stabilizing the power system. However, the data transmitted over smart grids are not protected, and then suffer from several types of security threats and attacks. Thus, a robust and efficient authentication protocol should be provided to strength the security of smart grid networks. As the Supervisory Control and Data Acquisition system provides the security protection between the control center and substations in most smart grid environments, we focus on how to secure the communications between the substations and smart appliances. Existing security approaches fail to address the performance-security balance. In this study, we suggest a mitigation authentication protocol based on Elliptic Curve Cryptography with privacy protection by using a tamper-resistant device at the smart appliance side to achieve a delicate balance between performance and security of smart grids. The proposed protocol provides some attractive features such as identity protection, mutual authentication and key agreement. Finally, we demonstrate the completeness of the proposed protocol using the Gong-Needham-Yahalom logic.

Elliptic Curve Cryptography-Based Authentication with Identity Protection for Smart Grids.

Science.gov (United States)

Zhang, Liping; Tang, Shanyu; Luo, He

2016-01-01

In a smart grid, the power service provider enables the expected power generation amount to be measured according to current power consumption, thus stabilizing the power system. However, the data transmitted over smart grids are not protected, and then suffer from several types of security threats and attacks. Thus, a robust and efficient authentication protocol should be provided to strength the security of smart grid networks. As the Supervisory Control and Data Acquisition system provides the security protection between the control center and substations in most smart grid environments, we focus on how to secure the communications between the substations and smart appliances. Existing security approaches fail to address the performance-security balance. In this study, we suggest a mitigation authentication protocol based on Elliptic Curve Cryptography with privacy protection by using a tamper-resistant device at the smart appliance side to achieve a delicate balance between performance and security of smart grids. The proposed protocol provides some attractive features such as identity protection, mutual authentication and key agreement. Finally, we demonstrate the completeness of the proposed protocol using the Gong-Needham-Yahalom logic.

Air Pollution Monitoring and Mining Based on Sensor Grid in London

OpenAIRE

Ma, Yajie; Richards, Mark; Ghanem, Moustafa; Guo, Yike; Hassard, John

2008-01-01

In this paper, we present a distributed infrastructure based on wireless sensors network and Grid computing technology for air pollution monitoring and mining, which aims to develop low-cost and ubiquitous sensor networks to collect real-time, large scale and comprehensive environmental data from road traffic emissions for air pollution monitoring in urban environment. The main informatics challenges in respect to constructing the high-throughput sensor Grid are discussed in this paper. We pr...

Memory accessibility and medical decision-making for significant others: The role of socially-shared retrieval induced forgetting

Directory of Open Access Journals (Sweden)

Dora M Coman

2013-06-01

Full Text Available Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, they read a pamphlet selectively presenting either relevant (Experiment 1 or irrelevant (Experiment 2 advantages or disadvantages. A final cued recall followed and, in Experiment 2, a decision as to the best treatment for a patient. Not only did reading the pamphlet induce forgetting for related and unmentioned information, the induced forgetting adversely affected decision-making. The research provides a cautionary note about the risks of searching through selectively presented information when making a medical decision.

The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial.

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Cheryl L L Carling

Full Text Available BACKGROUND: We conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values. METHODS AND FINDINGS: In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales (VAS. Participants viewed information (or no information to which they were randomized and decided whether or not to take medication. We compared positive framing over 10 years (the number escaping CVD per 1000; negative framing over 10 years (the number that will have CVD and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors. Finally, all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again. We calculated a relative importance score (RIS by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction. We used logistic regression to determine the association between participants' RIS and their choice. 1,528 participants completed the study. The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values (RIS increased as the RIS increased. Positively framed information lead to decisions most consistent with those made by everyone for the second, more fully informed decision. There was a statistically significant decrease in deciding to take antihypertensives on

The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial.

Science.gov (United States)

Carling, Cheryl L L; Kristoffersen, Doris Tove; Oxman, Andrew D; Flottorp, Signe; Fretheim, Atle; Schünemann, Holger J; Akl, Elie A; Herrin, Jeph; MacKenzie, Thomas D; Montori, Victor M

2010-03-01

We conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD) for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values. In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales (VAS). Participants viewed information (or no information) to which they were randomized and decided whether or not to take medication. We compared positive framing over 10 years (the number escaping CVD per 1000); negative framing over 10 years (the number that will have CVD) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors. Finally, all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction. We used logistic regression to determine the association between participants' RIS and their choice. 1,528 participants completed the study. The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values (RIS) increased as the RIS increased. Positively framed information lead to decisions most consistent with those made by everyone for the second, more fully informed decision. There was a statistically significant decrease in deciding to take antihypertensives on the second decision, both within groups and

Case-based medical informatics

Directory of Open Access Journals (Sweden)

Arocha José F

2004-11-01

Full Text Available Abstract Background The "applied" nature distinguishes applied sciences from theoretical sciences. To emphasize this distinction, we begin with a general, meta-level overview of the scientific endeavor. We introduce the knowledge spectrum and four interconnected modalities of knowledge. In addition to the traditional differentiation between implicit and explicit knowledge we outline the concepts of general and individual knowledge. We connect general knowledge with the "frame problem," a fundamental issue of artificial intelligence, and individual knowledge with another important paradigm of artificial intelligence, case-based reasoning, a method of individual knowledge processing that aims at solving new problems based on the solutions to similar past problems. We outline the fundamental differences between Medical Informatics and theoretical sciences and propose that Medical Informatics research should advance individual knowledge processing (case-based reasoning and that natural language processing research is an important step towards this goal that may have ethical implications for patient-centered health medicine. Discussion We focus on fundamental aspects of decision-making, which connect human expertise with individual knowledge processing. We continue with a knowledge spectrum perspective on biomedical knowledge and conclude that case-based reasoning is the paradigm that can advance towards personalized healthcare and that can enable the education of patients and providers. We center the discussion on formal methods of knowledge representation around the frame problem. We propose a context-dependent view on the notion of "meaning" and advocate the need for case-based reasoning research and natural language processing. In the context of memory based knowledge processing, pattern recognition, comparison and analogy-making, we conclude that while humans seem to naturally support the case-based reasoning paradigm (memory of past experiences

Wide-area situation awareness in electric power grid

Science.gov (United States)

Greitzer, Frank L.

2010-04-01

Two primary elements of the US energy policy are demand management and efficiency and renewable sources. Major objectives are clean energy transmission and integration, reliable energy transmission, and grid cyber security. Development of the Smart Grid seeks to achieve these goals by lowering energy costs for consumers, achieving energy independence and reducing greenhouse gas emissions. The Smart Grid is expected to enable real time wide-area situation awareness (SA) for operators. Requirements for wide-area SA have been identified among interoperability standards proposed by the Federal Energy Regulatory Commission and the National Institute of Standards and Technology to ensure smart-grid functionality. Wide-area SA and enhanced decision support and visualization tools are key elements in the transformation to the Smart Grid. This paper discusses human factors research to promote SA in the electric power grid and the Smart Grid. Topics that will be discussed include the role of human factors in meeting US energy policy goals, the impact and challenges for Smart Grid development, and cyber security challenges.

Liberal rationalism and medical decision-making.

Science.gov (United States)

Savulescu, Julian

1997-04-01

I contrast Robert Veatch's recent liberal vision of medical decision-making with a more rationalist liberal model. According to Veatch, physicians are biased in their determination of what is in their patient's overall interests in favour of their medical interests. Because of the extent of this bias, we should abandon the practice of physicians offering what they guess to be the best treatment option. Patients should buddy up with physicians who share the same values -- 'deep value pairing'. The goal of choice is maximal promotion of patient values. I argue that if subjectivism about value and valuing is true, this move is plausible. However, if objectivism about value is true -- that there really are states which are good for people regardless of whether they desire to be in them -- then we should accept a more rationalist liberal alternative. According to this alternative, what is required to decide which course is best is rational dialogue between physicians and patients, both about the patient's circumstances and her values, and not the seeking out of people, physicians or others, who share the same values. Rational discussion requires that physicians be reasonable and empathic. I describe one possible account of a reasonable physician.

A policy system for Grid Management and Monitoring

International Nuclear Information System (INIS)

Stagni, Federico; Santinelli, Roberto

2011-01-01

Organizations using a Grid computing model are faced with non-traditional administrative challenges: the heterogeneous nature of the underlying resources requires professionals acting as Grid Administrators. Members of a Virtual Organization (VO) can use a subset of available resources and services in the grid infrastructure and in an ideal world, the more resources are exploited the better. In the real world, the less faulty services, the better: experienced Grid administrators apply procedures for adding and removing services, based on their status, as it is reported by an ever-growing set of monitoring tools. When a procedure is agreed and well-exercised, a formal policy could be derived. For this reason, using the DIRAC framework in the LHCb collaboration, we developed a policy system that can enforce management and operational policies, in a VO-specific fashion. A single policy makes an assessment on the status of a subject, relative to one or more monitoring information. Subjects of the policies are monitored entities of an established Grid ontology. The status of a same entity is evaluated against a number of policies, whose results are then combined by a Policy Decision Point. Such results are enforced in a Policy Enforcing Point, which provides plug-ins for actions, like raising alarms, sending notifications, automatic addition and removal of services and resources from the Grid mask. Policy results are shown in the web portal, and site-specific views are provided also. This innovative system provides advantages in terms of procedures automation, information aggregation and problem solving.